The interfacility transport of critically ill newborns

Question 1

What are the preferred transport methods?

Answer 1

1. Transfer at risk pregnant women prior to deliver

2. Utilize a specialized retrieval team for neonate transport

Question 2

What is the preferred transport team composition?

Answer 2

Advanced medical directives with telephone access with a senior MD

1. RN
2. RT

Question 3

What is the success rate of intubations performed by RT vs residents?

Answer 3

92% vs 77%

Question 4

What team skills and training are required?

Answer 4

Must have competence in neonatal procedures esp. neonatal intubation

Question 5

What transport equipment are required?

Answer 5

1. Portable isolette
2. Ventilator
3. Medical air, oxygen, and NO
4. Suction
5. Vital signs monitor, pulse oximetry and capnography
6. Defibrillator
7. POC laboratory testing
8. 24-7 access to telephone advice
9. Earmuffs, warming devices, vibration lessening mattresses

Question 6

What is the recommended transport system and process?

Answer 6

1. A centralized process for team dispatch with a single number to call to access medical advice, a receiving physician and facility as well as triage and access to an appropriate transport team provides the most efficient streamlined practice
2. Dedicated vehicles
3. Accurate bed registry system
4. Land ambulances should be used <250km distances
5. Fixed wing aircraft are required >250km distances vs helicopters which reduce flight time

Question 7

What are the CPS recommendations regarding transport teams?

Answer 7

1. Teams used to transport newborns to tertiary neonatal-perinatal centres should be specifically dedicated for transport, based at a tertiary hospital and have expertise in the care of newborns. The inclusion of maternal and paediatric populations should depend on patient volumes, resources and needs.
2. A collaborative practice model, with one RN working with either another RN, an RT or an EMT/paramedic with expertise in neonatal or paediatric transport, is the optimal neonatal transport team. Medical ‘on line’ control is best provided by an experienced neonatologist with expertise in transport medicine.
3. Specific training in airway management and other procedural skills using effective teaching methods and validated assessment tools is recommended. Refresher skills courses and ongoing clinical assessment help to ensure maintenance of competencies.
4. Transport teams must have the equipment and supplies necessary to provide intensive care and meet all land and air ambulance specifications for safety. Transport safety measures for thermal regulation and noise reduction must be employed. Dedicated team vehicles permit the storage of equipment, supplies and the hydraulic lifts or stretchers needed for team and patient safety.
5. Policies and procedures must be in place to guide team performance and ensure optimal patient outcomes. A single access point, with provincial/territorial coordination and integration of transport modes, must ensure the immediate availability of medical advice, the rapid dispatch of a transport team, and the identification of a receiving hospital. Communication with families, referral and receiving staff from first contact to admission, is essential.
6. Transport teams must have a database that captures both the severity of illness, and clinical and utilization metrics, including transport times, which can be used for benchmarking, quality improvement and research.