Introduction:
High-risk and severely unwell neonates must be transported medically, which requires trained workers and specialized tools. Ideally, a neonatal transport team should be part of a wider system of perinatal care that includes a neonatal intensive care unit (NICU) for tertiary care, a perinatal care unit, a team of pediatric medical and surgical subspecialists, and a neonatal outreach program. Numerous newborns need to be transferred urgently to a tertiary care facility, frequently due to urgent medical, surgical, or postpartum issues.
What Are the Administrative Elements of Neonatal Transport Services?
Program Manager:
As healthcare financing becomes more difficult, the pressure to improve efficiency grows. However, transport scheduling is naturally unpredictable and ineffective, particularly for a specialty team with a low volume/high acuity, as is necessary for the neonatal population.
A dedicated hospital administration should support a transport service with an experienced manager or program director and foster communication between the hospital administration, the members of the transport team, and the medical director.
Physician in Charge of Medical Control:
Before and throughout transportation, the on-call medical control physician is readily accessible to offer guidance. The medical control physician is qualified to care for severely sick neonatal patients and must know the skills and protocols used by the neonatal transport team.
Director of Medicine:
The newborn transport team medical director oversees and assesses the standard of medical care. He or she should be a registered physician with experience in both air and ground emergency medical services. Ideally, this doctor has board certification in pediatric intensive care, neonatal/perinatal medicine, or both. Alternatively, a transport team's adult-focused medical director can communicate with specialized doctors.
The medical director should take a proactive role in (1) choosing the right staff, (2) ensuring ongoing team education and training, (3) creating and reviewing policies, (4) implementing a quality management program, and (5) choosing, orienting, and managing medical control physicians.
Communications:
A method must be in place for contacting the relevant medical control physician immediately after receiving a transfer request to start the transport procedure. The medical control doctor determines whether a transfer is necessary, talks with the referral doctor about stabilization concerns, and, if necessary, approves or suggests a mode of transportation. Medical control doctors, referral doctors, accepting doctors, transport team members, pilots, and drivers communicate further.
To provide continuous interaction during the triage process and transfer, a specialized communications center should be open 24 hours a day, seven days a week. A separate communications center is very useful for teams using many ground units or transporting rotor-wing aircraft.
What Abilities Are Required in the Neonatal Team to Manage the Transportation of Critically Unwell Newborns?
Airway:
Most critically ill newborns requiring transfer to a NICU have respiratory failure present or imminent as a main diagnosis or secondary to their underlying illness process. Because of this, respiratory therapists are frequently a part of transport teams. Depending on the resident's experience and level of expertise, the airway management competence of residents varies greatly.
In newborn airway treatment, team proficiency is crucial. The team should be able to:
-
Identify patients who are about to experience respiratory failure.
-
Carry out efficient bag-valve-mask ventilation.
-
Carry out atraumatic intubation with the proper endotracheal tubes.
-
Administer artificial surfactant.
-
Control ventilator settings.
Intravenous Access:
When transported, almost all sick newborns need peripheral or central intravascular access. The team must be equipped with the tools and knowledge to frequently and dependably secure intravenous (IV) access in these delicate and difficult individuals.
Advanced Techniques:
It is excellent for staff competency to include instruction in more uncommon invasive procedures such as:
-
Intraosseous vascular access.
-
Chest tube insertion.
-
Umbilical catheter insertion.
-
Percutaneous needle aspiration of the chest.
Further Qualifications and Expertise:
Additional crucial qualifications and experience include:
-
Independent judgment and behavior.
-
Extensive expertise in performing advanced clinical skills quickly in less-than-ideal circumstances.
-
Knowledge of additional aspects of patient care.
Who Exactly Makes up the Neonatal Team?
Rapid stabilization of critically ill newborn patients is the responsibility of paramedics, nurses, respiratory therapists, nurse practitioners, and doctors for quick transfer. It has been demonstrated that using the services of a specialized neonatal transport team is linked to decreased rates of acidosis and hypothermia as well as low birth weight baby death.
Neonatal transport utilizes a variety of transport team setups. An emergency medical technician (EMT) and a paramedic (EMT-P), utilizing the military transport configuration, typically staff adult advanced life support (ALS) ground transport units. An experienced registered nurse (RN) working alongside another nurse, a paramedic, a respiratory therapist, or a doctor are typical members of critical care transport teams.
An RN and an EMT-P make up the most typical crew combination. The second most typical arrangement is 2-RN. A respiratory therapist (RT) is often the second crew member in pediatric/neonatal transport programs due to their experience in airway care. But each type of specialist has benefits and drawbacks.
What Are the Different Modes of Transport Used in Transporting Critically Ill Newborns?
Ground Transport:
When ground transport is more effective and frequently faster than air transportation, it is utilized for relatively short-distance travel (up to 25 miles). Additionally, it must be used when weather conditions make flying impossible.
- Transport Using Helicopters With Rotor Blades:
Up to 150 miles of medium-distance transfers can be made with this form of transportation. Some benefits include swiftness and adaptability, reduced out-of-hospital time, and quick team leaving and arriving at the patient.
- Transport Through Fixed-Wing Aircraft (Airplane):
The stated purpose of this mode is long-distance travel (often greater than 150 miles). The benefits are fuel efficiency over long stretches, the patient's reasonable access during travel, and the interior space available for patient transport is sufficient.
What Equipment Must Be Present in Transportation Vehicles?
Transport vehicles, equipment, and resources must meet the requirements of the patient population as a portable intensive care unit. A portable isolette with a ventilator, medical air, oxygen, nitric oxide, vacuum, monitors for vital signs, pulse oximetry, capnography (end-tidal or transcutaneous carbon dioxide monitoring), and a defibrillator are all included in the equipment for transporting newborns.
The transportation setting is demanding. The danger of hypothermia is decreased when a warming mattress is used, even though it is a common occurrence and is linked to an elevated mortality rate. In both land and air transportation, background noise and vibration are issues. Ear muffs, which are easily accessible commercial products and have a demonstrated track record of effectiveness, have to be regularly used to lessen the impacts of noise. Similarly, a gel pillow and air-foam mattress might lessen potentially dangerous vibrations that could cause illness.
What Are the Steps Involved in Stabilizing a Critically Ill Newborn Before Departure?
Each neonatal patient receives a thorough evaluation (such as taking their vital signs), a quick blood glucose reading, and the provision of intravenous (IV) access. A specific focus should be placed on evaluating the airway and the proficiency of oxygenation and ventilation because respiratory distress affects a significant share of critically ill infants.
Most newborns who fail to remain stable or begin to deteriorate quickly after this initial, short assessment are promptly stabilized and then quickly transported. The provision of artificial surfactant for severe respiratory failure and the removal of a pneumothorax, among various clinical scenarios, demand more extensive and quick field interventions.
What Are the Duties of the Receiving and Referring Institutions?
The duties of the referring and receiving facilities should be understood, even though the transport team is in charge of the actual move. The referral institution should be included in the team. Rural and distant locations, in particular, are affected by this. Roles and responsibilities can be clarified by developing close ties with these communities and providing training in resuscitation and stabilization before transport. When the referring doctor advises the family that their baby needs to be transferred, permission for transport is anticipated. A mother's blood sample, colostrum for initial feeding, duplicates of relevant paperwork and medical photos, and more should be given.
How Should the Family Be Helped While Being Transported?
An infant's status and general prognosis are disclosed to family members openly and honestly. Parents should be urged to stay with their children during stabilization and, if feasible, during transportation.
Conclusion:
Infants who are premature or otherwise ill are transferred from one hospital to another using newborn transport, such as to a facility with a neonatal intensive care unit and other services.
Improved outcomes, specifically increased newborn survival, are linked to the employment of a specialized retrieval team for transfer.
