An expansion in Advocacy for Children Since 2020, Dorset and Somerset Air Ambulance (DSAA) has been formally supporting the time-critical inter-hospital transfer of children across the region. This has been achieved not by chance, but though collaboration, innovation and years of hard work. Background Within the South West and Wessex regions of England, critically ill and injured children receive specialist care within two centres: Bristol Children’s Hospital and Southampton Children’s Hospital. The transport of seriously ill and injured infants and children within these regions is co-ordinated by specialist paediatric critical care transport teams: WATCh (Wales and West Acute Transport for Children Service) and SORT (Southampton Oxford Retrieval Team). Injured children in the South West are jointly managed by the trauma team leader (TTL) at Bristol Children’s Hospital and WATCh. Clinicians within local acute hospitals refer patients to WATCh, the TTL at Bristol Children’s Hospital and SORT for decision support and inter-hospital transport. Regional challenges of Time-Critical Transport of Ill and Injured Children Every year, a small proportion of critically ill and injured children in the South West who are referred to WATCh or SORT, have time-critical emergency specialist care needs. Any delay in reaching the appropriate specialist care reduces the chance of a good outcome for the child. In these time-critical cases, the transport of the child is often performed by the referring hospital themselves rather than the WATCh or SORT specialist paediatric transport teams. To do this, the referring hospital needs to utilise a local critical care team, often a consultant anaesthetist and skilled assistant from the hospital, which can leave them significantly understaffed. An Expansion in Advocacy for Children In 2016, the charity realised that our helicopter based critical care service, set up for immediate response and staffed with a critical care practitioner and doctor, could support time-critical, inter-hospital paediatric transfers, by working in collaboration with the regional paediatric transport services. With this in mind, we began to upskill our team with the aim of developing them to objectively have the critical care competencies required of the Intensive Care Society and Paediatric Critical Care Society (PCCS) transport standards. This was achieved by using a blended approach of hospital placements within paediatric critical care units, formal lectures and simulation days by specialist paediatric transport team consultants and nurses. We also upgraded some of our equipment, such as ventilator software, to ensure they were suitable for paediatric and neonatal patients. The development programme continued for four years, to ensure that our clinicians gained significant exposure to paediatric critical care environments and had fully consolidated this into their team-based practice. In April 2020, when our practitioners and doctors reached the competency required and our service met the national standards, a formal review was made by the clinical leads for SORT. This comprised a full governance review, site visit, review of equipment and resources and a review against the PCCS 2015 standards. Following this, DSAA began formally supporting SORT with time-critical inter-hospital paediatric transfers at their request. In October 2020, DSAA and SORT presented our work at the PCCS’s national conference. The response was positive, with attendees engaged and supportive. Encouragingly, a request was made during the conference for the development of guidance standards. Following this, DSAA worked in collaboration with the South Western Ambulance Service NHS Foundation Trust (SWASfT), WATCh and SORT, the South West Paediatric Critical Care Network, South West Paediatric Major Trauma Network, Severn Major Trauma Network and Peninsula Major Trauma Network, to produce clear standards for Helicopter Emergency Medical Service (HEMS) teams involved with time-critical inter-hospital paediatric transport. These were based on the PCCS 2015 inter-hospital transport standards and were agreed by all three South West networks and SWASfT in January 2021. These generic regional standards enable other HEMS services in the region to develop a similar capability. Following a site visit and full governance review by the WATCh clinical leads in September 2020 and subsequent demonstration by DSAA of compliance with the regional network standards in January 2021, our time-critical inter-hospital paediatric transfer service to the South West region was expanded in support of both WATCh and SORT. To date, DSAA has provided 15 time-critical paediatric transfers at the request of WATCh (6 cases) and SORT (9 cases), which has enabled children with severe head injuries, spontaneous intracerebral bleeds, burns and abdominal emergencies, to be safely transferred from local hospitals to the regional children’s hospitals in Southampton and Bristol for emergency surgery and ongoing intensive care. This has been in addition to our pre-hospital critical care activity and regional time-critical inter-hospital adult transfer service, at no cost to the hospital, patients or their families. DSAA continues to be compliant with the most recent Paediatric Critical Care Society (PCCS) Transport Standards released in October 2021. This service continues to develop in collaboration with WATCh and SORT and is going from strength to strength. Supporting documents for patients and their families A support leaflet and bravery certificate provides information on what patients and their families can expect if a child needs to be transported by our team. The bravery certificate uses child friendly characters that were kindly created by Molly Watts, author of the brilliant ‘Nurse Dotty’ books. National recognition This innovative and collaborative project was the first of its kind in the UK and won ‘Innovation of the Year’ at this year’s Air Ambulances UK Awards of Excellence. It demonstrated, among many other things, that the air ambulance community, hospital community and regional networks can achieve substantial collaborative improvements in networked patient care under NHS governance. Thank You! On Christmas Day 2020, 13-year-old James Clark benefited from our time-critical inter-hospital paediatric transfer service. James’s family tell us more.