Introduction

The topic of database development and application in the setting of pediat­ric and neonatal transport is relevant, if not essential. A database, although described multiple ways, can simply be defined as an organized collection of logically related data.

Historically, the concepts of thoughtful introspection and “expert” review as comprehensive evaluation tools of a transport team’s performance have prevailed. In the modern era highlighting quality improvement and patient safety, these methods should only serve to complement a database that provides access and tracking of important barometers of individual and longitudinal team performance both internally and externally (for bench­marking purposes). Thus, databases within a transport organization can be informative to front-line staff (clinical care and outcomes), patient safety and quality improvement leadership (safety event tracking), billing and cod­ing specialists, and administrative leadership (budgetary planning, resource utilization, marketing). Although each organization struggles with the time, energy, and resources necessary to build or optimize a local database to orga­nize the massive information encountered each day, we are all reminded that as professionals, our goal is to seek order in the randomness of information that fosters our teams' improvement.

The following case illustrates many of the key clinical facts needing to be entered into a database record:

Case Scenario:

J.G. is a 9-week-old male infant who was brought to his local community hospital emer­gency department with respiratory distress, hypoxia, and a positive rapid respiratory syncytial virus antigen test. He was treated with oxygen and nebulized albuterol but remained distressed, and there was concern for impending respiratory failure. The deci­sion was made to transport via the pediatric specialty care transport team (nurse, respira­tory therapist, and paramedic), which was dispatched to travel the 46 miles by ground mobile intensive care unit and arrived to find the infant in impending respiratory failure. After a brief discussion with the online medical control physician (a pediatric intensivist in the intensive care unit at the tertiary children's hospital), the team proceeded with a protocol-based rapid sequence intubation, which included midazolam and succinylcho­line. The initial intubation attempt by the respiratory therapist was unsuccessful (likely esophageal), resulting in no color change on the calorimetric end-tidal carbon dioxide detector and a brief desaturation as low as 72%. After reoxygenating the infant, the second intubation attempt was successful, the endotracheal tube was secured, and a chest radiograph confirmed good midtracheal tube position. The patient was secured on the stretcher and transported to the tertiary children's hospital, receiving 1 dose of midazolam and 1 dose of vecuronium during transport. The total on-scene time at the referring hospital was 73 minutes, with a 61-minute en-route time and a 65-minute return travel time. On arrival at the tertiary children's hospital, he was directly admitted, and care was transferred to the intensive care unit.

Possible questions suitable for database tracking and “benchmarking”:

1. Criteria for use of specialty critical care transport team versus local emergency medical services (EMS)

2. Crew configuration

3. Air versus ground

4.Response times

5.Medications used for rapid sequence intubation

6.Intubation attempts and rates of intubation attempt failure

7.Influence of chest radiograph on tube repositioning