Pediatric Neonatal Specialty Transport Teams




TEAM COMPOSITION



Listen






  • 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






MODE OF TRANSPORT



Listen






  • 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






ROLE OF MEDICAL CONTROL PHYSICIAN



Listen






  • 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






FIGURE 2-1


Example of a transport call record for a medical control physician.






PROTOCOLS AND CLINICAL GUIDELINES



Listen






  • 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



Listen






  • 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






TEAM RESOURCES



Listen






  • 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




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Jan 14, 2019 | Posted by in PEDIATRICS | Comments Off on Pediatric Neonatal Specialty Transport Teams
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