CHILDREN S HOSPITAL EMERGENCY TRANSPORT
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1 RADY CHILDREN S HOSPITAL EMERGENCY TRANSPORT Dana Patrick, MHA,BSN, RN, CENP Director of PICU and Pediatric Emergency Transport Rady Children s Hospital San Diego
2 THE INCEPTION OF NEONATAL TRANSPORT: 1972 We ve seen some growth over the years.. THE INCEPTION OF PICU TRANSPORT: 1977 TOTAL TRANSPORTS FOR BOTH TEAMS LESS 100 PER YEAR
3 NEONATAL AND PEDIATRIC Emergent Transports CALENDAR YEAR COMPARISON Total Primary NICU Transports Total Primary PICU Transports
4 WHO IS CHET NOW??
5 TWO TEAMS. NICU CHET Team Delivery room resuscitation Newborn stabilization Will return convalescing newborns to the referral hospital PICU CHET Team Patients 30 days to adult Provide immediate response to community hospitals, physicians offices, clinics
6 MODE OF TRANSPORT 10% 11% 79% Ground Fixed Wing Rotor
7 CHET TEAM PROVIDES CRITICAL CARE TRANSPORT A mobile intensive care unit Team per call consists of licensed personnel 1 RN + 1 RRT Intensive care by training and education + skilled in Advanced Life Support (ALS) measures (intubation, needle thoracentesis, expert IV, UAC/UVC lines, IO placement, resuscitation code leaders) Team has ability to morph e.g. adding an MD or NP as the situation requires, once activated team has responsibility to community to respond quickly
8 MOBILIZATION In house 24/7 NICU CHET Team Back-up 2 nd team in house 12 hrs/day M-F Ability to Mobilize 3 rd team from home Total of 21 team members Ability to make 10 teams In house 24/7 PICU CHET Team Back-up 2 nd team in house 12/7 Ability to Mobilize 3 rd team from home Total of 22 Team members Ability to make 10 teams
9 PLACES WE GO All of San Diego County Riverside County Imperial County Orange County Los Angeles County Northern California Arizona: Yuma, Phoenix, Lake Havasu Hawaii Saipan Guam You call we go! We pick up in Emergency Rooms, Delivery Rooms, Birth Centers, Physicians Offices, Clinics, Urgent Cares, Hospital Inpatient Units (PICUs, NICUs, Medical units)
10 CHET RESPONSE TIMES. Once activated, team should be en route: By ground: 10 min or less By helicopter: launch 15 min or less By airplane: take-off 30 min or less
11 What we do when not on CHET. Code Blue Team Rapid Response Team Trauma Team Members and Responders Difficult IV Start Team Code Gray Responders Public Relations and Community Outreach
12 WHAT WE DO IN A DISASTER Teams can be deployed to a 3 county area as needed Advanced skills and training for Neonates and Pediatrics Specialty Training Includes Trauma Nurse Team Leaders Ebola response ECMO Inhaled Nitric Oxide Complex Multisystem Organ Failure management Advanced Cardio-Pulmonary Resuscitation Skills (Many team members teach PALS/NRP)
13 WHAT WE DO IN A DISASTER When in-house Respond to the PICU and NICU Prepare for possible patient evacuation Respond to the Emergency Department as directed EOC will Direct Dispatching of Team as needed.
14 WHAT WE DO IN A DISASTER Transport Car BLS ALS CCT Specialized Life Support Stable Stable Minimal Moderate Maximal Mobility Car/Car seat Home wheel chair Wheelchair or Stretcher Wheelchair or Stretcher Stretcher Incubator Transport Stretcher Nutrition All PO Intermittent Enteral Monitoring Level/ Stability Routine Vitals Routine Vitals & O2 Sat, moderately stable Continuous Enteral or Partial Parental Frequent Vitals & Cardiac Monitoring; Interventions possible Pharmacy PO Meds IV Lock IV Fluids IV Drip without titration TPN Dependent Continuous changing status; Interventions probable Titrated IV drip, TPN Dependent TPN Dependent Specialized requirements, equipment or limited resources; High Complexity IV Drip 2, complex med & monitoring requirement
15 WHAT WE DO IN A DISASTER Life Support Pharmacy Mobility Minimal = Moderate = Maximal = IV Drip = Car (Vehicle) = Wheelchair = Stretcher = Immobile = O2, Peripheral IV, Trach (non-vent) CPAP/BiPAP/Hi-Flow, Chest tube, Continuous Nebulizer, Stable home vent Ventilator, ECMO, External Pacemaker, Highly Specialized Equipment Pharmacological agents that cannot be discontinued for transport, agents that require active monitoring. IV drips that can be maintained safely at current rate versus those that need dose monitoring and possible titration en route to destination (i.e. vasopressors, insulin, etc ) Able to get in and out of non-ambulance car, van or bus, sit up and follow command Some impairment related to mobility, unable to ambulate long distances Unable to ambulate or contraindicated to current medical status condition Unsafe to move without specialized equipment. Non-ambulatory bariatric, unstable cervical fracture (includes incubator)
16 Questions? CHET CARING FOR OUR FUTURE
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