There are many barriers to implementation of an electronic health record in a prehospital care environment, in particular: financial, organizational, technical, and privacy/security. The organizational aspect of transport is complex and requires explanation, to gain a true understanding of the plethora of problems that can occur when trying to implement an electronic medical record. In this synthesis paper, we will explore the barriers to implementation of an electronic health record in the neonatal and pediatric transport environment as they relate to the unique and demanding conditions seen on neonatal and pediatric critical care transports.