Conan Gasque (Host): Welcome to Inside Pediatrics, a podcast brought to you by Children's Hospital of Alabama in Birmingham. I'm Conan Gasque. Today, we're talking about the Critical Care Transport Program here at Children's, celebrating its 40th anniversary in 2023. And I'm joined by the director of that program, Jason Peterson. Jason, thanks so much for your time today.

Jason Peterson: Oh, it's my pleasure. Thanks for having me.

Host: So, I want to talk first about the program and what exactly it does. I know there are a lot of people who don't understand the specific role that this program has. What role do you all play here?

Jason Peterson: Yeah. So, we're a team of nurses and respiratory therapists that are employed by Children's of Alabama, and we have extensive experience and tenure here at the hospital taking care of pediatrics and neonates. And we travel all across the state of Alabama throughout the southeast and even farther if we need to by either helicopter, jet, or ground ambulance. And we provide the extension of the ICUs to our patients in need. So, patients in the community and rural settings will present to local hospitals and they'll get some stabilization. And then, we will transport or we will send our team out to those facilities and transport those patients back here to Children's.

Host: So mainly, it's hospital-to-hospital transport. You all don't show up at the scenes of accidents.

Jason Peterson: Correct. Yeah. We're not an EMS agency. We're an interfacility critical care team. So, we specifically do from another facility or hospital back here to Children's. And again, it's more of an extension of the ICU and the critical care realm of patient care that we offer. We operate much like the EMS industry, but no scene flights or no scene response.

Host: How do you sum up the importance of the role that you all play and why it's so crucial to do what you do?

Jason Peterson: Well, first and foremost, I count it an honor and a privilege to be a part of it. That's important to me. Children's has been great to me and my family. But from our standpoint, the relevance of our existence in the community is being able to extend the scope of practice from within the hospital. Nothing against my EMS friends. I work in EMS as well. But there are scopes of practices that limit EMS to some degree. And then, just the experience level, we take care of kids all day, every day. So, we value that and we want to take that value to the community and to our referral centers.

Host: So, I guess you deal with a lot of situations where you may have a child who is in a critical care situation at maybe a rural hospital somewhere else in Alabama. They need to get to Children's for the care that we offer here at Children's and you provide that transport.

Jason Peterson: Absolutely, yes sir.

Host: And so, essentially, I guess, like you said, is it sort of like a mobile emergency room type thing?

Jason Peterson: Yeah, a combination. Mobile emergency room slash mobile ICU. We do a lot of the critical care levels. I mean, we carry the inhaled nitric oxide that's used a lot of times in our ICU for our babies and even our pediatrics that have really, really sick lungs. Especially with COVID and now with the RSV season kind of coming on, we tend to use that a little more. We have the specialty medications and specialty equipment and monitors and that sort of stuff. And again, all that stuff somewhat exists in the EMS world, but we take it to a little bit different level.

Host: And I know you have multiple methods of transport, including a helicopter, which is a brand new helicopter as of within the last couple of years.

Jason Peterson: Yeah. Just from an aircraft standpoint, it's new to us, yes sir. But in our industry, we refer to a multi-mode transport team, so we offer the ground transport, the fixed wing jet and then primarily, now the helicopter. And we've had that modality since about 1999. And over the years, we've transitioned through different airframes. And so, our current airframe is a much newer, nicer airframe, twin engine, instrument rated to fly in the clouds a little bit if we need to. And a lot of bells and whistles.

Host: And as I mentioned off the top, the critical care transport program has now been around 40 years here at Children's of Alabama. What is that like for you, thinking about all the difference that this program has made over four decades now?

Jason Peterson: Oh gosh, I really can't truly wrap my head around it. I was doing a little research, obviously-- well, I won't say obviously, but I wasn't here when the team first started in 1983. I joined the team in 1997. But just looking at the sheer numbers, some of the data that I had pulled, and if I really just sit and think about the number of lives we've touched, and I realize Children's of Alabama touches so many more lives, but even just this morning, thinking about the acuity and, you know, criticalness of the patients we deal with, they are the sick of the sick and the most injured of the injured. So just thinking about that scope that we've reached and the impact we've been able to have hopefully positively for all of them.

Host: What is it like for you being a part of this program and knowing that you're on the front lines of making a difference in these kids' lives?

Jason Peterson: You know, that's something that I kind of wax and wane over the years. I get a little bit complacent. I'll just be judgmental and honest with you. And I take for granted what we do, and I'm just being transparent with that. But when I really sit down and look at the impact we've made, it's really humbling. I'll have people just in the general public, in the grocery store or whatnot, and they'll recognize me. I had this conversation with a friend at church the other day, and folks will recognize me, and I feel badly when I don't necessarily remember or recognize them. But a lot of times, you know, we can refresh a story or memory and kind of bring that back to me. And that just drives it home to me. I truly take for granted the impact we make on folks. And I'm thankful that I'm able to do that.

Host: I guess it's kind of cool to sit back every now and then and think about the fact that your day to day job is saving lives.

Jason Peterson: Yes. And again, I don't want to say we take it for granted. We're very thankful. But we do have to check ourselves at times and realize when we're responding to these emergencies, a lot of these families are in a situation that's the worst day of their life, if not one of the worst days of their lives. And here we are, some complete strangers coming in to obviously take care of their family or their child, but we have to recognize that that's rough for them, too, and that we're there to make a positive impact and ultimately provide the care for that patient.

Host: And it really has made an impact on children throughout the state of Alabama, but it's not limited to Alabama, right?

Jason Peterson: No, no. We, again, primarily are in Alabama. And over the recent years, our healthcare system and insurance, if you will, has kind of driven us into the in-state stuff. But we still take care of patients out of state. There are specialty treatments that are only available here at Children's of Alabama. And so, we're fortunate to be able to go and transport those patients back by medical jet if we need to. And occasionally, pretty rare that we take patients from here at Children's out to other states for some super subspecialty surgeries or treatments. So, we do travel to other states, mostly in the southeast, but we have a range to go all across the country if we need to.

Host: And we talked about 40 years. I know in such a technology-driven business or industry, whatever you want to call it, that's a lot of time. How has this program evolved over the four decades?

Jason Peterson: I think probably the biggest evolution has been our travel modes. Some of our care modalities, I understand when the team first launched in 1983, they only provided the ground transport and ambulances and then, with a collaboration with UAB and their transport team, used their jet.

And at that time, I'm told that they kind of had folks in the emergency department or in the ICU, and the docs would just come through and say, "Okay. Tag, you're it. Come go with me, and we'll go get this kiddo." So, we have evolved the staffing model a little bit forward, so we do have, uh, dedicated team members, nurses and respiratory therapists for the transport team. We're still physician-led, we don't always take a physician with us, but we're in frequent contact with our physicians back here. But again, the biggest transition has been the method of travel. So, you know, for several years, and even when I joined the team, it was just the ground and the jet. And then in 1999, we were able to add a collaboration with Alabama LifeSaver to start using their helicopter in a shared model. And then a few years later, evolved that to a dedicated model for us. And then, we've transitioned over the years now through a few different airframes. So now, we're in a much larger airframe to be able to travel faster, better, farther.

Host: So, you've really seen a lot of changes over the years. You've had a chance to affect a lot of people's lives over the years. How about some of the numbers? Can you tell me about some of the statistics of, you know, numbers of flights and various things like that?

Jason Peterson: Surely, yeah. I was pulling a little bit of data. And in recent years, we've been a little busier. You know, we have been averaging a little over 1,000 or maybe 1,100 or 1,200 transports per year. But over the 40 years, I look back and October of '23, we just kind of broke the 36,000 patient transport mark. And again, this year, or the last few years, most of those have been in the helicopter.

But I think the biggest number that got me was two factors, was the miles we've traveled. And we've traveled just over 7,122,000 miles. And I couldn't wrap my head around that. I was like, "Wow, that's, a lot." And then, another number that is looking at our staff tenure, we have 13 full time staff members and about three part-time team members. And looking at that group of folks, we've got four crew members that are over 4,000 transports. We've got one that's over 3,000 transports. And then, I have another four that are over 2,000 transports. So, a lot of tenure in our department.

Host: A lot of people who have put in a lot of time to make a difference in really important situations.

Jason Peterson: Surely. Yes, sir.

Host: So, 40 years of the critical care transport program here at Children's of Alabama, what does the future hold now?

Jason Peterson: Gosh, we want to continue to provide the highest level of care for our patients. We again cou itnt an honor and privilege that we're able to be that first impression of Children's for a lot of folks. And we realize it's in probably some of the worst times of those families' lives. But we want to continue that excellence. We want to potentially look at broadening our scope, adding additional team members, or maybe additional modes of transport, or I won't say additional modes, but additional vehicles to that fleet.

Host: So, great success in the past here at Children's of Alabama for this program and many great things ahead for the Critical Care Transport Program as well. Once again, Jason Peterson, Director of the Critical Care Transport Program. Jason, thanks so much for your time.

Jason Peterson: Thank you, sir.

Host: Thanks for listening to Inside Pediatrics. For more podcasts like this one, go to childrensal.org.