There are patients who need an urgent response, and we have defined these criteria, which we refer to as ‘Go Now’ criteria.   These are not meant as thresholds for referral, for many such children we would wish to be called earlier, but rather they are triggers for urgent departure of our retrieval team. This is not an exclusive list of all children who are unwell. If you are worried about a child on presentation, or they are not improving as expected with therapy please refer for review and escalation. 

The PIPER Paediatric ‘Go Now’ Criteria are:

1.    Cardiac or respiratory arrest

2.    Children requiring emergency intubation

3.    Suspected severe sepsis and one or more of:

• Venous blood Lactate >3 mmol/L
• Neutropenia (neutrophil count <1000 / mm3), unexpected (i.e. not related to cancer chemotherapy)
• Coagulopathy (INR>1.6, APTT>60, Fib <1)
• Signs of shock* persisting despite a total of 40ml/kg fluid

4.    Upper airway obstruction persistent despite >2 doses of adrenaline, or hypoxic (SpO₂<90%)

5.    Pneumonia or asthma with hypoxaemia (SpO2 <90%) despite locally available non-invasive respiratory support and bronchodilators if relevant.

6.    Large pleural effusion (e.g. near white-out of hemi-thorax)

7.    Surgical abdomen with signs of shock*

8.    Ongoing seizures despite 2 doses of midazolam and loading with a long acting agent (phenytoin, levetiracetam, phenobarbitone)

9.    Signs of raised intracranial pressure

10.  Unconsciousness with worse than flexion motor response

11.   Patients with the following cardiac problems with haemodynamic compromise: shock*, hypotension, signs of heart failure, venous blood lactate >3, or about to be intubated:

• Congenital heart disease
• Arrhythmia
• Suspected cardiomyopathy / myocarditis

12.  Serum ammonia >150 mcg/dL

Any child fulfilling these Go Now criteria should be discussed urgently with a PIPER consultant.  Most of these children will need to be transported out by PIPER to RCH PICU or Monash PICU, but some will initially be stabilised in the regional ICU that has a paediatric intensive care section. 

The PIPER Clinician: ensure the appropriate team is sent to these cases. Availability of a second PIPER Nurse from PICU can be sought from the PICU NUM in hours and PICU AUM out of hours.  

* Signs of shock include capillary refill >3 seconds, low volume pulses, hypotension, tachypnoea, lethargic or poor conscious state.