The Evolution of Safe Transport Systems for Infants, Children and Maternal Patients in Canada- A Journey to Excellence

Submitted by: 
Dr. Allan de CaenPediatric Intensive Care Consultant and Clinical Professor of Pediatrics at the Stollery Children’s Hospital / University of Alberta
Kate Mahon, Executive Director of the Trauma Association of Canada

Not all Canadian infants and children have immediate access to tertiary level care, due in part to Canada’s regionalization of pediatric-subspecialty care in the last 40 years and how regional health care is resourced. This means that efficient transfer of critically ill and injured infants and children over the long distances between referral hospitals and accepting tertiary care pediatric centers has become more and more necessary.

Many medically-fragile infants and children are often transported by health care teams that are expert in adult transport services but are often limited in their training and experience in neonatal and pediatric acute care. Challenges have existed for these health care teams in providing a consistent and adequate level of neonatal and pediatric acute care to those infants and children being moved between Canadian health care facilities.

The challenges are amplified when the tools and vehicles to safely transport these patients are few and far between.

Kate Mahon, Executive Director of the Trauma Association of Canada, paints a vivid picture as she recounts working as a PICU nurse at the IWK Health Centre in Halifax, Nova Scotia in 1982.

If a critically ill child needed to be transported to the IWK, our first call would be to the Canadian Armed Forces Air Search and Rescue Squadron (located in Greenwood, NS or Summerside, PEI). If available, a Sea King Helicopter or C-130 Hercules aircraft would be dispatched with the caveat, if we get a call of a ship in distress you will be diverted with us in that Mission". In such a large aircraft, our neonatal team would be harnessed in, so they would not fall over in flight as we tended to our patients.

In a scenario where neither of these aircraft were available, we had to “shop around” to find a private ambulance service or even private transport helicopters shuttling workers to and from oil rigs to assist in the transport. Given that most of these private services had no specialized pediatric critical care experience, an extra stop would be made to pick up a member of our team to ensure appropriate care was delivered to the paediatric patient on-route.

These challenges and barriers continued to plague the neonatal and paediatric transport field for years.

At a national symposium entitled “Transport Systems: Moving our Children across Systems – Challenges, Barriers and Enablers,” held at CAPHC’s 2008 Annual Conference in Edmonton, delegates identified the need to develop national standards for the inter-facility transport of critically ill newborns, children and youth. At the time there were no Canadian standards to guide the safe and competent care of infants and children during transport.

As a result of that session, CAPHC, later that year established a National Transport Systems Steering Committee comprised of multidisciplinary experts from across the country that began to address this issue. Determined to raise the bar, work by this group resulted in the establishment of a tool that would drive the education standards for health care providers involved in the interfacility transport - Competencies Profile-Interfacility Critical Care Transport of Maternal, Neonatal, and Paediatric Patients.

The group also lobbied Accreditation Canada to revise their EMS standards to incorporate the minimum standard of care that one should expect for the transport of acutely ill infants and children when being moved between Canadian health care facilities, citing the CAPHC work as a reference. The result was "Accreditation Canada EMS and Interfacility Transport Standards" which outlines the minimum standard for air and ground ambulance and interfacility (emergent and non-emergent) transport of infants, children (and adults).

Today, this national working group continues to work together to resolve educational and equipment challenges that are faced by transport teams while willingly sharing solutions and innovations in moving acutely ill infants and children (and maternal patients) between health care facilities across Canada.