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There should be local hospital protocols in place that are clear on the roles and responsibilities of the multidisciplinary team in caring for the critically ill child.³⁷ Individual hospitals will have different personnel providing anaesthetic support to these teams.

Hospitals should have clear operational policies regarding the care of young people aged 16-18 years of age and for preterm babies who have been discharged from neonatal units.¹³

Individuals with responsibilities for paediatric resuscitation and stabilisation should fulfil the training requirements and maintain their competencies.¹⁹

Staff without recent paediatric experience or training may be able to contribute transferable skills as part of the multidisciplinary team, e.g. expertise with ultrasound to assist line placement or echocardiography skills, and such contribution should be supported by local protocols. 

In all emergency departments receiving infants and children, neonatal and paediatric resuscitation equipment, medications (including anaesthetic drugs) and fluids should be available to prepare an infant or child for PICU transfer.³⁸

There should be immediate access to protocols for management of acute life-threatening conditions. These will often be agreed with the local PICU network or PIC transport team. Protocols should include acute respiratory, cardiovascular or neurological emergencies, trauma, poisoning and major burns.¹³

Hospitals without a suitable PICU/NICU bed should obtain the advice of the local PICU transport team as soon as possible during the management of the sick or critically injured child or young person.

Specialist centres with PICU facilities should provide clinical advice and help in locating a suitable PICU bed once a referral has been made. 

Written guidelines should cover the policy for the collection of patients from the ward or admissions unit, as well as the handover by ward staff to a designated member of the operating department staff.

There should be data collection for all referrals to PICU.