Importance of effective collaboration between pediatric intensive care and emergency departments

Pediatric critical care and pediatric emergency medicine are disciplines that share responsibility for providing care for acutely injured or critically ill children. In many parts of the developed world, these disciplines are recognized subspecialties of pediatrics with excellent training programs, a welldefined body of knowledge, sufficient practitioners at the senior level and a track record of clinical and academic productivity [1,2]. Indeed, from modest beginnings in the 1960s, pediatric critical care medicine has evolved and can boast dramatic major advances in the areas of lung injury, sepsis, traumatic brain injury and postoperative care. Pediatric emergency medicine has also made significant advances in the evaluation and treatment of respiratory distress, asthma, croup, epiglottitis, traumatic injuries, poisonings, cardiopulmonary resuscitation and sepsis. Both pediatric emergency medicine and pediatric critical care have developed impressive and aggressive research programs both in the USA and Canada [101–104]. What these disciplines share in common is their expertise to render care to patients with the greatest physiological instability. For many of these children, critical illness first occurs in diverse settings outside the hospital environment, and early recognition and early aggressive therapy can lead to improved outcomes. Furthermore, the best outcome can be guaranteed if there is good communication and a seamless continuum of care starting in the pre-hospital setting, which is linked to an efficient transport system and tertiary pediatric emergency and tertiary pediatric critical care teams (Figure 1)