Elsevier

Early Human Development

Volume 85, Issue 8, August 2009, Pages 477-481
Early Human Development

Best Practice Guideline article
Setting up a neonatal transport service: Air transport

https://doi.org/10.1016/j.earlhumdev.2009.05.007Get rights and content

Abstract

Air transport is an integral part of any system that provides neonatal care in the developed world. To ensure that this is developed in an efficient and appropriate manner a prospective analysis is required to allow a multidisciplinary team to progress a project aimed at providing appropriate staff with adequate training using equipment that has satisfied all regulatory bodies.

This article highlights the difficulties in achieving this, reflecting on the way in which established air transport teams have overcome many of the difficulties.

The commonalities with land based transport are emphasised along with those issues which are specific to teams providing such a service who aspire to become “air capable”.

Introduction

Most parts of the developed world services in neonatology are structured in order that increased levels of dependency are provided by more regionalised or centralised institutions. Such a structure leads to the necessity to have in place a method of ensuring that infants can be transferred between these institutions in a safe and timely fashion. Regional neonatal transport services have existed in many areas worldwide for some time and many of these services have incorporated the ability to provide air transport [1], utilizing either aircraft dedicated to the service, leased on an ad-hoc basis or requesting the support of the military when necessary.

It is recognised by all who participate in transport that the air mode presents some difficult challenges. When setting up a service it is important to tease out those issues which require to be managed in a different fashion from isolated road transportation. Such issues are mainly in the domains of organisation, equipment, communication and staff training. Clinically, stabilisation has to take into account the fact that the aircraft cannot simply stop when the infant requires intervention.

It is also important to recognise that air transport does not exist in isolation, the infant will require a road transfer during the event, except in those circumstances where helicopter landing sites are available at both receiving and referring institutions. Any transport service regularly or even intermittently using air mode has to source and maintain equipment that can be used in both environments. It also has to ensure compatibility in all modes of vehicle with a common organisational base.

In countries such as the United States of America and Australia air transport for the newborn is well established. That is unfortunately not the situation in all developed countries. In the United Kingdom, Scotland alone has a fully developed national service, with England, Wales and Northern Ireland still highly dependant on the use of military assets for emergencies. The aims of this article are to highlight those issues which should be of prime concern to any region or country that is considering air transport and to discuss some of the ways of dealing with those issues. Although many of the regulatory bodies and rules mentioned relate to the United Kingdom, neonatal transport service commissioners in other countries should easily be able to identify their equivalent bodies.

Section snippets

Assessing the need

There are several reasons why air transport is considered. Most often it is when there is an emergency such as an infant requiring extracorporeal life support which can only be accessed at a distant institution. Such a transfer, if not executed by an organised and experienced team can be fraught with difficulties. It highlights the need for specialists in neonatal transport to be involved at the very early stages of development of any new regionalised service for the newborn. It should be an

Multi-professional approach

Developing a model for air transport does not just depend on the neonatal services. When an individual air transport event is analysed there are many professions involved in ensuring the safe passage of the infant and staff.

Air transport should not be viewed in isolation from road transport. At the start of a project aimed at creating an air transport service an individual should be identified who has the required background knowledge and inter-professional links needed to integrate clinicians,

Equipping a service

The level of equipment to be carried by an air transport team will depend on the planned clinical use of the service. It is highly likely that with the expensive investment involved most neonatal transport teams offering air capability will wish to provide for all possible clinical situations. To this end a transport incubator system (TIS) including a ventilator, syringe pumps, a multiparameter monitor, inhaled nitric oxide (iNO), alarms and oxygen analyzer will be required as a minimum.

Staffing a service

There is great diversity worldwide in terms of who actually undertakes the transport of infants by air. The traditional doctor and nurse team has seen many variations over the past few years. Most teams are led by a medical director, who has the overall responsibility for issues such as maintaining service delivery, training and clinical governance.

Actual service delivery however can be accomplished by many different professional groups provided appropriate training has been given.

In Vancouver

Communication and organizational issues

Central to any transport team are communication and an organizational structure. Air transport is extremely expensive and may put staff and patients in vulnerable situations. It is vital that decisions about air transport are made by experienced staff and those decisions have a clear pathway which will lead to the efficient execution of the transfer.

For this reason many services such as those in Vancouver and Toronto in Canada, Sydney and Melbourne in Australia and in Scotland have a one phone

Specific clinical issues

During the period immediately prior to staff training in expectation of starting an air transport service, all protocols and guidelines pertaining to road transport should be reviewed and adapted to include those issues pertinent to travel by air. Mostly these will be to do with the effects of altitude, acceleration / deceleration, thermal issues and lack of the usual space. The degree of stability and the interventions necessary to achieve that will require to be revised.

Conclusion

Air transport cannot be viewed independently from land based systems. It is essential that the infrastructure and component issues as described above are coordinated and finally brought together in a way which satisfies not only the transport team but the many different professional disciplines and regulatory bodies involved. Air transport is a constantly changing specialty requiring both rigid attention to detail in the acute events and an enquiring mind with a view to keeping up with the

Key guidelines

The following are the critical steps in establishing a neonatal air transport service:

  • Prospective assessment of numbers, demographics and validity of indications for transport by air.

  • Appointment of project leader with authority and experience of a multidisciplinary approach.

  • Assessment of expansion of land based transport services to provide adequate air cover for geographical area.

  • Adherence to all regulatory bodies involved.

  • Extensive training, protective clothing and insurance for staff.

  • Senior

Research directions

  • Validation of the appropriateness of combined paediatric and neonatal transport teams.

  • The use of CPAP in air transport.

  • The use of HFOV in air transport.

  • Effects of excess noise on staff and physiological parameters in infants.

  • Comparison of differing professional groups providing care during air transport of infants.

References (14)

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