4. EANING:
The transport service gives high – risk patients timely
access to the appropriate services without interrupting their
care.
5. ISTORY OF NEONATAL EMERGENCY
TRANSPORT SERVICES:
The development of specialized neonatal
intensive care units (NICUs) providing an
evolving “package” of care began in North
America, Europe, and Australia in the late
1960s. ‘Regionalization of care’ that paralleled
the establishment of tertiary centers influenced
the pattern of infants transported, with
increases in the number of in – utero transfer,
particularly in North America.
n 1966, the first newborn with respiratory
distress syndrome was transported to university
6. evel I [Basic Care] – Relatively minor problems
evel II [Speciality Care] – Low birth weight babies (1500 to 2500 gm,
32 to 36 weeks of gestation)
evel III [Subspeciality Care] – Maternal and Neonatal those at high
risk (less than 1500 gm birth weight or less than 32 weeks gestation)
1 2 3
Basic Specialty Subspecialty
7. evel I to Level II:
Complicated cases not requiring intensive care.
evel II to Level III:
Complicated cases requiring intensive care.
abor less than 34 weeks gestation
8. easons for transport
Commonest reason is transport for advanced level of care
such a situation may arise due to non availability of:
Pediatric subspecialty (Neurology, nephrology)
Specific investigation (MRI, 24 hours EEG etc), specific
facility (Advanced ventilation, plasmapheresis or it may be
due to non availability of continuous monitoring in the
referring hospital).
9. reparation for transport
Each hospital should be ready with plan for transport of
critical child long before such need arises.
Each institute should have list of hospitals in the
surrounding area which offer specialized facility.
10. taff:
all from referral hospital/pediatrician/physician.
taff should have the ability to assess the need and to perform
procedures.
efore leaving, clinically relevant information regarding the
patient should be communicated to the receiving unit.
xpected time of arrival should be notified to the receiving
unit.
11. quipment:
he transport ambulance should be equipped like a mini
NICU and should have a vital sign monitor, portable
ventilator, resuscitation bags, oxygen, life saving drugs and
disposables.
12. ecord:
efore leaving from referring hospital a set of vital signs.
linical condition and main interventions
n informed consent
atient:
he condition of the baby should be assessed before
transfer.
13. a. Airway Stable, if intubated – secured, position
confirmed
b. Breathing Well supported, put on transport
ventilator and settings confirmed by
blood gas
c. Circulation Heart rate and blood pressure controlled,
peripheral circulation stable, hemoglobin
concentration adequate, blood volume
near normal.
d. Metabolic Temperature well maintained, blood
glucose, calcium, potassium in normal
range
e. Neurology Seizures controlled, raised ICP
controlled.
14. tabilization during transport
esponsibilities of transport team – stabilization phase
Quick assessment of patient status
Stabilization of patient for transport
Anticipation of problems likely encountered on
transport
Secure all lines and tubes
Obtain consent and talk to parents/family
15. ransport is easy if we concentrate on the basics of
airway, breathing and circulation and anticipate
problems.
rauma – cervical spine stabilized, pneumothoraces
drained, intra – abdominal, intra – thoracic bleeding
controlled, intra – abdominal injuries well investigated,
long bones/pelvic fractures secured.
nce the transport team has stabilized the child and is
ready to move, it has to ensure that the patient is safety
moved in and out of the vehicle.
16. are and monitoring during transport
deally transport vehicles should have monitoring and
treatment facilities like those available in PICU.
There should be an ongoing monitoring of major
organ systems including vital parameters, invasive
and non – invasive blood pressure monitoring, end –
tidal CO2 temperature, oxygen saturation.
n case an emergency arises it is better to stop
transport vehicle and perform stabilization
procedures as it is difficult to perform intubation (or)
pneumothorax drainage in a moving vehicle.
17. esponsibilities of transport team – transport phase
afe movement of patient in and out of vehicle
ngoing monitoring of major organ systems
during transport.
rompt recognition and treatment of problems on
route.
rovision of detailed report to admitting
personnel.
etailed documentation of events during
18. anding over the patient
All the reports, x – rays and copies of medical
records should be handed over. The changes
in clinical scenario and events occurred
during the transport should be carefully
logged and notified to the physician in tertiary
care center.
19. ommunication
ffective communication at all points during
transport is the key to a successful retrieval.
he information exchanged in the first
communication between the referring and
transport teams should be relevant to the
transport. That is whether the patient requires
critical care transport, how quickly should the
team reach the patient; and what equipment is
required.
ommunication with the family is as important as
20. eneral curriculum for all transport
teams include
raining in:
Interpretation of x – rays
Interpretation of common laboratory
investigations
Pharmacotheraphy
Fluid therapy
27. Monitor:
o Heart rate, ECG and respiratory rate
o Blood pressure
o Pulse oximeter
o Temperature probe
o Defibrillator, cardioverter infusion pumps with
high (1000ml/H) and low (0.1 ml/H) flow.
o Portable oxygen cylinder
28. maller transport equipment (may be packed or
placed in a tray)
arious size of
ral / nasal airway
aryngeal mask airway
aryngoscope
31. as Expansion
Insert orogastric or nasogastric tubes open to air in every
infant and in any child who may experience
gastrointestinal symptoms or may be at risk for vomiting.
Avoid use of cuffed endotracheal tube. If cuff is used
consider using water for filling the cuff.
Ensure that chest tube, endotracheal tubes and other
artificial vents are patent.
Suction airway well before and during transport
Reevaluate for extrapulmonary air. Carry a
transillumination device and have a needle thoracentesis
device available.
Request if possible to fly at a lower attitude for patients
with trapped gases (pneumothorax, pneumoperitoneum,
bowel obstruction)
32. ecreased partial pressure of oxygen
efore leaving the referral hospital
a. Ensure that the child is as optimaaly oxygenated as
possible
b. Correlate oxygen saturation with PaO2
c. Check placement and stabilization of the
endotracheal tube.
n route
a. Increase FiO2 to keep saturation of more than 95%
b. FiO2 required can be calculated as follows:
FiO2 required = (FiO2 X BP1/BP2)
FiO2 = current FiO2
BP1 = current barometric pressure
33. tresses of flight
ollowing stresses have been identified by several
authors and various organizations.
ypoxia
emperature
ehydration
oise
ibration
atigue
34. ole of nurse in transport
he nurse who accompanies in transport of neonates
must possess advanced pediatric assessment skills.
he nurse should be comfortable with and have
significant experience using medications commonly
used in a critical care setting.
xplanation about the patient condition and need of
transport should given to the family members.
efore leaving the referring hospital a set of vital signs
such as oxygen saturation, heart rate, blood
pressure and temperature should be documented.
35. orking condition of the equipment should be
assessed and should be prepared for transport.
ondition of the baby during transport should be
documented.
