Typically, less than 10 percent of the patients transported by traditional “adult” transport teams are under the age of 14.
Research has shown that outcomes are better when children are transported by dedicated neonatal and pediatric transport teams.
Highly specialized neonatal and pediatric programs, such as the Critical Care Transport Program at Children’s Mercy Kansas City, can be the difference between life and death.
What do these programs offer that others don’t?
Angie Cunningham, RN, CCRN, C-NPT is here to explain how the Transport Program at Children’s Mercy is one of the largest in the nation and was the first neonatal/pediatric specialty program in the nation accredited by the Commission on Accreditation of Medical Transport Services (CAMTS) in all three forms of transport: ground, rotor wing and fixed wing.
Neonatal/Pediatric Transport: Experience Matters
Featured Speaker:
Learn more about Angie Cunningham, RN
Angie Cunningham, RN
Angie Cunningham is the Transport Outreach and EMS Relations Coordinator for the Children’s Mercy Critical Care Transport Team. She received her ADN at Moberly Area Community College in 1993 and recently completed her BSN at Western Governor’s University while holding CCRN-Neonatal and C-NPT specialty certifications. She has spent nearly her entire 22 year nursing career as a neonatal/ pediatric critical care nurse while specializing in mobile intensive care since 1999. After working as a traveling NICU nurse in various U.S. Childrens’ hospitals, Angie returned to St. Louis, Missouri and began her career in neonatal/ pediatric transport. In 2001 she moved to Kansas City to join the Children’s Mercy Critical Care Transport team and has experienced firsthand the growth of CMCCT into an award winning national leader in neonatal and pediatric transport medicine over the last 15 years. Providing education, tools and resources to ensure community healthcare providers are able to administer initial life saving treatment for ill and injured children has long been a passion of hers. Angie is active on several local, regional, state and national committees to improve pediatric training and education that improves the care provided to children regardless of their situation or location.Learn more about Angie Cunningham, RN
Transcription:
Neonatal/Pediatric Transport: Experience Matters
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I’m Dr. Michael Smith and our topic is “Neonatal Pediatric Transport: Experience Matters.” My guest is Angie Cunningham. Angie is the Transport Outreach and EMS Relations Coordinator for the Children’s Mercy Critical Care Transport Team. Angie, welcome to the show.
Angie Cunningham (Guest): Thank you, Dr. Mike. Thanks for having me on.
Dr. Mike: Why is this topic so important to you?
Angie: Well, it’s very, very important that our children are treated as children and making sure that they’re getting very specialized care that is guided towards what they actually need versus treating them the same as we treat an adult and we might have a different outcome.
Dr. Mike: When it comes to transport specifically, when you have, let’s call them an “inexperienced team” maybe not trained to transport kids, what are some of the common issues that you see when that happens? What are some of the outcomes that we want to avoid?
Angie: What we see with our typical EMS Programs is that they have some training in pediatrics but the volume of patients that they see are usually around less than 10% pediatric patients, even less than that are neonates. About less than about 1% of a typical EMS agency’s patients are actually critically ill newborns or children. In those situations, we see that they don’t necessarily have the experience or background to anticipate some of the potential complications. Children don’t tend to tolerate the actual transport environment physiologically as well as adults do, so with people that have critical care experience with pediatrics providing the transport, we are able to anticipate are they going to wake up, how are the medications going to work on them, how do they interact together, different disease processes and how we would see those kind of play out in the critically ill pediatric population. In addition to, we have a lot of children that have a lot of complex medical needs whether it’s congenital anomalies--they’re born with something that’s just not right; whether their heart isn’t formed correctly or it doesn’t function correctly or one of a myriad of different things. It’s just having the expertise of people that are used to these children and can anticipate so we see less actual full cardiac arrest events in these children, less accidental extubations where their breathing tubes come out, less situations where the breathing tube comes out; they’re not sedated appropriately or their seizures are treated adequately. Those types of things, we see a lot less if you use a pediatric specialty team for transport.
Dr. Mike: I think you said something important, Angie, and that is that the EMS system in the United States is top notch, obviously, and these are well-trained professionals but what it really comes down to, just to reiterate the point, it’s experience and that’s the point I’m trying to get at. Let’s go back. You mentioned some things there, the intubation tubes, seizure medication and that kind of stuff. Are there other outcomes that you can share with us that you see that are better when there is a properly trained transport team?
Angie: Absolutely. The biggest one is probably that there have been national studies that have proven that if you use a pediatric transport team for a critically ill pediatric patients, the morbidity and mortality will drop by 20%. So, you have a significant outcome of survival, long term effects.
Dr. Mike: That’s pretty impressive, Angie.
Angie: Yes, we feel like that’s a pretty big deal.
Dr. Mike: Yes! So, the next question, then, is with that type of outcome improvement are more and more EMS services, are they stepping up and providing more training, more experience to these transport teams or is it really kind of up to the hospital to take care of it?
Angie: It kind of depends. Most neonatal pediatric specialty teams are hospital-based out of pediatric hospitals. Not all, but the majority. The majority of your regular EMS response systems, they’ve stepped up pediatric training but the problem is the experience. They just don’t have the call volume. They don’t see the numbers of these children. When you spread out all the children over the entire nation, there’s just not enough volume that every EMS agency in the country would get enough experience with these kids to develop the level of comfort and expertise that you would get with a team that that’s all they see all day, every day.
Dr. Mike: So, when should a specially trained transport team be used? Are there specific guidelines that you apply?
Angie: There are. The American Academy of Pediatrics actually put out national guidelines several years ago. They recommend the use of a neonatal pediatric specialty team for any children being transferred that we anticipate ICU admission when they get to the receiving hospital; if they have respiratory distress that could possibly worsen during the transport period or any of our little guys that have had a recent life threatening event, even if they’ve been resituated and they’re stable at the point of transfer. Typically, those kids can have issues a little bit later on as well.
Dr. Mike: The American Academy of Pediatrics puts out these national guidelines for who should be transferred by a special team but who does the actual extra training that might be needed or, again, is that taken care of by the hospital? Is there any specific training that the transport team goes through?
Angie: Absolutely. It’s usually taken care of by the program that employs the specialty team which, again, is typically your pediatric hospital. It can be another type of hospital or other medical transport program. We do the gamut. We run a nurse respiratory therapist and an EMT team. So, that’s a little different than your EMS. It’s typically two paramedics or a paramedic and an EMT. Any of our nurses and respiratory therapists have to have a minimum of three years of critical care experience either in a newborn intensive care unit or in a pediatric intensive care unit before they even meet the qualifications to come join our team. Once they join, they have to do the entire gamut to make sure that we can take care of a 23-week gestation infant being born all the way to an 18-20 year old patient who has complex issues that we may continue to be seeing at the pediatric hospital. We have BLS, our neonatal resuscitation, pediatric advance life support, adult cardiac life support, transport professional advance trauma course. All of our nurses and therapists are also required to have a specialty certification within their first year of hire. We do many other trainings during the year. We do survival training with our crews once a year. We use all three modes of transport. We have a helicopter. We have 11 ground ambulances and then, we have a fixed-wing airplane and a jet that we utilize as needed. We have to do survival training with our crews in case we would have an unfortunate incident, then we need to know that the crew and the patient would have the best chance of survival. We actually take them out to the woods and we have them build fires and build shelters and do the things that they would need to survive in those situations. We do safety day training where we will take all of our aircraft, our primary and our backup, and our ambulances – we take our crews down and we go through every vehicle top to bottom. What would you do to shut this down if the pilot had an emergency? How would you handle emergency procedures in this vehicle? And all of those pieces as well. We so simulation with our medical directors. We have neonatal and a pediatric director who will come to our simulation lab here at Children’s with our teams and we actually do neonatal and pediatric simulation. We do it in our ambulances and in the sim lab. We are getting ready to start in our helicopter and fixed-wing as well. We actually do real-time situations and have the medical directors there for input and see how we follow our protocols and can people critically think and make sure that we can work through any possible eventuality that could happen since the team is kind of on their own when they’re out there physically.
Dr. Mike: Wow, that’s very in depth and very awesome what you guys are doing. Tell us about some of the success that the Critical Care Transport Program at Children’s Mercy has had over the years.
Angie: We are very proud of our program. Our program has grown immensely. When I came in 2001, we had two teams and we did probably around, I think, 2500 transports a year, 2000-2500. We know do almost 5300 transports a year. We have up to 10 teams on at a time during a 24-hour period. We were the first neonatal pediatric team to receive CAMES Accreditation, which is Commission on Accreditation of Medical Transport Systems, in all three modes of transport. We’ve been able to maintain that accreditation. I think we are on our fifth re-accreditation currently, actually. We’ve been honored by the National Air Medical Association with multiple awards over the years. The Critical Care Ground Award of Excellence, the Fixed-Wing Award of Excellence, the Transport Program of the Year. The one that really that kind of means the most to me is, in 2012, we received the Neonatal Pediatric Transport Award of Excellence. That’s sort of comparing apples to apples of the teams that do what we do. We were recognized as being very, very high quality and leaders in research, clinical care, operational procedures as well as safety. We have a very stringent safety program to make sure that our crews and our patients get where they need to be in a safe manner.
Dr. Mike: Very impressive, Angie. I just want to thank you for the work that you’re doing. It’s obviously extremely important and you guys have nailed it. You’ve got it down and that’s awesome. Also, thank you for coming on this show. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information you can go to ChildrensMercy.org. That’s ChildrensMercy.org. I’m Dr. Michael Smith. Thanks for listening.
Neonatal/Pediatric Transport: Experience Matters
Dr. Michael Smith (Host): Welcome to Transformational Pediatrics. I’m Dr. Michael Smith and our topic is “Neonatal Pediatric Transport: Experience Matters.” My guest is Angie Cunningham. Angie is the Transport Outreach and EMS Relations Coordinator for the Children’s Mercy Critical Care Transport Team. Angie, welcome to the show.
Angie Cunningham (Guest): Thank you, Dr. Mike. Thanks for having me on.
Dr. Mike: Why is this topic so important to you?
Angie: Well, it’s very, very important that our children are treated as children and making sure that they’re getting very specialized care that is guided towards what they actually need versus treating them the same as we treat an adult and we might have a different outcome.
Dr. Mike: When it comes to transport specifically, when you have, let’s call them an “inexperienced team” maybe not trained to transport kids, what are some of the common issues that you see when that happens? What are some of the outcomes that we want to avoid?
Angie: What we see with our typical EMS Programs is that they have some training in pediatrics but the volume of patients that they see are usually around less than 10% pediatric patients, even less than that are neonates. About less than about 1% of a typical EMS agency’s patients are actually critically ill newborns or children. In those situations, we see that they don’t necessarily have the experience or background to anticipate some of the potential complications. Children don’t tend to tolerate the actual transport environment physiologically as well as adults do, so with people that have critical care experience with pediatrics providing the transport, we are able to anticipate are they going to wake up, how are the medications going to work on them, how do they interact together, different disease processes and how we would see those kind of play out in the critically ill pediatric population. In addition to, we have a lot of children that have a lot of complex medical needs whether it’s congenital anomalies--they’re born with something that’s just not right; whether their heart isn’t formed correctly or it doesn’t function correctly or one of a myriad of different things. It’s just having the expertise of people that are used to these children and can anticipate so we see less actual full cardiac arrest events in these children, less accidental extubations where their breathing tubes come out, less situations where the breathing tube comes out; they’re not sedated appropriately or their seizures are treated adequately. Those types of things, we see a lot less if you use a pediatric specialty team for transport.
Dr. Mike: I think you said something important, Angie, and that is that the EMS system in the United States is top notch, obviously, and these are well-trained professionals but what it really comes down to, just to reiterate the point, it’s experience and that’s the point I’m trying to get at. Let’s go back. You mentioned some things there, the intubation tubes, seizure medication and that kind of stuff. Are there other outcomes that you can share with us that you see that are better when there is a properly trained transport team?
Angie: Absolutely. The biggest one is probably that there have been national studies that have proven that if you use a pediatric transport team for a critically ill pediatric patients, the morbidity and mortality will drop by 20%. So, you have a significant outcome of survival, long term effects.
Dr. Mike: That’s pretty impressive, Angie.
Angie: Yes, we feel like that’s a pretty big deal.
Dr. Mike: Yes! So, the next question, then, is with that type of outcome improvement are more and more EMS services, are they stepping up and providing more training, more experience to these transport teams or is it really kind of up to the hospital to take care of it?
Angie: It kind of depends. Most neonatal pediatric specialty teams are hospital-based out of pediatric hospitals. Not all, but the majority. The majority of your regular EMS response systems, they’ve stepped up pediatric training but the problem is the experience. They just don’t have the call volume. They don’t see the numbers of these children. When you spread out all the children over the entire nation, there’s just not enough volume that every EMS agency in the country would get enough experience with these kids to develop the level of comfort and expertise that you would get with a team that that’s all they see all day, every day.
Dr. Mike: So, when should a specially trained transport team be used? Are there specific guidelines that you apply?
Angie: There are. The American Academy of Pediatrics actually put out national guidelines several years ago. They recommend the use of a neonatal pediatric specialty team for any children being transferred that we anticipate ICU admission when they get to the receiving hospital; if they have respiratory distress that could possibly worsen during the transport period or any of our little guys that have had a recent life threatening event, even if they’ve been resituated and they’re stable at the point of transfer. Typically, those kids can have issues a little bit later on as well.
Dr. Mike: The American Academy of Pediatrics puts out these national guidelines for who should be transferred by a special team but who does the actual extra training that might be needed or, again, is that taken care of by the hospital? Is there any specific training that the transport team goes through?
Angie: Absolutely. It’s usually taken care of by the program that employs the specialty team which, again, is typically your pediatric hospital. It can be another type of hospital or other medical transport program. We do the gamut. We run a nurse respiratory therapist and an EMT team. So, that’s a little different than your EMS. It’s typically two paramedics or a paramedic and an EMT. Any of our nurses and respiratory therapists have to have a minimum of three years of critical care experience either in a newborn intensive care unit or in a pediatric intensive care unit before they even meet the qualifications to come join our team. Once they join, they have to do the entire gamut to make sure that we can take care of a 23-week gestation infant being born all the way to an 18-20 year old patient who has complex issues that we may continue to be seeing at the pediatric hospital. We have BLS, our neonatal resuscitation, pediatric advance life support, adult cardiac life support, transport professional advance trauma course. All of our nurses and therapists are also required to have a specialty certification within their first year of hire. We do many other trainings during the year. We do survival training with our crews once a year. We use all three modes of transport. We have a helicopter. We have 11 ground ambulances and then, we have a fixed-wing airplane and a jet that we utilize as needed. We have to do survival training with our crews in case we would have an unfortunate incident, then we need to know that the crew and the patient would have the best chance of survival. We actually take them out to the woods and we have them build fires and build shelters and do the things that they would need to survive in those situations. We do safety day training where we will take all of our aircraft, our primary and our backup, and our ambulances – we take our crews down and we go through every vehicle top to bottom. What would you do to shut this down if the pilot had an emergency? How would you handle emergency procedures in this vehicle? And all of those pieces as well. We so simulation with our medical directors. We have neonatal and a pediatric director who will come to our simulation lab here at Children’s with our teams and we actually do neonatal and pediatric simulation. We do it in our ambulances and in the sim lab. We are getting ready to start in our helicopter and fixed-wing as well. We actually do real-time situations and have the medical directors there for input and see how we follow our protocols and can people critically think and make sure that we can work through any possible eventuality that could happen since the team is kind of on their own when they’re out there physically.
Dr. Mike: Wow, that’s very in depth and very awesome what you guys are doing. Tell us about some of the success that the Critical Care Transport Program at Children’s Mercy has had over the years.
Angie: We are very proud of our program. Our program has grown immensely. When I came in 2001, we had two teams and we did probably around, I think, 2500 transports a year, 2000-2500. We know do almost 5300 transports a year. We have up to 10 teams on at a time during a 24-hour period. We were the first neonatal pediatric team to receive CAMES Accreditation, which is Commission on Accreditation of Medical Transport Systems, in all three modes of transport. We’ve been able to maintain that accreditation. I think we are on our fifth re-accreditation currently, actually. We’ve been honored by the National Air Medical Association with multiple awards over the years. The Critical Care Ground Award of Excellence, the Fixed-Wing Award of Excellence, the Transport Program of the Year. The one that really that kind of means the most to me is, in 2012, we received the Neonatal Pediatric Transport Award of Excellence. That’s sort of comparing apples to apples of the teams that do what we do. We were recognized as being very, very high quality and leaders in research, clinical care, operational procedures as well as safety. We have a very stringent safety program to make sure that our crews and our patients get where they need to be in a safe manner.
Dr. Mike: Very impressive, Angie. I just want to thank you for the work that you’re doing. It’s obviously extremely important and you guys have nailed it. You’ve got it down and that’s awesome. Also, thank you for coming on this show. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information you can go to ChildrensMercy.org. That’s ChildrensMercy.org. I’m Dr. Michael Smith. Thanks for listening.