Q&A;’s about the Transport of Pediatric Patients (< 18 years of age) Under Investigation or with Confirmed Ebola

Key Points

• EMS agencies specializing in pediatric transport are preferred for the transport of a pediatric PUI or a child with known Ebola.
• Use the child’s own car seat for transport, if available. Otherwise, use the EMS agency’s car seat or child restraint system (Pedi-Mate).
• Isopods (pediatric isolation transport units) for transport of children are available through durable medical equipment suppliers.
• A vehicle and equipment decontamination plan is recommended.
• Children should not be put in personal protective equipment (PPE).
• A caregiver may accompany the child only if the child is not exhibiting obvious bleeding, vomiting, or diarrhea. In this document, a caregiver is a child’s parent or legal guardian. In the event that a parent or legal guardian cannot be present for transport, they may designate an alternative adult caregiver. The caregiver must use
  • a face shield and surgical face mask
  • an impermeable gown
  • two pairs of gloves

What are the considerations for safe transport of children?

The guidelines for safe transport as found in the Department of Transportation’s (DOT) ground ambulance guidance¹ should be followed. Use of the patient's own car seat, if available, is preferable, which will be left with the receiving facility for decontamination or disposal in accordance with CDC’s Waste Management Guidelines². If an EMS agency's car seat or Pedi-Mate (a restraint that adapts a standard ambulance cot for safe pediatric transport) is used, it will likely be left with the receiving facility and decontaminated or disposed of in accordance with CDC’s Waste Management guidelines. Invasive procedures, including the use of needles and other sharps, should be kept to a minimum³.

Our agency does not have an EMS team that specializes in children. How does this affect pre-hospital EMS transport of a pediatric PUI?

When available, EMS agencies specializing in pediatric transport are preferred to transport a pediatric PUI. Even in situations where pediatric transport is not available, all EMS units should be stocked with equipment to meet basic and advanced life support needs of children⁴.

Are there special considerations for the inter-hospital EMS transfer of a pediatric PUI?

Scheduled EMS transfer of pediatric patients should follow appropriate CDC guidance including the use of PPE⁵. A toolkit has been developed to facilitate pediatric transport between facilities⁶.

Are isopods available for the transport of children?

An Isopod (pediatric isolation transport unit) is a piece of equipment that allows full air circulation or negative pressure and access for up to three persons. Medical transport agencies will want to discuss the use of isopods with their medical authorities to decide if the purchase of an isopod meets their needs. If an agency decides to purchase isopods, they are available from supply companies that also carry durable medical equipment such as Stokes stretchers and IV pumps.

What about vehicle and equipment decontamination?

EMS agencies should have a plan in place for vehicle and equipment decontamination after transport of a child suspected to have Ebola, particularly if an isopod is not available. Agencies that do not have their own decontamination team should consider working with the hospital to decontaminate the transport vehicle after a patient is transferred to hospital care. Likewise, an agency could consider working with other first responder agencies in the region that have experience in decontamination.

Should children wear PPE for transport?

Children should not wear PPE. PPE is designed to protect the person wearing it from exposure to another person’s body fluids, not to contain the wearer’s body fluids. In addition, placing a child in PPE or covering the child with other protective equipment may interfere with the EMS provider's ability to adequately assess the child's clinical status and may restrict access to the child during transport.

Should parents or other family caregivers be present during transport?

Allowing a caregiver to be with a child during transport is standard practice in pediatric care. However, because of the risk inherent with Ebola and concern for disease containment³, special precautions during transport of an ill child are warranted:

• Caregivers should only travel with a child if the child’s symptoms are mild (e.g., fever, aches, no bleeding, vomiting, or diarrhea). The caregiver should use a face shield and surgical mask, an impermeable gown, and two pairs of gloves. The caregiver must be observed and assisted in donning and doffing (taking off) the PPE.
• Donning and doffing PPE requires training and may introduce risk. Therefore, caregivers should not accompany a child in transport if they will be exposed to the child’s blood or body fluids, such as vomit or diarrhea. CDC is currently developing guidance on visitor presence.

References

1. National Highway Traffic Safety Administration, Department of Transportation. Working group best-practice recommendations for the safe transport of children in emergency ground ambulances. DOT 811 677.
2. Centers for Disease Control and Prevention. Ebola (Ebola Virus Disease). Ebola-Associated Waste Management.
3. Centers for Disease Control and Prevention. Ebola (Ebola Virus Disease). Interim Guidance for Emergency Medical Services (EMS) Systems and 9-1-1 Public Safety Answering Points (PSAPs) for Management of Patients with Known or Suspected Ebola Virus Disease in the United States.
4. Equipment for ground ambulances. Prehospital emergency care: official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. 2014;18:92-7.
5. Centers for Disease Control and Prevention. Ebola (Ebola Virus Disease). Guidance on Personal Protective Equipment to be Used by Healthcare Workers During Management of Patients with Ebola Virus in U.S. Hospitals, Including Procedures for Putting on (Donning) and Removing (Doffing).
6. EMSC National Resource Center, Emergency Nurses Association, Society of Trauma Nurses. Inter-Facility Transfer Tool Kit for the Pediatric Patient. 2013.