Maryland Regional Neonatal Transport Program

Ground versus Air Transport

Maryland Patient Safety Center

Perinatal/Neonatal ReunionDecember 3, 2013

Webra Price-Douglas, PhD, CRNP

Coordinator

I have no financial conflict of interest

Maryland Regional Neonatal Transport

ProgramJenny Yu, MD

Co- Director

Johns Hopkins

Children’s Center

Sara Mola, MD

Co-Director

University of Maryland

Children’s Hospital

Webra Price-Douglas, PhD, CRNP

Coordinator

Transport is not a benign event

PatientsTransport team

MSP-Daulphin

MSP- AW139

Maryland Regional Neonatal Transport Program

To Fly or Not to Fly

Criteria ItemDistance > 60 miles/ minutes driving

Increased out of hospital time detrimental to patient

Treatment provided by team will prevent death, arrest, acute deterioration.

Referral center unable to provide appropriate care (MD Perinatal Levels of Care)

Time of day/year (traffic, construction, geography, etc..)

Total

ScoringScore- 1-2- ground (no discussion)Score- 3-4- strongly consider flight (team discussion)Score -5- fly if weather permitting

Yes =1 No = 0

Date Score Birth Wt Gest AgeDiagnoses Mode OutMode In Rec NICU Date Outcome LOS7/17/2012 1260 Bloody stools/R/O Sepsis/Apnea HEL HEL PICU-JHH 6/19/2013 back 3377/18/2012 4 636 24 extreme prematurity/RDS Heli Ambo DPT DPT7/22/2012 3 2406 33 NAS/Prematurity HEL HEL JHH 8/5/2012 home 148/13/2012 4 877 27 RDS/Prematurity Heli Heli UMMC 1/1/2013 Home 1418/16/2012 4 499 23.2 extremely premature Heli Heli JHBMC 8/29/2012 expired 138/16/2012 4 495 23.2 extremely premature Heli Heli JHBMC 8/29/2012 expired 138/23/2012 3 2200 34 Respiratory Distress/R/O Sepsis HEL HEL UMMS 9/12/2012 home 209/23/2012 3 3045 38 r/o pneumonia/r/o sepsis Heli Heli UMMC 10/22/2012 back 2910/11/2012 4 1570 28.2 RDS/premie Heli Heli UMMC 10/25/2012 Back 1410/13/2012 4 2922 37 RDS VS PPHN/R/O Sepsis HEL HEL JHH 10/21/2012 home 810/14/2012 3 958 28 Prematurity/RDS HEL HEL JHBMC 11/27/2012 PRMC 4410/28/2012 3 2790 36 RDS HEL HEL JHH 1/17/2013 home 8110/31/2012 4 4101 39 Seizures HEL HEL JHH 11/8/2012 home 811/1/2012 3 2210 33 RDS/R/O Sepsis HEL HEL JHBMC 11/15/2012 Easton 1411/1/2012 4 1180 30 Poss bowel obstruction HEL HEL JHH 11/9/2012 Back-PRMC 811/16/2012 4 1053 29 Prematurity/RDS/R/O Sepsis HEL AMB UMMS 3/8/2013 home 11211/16/2012 4 798 29 Prematurity/RDS/R/O Sepsis HEL AMB UMMS 4/24/2013 home 15912/14/2012 4 2.59 40.6 TET Heli Heli JHH 12/18/2013 home 36912/19/2012 3 1820 34 Bi choanal Atresia/resp distress Heli Heli UMMC 1/25/2013 back 3712/27/2012 4 1116 31 Prematurity/RDS HEL HEL JHBMC 2/8/2013 Easton 431/4/2013 3 1664 35 RDS/premie/IDM Ambo Heli UMMC 1/29/2013 Easton 251/8/2013 4 3728 39.1 r/o coarctation Heli Heli UMMC 1/10/2013 PICU- DC 1/21/13 21/18/2013 3 1403 28 premie/RDS Heli Heli UMMC 3/24/2013 home 651/24/2013 4 600 prematurity/Sepsis HEL HEL DPT DPT 2/8/2013 3 1.368 32.3 RDS/premie Heli Heli UMMC 2/19/2013 JHH 113/2/2013 4 4483 37 Neonatal Encephalopathy/PPHN HEL HEL PICU-JHH 4/2/2013 home 314/20/2013 4 814 25.5 Respiratory Distress Hel Hel JHH 8/30/2013 in NICU 1324/21/2013 4 603 24 Prematurity Hel Hel JHH 8/23/2013 expired 1245/2/2013 4 620 23 Prematurity/RDS/Sepsis HEL HEL JHBMC 5/11/2013 expired 95/2/2013 4 3009 37 HIE/Cooling HEL HEL JHH 5/11/2013 home 96/13/2013 3 1975 34 Trisomy-21/Imperforate anus/SepsisHel Hel JHH 7/2/2013 Back- Western MD196/14/2013 3 3640 39 GI Obstruction/GI- Hirschsprungs rule outHel Hel JHH 6/16/2013 home 2

Maryland Regional Neonatal Transport Program Air Transport Utilization FY13

Maryland Regional Neonatal Transport Program

Air Transports FY13• 32 air transports ( 4 one way- air & ground)• 1-5 air transports per month- median-2.5• 60% score of 4• Median gestational age= 33weeks (23.2-40.6)• Median weight=1480grams (495-4483)• Most common diagnoses:

– Prematurity and related issues (RDS,sepsis, GI obstruction…)

– HIE – 6 hour window• Outcome- home(15) died prior to transport(2),

death (4), Back (MWPH/G)/closer to home (10) still in hospital at time of report (1)

• Median Length of stay=15 days (2-159)

Telephone Consult with Neonatologists

Once the decision to transport is made all communication must be conducted via a communication center on a recorded line.

Education

•Thank you for your attention.

•Questions???

© S . T . A . B . L . E . ®

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T h a n k y o u !T h a n k y o u !

Used with permission, Karlsen, 2001