By Jody Gross, MD, Director, Neonatal Transport / NICU
Ministry Saint Joseph’s Children’s Hospital and Marshfield Clinic
Medical transport is an old concept that keeps developing new twists. Transferring patients has evolved from ‘pick up and run’ to ‘stabilize first and then move.’ Neonatology has also continued to evolve to the high-tech environment of today. When we need to move our extremely vulnerable, tiny patients from one facility to another, we need all of the ‘high tech’ abilities that our Neonatal Intensive Care Unit provides, only in a more mobile format.
First and foremost is the neonatal transport team. Our team consists of a specially trained transport nurse and a respiratory therapist, as well as crew from Ministry Spirit Medical Transportation Service. Most neonatal transport today is done by an RN, or an RN plus an RT, and not by a physician. They work by protocol, and the care is much more consistent than care provided when physicians are involved. The nurses are trained to put in arterial and venous umbilical lines, to do emergency aspiration of the chest for a pneumothorax, and to intubate. The nurses are also trained to interpret radiographs. The respiratory therapists are specially trained on our transport ventilator, which has all the capabilities of our in-house machines: patient-triggered breathing, pressure-supported breaths, and pressure- or volume-limited ventilation. The team concept is vital in this situation, including the nurses and physicians at the hospital where the baby was delivered.
Next are the technical aspects of transport. The transport incubator is equipped with seatbelts, a cardiorespiratory monitor that measures heart rate, respiratory rate, blood pressure and oxygen saturation, IV pumps that can give one one-hundredth of a cc at a time, and ventilators equipped with pneumotachometers to enable tidal volume determination. (The ventilators are also special neonatal devices which can deliver tidal volumes of 2 cc/kg to babies that are less than 500 grams.) We also have the capability of delivering nitric oxide during transport, the first neonatal transport service to do so in the state. In addition, we utilize specially made ‘ear muffs’ to protect a baby’s delicate ears, especially during helicopter transport.
One of the most challenging decisions we face is how to transfer the patient. Many considerations go into the method of transport. First is patient acuity: if the baby is stable in the referring institution, they are by definition, not an emergency. However, if babies less than 1500 grams (or 3 pounds) are being hand-ventilated in order to keep them stable, that is still an emergent transfer, as manual ventilation may actually harm the baby’s lungs, and set it up for chronic lung problems. There are obviously other issues that go into this decision, such as weather and distance. If the facility is close, there oftentimes really is no time advantage to air over ground transport.
Ultimately, our goal is to provide the best care to our neonates and to do it in the most efficient and safe manner. We will work with nurses and physicians in our referral area to make sure that you have the tools and knowledge to deliver the best care to your moms and babies, and when needed, that our NICU transport team continues the work of your team to assure healthy babies and happy families.
If you need our services, please call MinistryConnect at 888.411.1362.