care quickly Ideally, advanced pediatric care begins the moment the transport team is contacted Pediatric medical or surgical advice, before the arrival of the transport team, can be stabilizing and potentially lifesaving for the patient Finally, in geographic locations where specialized pediatric transport is unavailable, involvement of skilled acute care/critical care pediatricians on the referring and/or receiving end is extremely important A final consideration is when transport across international borders is indicated This mode of transport requires significant preplanning Specific issues to be considered for these patients include language of providers (and patients), compatibility and redundancy of medical equipment, power sources, medication issues with customs, communications during transport, visas, passports, parental consent for a patient to leave the country, documentation, and logistics of transport durations For many international, long-distance transports, air crews are required to “time out,” necessitating transport times that may require multiple days, or use of additional personnel for the transport Similar work rule considerations, although perhaps not as rigid as established Federal Aviation Administration (FAA) crew requirements, should be afforded to the transport healthcare personnel Options and solutions to these issues are available, but must be anticipated prior to need Several services specialize in international transports; these services are useful consultants for teams less familiar with international transports MODES OF TRANSPORT When a decision is made to transport a pediatric patient, there is often a discussion on the appropriate mode of transport Nonmedical modes of transport include a parent’s automobile or a taxicab Problems with those options include lack of assurance of direct transport to the receiving facility, inability to ensure patient safety, and the lack of available medical care during the transfer Even the accompaniment of a physician or nurse does not markedly improve the ability for medical intervention in these nonmedical vehicles A Basic Life Support (BLS) ambulance offers direct transportation to the receiving institution, but does not offer much in the way of pediatric expertise or intervention capability Physician or nurse accompaniment in a BLS ambulance increases potential level of medical care, however the BLS environment is limited with regard to standard personnel, pediatric equipment, and medications ALS transport offers more sophisticated resuscitation abilities, including intubation equipment, vascular access capabilities, and medication administration for adult and pediatric patients These ALS interventions are generally guided by state and region-specific regulations