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News and Features Transport Brings NICU to the Bedside, Improves Outcomes

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News and Features Transport Brings NICU to the Bedside, Improves Outcomes

Since transporting the first tiny patient in 1971, Children's Mercy's Critical Care Transport program has grown to one of the busiest in the country. In 2010, the transport team performed nearly 5,000 transports, about a quarter of them neonates.

"We bring critical care to the bedside. Our crew configuration is a registered nurse, registered respiratory therapist and an EMT. Most neonatal and pediatric patients have respiratory issues, so the fact that we have a registered respiratory therapist on board is important," says Pam Grimes, RN, BSN, N-CPT, Critical Care Outreach Transport Coordinator. "We have found that when looking at quality of care and the bottom line, this is the best team configuration and is what most of the other national big teams use."

The transport team's goal is to bring Children's Mercy's NICU to the patient, stabilizing the patient at the referral hospital rather than rushing to transport with the goal of stabilizing after arrival. Bringing a more stabilized pediatric patient back to Children's Mercy reduces mortality and morbidity in the long run.

"By bringing the intensive care unit to the infant, all the technical innovations that you have at your fingertips in the NICU you'll now have on wheels or in a rotor wing or in a fixed wing," says Emily McNellis, MD, Director of Neonatal Transport Medicine for Children's Mercy. "And the level of care is going to be just the same as what you're going to get in the NICU."

The transport program's experienced team is capable of safely transporting extremely premature babies, to newborns with heart defects and other congenital anomalies, and any other critically ill baby.

The team's specialty services include:

  • Neonatal therapeutic cooling
  • High-frequency ventilation
  • Inhaled nitric oxide
  • Helium oxygen therapy
  • Intubation
  • Needle decompression
  • Invasive line placement

With the only level IIIc NICU within a 250-mile radius catchment area, Children's Mercy transports patients mostly from Kansas and Missouri. However, the team also transports patients from across the nation and internationally. The Critical Care Transport team is made up of more than 70 dedicated staff members who do only neonatal and pediatric transports.

The transport fleet includes nine ground ambulances equipped especially for infants and children, a dedicated American Eurocopter EC-145 helicopter with IFR configuration, and a Beechcraft King Air 200 fixed-wing plane, all prepared with the specialized equipment and supplies needed to treat seriously ill neonates. The program is accredited in all modalities by the Commission on Accreditation of Medical Transport Services.

"These babies require very specialized care," says Dr. McNellis. "Our teams have the training to perform high-level skills like oral intubation, inserting invasive lines and interosseous lines, laryngeal mask airway, long nasal CPAP, needle cricothyrotomy, chest decompression, umbilical line placement, external jugular line placement and VP shunt management—things a typical ambulance can't provide. We bring a lot of experience and skill to the patient's bedside."

All patients less than 5kg are transported in isolettes to keep them warm and help with the stabilization process, improving morbidity and mortality, according to Grimes. The team also brings high-frequency ventilation to the bedside for patients in respiratory failure, whatever it may be caused by, including meconium aspiration, diaphragmatic hernia or just very premature babies.

"Our transport service is an integral part of the continuum of care we provide for critically ill newborns and is a perfect complement to our intensive care nursery," says Dr. McNellis.

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