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TEAM COMPOSITION

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  • 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

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MODE OF TRANSPORT

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  • 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

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ROLE OF MEDICAL CONTROL PHYSICIAN

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  • 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

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FIGURE 2-1

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

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PROTOCOLS AND CLINICAL GUIDELINES

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  • 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

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DISPATCH AND COMMUNICATION

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  • Dispatch and communication centers can be located on ...

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