The general characteristics of national, regional and local transport are summarized in Table 1.

All of the hospitals have a pre-hospital medical care system established at national level.

Only two countries have a unified national transport system. Portugal possesses a unified inter-hospital system specifically designed for pediatric and neonatal patient transport. This is a public system with 24-hour availability, and is organized into three regional areas (North, Center and South)–each with its own coordination system.

Chile has a mixed (pediatric and adult) unified public medical transport system organized by the Emergency Care System (Sistema de Atención Médica de Urgencia [SAMU]). Transport is available 24hours a day, and there is a specific local coordinating center per region–with a regional regulating center and bases distributed throughout the different towns that in turn are regulated nationally by the Ministry of Health. The staff is not specialized in pediatric care but must complete a pediatric transportation course.

Other countries such as Spain do not have a unified national medical transport system. A specific pediatric unified transport system is found in only two Autonomous Communities (Catalonia and the Balearic Islands). The rest of the Communities have a mixed unified system for adults and children, and some Communities such as Madrid offer specific neonatal transport.

The rest of the Latin American countries have no unified transport system: public and private systems that are not of a specifically pediatric nature are seen to coexist.

The characteristics of the patients, transport means, teams and training are shown in Table 2.

In most cases transport team training is not structured: there are variations in its theoretical and practical dimensions, organization by the Department of Emergency Care or the PICU, and in the frequency of training.

The available neonatal and pediatric transport material is described in Figs. 1 and 2.

Figure 1.

Availability of pediatric transport material (available online).

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Figure 2.

Availability of neonatal transport material (available online).

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Regarding the generated documentation, all of the hospitals make use of a specific form containing the data referred to transfer (patient information, treatments, evolution, etc.), and 58.8% require written informed consent.

Table 3 summarizes the comparison of the different transport systems between the Iberian Peninsula and Latin America.

Transport means

The use of mobile ICUs and medicalized helicopters as transport means is more common on the Iberian Peninsula, while in Latin America conventional ambulances and aircraft ambulances mark the tendency (Fig. 3).

Figure 3.

Comparison of the transport means between Latin America and the Iberian Peninsula (Spain and Portugal).

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Transport material

On the Iberian Peninsula, the teams have a greater availability of transport material–both pediatric and neonatal–than in Latin America (Figs. 4 and 5).

Figure 4.

Comparison of the pediatric transport material between Latin America and the Iberian Peninsula (Spain and Portugal).

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Figure 5.

Comparison of the neonatal transport material between Latin America and the Iberian Peninsula (Spain and Portugal).

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Transport team

A specific pediatric training system for the medical transport staff is more frequently found in Portugal and Spain than in Latin America (Table 3 and Fig. 6).

Figure 6.

Comparison of the medical transport staff between Latin America and the Iberian Peninsula (Spain and Portugal).

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Our results show that at present, most of the surveyed countries do not have a unified pediatric transport system, and most children are transferred by non-pediatric teams. The coexistence of different models–public and private, pediatric and adult, neonatal or pediatric, local and regional–within one same area is relatively common, and this makes the optimization of human and material resources difficult. Only Portugal, Catalonia and the Balearic Islands have a unified specific pediatric transport system, and these are precisely the only areas that hold a positive view of the system.6–8 On the other hand, the training of medical transport staff is generally inadequate. Very few hospitals have transport training programs, and many teams do not have specific pediatric training.

Little information is available on the organization of medical transport in other countries. In relation to adults, The Netherlands, United Kingdom, Australia and New Zealand expect all hospitals to be able to transport critical patients by means of their own specialized staff.4 In the United States, the composition of the teams is not homogeneous, and in many hospitals the teams are composed of a nurse, a paramedic and a driver–though some teams are highly trained.4 In Canada, many critical patient transport teams also operate without a physician. However, the paramedics are well trained and are experienced in emergencies and the transfer of critical patients.4

It is very difficult to establish teams specialized in the transport of pediatric patients in all hospitals. The most reasonable solution therefore might be to organize a coordinating center at regional or local level, with specifically pediatric and neonatal transport teams dependent upon some of the receptor hospital centers in the region–as successfully occurs in Portugal, Catalonia and the Balearic Islands.6–8

Furthermore, it is important to note that only 67.5% of the teams are equipped with a mobile ICU, and only 27.7% have a mobile ICU adapted to pediatric patients–despite the studies that show transport under the best possible conditions to lessen the incidence of adverse events (medical or technical).9,10 Technical incidents represent up to 46% of the total,4 which underscores the importance of adequate knowledge of the equipment used.9,10

In coincidence with other studies,10 the disorders most often requiring transport are of a respiratory, cardiac and traumatic nature, together with specifically pediatric conditions such as prematurity, congenital heart disease or meconial aspiration syndrome. These circumstances in turn require specific knowledge and practical experience. Consequently, specific theoretical and practical staff training is a crucial aspect of medical transport, along with the availability of clinical guides as support for the diagnosis, management and transfer of critical patients.11,12

Medical transport on the Iberian Peninsula is generally public, is more often unified, and has more specific pediatric and neonatal transport teams, which moreover receive greater training in patient transport. With regard to the material resources on the Peninsula, the use of a mobile ICU as means of transport is more common, and the teams have more both pediatric and neonatal care material than in Latin America. These imbalances are probably due in part to economic differences between countries, though health system organization capacity and awareness of medical transport as an important healthcare and social need also exert an influence.13 The existing differences are further accentuated by the greater need for pediatric transport in Latin America, where there are generally greater contrasts in healthcare coverage between the different hospitals, and the geographical distances are moreover greater.

National and international collaboration is very important to overcome these differences. Although there is some experience in pediatric transport training through the collaboration of expert teams such as for example in Honduras, a multinational work network is needed. In this sense, the creation of a Latin American Pediatric Transport Network (Red Iberoamericana de Transporte Pediátrica [RITRANSPED]) has been proposed as a means to coordinate the efforts of the different countries.

Our study has several limitations. Firstly, the data were obtained from an open survey, with a non-homogeneous geographical distribution of the hospitals included in the study, and we received a larger number of completed surveys from certain regions generally corresponding to the most populated cities. Because of this, the study might not exactly reflect the situation of pediatric transport, particularly in Latin America, where there is an enormous pediatric population and healthcare organization is highly diverse. On the other hand, the number of surveys returned from each country was not enough to allow comparisons by countries. In this regard, our study only analyzes a small sample not fully representative of the real situation in Latin America; the statistical conclusions are therefore of limited validity. Nevertheless, our results are useful in illustrating the main characteristics and shortcomings of the pediatric transport systems.

In contrast to the above, the number of responding centers in Spain was very high (54 hospitals), and this means that the results obtained reliably reflect the situation of pediatric transport in this country. Information was only lacking from certain Communities such as the Canary Islands, La Rioja and the cities of Ceuta and Melilla.

On the other hand, our study only addresses the general characteristics of the pediatric transport system. The creation of a clinical pediatric transport registry is needed at national and international level in order to assess the problems and requirements of transport, and to facilitate its organization and efficacy.

Lastly, the survey does not analyze the in-hospital transfer systems, which are also of great clinical relevance.14