P E T S. The Victorian. Paediatric Emergency Transport Service. Activity Report

P E T S The Victorian Paediatric Emergency Transport Service Activity Report 2011

AUTHORSHIP This report has been prepared by the staff of the Victorian Paediatric Emergency Transport Service, PETS. Alison Fleming Shradha Balia PETS Senior Nurse Clinician PETS Administrator T +61 3 9345 9028 T +61 3 9345 5430 E alison.fleming@rch.org.au E shradha.balia@rch.org.au Dr Felix Oberender Acting PETS Medical Director (clinical) T +61 3 9345 9888 E felix.oberender@rch.org.au ACKNOWLEDGEMENTS PETS operates as an integral part of the Paediatric Intensive Care Unit of the Royal Children's Hospital Melbourne. We gratefully acknowledge the support of hospital management as well as of the Intensive Care Unit. A/Prof Warwick Butt Director, PICU T +61 3 9345 5224 E warwick.butt@rch.org.au Adrian Hutchinson Nurse Unit Manager, PICU T +61 3 9345 6284 E adrian.hutchinson@rch.org.au The Royal Children's Hospital Melbourne 50 Flemington Road Parkville Victoria 3052 AUSTRALIA T +61 3 9345 5522 www.rch.org.au 1

LIST OF ACRONYMS AAV APLS ARV ECLS ED ICU MICA MMC NETS NSW PERS PETS PICU RCH TAS VIC WA Air Ambulance Victoria Advanced Paediatric Life Support Adult Retrieval Victoria Extracorporeal Life Support Emergency Department Intensive Care Unit Mobile Intensive Care Ambulance Monash Medical Centre, Melbourne Newborn Emergency Transport Service, Victoria New South Wales Perinatal Emergency Referral Service The Victorian Paediatric Emergency Transport Service Paediatric Intensive Care Unit The Royal Children's Hospital Melbourne Tasmania Victoria Western Australia 2

CONTENTS 1 Introduction 4 2 History of Paediatric Emergency Transport in Victoria, Australia 5 3 PETS team 6 Organisation 6 Transport staff 6 4 Outreach Education 7 5 Service Development 8 6 ECLS Retrievals 8 7 PETS Activity 10 PETS activity referral and retrieval trends 10 Referral calls to PETS 11 Teams retrieving patients following PETS referral 11 Timeframes for patient retrieval 12 PETS Calls and Retrievals by Month 2011 13 PETS Calls and Retrievals by Time 2011 14 Staff used for PETS retrievals 2011 14 8 Patient Diagnoses 15 Diagnostic categories of patients transferred by PETS 15 Distribution of Diagnostic Categories at PETS in 2011 15 Diagnostic categories Trends 15 Diagnoses of Patients retrieved by PETS 2011 16 9 Transport 18 Transport Out 18 Transport Return 18 Transport Out Trends 19 Transport Return Trends 19 10 PETS Age Distribution of Patients 20 11 PETS Activity Geographical Distribution 21 Activity by Victorian Health Care Region 21 Referrals Metropolitan and Regional 21 Referring Hospitals Victoria 22 Interstate Hospitals 24 PETS Patient Disposition 2011 25 PETS Patient Disposition Trends 25 12 Conclusion 26 3

1. Introduction With over 1000 calls and 475 retrievals, 2011 has been the busiest year in the 32 year history of the Victorian Paediatric Emergency Transport Service. The Victorian Paediatric Emergency Transport Service (PETS) transfers critically ill children from hospitals throughout Victoria, Tasmania, and southern New South Wales for life saving treatment to the Royal Children s Hospital and to Monash Medical Centre in Melbourne. Operating out of the Paediatric Intensive Care Unit of the Royal Children's Hospital Melbourne, PETS brings the highly specialized, world class resources of paediatric intensive care to critically ill children in Victoria and beyond providing safe, expert, emergency inter hospital transfer to a paediatric intensive care unit. PETS staff also give telephone advice to doctors, nurses, and ambulance personnel on the resuscitation of severely ill children thus making a unique specialist resource available to healthcare workers throughout all of Victoria. PETS is available 24 hours a day for advice and for retrieval of critically ill children in Victoria, Tasmania, and Southern New South Wales. Hotline 03 9345 7007 Website www.rch.org.au/pets The PETS Activity Report has been published annually since 2002. Following this edition, publication will occur after the end of the financial year in line government health care planning. 4

2. History of Paediatric Emergency Transport in Victoria, Australia Victoria has an area of 227,600 square km (87,884 square miles, roughly the size of the United Kingdom) and a population of 5.4 million, of whom 4 million live in greater Melbourne. 1.2 million of the 5 million are children (< 17 years). Victorian PETS covers all of Victoria, southern New South Wales and northern Tasmania. The total population of this area is about 6 million (approx. 1.5 million children), living within 600 km of the base of operations. On occasion, PETS may also retrieve children from other paediatric ICUs in Australia for treatment available only at the RCH Melbourne. Tertiary paediatric services in Victoria are located at the Royal Children s Hospital (RCH) and at Monash Medical Centre (MMC), both in Melbourne. Large general hospitals are located in regional cities and in central and suburban Melbourne. Many of these have paediatric departments and paediatric wards, with senior and junior paediatric medical staff, but not tertiary paediatric services. Smaller towns around the state usually lack specialist paediatric facilities; hospitals in these towns are staffed by general practitioners. In 1976, a Neonatal Emergency Transport Service (NETS), based at the Royal Women s Hospital, began transporting ill newborn babies from hospitals around Victoria to tertiary neonatal intensive care units in the Royal Women s, Royal Children s, Mercy Maternity and Queen Victoria Hospitals in Melbourne, immediately reducing mortality and morbidity rates in Victorian newborns. A paediatric emergency transport service, based at the Paediatric Intensive Care Unit of the Royal Children s Hospital, Melbourne, subsequently began operations in 1979, retrieving 46 patients in that year. In 2011, PETS received over 1000 phone calls and transferred more than 450 critically ill children. In November 2011, the Royal Children s Hospital moved into a new, purpose built facility, next door to the old hospital. In the process, NETS, PERS (the Perinatal Emergency Referral Service) and PETS moved into a joint office. It is envisaged that the three services will establish a single point of access for call co ordination and, eventually, amalgamate clinical operations in the future. 5

3. PETS Team PETS is staffed by the Paediatric Intensive Care Unit (PICU) of the Royal Children s Hospital Melbourne. This allows clinical advice and treatment during retrieval to be given by experienced and highly specialised teams. PICU thus comes to the child before the child can be moved to the PICU. Organisation PETS clinical operations are overseen by a medical director and a senior nurse clinician. They are supported by the PETS administrator. Transport staff All transfers are performed by a PICU doctor and a PETS nurse or by a PICU doctor and a paramedic. Medical staff are either experienced registrars (>4 years training in paediatrics, intensive care, anaesthesia or emergency medicine) with extra training in retrieval medicine or, in some highly complex retrievals such as transport on extracorporeal life support (ECMO), they are senior ICU specialists from the RCH PICU. PETS nurses are very experienced nursing staff with a strong background in looking after critically ill children as well as in retrieval nursing. They have undertaken a 1 year post graduate specialist course in PICU nursing, attended a PETS Workshop, Air Ambulance Orientation, and completed a Competency Package. Many nurses have also completed the Introduction to Aeromedical Retrieval Course through Monash University and the Advanced Paediatric Life Support (APLS) Course. 6

4. Outreach Education The successful and sought after PETS Outreach Education programme, organised by the PETS clinical nurse clinician, continued in 2011. The programme is available to hospitals throughout Victoria, Tasmania and southern New South Wales. In 2011, full day seminars were conducted at the following hospitals: Albury, Colac, Hamilton, Austin, John Fawkner (x3), and Sunshine. PETS has also provided separate education sessions to Sunshine Hospital, Latrobe Private Hospital, Monash University Paediatric Nursing Course and Emergency Nursing Course, The Royal Children s Hospital Recognising the Sick Child Workshops, Paediatric Nursing Course, and Paediatric Intensive Care Nursing Course. PETS nurses have been involved in Trauma Outreach Seminars which in 2011 were conducted in: Ballarat, Bendigo, Hamilton, Benalla, and Churchill. Regularly recurring education events include the PETS orientation and workshops for new PICU registrars and PICU nurses conducted each February and August. This also involves orientation to Air Ambulance, including tutorials at Essendon airport. 7

5. Service Development PETS continued to review and update its operations in 2011. Centre stage took the ongoing work towards amalgamation with the Newborn Emergency Transport Service which is set to continue in 2012. At the same time, the move into the New Royal Children Hospital in November represented a once in a lifetime event for our staff. PETS maintained full operational readiness on and around move day. PETS also served as an invaluable resource to the RCH with the PETS Senior Nurse Clinician and Dr Robert Henning, long time PETS director, taking lead roles in planning the move of critically ill patients in the RCH PICU. Other initiatives included the streamlining of clinical operating procedures and revisions of the PETS database. PETS was also active in telemedicine linking with the Southwest Region via SWARHnet and trialling a tablet device for video communication between retrieval team and base of operations. 6. ECLS Retrievals Transport of critically ill children on extracorporeal life support (ECLS) "heart lung machines" is a challenging undertaking of extreme complexity and only performed by a few selected centres worldwide. The Victorian Paediatric Emergency Transport Service in cooperation with the RCH PICU and the Cardiac Surgery Unit, have been able to offer this service to eligible patients in Victoria and throughout Australia. PETS teams consisting of a senior PETS nurse and a senior PICU doctor, a paediatric cardiac surgeon and a paediatric cardiac perfusionist travel emergently to critically ill children, place or transfer them on to mobile extracorporeal life support equipment and retrieve them the RCH PICU. In 2011, 7 children were transported on ECLS and retrieved from the following hospitals: 8

Adelaide Women s & Children s (SA), Sydney Children's Hospital Randwick (Sydney, NSW), Princess Margaret Hospital (Perth, WA), Wangaratta Hospital (VIC), Dandenong Hospital and Monash Medical Centre (both VIC). Patient diagnoses included: cardiomyopathy/myocarditis, ARDS pneumonia, and meconium aspiration. All patients survived the transfer to the Royal Children s Hospital and 5 survived to discharge from the Royal Children s Hospital. In total, 34 patients have been transferred by PETS on ECLS since 2000. 9

7. PETS Activity In 2011, PETS received 1024 referring phone calls and retrieved 475 patients. PETS activity referral and retrieval trends 2006 2007 2008 2009 2010 2011 Total Calls 690 760 700 737 903 1024 PETS 295 303 334 283 410 475 NETS 49 72 61 56 68 80 Advice only 113 133 126 135 130 150 MICA/AAV 132 119 79 127 138 133 (MICA:86 (MICA:54 (MICA:43 (MICA:76 (MICA:94 (MICA:93 AAV: 46) AAV: 65) AAV:36) AAV:51) AAV: 44) AAV: 41) Regular Ambulance 81 108 81 116 132 157 Referring doctor 11 10 10 9 4 11 Other 9 14 9 11 21 16 (Other: refers to different transport services used to transfer the patients to hospitals throughout Australia. These services include the Tasmanian retrieval service, MedSTAR Kids (South Australia), and Adult Retrieval Victoria, ARV. It also includes patients who died or stayed at the referring hospital). 10

Referral calls to PETS Number of calls 1200 1100 1000 903 1024 900 800 690 760 700 737 700 600 2006 2007 2008 2009 2010 2011 Year Teams retrieving patients following PETS referral Retrievals 500 450 400 350 300 250 200 150 100 50 0 PETS NETS MICA/Air Ambulance Regular Ambulance 2006 2007 2008 2009 2010 2011 Year 11

Timeframes for patient retrieval Median Activation Time hours (median time from referral phone call to departure from RCH) Median Response Time hours (median time from referral call to arrival at referring hospital) 2006: 0.7 2007: 0.9 2008: 1.0 2009: 1.0 2010: 0.9 2011: 1.0 2006: 1.7 2007: 2.0 2008: 2.2 2009: 2.0 2010: 2.0 2011: 1.8 Median Retrieval Time hours (median time from referral to arrival of PETS team at receiving hospital) 2006: 3.0 2007: 2.8 2008: 2.9 2009: 2.8 2010: 2.9 2011: 3.0 Total Retrieval Hours (total annual time from PETS team leaving RCH to admission of patient to receiving hospital) 2006: 873.8 2007: 946.9 2008: 1129.3 2009: 953.3 2010: 1372.1 2011: 1448.3 12

PETS Calls and Retrievals by Month 2011 Month Calls Retrievals January 72 28 February 52 24 March 78 35 April 73 37 May 87 41 June 112 65 July 140 62 August 112 47 September 78 37 October 61 28 November 82 36 December 77 35 Total 1024 475 140 120 100 80 60 40 20 0 Calls Retrievals 13

PETS Calls and Retrievals by Time 2011 Time Calls Retrievals Retrievals Nursing Shifts 07:00 19:30 537 279 256 13:30 22:00 498 243 237 19:00 07:30 452 231 256 Medical Shifts 08:00 20:30 580 297 279 20:00 08:30 405 209 227 Staff Used for PETS Retrievals 2011 ICU Registrar 475 ICU Consultant 1 ICU Nurse 462 MICA Paramedic 2 Air Ambulance Paramedic 0 No ICU Nurse or Air Ambulance/MICA 14 Paramedic Unknown/Other (if nurse or paramedic on 0 retrieval) 14

8. Patient Diagnoses Diagnostic categories of patients transferred by PETS 2006 2007 2008 2009 2010 2011 Respiratory 151 (51%) 128 (42%) 177 (53%) 146 (56%) 228 (56%) 266 (56%) Neurological 54 (18%) 73 (24%) 67 (20%) 54 (21%) 75 (18%) 77 (16%) Trauma 19 (6%) 76 (25%) 40 (12%) 26 (10%) 38 (9%) 27 (6%) Miscellaneous 72 (25%) 80 (26%) 27 (8%) 34 (13%) 69 (17%) 105 (22%) Distribution of Diagnostic Categories at PETS in 2011 105 Respiratory 27 Neurological 77 266 Trauma Miscellaneous Diagnostic Categories Trends Retrievals 500 400 300 200 100 Miscellaneous Neurological Trauma Respiratory 0 2006 2007 2008 2009 2010 2011 Year 15

Diagnoses of Patients retrieved by PETS 2011 Diagnosis Number of retrieved patients CVS: AV Malformation 1 CVS: Cardiomyopathy 1 CVS: Cardiomyopathy/Myocarditis 2 CVS: Dysrhythmia Supraventricular 1 CVS: Dysrhythmia Ventricular 2 CVS: Hypertension Pulmonary 1 CVS: Single Ventricle 1 CVS: Tetralogy of Fallot 1 ENTSurg:Adenoidectomy/Tonsillectomy 5 Env: Anaphylaxis 3 Env: Burns 8 Env: Immersion (Near Drowning) 1 Env: Ingestion 3 Env: Ingestion non drug 1 Env: Ingestion Drug 5 Env: Trauma Chest 1 Env: Trauma Facial 1 Env: Trauma Head 23 Env: Trauma Spinal 1 Env: Trauma Abdominal 1 Gastro: Bowel Obstruction 1 Gastro: Gastroinestinal Other 1 Gastro: Intussusception 7 Gastro: Peritonitis 1 Gastro: Varices Oesophageal or Gast 1 Gastro: Volvulus 1 GenSurg: Appendicectomy 1 Misc: Cardiac Arrest In Hospital 2 Misc: Dehydration 2 Misc: Electrolyte Disorder 4 Misc: Haematological Disorder 1 Misc: Inborn Error of Metabolism 1 Misc: Leukaemia or Lymphoma 1 Misc: Necrotising Fascitis 1 Misc: Pancytopenia 1 Misc: Sepsis 42 Misc: Shock Septic 7 Misc:Cardiac Arrest Out of Hospital 3 Misc:Diabetes Mellitus with Ketoaci 10 Misc:Immunodeficiency Congenital 1 Misc:Solid Organ Neoplasm Maligna 1 Neuro: Brain AV Malformation 3 Neuro: Brain Tumour 2 Neuro: Intracranial Haemorrhage Traumatic 2 16

Neuro: Meningitis 13 Neuro: Neurological Other 3 Neuro: Neurological Other Ataxia 1 Neuro: Seizures 45 Neuro:Encephalitis 4 Neuro:Encephalopathy, Acute Other 1 Neuro:Guillain Barre Syndrome 1 Neuro:Intracranial Hge Spontaneous 2 Renal: Renal Failure acute 2 Resp: ARDS 1 Resp: Aspiration 4 Resp: Asthma 80 Resp: Bronchiolitis 52 Resp: Epiglottitis 1 Resp: Laryngomalacia 1 Resp: Lower respiratory Infect Othe 4 Resp: Meconium Aspiration Syndrome 1 Resp: Pertussis Syndrome 2 Resp: Pneumonia or Pneumonitis 41 Resp: Respiratory Failure 2 Resp: Retropharyngeal Abscess 1 Resp: Upper Airway Obstruction Other 3 Resp:Foreign Body Inhaled 1 Resp:Laryngotracheobronchitis Croup 46 Resp:Upper Airway Other 1 Resp:Upper Respiratory Infect Other 1 475 17

9. Transport Transport Out Mode of transport used by PETS to reach referring hospital 2006 2007 2008 2009 2010 2011 Taxi 184 178 189 165 242 293 Air Ambulance 77 75 72 67 96 90 Helicopter 23 33 35 34 58 78 Road Ambulance 9 16 35 15 11 11 Commercial Airline 2 2 3 3 Transport Return Mode of transport used by PETS to retrieve patient to the Royal Children s Hospital or Monash Medical Centre 2006 2007 2008 2009 2010 2011 Taxi * 7 17 18 8 11 13 Air Ambulance 79 77 73 68 97 90 Helicopter 24 27 33 34 54 75 Road Ambulance 184 179 207 172 246 299 Lear Jet 1 0 2 1 1 2 * Taxi is sometimes recorded on PETS forms when the patient was retrieved on specialised transport platform to another hospital and staff returned to RCH by taxi. Taxi is also recorded for patients that have remained at the referring hospital because they have improved or have died. 18

Transport Out Trends Retrievals 350 300 Taxi Fixed Wing Aircraft Helicopter 250 Road Ambulance Commercial Airline 200 150 100 50 0 2006 2007 2008 2009 2010 2011 Year Transport Return Trends 350 Retrievals 300 250 200 Taxi * Lear Jet Fixed Wing Aircraft Road Ambulance Helicopter 150 100 50 0 2006 2007 2008 2009 2010 2011 Year *see footnote on previous page 19

10. PETS Age Distribution of Patients 2006 2007 2008 2009 2010 2011 Birth 1 year 89 54 92 54 87 108 (30%) (18%) (27%) (19%) (22%) (23%) 1 5 years 145 152 142 130 169 219 (49%) (50%) (43%) (46%) (41%) (46%) 5 10 years 27 24 32 34 61 46 (9%) (8%) (10%) (12%) (15%) (10%) > 10 year 26 42 32 34 48 64 (9%) (14%) (10%) (12%) (12%) (13%) Unknown 8 31 31 31 39 38 (3%) (10%) (9%) (11%) (10%) (8%) Retrievals 500 400 Unknown > 10 years 5 10 years 1 5 years Birth 1 year 300 200 100 0 2006 2007 2008 2009 2010 2011 Year 20

11. PETS Activity Geographical Distribution Activity by Victorian Health Care Region Region Number of PETS calls 2011 % Number of PETS retrievals 2011 % Metropolitan 496 48% 268 56% Barwon South West 107 10% 54 12% Gippsland 106 10% 31 6% Grampions 58 6% 22 5% Hume 90 9% 33 7% Loddon Mallee 103 10% 43 9% Other* 66 7% 28 5% 1024 100% 475 100% *Please see interstate table in next section. Referrals Metropolitan and Regional Regional 52% Metro 48% 21

Referring Hospitals Victoria Hospital Number of PETS calls 2011 Number of PETS retrievals 2011 Alfred 1 0 Alpine Health Myrtleford 1 0 Ambulance Victoria Sorrento 1 0 Angliss Hospital 19 10 Austin 60 33 Bairnsdale Regional Health Service 10 4 Ballarat Health Services Ballarat Base Hospital 38 16 Barwon Health The Geelong Hospital 70 48 Benalla and District Memorial Hospital 3 2 Bendigo 35 13 Box Hill Hospital 21 15 Cabrini 20 10 Casey Hospital 56 29 Castlemaine 1 1 Central Gippsland Health Service Sale 4 0 Cohuna District Hospital 4 1 Colac Area Health Colac 5 1 Dandenong Hospital 42 17 Djerriwarrh Health Service Bacchus Marsh 4 1 East Grampians Health Service Ararat 1 0 Echuca Regional Health 17 8 Edenhope and District Hospital 1 1 Essendon Private 1 0 Euroa Health Inc. 1 0 Falls Creek Medical Centre 1 0 Ferntree Gully ED 1 1 Frankston Hospital 42 28 Gippsland Southern Health Service Korumburra 1 0 Gippsland Southern Health Service Leongatha 11 3 Goulburn Valley Health (GVBH) Shepparton 44 13 Hepburn Health Service Daylesford 1 1 John Fawkner 1 1 Kerang and District Hospital 3 1 Kilmore and District Hospital 3 0 Knox 8 3 Kyabram and District Health Service 2 2 kyneton District Health Service 7 3 Latrobe Regional Hospital 25 3 Lorne Community Hospital 1 0 Mansfield District Hospital 3 0 Maroondah Hospital 20 6 22

Maryborough District Health Service 4 2 Melbourne Eye & Ear Hospital 1 0 Mercy Hospital for Women 4 2 Mercy Private 1 1 Monash Medical Centre, Clayton Campus 23 12 NETS 1 0 New Mildura Base Hospital 12 5 Northeast Health Wangaratta 19 9 OMEO District Hospital 1 0 Orbost Regional Health 2 0 Otway Health and Community Service Apollo Bay 4 1 Peter Mac 1 0 Portland and District Hospital 8 3 Rosebud Hospital 12 3 Royal Children's 8 8 Royal Melbourne Hospital City Campus 1 1 Royal Women's 2 0 Sandringham and District Memorial Hospital 10 4 Sea Lake and District Health Service 1 0 Seymour District Memorial Hospital 1 1 South Gippsland Hospital Foster 5 1 South West Health Care Camperdown 6 1 South West Health Care Warrnambool 9 3 St John of God Hospital Ballarat 2 0 St Vincent's Hospital 1 0 Stawell Regional Health 4 2 Sunshine Hospital 77 44 Swan Hill District Hospital 14 4 The Northern Hospital 48 27 Valley Private 1 1 Werribee Mercy Hospital 12 8 West Gippsland Health Care Group Warragul 18 9 West Wimmera Health Service Nhil 1 1 Western District Health Service Hamilton 7 1 Western Hospital 1 0 Williamstown Hospital 1 1 Wimmera Health Care Group Wimmera Base Hospital 13 3 Wodonga Regional Health Service 2 2 Wonthaggi and District Hospital 28 11 Yarram and District Health Service 1 0 Yarrawonga District Health Service 1 1 958 447 Interstate 66 28 Total 1024 475 * Patients transferred from RCH PICU and Emergency to Monash, Royal Melbourne, Austin, Northern and Alfred hospital. 23

PETS Activity Interstate Hospitals Region Hospital Number of PETS calls 2011 Number of PETS retrievals 2011 New South Wales Albury Base* 39(4%) 21(4%) Barham Koondrook Soldiers Memorial 3(0.29%) 1(0.2%) Deniliquin 8(0.78%) 4(0.8%) Sydney Children's Hospital 2(0.19%) 1(0.2%) Tasmania Royal Hobart 4(0.39%) 0 Launceston General 1(0.09%) 0 Mersey Community 1(0.09%) 0 North Western 0 Regional Burnie 2(0.19%) Others Queensland 1(0.09%) 0 Northern Territory 2(0.19%) 0 Adelaide,South Australia 2(0.19%) 1(0.2%) Western Australia 0 0 Pacific 1(0.09%) 0 *Albury Base Hospital is located within the Victorian Hume Healthcare region 24

PETS Patient Disposition 2011 PETS Patient Disposition Total % RCH ICU 129 27% RCH ED 151 32% Monash ICU 78 16% Monash Emergency 95 20% Other 22 5% Retrievals 475 100% MMC ED 20% OTHER 5% RCH ICU 27% MMC ICU 16% RCH ED 32% PETS Patient Disposition Trends 100% 80% 60% 40% Retrievals to RCH Retrievals to MMC 20% 0% 2008 2009 2010 2011 25

12. Conclusion PETS delivers a highly specialised service to the children of Victoria and beyond. Giving clinicians throughout the state ready access to the expertise of PICU specialists at the Royal Children's Hospital and taking the skills, knowledge and resources of paediatric intensive care to critically ill paediatric patients, PETS makes a unique contribution to the healthcare of some of Victoria's sickest children. 2011 has been the busiest year on record in the history of the Victorian Paediatric Emergency Transport Service with over 1000 referral calls and 475 retrievals. At the same time, the service moved into the New Royal Children's Hospital and continued its education and improvement initiatives. In this context, PETS is looking forward to continuing to streamline operations in close cooperation with NETS and in consultation with stakeholders in government and the Victorian healthcare sector. Melbourne, 16 th February 2012 26