Introduction It has been well recognised that the retrieval (transportation) of the critically ill child to a paediatric intensive care unit (PICU) by a specialised team is the “gold standard” resulting in improved patient outcomes (NHS Executive 1997). For the past 10 years, the South Thames Retrieval Service (STRS) operating out of the Evelina Children’s Hospital, London, has provided a 24-h, 7 days a week team of nurses and doctors skilled and competent in moving these vulnerable children. STRS covers an area of 5000 square miles with an estimated 1.5 million children in this region, averaging over 600 retrievals per year (Davies and Lynch 2007). Over the past 10 years there has been dramatic development of this service. We will explore and discuss the pertinent issues in relation to the past, present and future of this service: Past: initial “set-up” of the service; training of nursing and medical staff; staff and patient safety; development of the specialist roles; retrieval coordinator and retrieval nurse practitioners. Present: how the service works on a day-to-day basis; audit and management of critical incidents; collaborative working with the lead PICU and with other PICU; teaching, training and supporting the referring team; parental presence in the ambulance. Future: development of air transportation service; further development of nursing roles; streamlining of the retrieval process.

Conclusion The lessons learnt from our experiences will provide valuable insight into this specialist aspect of paediatric critical care.