Chapter 2: Pediatric Neonatal Specialty Transport Teams

TEAM COMPOSITION

• 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

• 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

• 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 AND CLINICAL GUIDELINES

• 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

• Dispatch and communication centers can ...