Overview
The interfacility transport of critically ill neonates and children requires basic and specialized equipment and medications geared toward the needs of pediatric patients. Transport teams should be self-sufficient, with dedicated, organized supplies for quick, efficient access.
Storage packs especially designed for neonatal-pediatric transports are commercially available and can be manufactured to be resistant to water and bloodborne pathogens. These packs and equipment containers should be organized, maintained, and verified by members of the transport team on a routine and documented basis. If any equipment needs to be shared among transport programs, local hospitals, or emergency medical services teams, plans and checklists should be developed to ensure that equipment is available and properly maintained. It is not advisable to rely on or plan to borrow equipment or medications from a referring hospital on a routine basis to serve a transport team's needs.Transport equipment needs to be lightweight, portable, rugged, and easy to clean; to meet or exceed all hospital, local, state, federal and Federal Aviation Administration (FAA) requirements; and to have been tested in the transport environment. Use of a single universal equipment pack to treat patients ranging from preterm neonates to adults is not recommended. There are too many age-specific tools, medications, delivery devices, and techniques to enable efficient use of this type of equipment organization. The weight of stocked packs should be documented for air transports. All medical packs should be checked before and after each transport as well as daily. All electrical equipment must have independent, rechargeable power sources that can easily connect to power outlets in ground and air transport vehicles. These issues can be especially troublesome in the international transport arena, and the use of international travel electrical adapters should be considered.
Compatibility of all mechanical equipment is critical (eg, the oxygen and air connectors must be compatible with all such connectors on all vehicles to be used) to avoid potentially disastrous interruption of therapy. Routine, scheduled equipment maintenance should be performed by competent, well-trained biomedical technicians.The safety of all equipment used in transport is mandatory. Approved methods must be used to secure all equipment inside all transport vehicles and aircraft, whether equipment is portable or a permanent part of the vehicle. Techniques for securing patients, incubators, ventilators, stretchers, and equipment and drug packs need to be reviewed rigorously, and all personnel should be trained in these vital aspects of transport safety (see Chapter 9, 10).
Changes in weather and environmental conditions encountered during transport may affect performance of equipment. The real effects of vehicle vibration, temperature swings, and barometric pressure changes with altitude or sudden decompression must be determined before equipment is used. If this has not been accomplished by the manufacturer or by another organization, local biomedical testing services may be helpful in simulating transport conditions while testing proposed equipment.
Proper storage and dispensing of medications is essential for providing safe, effective care. Medications such as prostaglandins and surfactant require special procedures for refrigerated storage, shelf-life adjustment when not refrigerated, and additional training regarding their use on transport. A clinical pharmacist can be a valuable resource for identifying specific issues related to medication use during transport. Most transport teams carry controlled substances; institutional, state, and federal regulations should be consulted for security and documentation requirements. Additional regulations may be applicable for the international transport of controlled substances. The Joint Commission has mandated the use of standardized medication concentrations in hospitals and intensive care units (ICUs) but has not specifically required this change for interfacility transport. It is recommended that each transport program, however, consult its compliance experts to determine how to interpret standards of The Joint Commission within the transport environment.