"Is it better for the child to be transported by paramedics 30 minutes (or
many times longer) in order to get to a "Pediatric Critical Care Center"
(may not necessarily be soley a "children's hospital") or is it better for
the child to be transported only a few minutes to a general emergency
I would also support going to the NEAREST CENTER even if they are "tubed"
because displacements, obstruction, pneumothoraces ..... can occur very
easily during transport.
The reality, in my opinion, is that your question does not have one right
answer. It is so REGION SPECIFIC. There are many general ED's around the
Children's hospital where I am, even within 30 minutes or so from us, who
on given shifts, are not comfortable with such a pediatric emergency and
routinely offer diversions to us. Sometimes, the EMS folks will bypass
these so called EDAP's in anticipation of such a response and send all such
sick kids to us!!
The focus of our energies, I believe, should be on providing good EMS-C
training to all pre-hospital providers in our areas so that the "golden
minute" of airway management is not lost on the field especially if the
patient has "severe"=RD.
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