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