Centralization of tertiary paediatric and neonatal services throughout the United Kingdom has influenced the provision of neonatal intensive care facilities. When a neonate requires additional care to that which is provided locally it may be necessary to transfer them to a specialized centre for assessment and ongoing care. This development has had an effect on the demands placed on local and regional neonatal transport services.
Neonates transferred by transport teams are frequently critically ill. They may be extremely preterm, require surgical assessment and intervention or have congenital heart disease. Ongoing innovations in clinical management during transport such as extracorporeal membrane oxygenation (ECMO), high frequency oscillation (HFO) and inspired nitric oxide therapy (iNO) have resulted in the need for highly technical and specialized transfers.
Transporting a sick neonate can be a complex procedure, involving preparing the neonate for movement into portable intensive care equipment, loading of the equipment into vehicles for transfer such as an ambulance, a helicopter, fixed wing plane or military helicopter. During transport, environmental influences such as fluctuations in temperature, noise, movement, vibration, G forces and barometric pressure can potentially be areas of stress, pain and discomfort to the neonate.
These innovations have necessitated the development of specialized teams of clinicians and nurses to manage these transfers safely and in a timely manner.
Planning a transport
Detailed local procedures for referral and transfer of a neonate are available regionally within the United Kingdom. However, the principles of a safe and effective transport are outlined in several publications (Jaimovich and Vidyasagar 1996; Barry and Leslie 2003) and are contained within a structured education programme to guide management of a transport (Byrne et al. 2008).
Organization and management of a transport
The stages involved in transporting a patient have been described within a systematic approach in order to facilitate a streamlined, safe and effective transport. One approach is the ACCEPT method described by Byrne et al. (2008), which is used in adults but can also be used in paediatrics and neonates and will be applied to summarize the process.
Assessment (A)
The first stage in the transport is assessment. In some situations the clinicians involved with the care of the neonate may undertake the transport. However, increasingly, regional transport teams are mobilized to facilitate the transport and will therefore have no prior knowledge of the neonate’s clinical history. Communication and documentation is therefore paramount between the referring unit and the transport team.
The clinician who is responsible for the decision to transfer the neonate will liaise with the transport services and the receiving unit. A succinct summary of the problem should be relayed to the transport team. This will enable a decision to be made on the most appropriate mode of transport and receiving unit.
What information should be relayed to the transport team?
- Description of the problem: history, clinical condition, vital signs laboratory results.
- Intervention: what has been done or is needed, what has been the effect? This information will aid diagnosis and future management.
- What further management is needed? This will facilitate appropriate management during transport and on arrival at the receiving unit.
Control (C)
A transport lead is delegated to provide advice prior to and during transport and delegate tasks.
Communication (C)
At all stages of the transport communication is crucial.
- Parents: update on their baby’s condition, reasons for transfer and information about the receiving unit such as location and visiting.
- Colleagues: concise information throughout the transfer relayed among the referral unit, transport team and receiving unit.
- Documentation: pre-transport, during transport and on arrival at the receiving unit. Including vital signs, all interventions, effects and changes in management.
Evaluation (E)
- Is transfer appropriate for the baby? Is the baby too unstable for transfer, or can a specialist review the baby in the referral unit?
- Identify and document problems at each stage of the transfer.
Preparation, packaging and pre-departure check (P)
- Stabilization before transfer: rapid assessment and management of life-threatening problems (ABC):
- Airway: must be patent and stable throughout the transfer
- Breathing: may be necessary to intubate prior to transfer
- Circulation: vascular access secured and dependent on intensity of patient
- Airway: must be patent and stable throughout the transfer
- Equipment checks: prior to departure
- Pre-departure checklist: includes final review of ABC.
Transportation (T)
- Mode of transport: select the most appropriate for the patient and circumstances.
- Safety of patient and staff during journey: safety is a priority throughout. Is it safe to move the patient? Is it safe for staff to move the patient?
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