An 8-month-old baby was brought to a district general hospital A&E with reported right-sided abnormal movements thought to be seizures. She had not been feeding well for the previous 2 days and seemed generally lethargic. The arm movements, described as jerking in the whole right arm, had been noticed by the parents for the first time that day. When the movements did not stop after a few minutes, they called an ambulance.

You have just started your shift and been handed five referrals of children that need transferring. The human resources available to you at your transfer hub are as follows.

A 2-year-old girl with known spinal muscular atrophy (SMA) was referred with a 3-day history of worsening tachypnoea and increasing lethargy. She was no longer tolerating feeds and had visible mild intercostal and subcostal recession. Initially the child had improved on high flow nasal cannula (HFNC); however, oxygen requirements gradually increased to FiO2 of 0.64 in 3 L/kg HFNC by the time of referral.

A 4-year-old child was brought into their local district general hospital in his mother’s arms having fallen from a first storey window (around 5 metres in height), and rolled off the porch roof part of the way down. Mum was alerted to the fall by his 5-year-old sister, who was with him when he climbed on the dresser under the window and then fell out of the open window. Mum ran out the house to find the child prone outside the porch, crying and trying to get up on hands and knees. He had some bleeding from his forehead, face, nose and a little from the mouth. She picked him up, called the neighbour for help and took him immediately to the local A&E.

A 6-month old, 8-kg baby was brought into A&E by ambulance, after mother called 999 following a pale, blue, floppy episode at home.

An 11-month-old, 8.7 kg baby was brought in to hospital urgently by ambulance in shock.