Vehicle Operations
Various options are available for neonatal-pediatric transport teams to obtain the vehicle of choice. A hospital can decide to operate the entire medical ambulance program independently.
The vehicle(s) can be purchased or leased, and the personnel (pilots, drivers, and mechanics) can work directly for the base facility (usually a hospital). The base facility is then financially and legally responsible for compliance with all state and federal regulations. This option places all the financial and legal risk on the base facility, and expenses and liabilities are less predictable than with other options. If the transport program is well managed, the base facility can save a significant amount of money, but if poorly managed, the endeavor can be very costly.Another option is for the base facility to enter into a contractual agreement for the entire air or ground operation. The contract operator usually will assist the base facility with vehicle selection and medical configuration. The entire operation (vehicle maintenance, backup vehicle, nonmedical personnel, and regulatory compliance) becomes the responsibility of the operator, and all of the base facility’s costs are determined by the contract. This option is often the most expensive, but the financial and legal risk belongs to the operator. Under this option, annual expenses are much more predictable.
The base facility may select another option—buy or lease the vehicle(s) and have an operator manage the entire operation. The base facility gains the benefit of owning or leasing and retains a purchased vehicle if operators are changed.
A fourth option is for a transport team to enter into agreements with other air and/or ground ambulance services that then transport the neonatal- pediatric transport team when a transport request is received. Depending on the volume of transports, this option may be the most cost-effective and is the practice of many helicopter and airplane programs that make their aircraft available to several transport teams.
Any contract between a base facility and an operator or an agreement between a transport team and an outside transport service should address several important issues. A commitment to safety must be evident, and the safety record should be reviewed carefully. The qualifications, experience, training, and licensure of the pilots, drivers, and mechanics must be known. Vehicle specifications and capabilities should be discussed, and there should be a plan for backup when maintenance is required on the vehicle or when personnel are on vacation. Vehicles should be dedicated and configured specifically for the needs of the transport team. Availability (ie, 24 hours per day, 7 days a week, except when the vehicle is already on a transport) and response times (ie, within 30 minutes of the contact call) should be defined. Provision of liability limits and insurance verification data for all transport vehicles and vehicle operators should be mandated.