Sample Transport Database Collection Fields

I. Demographic data

Unique transport identifier

Medical record number

Date of birth (and time of birth for neonates)

Age (gestational age for neonates)

Sex

Weight (kg)

Race/ethnicity

Patient address

Referring physician/medical professional with telephone/fax number Date of transport

Name of parents (responsible for consent)

Name of guarantor (responsible for bill)

Primary physician (with contact information)

Religious preference if stated

Special family circumstances (e.g., sick mother from birth, deaf family member, need for translator)

II.

Community code (community, city, county, region, or state name) Transport system type (public, private, hospital, volunteer) Type of team (neonatal, pediatric, trauma, ECMO, burn) Mode of vehicle (ground, fixed-wing, helicopter, combination, other) Type of transport (acute vs return)

Team configuration (personnel dispatched with names, identifiers,

eg, physician, RN, RRT, EMT, NNP, other

Time call received

Time vehicle called

Ambulance/aircraft No.

Time and location of dispatch

If air: Outbound

Departure to aircraft location (if off site) Take-off (airport/helipad and time) Landing (airport/helipad and time) Inbound

Departure to aircraft location (if off site) Take-off (airport/helipad and time) Landing (airport/helipad and time)

Time of arrival at referring hospital

Referring facility

Referring physician

Time of departure from referring hospital

Time of arrival at destination facility

Destination facility (name, code, level of care)

Admitting physician at destination facility

Time of departure from destination facility

Time of arrival at home base facility/office

Special equipment needed (eg, nitric oxide)

III. Clinical data

Reason for transport

Type of case

Medical

Surgical

Trauma (use pediatric trauma registry format)

Neonate

Cardiac

Intake diagnosis (for neonate multiples: twin A, triplet B)

Vital signs

Respiratory status (room air, Fio₂, NC, CPAP, intubated, ventilation)

Respiratory support (ventilator settings, Fio₂, nitric oxide)

Transport team recommendations to referring team before transport team arrival

Transport team interventions/procedures

Use CPT codes

Medications administered by transport team

Grouped according to degree of medical control required

(group 1, highest)

Group 1: Resuscitation (eg, epinephrine, atropine, bicarbonate, airway control adjuncts, vasoactive infusions)

Group 2: Drugs to treat neurologic emergencies and for gastro­intestinal tract decontamination, antidotes, analgesics, drugs to treat acute metabolic disturbances (eg, insulin, glucagon, hypertonic dextrose, polystyrene sulfonate [Kayexalate]), intravenous fluid administration for shock, surfactant

Group 3: Routine therapy for acute but not life-threatening con­ditions, such as bronchodilator treatment, antibiotics, intravenous fluid therapy (except for shock)

Contact to transport team base/MCP

No Yes

Time/name of MCP contacted

IV.

1. Death

2. Cardiac arrest

3. Respiratory arrest (as defined by team)

4. Hypotension (as defined by team)

5. Unplanned extubation

6. Obstructed, dysfunctional, or replaced endotracheal tube

7. Air leak or pneumothorax

8. Equipment failure

a. Loss of oxygen

b. Loss of suction

c. Battery or power failure

d. Ventilator malfunction

e. Monitor malfunction

f. Medication/catheter infiltration

g. Vehicle mishap

h. Other

9. Delayed transport

a. Ambulance, aircraft (reason)

b. Personnel

c. Multiple calls

d. Elective/nonemergency

e. Bed/staff availability

f. Communications

g. Weather

h. Equipment

10. Aspiration

11. Dislodged catheter/line

12. Bradycardia/arrhythmia during transport

13. Worsening respiratory status

14. Medication error

15. Hypoxemia (eg, SpO₂ decreases by >10%)

16. Hypothermia (as defined by team)

17. Airway not cleared at time of admission (head positioning, mucus, poor mask control)

18. Patient's condition unstable on arrival at referring or receiving hospital

19. Referring physician

a. Present on team arrival

b. Present at any time but not on arrival

c. Not present

20. Training of referring physician

a. Pediatrics

b. Pediatric emergency medicine

c. Pediatric critical care

d. Pediatric subspecialist

e. Emergency medicine

f. Neonatologist

g. Family practice

h. Other

21. Referring team (staff, nurses, respiratory therapists)

a. Interactions

b. Conflicts

22. Adverse events reporting

a. Staff meeting

b. MortalityZmorbidity conference

c. Legal affairs

d. DebriefingZcrisis management

e. Human resources

V. Diagnosis at transfer from ward, emergency department, PICU, NICU, step-down unit

1. Medical

2. Surgical

3. Trauma

4. Still hospitalized

VI. Severity scoring

Systolic blood pressure: highest, lowest

Diastolic blood pressure: highest, lowest

Heart rate: highest, lowest

Pao₂ZFio₂: lowestZhighest

Pco₂: highest

pH: highestZlowest

Pupillary reaction: normal, unequal or dilated, fixed and dilated Prothrombin time and control

PTTZcontrol ratio General policies, guidelines, and information

• Safety and travel policies

• Communication policies

• Documentation policies

• Human resources policies

• Medical protocols and policies

• Policy examples

—Management of congenital abdominal wall defects

— Guidelines for primary medical provider participating in neonatal transport

— Management of neural tube defect

— Roles and responsibilities for transport

— Infant ground transport provider/nurse/respiratory therapist skills competency

— Emergency lights and siren use during transport

Policies and protocols are recommended for neonatal-pediatric transport teams.

General Policies, Guidelines, and Information

• Organizational chart

• Mission, vision, and value statements

• Scope of care

• Definition of line of authority for transport team members and contracted ground and air teams

• Press-release policy

• Confidentiality and security of patient care records, meeting minutes, and policies and procedures

Safety and Travel Policies

• Age parameters of patients to be transported

• Dress code

• Hearing protection, when appropriate for patient and/or team

• Seat belts and shoulder harnesses for patient and team

• Transport of twins and/or dual patient transport

• Helmet use by ground and/or air transport team personnel

• Interior modification of transport vehicles

• When to use alternative (backup) vehicles

• How to choose mode of transport (eg, ground, air, type of aircraft)

• Weight restrictions, density altitude (aircraft-related)

• Physical examinations and performance standards for weight, height, and lifting appropriate for service

• Annual tuberculosis testing

• Policy requiring immunization history (eg, tetanus, hepatitis B, measles, mumps, rubella)

• International transport policy, when appropriate

• International immunization history, when appropriate

• Passport requirements, when appropriate

• Use of medications (prescription and over-the-counter)

• Use indications and allowances for nonstandard personnel

• Minimum personnel configurations

• Medical control identification and backup

• Appropriate loading and unloading of patients

• Weight limit for each incubator and transport stretcher

• Refusal to transport patients (combative patient or family member)

• Screening family belongings for potential weapons or hazardous materi­als before flight

• Sharps disposal and disposal containers

• Securing equipment in transport vehicle

• Restraints, physical and chemical

• Cleaning and disinfecting transport vehicles, equipment, instruments, and uniforms

• Standard precautions and special precautions for identified or suspected

infectious patients

• Infection control

• Process for identifying people at risk for exposure to infectious disease and communicating exposure to all affected personnel

• Occupational Safety and Health Administration (OSHA) exposure con­trol plan for bloodborne pathogens and tuberculosis

• Hazardous materials

• Risk management

• Refueling (eg, with no patient on board, no crew members on board)

• Emergency procedures, method of exiting transport vehicle in a cata­strophic event

• Emergency plan including the following:

— List of personnel to be notified and order of notification

— Communication with aircraft or ambulance

— Process to initiate search and rescue

— Plan to transport patient in case of an incident

— Timeframe to activate emergency plan

— Method of information dissemination and press release to ensure accuracy of information

— Annual drill of emergency preparedness

• Policy stating the program will follow all Federal Aviation Regulations and Federal Communications Commission regulations

• Policy stating compliance with the Consolidated Omnibus Budget Reconciliation Act of 1986 (COBRA) and Emergency Medical Treatment and Active Labor Act (EMTALA) regulations

• Criteria and procedure for using lights and sirens

• Criteria for speed limitations

• Policy addressing security of aircraft and ambulance transport vehicles when unattended

• When nitric oxide or other inhaled gases are used, policies addressing: cylinder safety, monitoring, transportation regulations, weight, mounting, delivery of drug, emergency procedures, and occupational exposure

• Process for conditions causing delay of transport team (eg, weather, traffic, mechanical breakdown, deterioration in patient's condition)

Communication Policies

• Request for transport

• Identify authorized requestors, including “without discrimination” clause

• Process for admitting the patient, if applicable

• Process for monitoring transport (eg, time of departure, arrival, locations, and any necessary changes)

• Diversion criteria

• Weather and launch protocols

• Outline of location, distance, preferred transport arrangements, capabili­ties, and resources of receiving facility or facilities

• Cellular phone use

• Guidelines for timely notification of team for request for transport

Documentation Policies

• Record of patient care

— Minimally including purpose of transport, treatments, medications, and patient's response to treatments and medications; transport facilities (referring and receiving hospitals); and who is receiving report

Human Resources Policies

• Disciplinary policies

• Written code of conduct

• Scheduling policies (addresses duty time to ensure adequate rest)

• Wellness programs (eg, smoking cessation, weight control)

• Preemployment and annual physical examinations or medical screening that includes history of chronic or acute illnesses and illnesses requir­ing use of medications that may cause drowsiness or affect judgment and coordination

• Duty status during pregnancy

• Duty status during acute illness

• Duty status while taking medication that may cause drowsiness

• Job requirements (education, training, licensing, experience level)

• Continuing education requirements

• Background checks of personnel and personnel carrying photo identifica­tion at all times

• Hours worked by transport personnel with minimum rest and duty times

Medical Protocols and Policies

• Diseases and injuries transported as dictated by scope of team mission (eg, neonatal diseases for neonatal teams, common injuries encountered when transporting to pediatric trauma center)

• Diseases affected by altitude as appropriate for flight teams

• Specification of certain specialty patients requiring prompt consultation

• Preparation for transport (eg, staff, equipment, supplies)

• Stating transfer of care is to higher level of care

Policy Examples

Examples of policies are provided and serve as examples of ways to write a policy.

Management of Congenital Abdominal Wall Defects

Definition:

Omphalocele: a central abdominal wall defect of variable size involving herniation of abdominal contents into the base of the umbilical cord. The malpositioned abdominal contents are covered by a protective membrane/ translucent sac (unless rupture has occurred). The umbilical cord and vessels radiate onto the sac.

Gastroschisis: a central abdominal wall defect involving herniation of abdominal contents lateral (most commonly to the right) of the umbilical attachment. There is no protective membranous covering.

Associated Factors:

Clinical Findings:

Omphalocele:

• Defect may be central, hypogastric, or epigastric

• Smaller omphaloceles usually contain only intestine compared with larger or giant omphaloceles that contain liver and/or spleen as well

• Respiratory compromise secondary to pulmonary hypoplasia may occur

• Ruptured omphalocele may be confused with gastroschisis (omphaloceles do not have an intact umbilical cord at level of abdominal wall)

Gastroschisis:

• Edematous, matted intestine, often with an inflammatory rind or “peel”

Laboratory Findings:

No laboratory data necessary

• Hypoglycemia can be seen in association with Beckwith-Wiedemann syndrome

Radiography:

Radiographic examination is not necessary unless other clinical indications dictate (respiratory distress, dysmorphology)

Differential Diagnosis:

• Umbilical cord hernia

• Umbilical polyp

• Omphalomesenteric fistula with intestinal prolapse

Assessment and Initial Management:

Management goals include: diagnose omphalocele or gastroschisis, cover bowel defect, minimize heat loss, decompress stomach, and avoid dehydra­tion and hypothermia.

• Physical examination should assess the ABCs including respiratory (SpO₂; tachypnea) and cardiovascular compromise (blood pressure; heart rate; peripheral pulses; capillary refill), and the abdominal defect

• Limit excessive handling of defect

— Examine defect for discoloration, infarction, or torsion; if present, call Fellow/Attending immediately to notify Pediatric Surgery

• Cover bowel/defect with a sterile, warmed-saline-soaked dressing

— Infants are at increased risk for hypothermia secondary to exposure of intestinal surface (Gastroschisis and Ruptured Omphalocele)

• Place infant in a sterile bowel bag secured at the level of the axilla to help minimize heat loss

— If bowel has been wrapped prior to arrival of transport team, unwrap defect, examine for discoloration/infarction/torsion, and rewrap as described above

• Place an oro/nasogastric tube and aspirate gastric contents with syringe or Replogle tube on low continuous suctioning

• Place infant NPO

• Place peripheral IV; start IV fluids with D₁₀W at 140 mL/kg/d mainte­nance for gestational age (Gastroschisis)

• Obtain or review laboratory studies including

— CBC with differential and peripheral blood culture (if needed)

— Serum glucose/Dextrostix

• Start ampicillin and gentamicin (see Sepsis and Meningitis section for gentamicin dosing)

• Correct metabolic abnormalities: hypo/hyperglycemia; metabolic acidosis

— Metabolic acidosis

■ Check peripheral perfusion; capillary refill; color of bowel

■ Correct with volume expansion with normal saline bolus FIRST

■ If requires sodium bicarbonate, ensure adequate ventilation prior to administration as administration during inadequate ventilation may worsen respiratory acidosis and infant's condition

— See Correcting Metabolic Abnormalities section

• Maintain thermal neutral environment/correct hypothermia

• If infant is in respiratory distress, review or obtain arterial (preferably) blood gas, but do not spend a prolonged period of time establishing arterial assess

— Obtain or review chest radiograph

— Deliver O₂ via nasal cannula or facemask or oxygen hood at community hospital to maintain SpO₂ 90% to 98% (≥34 weeks gestation) and 88% to 95% (60% oxygen, perform elective intubation and commence mechanical ventilation

■ AVOID NCPAP and Prolonged Mask Positive Pressure Ventilation!

■ See Intubation section and Assisted Mechanical Ventilation for Transport section for initiating mechanical ventilation

• Closely monitor mean systemic blood pressure as it should be greater than infant's gestational age

• Provide aggressive cardiovascular support if hypotensive or poor perfusion

— Normal saline or lactated ringers bolus 10 to 20 mL/kg over 10 to 20 minutes (normal saline is the most readily available fluid at com­munity hospitals)

— Repeat boluses as required while monitoring response/changes (heart rate; blood pressure; perfusion; bowel color)

— If infant requires greater than 20 mL/kg of volume expansion, call Medical Control immediately

• Call Medical Control immediately if infant has respiratory or cardio­vascular compromise

• Re-evaluate infant prior to leaving community hospital

— Bowel defect/dressing

— SpO2; heart rate; blood pressure; capillary refill time; temperature

— Serum glucose/Dextrostix

• Elevate head of transport bed and attempt to position infant on right side to avoid mass pressure on inferior vena cava that could impede venous return to the heart

• Prior to departure, call Medical Control and alert Pediatric Surgery (and other subspecialties if suspect anomalies) of pending patient

• On return to hospital call Pediatric Surgery fellow and provide update/ clinical status

Potential Complications:

• Respiratory failure

• Hypothermia

• Metabolic abnormalities and dehydration

• Torsion of bowel with vascular compromise

Guidelines for Primary Medical Provider Participating in

Neonatal Transport^1,2

Neonatal Attending:

• All infants to be discussed with on call staff (medical control)

Neonatal Fellow:

• Any potential life threatening situation or congenital anomaly and/or infants not responding adequately to initial medical or airway manage­ment or for whom intubation was unsuccessful

• Multiples managed.

Associated Factors:

The etiology of NTD is multifactorial, including genetic and environmental factors.

• Previous pregnancy/sibling affected with NTD

• Prenatal folate deficiency

• Maternal medications: carbamazepine; valproate; additional antimetabo­lites of folic acid

• Infant of a diabetic mother (non-gestational diabetes)

• Chromosomal syndromes (trisomy 13 and 18; triploidy)

• Infant of consanguineous parents

• Maternal hyperthermia

Clinical Findings:

• Open lesions are usually clinically apparent at birth, whereas closed defects have a variable presentation. Prenatal history may reveal elevated (≥2.5 multiples of the mean) maternal serum alpha-fetoprotein (open neural tube defects) and polyhydramnios. Genetic counseling and detailed fetal ultrasonography may have been performed.

Anencephaly

• The most severe (incompatible with life) and most common anterior tube closure defect

• Is readily apparent at birth due to incompletely developed or absent cal­varium and portions of the cerebrum and cerebellum

• Majority are stillborn. Spontaneous abortion frequently occurs. Delivery is often post-dates.

Encephalocele

• Cranial defect through which brain tissue protrudes

• 75% to 80% occur in the occipital region with remainder in the frontal (nasal cavity protrusion), temporal, and parietal regions

• Associated with Meckel-Gruber syndrome; microcephaly; cleft lip/palate; Chiari III malformation; partial or complete corpus callosum agenesis

Myelomeningocele

• Characterized by herniation of meninges, spinal cord, CSF, and nerve roots through deficient axial skeleton with variable dermal covering

• Approximately ¾ are lumbar, of which 90% are associated with hydrocephalus

• May present with varying degree of paresis of legs and sphincter dysfunction

• Associated with cardiac, intestinal, genitourinary, orthopedic, and esophageal anomalies

• 75% to 90% association with Chiari II malformation/hydrocephalus as well as several other CNS anomalies

Meningocele

• Restricted herniation of the meninges (without associated neural tissue) through a bony defect site, which usually has a dermal covering

Occult Spinal Dysraphisms

• Disorders of the caudal neural tube with dermal covering

• Includes intraspinal lipomas, epidermoid cysts, subcutaneous lipomas, and tethered cords

• Variable clinical symptoms (absent; minimal; moderate; severe) depend­ing on degree of neural tissue involvement

• May present with a cutaneous marker (hypo/hyperpigmentation; heman­gioma; hypertrichosis; skin appendage)

Laboratory Findings:

Necessary laboratory studies (chromosomes) will be obtained after transport

Radiography:

Radiographic examination is not necessary unless other clinical indications dictate (respiratory distress).

Differential Diagnosis:

• Iniencephaly

— Rare neural tube defect involving rachischisis of cervical and thoracic spine and with extreme retroflexion of the head

• Lipoma

• Teratoma

• Caudal regression syndrome

Assessment and Initial Management

Management goals include covering the defect securely and maintaining an adequate airway.

• Physical examination should assess respiratory status (the ABCs) and neu­rologic abnormalities. Evaluate:

—Lesion (level; size; surrounding tissue; ruptured)

—Head circumference (hydrocephalus)

— Motor function (muscle tone; muscle power and bulk; spontaneous active movements; tendon and neonatal reflexes)

—Sensory function (cutaneous sensation/pinprick)

—Orthopedic deformities (foot; knee; hip; spine)

—Anal sphincter tone; urinary stream; bladder

—Presence of associated malformations

Anencephaly

• Given the 100% lethality of this condition, only supportive care is provided (warmth; comfort; enteral nutrition)

Encephalocele, Myelomeningocele, Meningocele

• Limit excessive handling of defect

• Cover defect with sterile, warmed-saline soaked non-adherent dressing

—Do not use betadine

—Infants are at increased risk for increased insensible loss and hypothermia.

• Place infant in a sterile body bag secured around defect to minimize heat loss

• Preferably place infant in prone or side position if respiratory status allows

—Avoid placing infant on back

• Obtain if necessary or review chest radiograph

• Obtain or review laboratory studies including

—CBC with differential

—Serum glucose/Dextrostix

• Place infant NPO

• Place peripheral IV; start IV fluids with DioW at appropriate rate

for gestation

—Secondary to increased insensible loss, may need to increase fluids to

1.5 maintenance

■ Lesions not adequately covered and open lesions are at highest risk for increased insensible loss

• Place an oro/nasogastric tube and aspirate gastric contents with a syringe

• Catheterize bladder if full/paralyzed

— May perform intermittently depending on response

• Maintain thermal neutral environment/correct hypothermia

• Ensure adequate airway; have oxygen, suction, bag and mask, laryngo­scope, and ET tube readily available

— Monitor SpO₂, heart rate, blood pressure

• If infant exhibits respiratory distress, review or obtain arterial (preferably) blood gas

— Deliver O₂ to maintain SpO₂ 90 to 98% (≥34 weeks gestation) and 88 to 95% (60% Fio₂, perform elective intubation and commence mechanical ventilation

■ See Intubation section and Assisted Ventilation for Transport section for initiating mechanical ventilation

• Provide aggressive cardiovascular support if hypotensive and/or poor perfusion

—Normal saline bolus 10 to 20 mL/kg (normal saline is the most readily available fluid at community hospitals)

— Repeat boluses as required while monitoring response/changes (heart rate; blood pressure; perfusion; liver edge)

• Correct metabolic abnormalities: hypo/hyperglycemia; metabolic acidosis

— See Correcting Metabolic Abnormalities section

• If suspect sepsis, if defect is open, or if defect’s sac ruptures, obtain blood culture (or recheck if obtained) and start Ampicillin and Gentamicin (see Sepsis and Meningitis section for dosing)

• Call Medical Control immediately if infant has respiratory or cardio­vascular compromise, or if the defect appears concerning

• Re-evaluate infant prior to leaving community hospital

— Dressing over defect

— SpO2; heart rate; blood pressure; capillary refill time; temperature

— Serum glucose/Dextrostix

• En route to receiving facility, call team to alert Pediatric Neurosurgery of pending patient

Potential Complications

• SepsisZmeningitis

• Urinary retention

• Hydrocephalus

Roles and Responsibilities for Transport

MD Responsibilities:

1. Take call from referring physician and document history with pertinent information

2. Discuss case with the charge nurse verifying bed availability and ability to accept case

3. Make recommendations regarding stabilization of infant and plan for transport with referring physician once a bed is secured

4. Discuss case with the accepting attending physician/medical control

5. If unable to accept case, assist the community facility in locating a bed at another facility

6. Order appropriate medication and fluids from pharmacy that may be needed

7. En route: provide details of the case to the entire team, plan approach and make recommendations as appropriate

8. On site: request a sample of the mother's blood and the placenta if possible

9. At referral facility, identify self and staff and obtain report, up to date vital signs and any interventions performed prior to team's arrival.

10. Assess patient and formulate plan for safe transport

11. Call receiving hospital and have secretary arrange conference call with Fellow and Medical Control to discuss plan and management of patient

12. Obtain copies of patient's medical records (ie, radiology reports/images, labs, placenta, consultation reports)

13. En route, call unit with brief

14. On arrival, sign out to accepting team

15. Call family at referral facility that infant has arrived safely and provide brief update

16. Complete NICU Transport Evaluation

Unit Secretary:

1. Triage phone call to the Fellow or Attending

2. Once transport accepted book an ambulance

3. Provide transport checklists and charged transport phones to (Medical Provider, RN, and Respiratory)

4. Notify Security of transport and ask for call with ambulance arrival

5. Record information in the transport Log

6. When Ambulance arrives, call Transport Phones to notify Team

7. Call transferring hospital for demographics and birth information

8. Assemble charts

9. Charge for NICU transport in the computer including ICD-9 code for medical control

10. Fill out and enter newborn screen if not completed at referring hospital

11. Assist with initiation of conference call for the medical provider in the field to Medical Control, Fellow and Charge Nurse

12. Notify Charge Nurse when team calls with the “ETA” back to hospital

13. If placenta and maternal blood is brought back, label with baby label and notify laboratory

14. Complete NICU Transport Evaluation

Charge Nurse:

1. Consult with fellow or attending regarding composition of transport team

2. Notify secretary to initiate the transport process

3. Notify admission nurse of transport

4. Notify respiratory of transport

5. Assist transport nurse preparing for transport (eg, call referring hospital for update before team departs)

Transport Nurse:

1. Prepare transport bed by double checking temperature, supplies, IV pumps, supply boxes, etc

2. Place the refrigerator medication bag on the bed and obtain Fentanyl and Versed from Pyxis

3. Call pharmacy regarding the status of any additional medications ordered through CPOE by the NICU fellow for transport

4. Call referring hospital for updated report utilizing the Transport Record

5. Take the transport telephone, confirming it is properly charged

6. Complete NICU Transport Evaluation

Respiratory Therapist:

1. Check O₂ and air levels of cylinders for transport bed

2. Check to ensure the ventilator circuit is attached and ventilator is functioning properly

3. Check to ensure the respiratory transport bag is secure and stocked appropriately

4. Obtain appropriate dose of Surfactant, place in cooling pack

5. Obtain appropriate spare O₂ and air cylinders

6. Obtain the I-STAT device (newly charged) and 4 cartridges (check expiration dates)

7. Check transport ambulance to ensure the electrical inverter is working properly

8. Check transport ambulance to ensure an adequate O₂ supply is available

9. Complete NICU Transport Evaluation

Infant Ground Transport Provider/Nurse/Respiratory Therapist Skills Competency

I. Purpose

A. To establish guidelines for objective evaluation of each team mem­ber’s competency to perform expected responsibilities/procedures/ interventions for critically ill newborns on transport.

II. Procedure

A. The transport team member will complete an orientation program including didactic, simulation in the field training

a. Appropriate for team member’s specific job description and set of responsibilities

b. Completed before independent performance of transport activities

c. Complete no fewer than three supervised transports

B. The yearly evaluation will include the following information:

a. Required ICU and Respiratory Care Department annual compe­tency records completed in home department personnel file

b. Biannual CPR, NRP certification

c. Transport Skills lab attendance date (when available)

d. Transport i-STAT competency

e. Transport equipment checklist

C. Regular transport case reviews and quality assessments

Emergency Lights and Siren Use During Transport

Policy Statement:

Emergency lights and sirens will be used only in critical situations and only when endorsed by the medical control physician. During emergency operation, the vehicle shall not exceed the posted speed limit. On Interstate highways, the maximum speed limit is 75 mph. All school zone speed limits must be adhered to at all times. Vehicle operators are required to drive at a speed that is safest for existing road and weather conditions, regardless of the posted speed limit. If possible, the family will be informed of emergency lights and sirens use. Use of lights and sirens will be documented in the phy­sician's note.

Selected Readings

American Heart Association and American Academy of Pediatrics. Neonatal Resuscitation Program (NRP) Manual. 4th ed. Dallas, TX and Elk Grove Village, IL: American Heart Association/American Academy of Pediatrics; 2000

Bishop MJ. Who should perform intubations? Respir Care. 1999;44:750-755

Cochrane D, Aronyk K, Sawatzky B, Wilson D, Steinbok P. The effects of labor and delivery on spinal cord function and ambulation in patients with meningomyelocele. Child Nervous System. 1991;7(6):312-315

Commission on Accreditation of Medical Transport Systems. Accreditation Standards. 5th ed. Sandy Springs, SC: Commission on Accreditation of Medical Transport Systems; 2002 Cragan JD, Roberts HE, Edmonds LD, et al. Surveillance for ancephaly and spina bifida and the impact of prenatal diagnosis—United States 1985-1994. MMWR CDC Surveill Summ. 1995;44(4):1-13

Gomella TL. LANGE Clinical Manual. 5th ed. 2004;172-173

Gomella TL. LANGE Clinical Manual. 5th ed. 2004;595, 604, 608, 616, 622, 627

Hess DR. Indications for translaryngeal intubations. Respir Care. 1999;44:604-609

Hogge WA, Dungan JS, Brooks MP, et al. Diagnosis and management of prenatally detected myelomeningocele: a preliminary report. Am J Obstet Gynecol. 1990;163(3):1061-1065

Hurford WE. Orotracheal Intubation Outside the operating room: anatomic considerations and techniques. Respir Care. 1999;44:615-626

Luthy DA, Wardinsky T, Shurtleff DB, et al. Cesarean section before onset of labor and subse­quent motor function in infants with meningomyelocele diagnosed antenatally. New Engl J Med. 1991;324(10):662-666

MacDonald MG. Umbilical artery catheterization. In: MacDonald MG, Fletcher MA, eds. Atlas of Procedures in Neonatology. 2nd ed. Philadelphia, PA: JB Lippincott Co; 1993:155-174 MacDonald M. Umbilical vein catheterization. In: MacDonald MG, Fletcher MA, eds. Atlas of Procedures in Neonatology. Philadelphia, PA: JB Lippincott Co; 1993:178-187

McEnery G, et al. The spinal cord in neurologically stable spina bifida: a clinical and MRI study. Dev Med Child Neurol. 1992;34(4):342-347

Shurtleff DA, Lemire RJ. Epidemiology, etiologic factors, and prenatal diagnosis of open spi­nal dysraphism. In: Pand D, ed. Neurosurgery Clinics of North America. Philadelphia, PA: WB Saunders Co; 1995:183-193

Shutleff DB, Luthy DA, Nyberg DA, Benedetti TJ, Mack LA. Meningomyelocele: management in utero and post natum. Ciba Found Symp. 1994;181:270-280

Thompson AE. Issues in airway management in infants and children. Respir Care. 1999;44: 650-658

Tung BJ. The pediatric rescue airway. Air Med J. 2005;24(2):55-58

Watson CB. Prediction of a difficult intubation: methods for successful intubation. Respir Care. 1999;44:777-796