There are particular 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.

The PIPER Paediatric ‘Go Now’ Criteria are:

1. 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
2. Any child with shock requiring intubation or inotropes
3. Upper airway obstruction persistent despite >2 doses of adrenaline, or hypoxic (SpO2 <90%)
4. Pneumonia with hypoxaemia (SpO2 <90%) despite locally available non-invasive respiratory support
5. Large pleural effusion (e.g. near white-out of hemi-thorax
6. Ongoing seizures despite 2 doses of midazolam and loading with a long acting agent (phenytoin, levetiracetam, phenobarbitone)
7. Signs of raised intracranial pressure
8. Unconsciousness with worse than flexion motor response
9. Any arrhythmia with haemodynamic compromise (shock*, hypotension, signs of heart failure
10. Any child with suspected systemic to pulmonary shunt who is about to be intubated or needing inotrope
11. Any child with suspected cardiomyopathy / myocarditis who is about to be intubated or needing inotropes
12. Cardiac or respiratory arrest
13. Serum ammonia >200 mcg/dL

Any child fulfilling the PIPER Paediatric Go Now criteria should be discussed urgently with a PIPER Paediatric consultant.

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