This study reveals that our team complied with most of ESPNIC recommendations (over 70% of agreement in 9 out of 12 analyzed recommendations).
For recommendation number 5, only 7/29 patients (24%) wore a surgical mask to minimize aerosol spread. A recent study by Esposito et al  showed that it is not recommended for children under 2 years of age to wear any type of mask as these children with smaller airways can have trouble breathing if wearing one face mask. In our study, patients without a surgical mask (22/29) had a median age of 127 days [35; 427] and only 2 were over 2 years old. It is known that children have difficulty keeping their mask on and often try to remove it. Indeed, they end up touching their faces even more, and the use of masks can then lead to the nosocomial spread of the virus.
Regarding recommendation number 15, the transport of infants and children without parents or relatives, regardless if symptomatic or not, sparked discussions within our team: in 69% of cases we had a full agreement. Parental accompaniment during inter-hospital transportation of critically ill children is common in our team practices. It has been described that taking one of the parents during transportation was feasible, beneficial and didn’t increase staff stress or compromised the performance of medical interventions [7, 8]. It also potentially helped reduce anxiety for both patient and parent . When parents were allowed to come in the ambulance, they were asked to wear full PPE as well. The retrieval team balanced the risk to create potential breaches in virus spread when transporting potentially infected parents, with the inconvenience to depart from our routine practice with increased major anxiety for the patient.
For recommendation 16 regarding the dedicated pathway to entering the receiving unit, we didn’t comply with the ESPNIC’s recommendation in 34,4% (n=10) of cases. In fact, among the 10 transportations in question, we dropped patients in 7 different hospitals where the pathways for suspected COVID-19 weren’t well signposted in hospitals, and most of the time at the beginning of the pandemic period (before the 1st of April).
However, this study has some limitations. The interpretation of our results is limited by the small sample of the cohort and the retrospective nature of the study. We only explore our compliance with these recommendations, but it is not possible to measure whether if it was efficient to avoid the spread of the virus. We are now considering using the recommendations which met our full agreement in the context of other viral outbreaks such as bronchiolitis.