3rd March 2010

THERE IS AN URGENT NEED FOR SPECIAL AMBULANCES MEANT FOR NEONATES & CHILDREN

The decision to transport a critically ill patient, either within a hospital or to another facility, is based on an assessment of the potential benefits of transport weighed against the potential risks. Critically ill patients are transported to alternate locations to obtain additional care, whether technical, cognitive, or procedural, that is not available at the existing location.

A tertiary level centre is being run for the past 20 years where new born babies who get critically ill are taken care. The centre is located at such a point that families having babies, staying within a radius of approximately 150 kms get admitted at this centre. More often than not the babies who get admitted here are found  to be profoundly moribund and in terminal condition, beyond any help at the time of arrival at the centre. What struck a chord in the heart, was the fact that these babies were not so bad (as per their status as stated by the referral doctor at the time of reference) when they had initially started their journey to this (NBCC) centre. They had deteriorated on the way. The curious feature was that, many babies were transported in these routine ambulances but, met with the same fate.

NEWBORNS & CHILDREN ARE NOT LITTLE ADULTS

The response of children to disease and injury differ both physically and physiologically from that of an adult in terms of:

  • Airway anatomy
  • Resistance
  • Various lung parameters
  • Oxygen consumption
  • Cardiopulmonary interactions
  • Temperature regulation and
  • Drugs doses

Essentials

The special requirements of a critically sick newborn or a child while being transported are as follows:

  • Maintenance of thermo neutral temperature
  • Asepsis
  • Accurate I/V fluids and ionotrops infusion
  • Monitoring of pulse, BP and oxygen saturation
  • Provision for Emergency medicines / drugs
  • Provision for procedures like –
  • Bag ‘n’ mask ventilation
  • Intubation
  • I/V cath/ intraosseous needle insertion
  • Suction, aerosol therapy
  • Proper illumination for observation/ procedures
  • Prevention of jolting/ untoward movements during transportation

Provision for oxygen

  • A H-Tank (Jumbo) oxygen cylinder is fixed beneath the combo bed with the help of two clamp for immovability
  • A small portable aluminium E Class oxygen cylinder which weighs only 3.1 kg was also placed, for short term use

Provision for monitoring

  • For oxygen saturation and pulse rate, a hand held pulse oximeter is placed
  • NIBP monitor for blood pressure measurement
  • Radiant warmer temperature probe for skin temperature

Provision for infusion of fluid

  • A screwed volumetric infusion pump and syringe driven pump was strategically placed to the ambulance wall for large volume and for catecholamine infusion respectively
  • A cage for holding IV infusion bottle was also secured to the roof of the ambulance

Asepsis during transportation

  • Most important aspect as patient may be lost after three-four days in the nursery / PICU due to sepsis acquired during transportation
  • Two hand rub antiseptic lotion bottles placed in a manner that the doctor and accompanying staff can access it easily in a sitting position

Battery backup and electricity supply

  • A KVA sine wave inverter has been installed
  • There are six electrical outlets supplied by the inverter

Organisation of ambulance services

  • Two drivers were appointed to ensure round the clock availability
  • Our EMOs doctors were trained extensively in neonatal and paediatric resuscitation
  • Transport team consists of one doctor, one staff and one helper

Medico Legal Issues during Transportation

  • Vehicle must be registered as ‘ambulance’ under Motor Vehicle Act 1988. Speaking plainly, one cannot convert any vehicle to an ambulance unless originally specified by the manufacturer
  • The insured may not be indemnified if the vehicle insured is not registered as ‘ambulance’ in Regional Transport Office (RTO)
  • Proper maintenance of the vehicle and the equipment
  • Written consent before transportation
  • Proper documentation before and during transportation
  • Develop a proper transportation team
  • Scoop and run approach by the referring institution is not taken kindly by Honourable court
  • One is liable for prosecution under CPA if the facilities in the ambulance are not at par with the care which the baby receives at the referring institution or the hospital

 

 

Source: Express Healthcare Management

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