Paeds · acute-care-resuscitation-and-toxicology
Retrieval, transport and interfacility stabilisation
Also known as Paediatric critical care retrieval · Interfacility transport of the critically ill child · Specialist retrieval team and stabilisation · Neonatal and paediatric transport medicine · Pre-transport stabilisation and safe transfer
A fellowship approach to moving a critically ill or injured child between facilities. Treat retrieval as a system that brings intensive care to the child before the child is moved, stabilise the airway, breathing and circulation in full before departure, run a structured referral and handover, choose the right mode of transport and escort for the child and the weather, manage the hostile physics of altitude, vibration and cold, monitor continuously, and rehearse the contingency for deterioration in flight.
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Target exams
Red flags
- An airway, breathing or circulation problem that is not fully controlled before departure: optimise at the referring hospital rather than moving an unstable child
- An undrained pneumothorax in a child about to fly: gas expands with altitude and tension pneumothorax can develop in the cabin
- A child needing definitive care beyond local capability: call retrieval in parallel with resuscitation, before local resources are exhausted
- A cuffed endotracheal tube with unmeasured cuff pressure at altitude: cuff gas expands and can injure the trachea, so check and adjust it
- A neonate or small infant who is cold: hypothermia is among the commonest transport complications, so warm actively before and during the move
- Unreliable vascular access or a tube, line or drain that is not secured: dislodgement in a moving, cramped cabin is dangerous and hard to repair
- An unstructured referral or handover: communication failure is a leading contributor to transport-related harm, so use a standardised format
Life stages
Care settings
Clinical exam formats
Board mappings
- Acute Care
- Current 2026 PREP curriculum — Learning Objective 2.2.1: Recognise, prioritise and manage an acutely ill infant, child or young person
- Current 2026 PREP curriculum — Learning Objective 2.2.3: Perform acute resuscitation and advanced life support
- Current 2026 PREP curriculum — Learning Objective 2.4.5: Manage transfer of an unwell newborn, infant, child or young person
- Renewed curriculum for first-year trainees from 2027 — Learning goal 11: Acute care and procedures
- Renewed curriculum for first-year trainees from 2027 — Learning goal 17: Acute care
- Clinical Applications
- Medical Sciences
- Long Cases
- Short Cases
- 4. Professional skills and knowledge: Patient management
- 6. Leadership and team working
- 7. Patient safety, including safe prescribing
- 8. Systems and quality improvement
- General Paediatrics: Resuscitates, stabilises and treats extremely unwell babies, children and young people, liaising with specialist teams, as necessary
- Foundation of Practice (FOP)
- Theory and Science (TAS)
- Applied Knowledge in Practice (AKP)
- Clinical
- History
- Communication
- Video
- General Pediatrics Content Outline — Domain 7: Emergency and Critical Care
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- General Pediatrics Content Outline — Universal Task 6: Systems-Based Practice
- General Pediatrics EPA 7: Recognizing a Severely Ill Patient, Providing Initial Management, and Mobilizing Resources Needed for Continued Care
- Patient Care 3: Organize and Prioritize Patient Care
- Patient Care 5: Patient Management
- Systems-Based Practice 1: Patient Safety
- Systems-Based Practice 2: System Navigation for Patient-Centered Care
- Interpersonal and Communication Skills 2: Interprofessional and Team Communication
- Medical Expert
- Manager
- Pediatrics: Foundations EPA #1 — Recognizing deteriorating and/or critically ill patients and initiating stabilization and management
- Pediatrics: Core EPA #2 — Resuscitating and stabilizing critically ill patients
Overview & Definition
Retrieval is the organised process of bringing specialist intensive care to a critically ill child at a referring hospital and then moving that child to a centre that can deliver definitive care. Transport is the act of moving the child between those places. Interfacility stabilisation is the work done at the bedside before, during and after the move to keep the physiology controlled. The three are inseparable, and the candidate who thinks of them as one linked system will answer well. [1] [8]
The single most important idea is that you bring the intensive care to the patient, and then move the patient through the intensive care. The retrieval is not an ambulance ride, and it is not a holding pattern until the child reaches the definitive centre. The standard of monitoring, airway control, ventilation, circulatory support and vigilance on the trolley at the referring hospital is the same standard that travels with the child, and it is the same standard that hands over at the receiving door. [4] [11]
A second idea follows from the first. The dangerous moment in retrieval is the move itself, because the environment deteriorates sharply moment child leaves a controlled bed space. The cabin or ambulance is cramped, noisy, vibrating, poorly lit, cold and hard to work in. Adverse events are common when transport is added to critical illness, and most of them are preventable by completing resuscitation first and by using a specialist retrieval team. [2] [3]
[1] [4]The bedside clinician sits in the middle of this system. You receive the referral, you resuscitate and stabilise, you communicate with the retrieval service and the receiving unit, you prepare the child for the move, you hand over in a structured way, and you build a contingency for the journey. You do not have to perform the transport yourself to own it: your decisions at the referring hospital decide whether the journey is safe. [6] [1]
The retrieval sequence, from referral to handover
- 1
Referral and accept
Take a structured referral, agree the receiving unit and bed, and call the retrieval service in parallel with resuscitation.
- 2
Stabilise before moving
Control the airway, breathing and circulation in full at the referring hospital, secure every tube and line, and document a pre-transport checklist.
- 3
Prepare for the mode
Decide road, rotary-wing or fixed-wing for the child, the distance and the weather; manage the physics of altitude, vibration and cold.
- 4
Transport and monitor
Move with continuous monitoring, a defined escort and a rehearsed contingency for deterioration en route.
- 5
Hand over and close the loop
Give a structured handover at the receiving door, confirm acceptance of care, and feed the case back into the system for learning.
References12ShowHide
- [1]Stroud MH, Trautman MS, Meyer K, et al. Pediatric and neonatal interfacility transport: results from a national consensus conference Pediatrics, 2013.PMID 23821698
- [2]Haydar B, Baetzel A, Elliott A, et al. Adverse Events During Intrahospital Transport of Critically Ill Children: A Systematic Review Anesthesia and analgesia, 2020.PMID 32925334
- [3]Shinozaki RM, Schwingshackl A, Srivastava N, et al. Pediatric interfacility transport effects on mortality and length of stay World journal of pediatrics, 2021.PMID 34319538
- [4]Wilcox SR, Wax RS, Meyer MT, et al. Interfacility Transport of Critically Ill Patients Critical care medicine, 2022.PMID 36106970
- [5]Ramnarayan P, Intikhab Z, Spenceley N, et al. Inter-hospital transport of the child with critical cardiac disease Cardiology in the young, 2017.PMID 29198261
- [6]Thirnbeck CK, Espinoza ET, Beaman EA, et al. Interfacility Referral Communication for PICU Transfer Pediatric critical care medicine, 2024.PMID 38483193
- [7]Patterson KN, Beyene TJ, Bergus K, et al. Interfacility helicopter transport to a tertiary pediatric trauma center Journal of pediatric surgery, 2022.PMID 35672168
- [8]Noje C, Rozenfeld R, Holcomb RG, et al. Consensus on Neonatal and Pediatric Interfacility Transport Air medical journal, 2026.PMID 42331499
- [9]Ali A, Miller MR, Cameron S, et al. Pediatric Transport Safety Collaborative: Adverse Events With Parental Presence During Pediatric Critical Care Transport Pediatric emergency care, 2022.PMID 34693934
- [10]Hutton H, Sherif A, Ari A, et al. Noninvasive Respiratory Support during Pediatric Critical Care Transport: A Retrospective Cohort Study Journal of pediatric intensive care, 2024.PMID 39629146
- [11]Campbell A, Ascenzi J, Busch DW An Integrative Review Regarding Knowledge and Self-Competency of Pediatric and Neonatal Critical Care Transport Nurses Air medical journal, 2022.PMID 36153147
- [12]Gleich SJ, Myers LA, Montgomery MD, et al. Low Utilization of Synchronous Telemedicine in Pediatric Critical Care Interfacility Transport: Barriers and Lessons Air medical journal, 2022.PMID 35750446