Children’s Transport: Bringing critical care to pediatric patients

 

 

 

CME CREDIT NOW AVAILABLE-See the end of the article

By Jennifer Plagemann, Paramedic; Ryan Sullivan, RN; Simeon Smith, Paramedic; and Rebecca Ogrin, RN

The Children’s Healthcare of Atlanta transport team is excited to spread the word about our Transport Program. As a direct extension of the Children’s Emergency Departments and Intensive Care Units, we pride ourselves on providing the highest level of pediatric care. We look forward to introducing our team and explaining some of the capabilities that separate us from other transport options.

Transport requests begin in our Communications Center, where communications specialists are advanced EMTs and paramedics with specialized training in triage and pediatric critical care. They work in collaboration with the Children’s Transfer Center to expedite dispatch times and facilitate appropriate modes of transport. Our communications specialists also keep our teams connected to Children’s emergency physicians and intensivists for real-time consultations and care recommendations.

Children’s operates three to four specially outfitted critical care emergency vehicles and one critical care helicopter*. We also have the capability of staffing a dedicated medical fixed-wing aircraft for longer transports. Our teams include registered nurses, respiratory therapists, paramedics and EMTs. In particularly complicated or critical cases, a pediatric intensive care fellow will join the team to assist with bedside stabilization and transport. Children’s requires several years of experience and advanced certifications for prospective team members. Our nurses are required to have experience in pediatric emergency and intensive care unit environments. Our respiratory therapists and paramedics receive extensive training and regularly spend time with Children’s anesthesia staff in the operating room to maintain pediatric airway management competence. All team members attend regular training throughout the year and participate in monthly “mock code” simulations with Toni Petrillo, MD, Medical Director. We also have an intensive QA process that helps make sure we are following our protocols and are continually finding ways to improve our processes and care.

Our critical care helicopter completes more than 600 patient flights each year and responds to 911 scenes, as well as interfacility transports. The Children’s transport team has the capability of rapidly reconfiguring the aircraft to transport two patients. Just like with our emergency vehicles, we can often bring a patient’s family member along in flight in order to maintain the Children’s vision of family-centered care. Our flight team includes a pilot, flight nurse and flight paramedic. We operate the largest civilian medical helicopter in Georgia. Our pilots have thousands of hours of flight time and participate in extensive recurrent training. In addition to the transport team, we have the capability of bringing physicians and/or respiratory therapists if required by a patient’s condition. We have many advanced safety features, including night vision goggles, weather radar, and GPS with terrain awareness and warning systems.

At Children’s, we understand that kids are not just “small adults,” so having pediatric-specific equipment is one of our greatest advantages. On any given shift, our teams can be called to care for the smallest of neonates or even young adults with chronic congenital conditions. A typical non-Children’s 911 or interfacility transport emergency vehicles team includes one EMT and one paramedic equipped with basic and advanced resuscitation supplies and medications. Ventilators and medication pumps are rarely found on these units. In contrast, our teams carry all of the same equipment found on most ambulances, but much more.

About our units

  • All of our units are equipped with iStats for rapid analysis of blood gases and electrolytes.
  • Our respiratory care toolbox includes noninvasive mechanical ventilation (BiPAP), high flow nasal cannula, heliox 80/20, RAM bi-level nasal cannula and the Aerogen aerosol drug delivery system. These initiatives in transport have been shown to reduce a patient’s need for intubation, which can result in shorter hospital stays with fewer complications.
  • Our respiratory therapists can administer the potent pulmonary vasodilator nitric oxide, through specialized ventilatory equipment. This can be a lifesaving therapy for patients with severe acute respiratory distress syndrome, as well as for certain congenital cardiovascular diseases.
  • Should a patient require intubation, we carry C-MAC video laryngoscopes and have a variety of medication choices for sedation, analgesia and paralysis to suit the hemodynamic requirements of a patient.
  • We carry and are trained in the administration of other specialized medications, including vasopressors, antibiotics, hypertonic saline, albumin, insulin and prostaglandins. Almost all of our medications and infusions are delivered through hospital quality pumps.
  • All of our patients weighing less than 5 kilograms are transported in custom isolettes, which allow us to safely transport our smallest and most vulnerable patients. The isolette allows us to monitor and maintain a patient’s temperature and includes neonatal-specific ventilators and medication pumps.

Because we are hospital-based, the Children’s transport team is able to quickly configure our emergency vehicles and helicopter to meet the needs of a patient without sacrificing precious time. Our units are available for dispatch 24 hours a day, 365 days a year.

By the numbers

Children’s developed its transport team in 1995. In that first year, we responded to 647 calls. Today, the team provides treatment and transportation to more than 5,000 patients annually. The tables below provide a breakdown of our calls by receiving department for 2017-18.

 

 

A patient’s condition and acuity may vary from call to call. Referring physicians and emergency medical services agencies can rest assured that every patient transported by our team at Children’s will receive the highest level of safety and cutting-edge pediatric critical care. We are honored to provide this resource to the children and families of Georgia and across the region.

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