99466 Critical care face-to-face services, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or younger; first 30-74 minutes of hands-on care during transport

Name of the Procedure:

Critical Care Face-to-Face Services during Interfacility Transport of Critically Ill or Critically Injured Pediatric Patient, 24 Months of Age or Younger; First 30-74 Minutes of Hands-On Care During Transport

Summary

This procedure involves providing critical care to a severely ill or injured child (aged 24 months or younger) during transport between healthcare facilities. It includes direct, hands-on medical attention by a healthcare provider for the first 30 to 74 minutes of the transport.

Purpose

The procedure addresses severe medical conditions or injuries in very young children that require urgent, specialized care only available at another facility. The goal is to stabilize the child's condition during transport, preventing deterioration and ensuring a safe transfer to the receiving facility.

Indications

• Life-threatening conditions like severe respiratory distress, cardiac failure, or traumatic injuries.
• Specific criteria include unstable vital signs, need for advanced airway management, or ongoing resuscitation.

Preparation

• Ensure all pertinent medical records and a summary of the child's current medical condition are available.
• Pack necessary medications, equipment, and supplies for the transport.
• Parents may need to sign consent forms and receive instructions on what to expect.

Procedure Description

1. Stabilize the patient before transport, ensuring all life-support measures are in place.
2. Transport team, including a specialized pediatric healthcare provider, boards with the patient.
3. Continuous monitoring and hands-on care are provided during transport, including managing airways, administering medications, and interpreting vital signs.
4. Communication with the receiving facility to update on patient status and ensure preparedness upon arrival.

Tools and Equipment:

• Portable ventilators, monitors, intravenous (IV) access equipment, emergency medications, and resuscitation supplies.

Anesthesia or Sedation:

• Only if necessary to stabilize the patient, typically managed with minimal to no sedation due to the critical status of the patient.

Duration

The first 30 to 74 minutes of hands-on care during transport.

Setting

Performed in a specialized ambulance or medical transport vehicle capable of critical care.

Personnel

• Pediatric intensivist or trained critical care provider
• Transport nurse
• Paramedic or emergency medical technician (EMT)
• Driver with training in safe transport of medical patients

Risks and Complications

• Potential deterioration of the patient's condition during transport.
• Risks associated with invasive procedures such as intubation or IV placement.
• Possibility of equipment failure or unforeseen complications.

Benefits

• Immediate medical attention during transport increases the chances of successful stabilization.
• Ensures continuity of care from the sending to the receiving facility.
• Enhances the likelihood of better outcomes by preventing deterioration en route.

Recovery

• Continuous monitoring upon arrival at the receiving facility.
• Further treatment and stabilization as per the receiving healthcare team's plan.
• Family will be informed about the child's condition and next steps.

Alternatives

• Telemedicine consultation if transport is deemed too risky.
• Treatment stabilization at the current facility until the patient is stable enough for transport.
• Each alternative has limitations, such as lack of specialized care at the current location or delayed definitive treatment.

Patient Experience

• The child may experience discomfort due to their critical condition.
• Pain and sedation needs are managed by the transport team.
• Parents or guardians are typically not allowed during transport but will be informed of the child's status and expected arrival time.