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child on the lap of a parent in an ambulance, regardless of how the child is secured to the parent or stretcher Lights and Siren Use There are few times when a higher-speed transport with lights and siren (L&S) will be of benefit to a sick or injured child—in fact, this practice may introduce more danger than benefit to the patient In 2019, Watanabe et al demonstrated that the increased odds of collision is 1.5 with L&S when compared to without Although in some communities it is legal for emergency vehicles to exceed the speed limit and pass through red lights, this does not mean that it is safe to so A NAEMSP position paper recommended that EMS services should develop a policy on L&S use, which should be reviewed by the services’ medical directors It should be noted that accidents while running with L&S are a common cause of litigation Multiple vehicles responding to an incident using L&S is another practice that is frequently done, but is likely unnecessary Emergency vehicle accidents are an area of high, and frequently unnecessary, liability in EMS that are borne more out of a tradition of L&S use, than a medical necessity for the patient This is a good example of a nonmedical aspect of a transport system that may adversely affect patient care STABILIZATION FOR TRANSPORT The patient care paradigm of most interfacility transport teams stands somewhat in contrast to that of prehospital care systems EMS providers are usually bringing a patient from an environment without medical care (e.g., home or accident scene) to a hospital In many of these cases, the patient is better served to have the minimum stabilization necessary at the scene, followed by rapid transport to an appropriate hospital, with further intervention being performed en route or on arrival In contrast, the interfacility transport team is most often taking a patient from a hospital, usually an ED or another monitored setting, to a monitored bed within a higher level or specialty care center The transport team, therefore, is responsible for maintaining an appropriate advanced level of care between the two centers Ideally, the transport team should provide the level of care that the patient will receive at the receiving facility At a minimum, the transport team must maintain the patient’s present level of care Stabilization before transport is the key to this process Initial preparation for transport often begins when the referral caregivers recognize that the patient requires care beyond the capabilities of their personnel or center Appropriate advice and suggestions from transport personnel or the receiving physician ideally will enable much of the necessary stabilization,