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INTRODUCTION

Many infants are born in a location where definitive care is not available for their condition. These infants subsequently require transportation to a higher level of care. The conditions requiring transport range from prematurity or hyperbilirubinemia to surgical emergencies, need for extracorporeal membrane oxygenation, or therapeutic hypothermia for hypoxic ischemic encephalopathy. The transport of neonates requires specialized providers and equipment in defined neonatal teams (NNTs). There are many different configurations for transport teams. Of 956 neonatal intensive care units (NICUs) identified by Karlsen et al, 398 offered neonatal transport services. Of 335 respondents in this study, 68% were unit-based teams, and the remainder were dedicated teams, either stand alone or hospital affiliated.

I. RESOURCE MOBILIZATION

Regardless of team type or configuration, efforts should be made to streamline the dispatch process and improve ease of use for referring facilities and physicians. A single contact number for referring facilities or physicians to arrange for transport of ill neonates as well as to obtain consultation when necessary allows open communication as well as rapid mobilization of the NNT.

Timing of NNT mobilization is an important factor to consider. Research has demonstrated that effective resuscitation and stabilization of critically ill neonates is most successful when performed by specially trained retrieval teams. Rapid mobilization of the NNT for high-risk deliveries may not only impact neonatal morbidity and mortality, but also allow for continuous quality improvement and education of local hospital staff through active involvement in the resuscitation and stabilization. Regardless of team type, many variables have to be considered.

  1. Team composition.

    1. Teams usually have 2 to 4 providers.

    2. State neonatal transport team requirements can vary. As an example, the state of Maryland requires 2 licensed providers (physicians, nurse practitioners, nurses, respiratory therapists, paramedics) and 1 emergency medical technician to operate the vehicle.

    3. Neonatal teams are most often an interdisciplinary collaborative practice comprised of a registered nurse working with another nurse, respiratory care provider, or paramedic. Some teams incorporate physicians (eg, pediatric residents, neonatal fellows, or neonatologists) or advanced practice nurses (eg, neonatal nurse practitioners [NNPs]) routinely or based on the perceived acuity of the infant being transported. Studies have found no difference in mortality or long-term outcomes between physician-nurse and nurse-only teams and have shown that nonphysician personnel can be trained to provide equally safe care and similar outcomes.

  2. Supervision and standard of care. Medical oversight of emergency medical services (EMS) and interfacility transport is contingent upon federal, state, and local regulations. A transport services typically must have a medical director who is responsible for the overall care provided by the team. Because neonatal transport is a specialized form of interfacility transport, typically service medical directors work closely with a neonatologist to ensure quality care. Specialty care physicians may provide indirect (offline) medical consultation in the form of protocol development and quality case reviews as well as direct (online) consultation in the form of ...

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