Pediatric neonatal specialty transport teams can have various team compositions.

The optimal team makeup is best determined by the needs of the patient.

Transport team personnel include physicians (MD/DO), advance practice nurses (APN), nurses (RN), respiratory care practitioners (RCP), paramedics (EMT-P), and emergency medical technicians (EMT).

Examples of various team compositions:

• RN-RCP

• RN-RN

• RN-MD/DO/APN

• RN-EMT-P

• RN-RCP-MD/DO/APN

• Some teams routinely take a physician or APN; other teams take them as needed

Importance of the decision

• The team composition should support the team’s scope of care.

• Team members should be able to initiate the desired level of care on arrival to the referring hospital.

Team members must hold certifications to support the scope of practice to care for the patients transported. Examples include:

• PALS

• ACLS

• NRP

• PEPP

• C-NPT

Various modes of transport are utilized by pediatric neonatal specialty teams

• Ground transport (ambulance)

• Rotor wing aircraft (helicopter)

• Fixed wing aircraft

Some teams have all three modes available to them; other teams only utilize one or two modes and may contract out for the other modes

Many teams utilize guidelines to help frame the decision on which mode to utilize for a specific patient

Decision is based on:

• Patient acuity

• Time-sensitive nature of illness or injury

• Distance

• Travel time

The medical control physician has multiple responsibilities

• Acceptance of patient to the organization

• Assure bed and specialty care are available

• Determine necessary level of care

• Determine mode of transport (must be familiar with various modes)

• Medical decision making during transport

• Must be familiar with transport topics such as altitude physiology

  • Patients with recent surgical procedures may have retained air, which can have a severe impact during flight at higher altitudes

  • Considerations must be given to air-filled endotracheal tube (ETT) cuffs or balloons in Foley catheters

• Documentation by medical control physician

• Recommendations given to referring hospital (see Figure 2-1)

• Medical decision making with transport team throughout transport

• Signing of any orders given to transport team

Protocols allow nonphysician teams to provide patient care within the team’s scope under the authority of the medical director

Teams may have multiple protocols depending on the scope of care. Examples include:

• Neonatal protocols, including the care of the surgical neonate and neonates with congenital heart disease

• Pediatric protocols

• Trauma protocols

Protocols require initial review with legal/risk management team

• In many states protocols are legally necessary to allow hospital-based, nonphysician team members to provide critical care outside the hospital

Protocols require annual review to assure they reflect current practice

Dispatch and communication centers can be located on site or at a central facility

They are often staffed by nurses or paramedics

Responsibilities include:

• Intake phone call with demographics and clinical information

• Communication between referring facility and medical control physician

• Bed placement at receiving hospital

• Arranging mode of transport once mode is determined

• Ongoing team communication

• Ongoing team tracking

All communications should take place via a recorded line

• Quality control

• Documentation of recommendations made to referring facility

Equipment and supplies

• Factors that determine the appropriate equipment for the transport environment:

  • Size

  • Weight

  • Battery life

  • Ability to secure

• Strict compliance with hospital, local, state, federal, and Federal Aviation Administration guidelines is necessary

• Equipment and supplies necessary to support scope of care

• The population served by each team will determine the type of equipment and the variety of sizes they are required to have available

• Typical equipment carried: see Tables 2-1 and 2-2

• Departure checklists are recommended for daily operations

Medications

• Checked daily and after transport to assure availability

• Checked monthly to assure medications used within expiration date

• Narcotics and other controlled substances are carried by many teams; safe storage, oversight, and administration are vital to safe practice

• Medications requiring refrigeration can be safely carried in an insulated pack for transport

• Types of medications carried: see Table 2-3

Handoff tool

• Handoff should be standardized

• Reference cards are helpful to assure consistent content (see Figure 2-2)

Risk assessment tool

• To help determine safety of transport and risk avoidance

• Items include:

  • Weather conditions

  • Road conditions and flight conditions

  • Crew experience

  • Crew member fatigue

  • Time of day