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Woman And Infants
Woman And Infants

Pediatrics - Neonatal Transports

Women & Infants Hospital is called for neonatal transports from any of our affiliated hospitals in Rhode Island and southeastern Massachusetts. These include Kent Hospital, Memorial Hospital, Landmark Medical Center, Newport Hospital, St. Joseph's Hospital, South County Hospital, Westerly Hospital and the following hospitals in southeastern Massachusetts: Brockton Hospital, Charlton Memorial Hospital, Morton Hospital, St. Luke's Hospital, Sturdy Memorial Hospital, Tobey Hospital and several others.

Purpose of Service
The Neonatal Transport Service provides a highly specialized, skilled team for the stabilization and transportation of newborns in the Rhode Island and southeastern Massachusetts region. The majority of neonatal transports involve infants born at community hospitals who require treatment in a Level 3 intensive care nursery. Occasionally, infants are transported from Women & Infants to other institutions for therapies not currently provided (e.g., dialysis, extra corpal membrane oxygenation(ECMO), complex cardiac surgery and cardiac catheterization). The goals of the transport service include provision of efficienct, timely responses, essential stabilizing procedures and treatments, and safe, effective transport with continuous assessment and monitoring to reduce morbidity and mortality.

Team Composition
The neonatal transport team consists of a transport physician and a nurse, and often a respiratory therapist. In addition, two emergency medical technicians or paramedics operate the ambulance and provide assistance with equipment. The on-call resident or fellow is expected to be available in the Special Care Nursery within 30 minutes to depart for a transport. On occasion, for a critically ill newborn, the on-duty neonatal fellow will go on the transport while the unit is covered by the attending neonatologist.

A transport nurse is an important member of the team who is familiar with the equipment and transport procedures. When an infant is intubated or in respiratory distress requiring oxygen, a respiratory therapist will also be a member of the team.

Policies and Procedures
All transport requests are referred to the neonatal fellow or attending. A transport referral form is used to record essential information and document recommendations given to the referring physician. Once the team has been mobilized, the attending neonatologist or fellow in neonatology should call the referring physician to advise him/her of the team's estimated time of arrival and get an update on the infant's condition. All available information should be communicated to the transport team prior to its departure.

Air Transportation
There are situations in which air transportation for critically ill newborns is desirable, such as the infant who is an ECMO candidate. The decision to use helicopter transportation should be made by the neonatal fellow and attending in conjunction with the assistant nurse manager. It is important to realize that transportation by helicopter does not necessarily result in arrival of the infant at the receiving institution more quickly than ground transportation since there is often a response time of up to one hour. However, the critical period of time during which the infant is outside of the intensive care unit is minimized. In general, transportation to Boston by helicopter can be accomplished in approximately 20 minutes once the helicopter has arrived at Women & Infants. Frequently, a helicopter team picks up the infant but on occasion the fellow or attending performs the transport.

Transport Deferrals
As a center of excellence it is important for us to accept all transports. On very rare occasions, it is not possible for Women & Infants to accept a transported infant due to staffing or other constraints. When this is absolutely necessary, the physician taking the call should offer to make alternative arrangements for the referring physician and contact another Neonatal Intensive Care Unit to provide information and request transportation. Options include Boston Children's Hospital, Brigham and Women's Hospital, Beth Israel-Deaconess Hospital, Massachusetts General Hospital, and The Floating Hospital (New England Medical Center) in Boston and Yale-New Haven Hospital in Connecticut. The phone numbers for these institutions are available in the Neonatal Intensive Care Unit/Special Care Nursery.

If you require a neonatal transport team, contact the Neonatal Intensive Care Unit, 24 hours a day at 401-453-7999 and the transport team will arrange the rest.

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