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interventions, and preparation for transport to be accomplished before the team arrives Telemedicine can improve the pretransport assessment availability of visual and auditory data and should offer a more individualized, higher level of initial assessment and advice When the transport team arrives, after a concise medical handoff, they should review the medical history, including all therapeutic maneuvers and interventions performed at the referring hospital Ideally this handoff is part of a standardized process as described in 2013 by Weingart et al An efficient and focused physical examination is mandatory During this pretransport process, endotracheal tubes, chest tubes, IV and intra-arterial catheters, and other indwelling devices should be checked for proper placement and stabilization When doubt exists, devices should be resecured or replaced After this initial assessment, the transport team, in concert with the medical control physician, should decide if any, additional medical interventions are required to be initiated and/or continued before leaving the referring center Such interventions are most appropriate when they may have a direct impact on patient outcome For example, the child who may have meningitis should receive antibiotics before or during the transport process, but a lumbar puncture may be deferred until arrival at the receiving hospital The appropriateness of interventions will, to some degree, be dictated by the distance to the receiving hospital For example, a child with a circumferential burn of an extremity may require an escharotomy to minimize or prevent vascular compromise If the receiving hospital is minutes away, this might be appropriately deferred However, if the receiving hospital is hours away, it may be prudent to have the procedure performed before departing from the referring center Again, transmission of images or materials to the receiving center or medical control physicians can help in the patient management This could include images of the patient, computed tomography scans or x-rays, as well as copies of ECGs or other assessments Availability of point-of-care testing is helpful for continued patient assessment during transport After the patient is optimally prepared for transport, he or she must then be moved from the referral facility’s bed to the transport stretcher, and then to the vehicle Such movements represent great risk to the patient, so staff should exercise extra vigilance during patient transfer IV catheters and endotracheal tubes are most likely to be displaced while the patient is being moved Consequently, patients should be subjected to the fewest transfers necessary to get them from the referring hospital to the definitive bed/location they will occupy at the receiving hospital Personnel should be assigned to secure lines and tubes, and
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