Maggie McKay (Host): Welcome to the Peds Pod by Le Bonheur Children's Hospital. I'm your host, Maggie McKay. Today we'll find out more about Le Bonheur's Transport Team, Pedi-Flite with Kevin Witzel, Pedi-Flite Manager and paramedic. Kevin, thank you so much for joining us.

Kevin Whitsell, NR-P, BSHA: Thanks for having me. I'm excited to be here.

Host: We're excited to have you. So what specific services does Le Bonheur's Pedi-Flite Transport offer.

Kevin Whitsell, NR-P, BSHA: So Pedi-Flite is Le Bonheur's neonatal and pediatric critical care transport team. So basically what we're doing is we are bringing the ICU to the bedside of a patient that needs to be transported from an outside hospital to Le Bonheur.

Host: What are the most common conditions requiring pediatric transport via Pedi-Flite?

Kevin Whitsell, NR-P, BSHA: So one of the ones that really stick out because we're the only service within a vast amount of mileage, is neonates. Some of the other things, when you venture into the pediatric realm, we deal with everything from traumas such as gunshot wounds, any trauma that may be incurred from car wrecks, any of that trauma based stuff.

Respiratory season always hits us really hard in the aspect of busy ness and lots of patients coming in RSV, bronchiolitis, strep, all those things that we think of when we think about respiratory season. Those are some of our highest patient populations that we go and get. We can do something called high flow oxygen, which is something they utilize here in the hospital to get those children past that hump of being too sick to stay home, but also not sick enough for an ICU based admission. So these are the kids that go to the floors and our floor here at Le Bonheur is awesome at taking care of those high flow patients. So that's one of the biggest things that we offer is we travel with a very specialized team in the sense of we take a nurse, a paramedic, and a respiratory therapist with us on every single call that we go on.

So we have a vast amount of knowledge and all of those knowledge bases kind of complete this perfect circle in the way that we treat our patients.

Host: That is amazing. Is this on a helicopter or an airplane?

Kevin Whitsell, NR-P, BSHA: So there's a few ways that we can transport. Typically in the Memphis area, it's usually by ambulance. We have four staffed bases. We have a total of seven ambulances, and we have a couple of aircraft that we partner with Hospital Wing here in Memphis. That's their home base location, but they also provide us helicopter services in both Jackson and Jonesboro, which is also where our bases happens to be.

So they're able to provide us that helicopter transport. So it just depends on the sickness of the child along with times and mileages and things like that, that kind of determine which way we go. And we also for years now, but really has picked up in the last probably year, offer fixed wing transport in the continental United States.

So if you're anywhere in those 48 states and you need to come to Le Bonheur, we can get on a jet airplane and go across the country, pick you up, and bring you back to Le Bonheur for your treatment.

Host: That's amazing. Wow. Kevin, in what ways does Pedi-Flite address the unique needs of infants and neonates during transport?

Kevin Whitsell, NR-P, BSHA: So one of the ways during transport that we're always trying to let the patient have the best outcome from what we are doing, is we offer entertainment during the ride, whether that's us being the entertainment or having an iPad or a TV or something like that for them. We directly partner with Child Life very often to get these kind of ideas to make the transport feel a little bit better for the child or the infant.

 One of the things on the medical side that we do really well is our providers are such high level trained providers that they are able to see a child for what it is in the moment. And what I mean by that is many times as medical providers, especially coming from an EMS background, we look for big changes in patients and that will cue us into there's something happening.

We also carry very specialized medications. Normal EMS services don't carry antibiotics. They don't carry some of the narcotics that we carry and IV fluids that we carry. So it's a very specialized service in the way that we treat our patients. So during transport, we just have an impeccable assessment, when it comes to watching that child so closely, and it's something that typical transport just doesn't have.

Host: That's incredible. What are the criteria for determining whether a pediatric patient should be transported by air versus ground?

Kevin Whitsell, NR-P, BSHA: So a lot goes into this. There's been a lot of planning over the course of many, many years to get this down to an actual science. So we prioritize our calls in a certain way. So you have a priority one that is immediate life threat or a threat to losing a limb. So those would be things that fall in that priority one category.

And typically most of those are flights, just because, unless it's in just the Memphis local area, these five or 10 hospitals that we have around Memphis, those will typically always be flights. And then we prioritize the next level down, which is probable decompensation within an hour. So we use that criteria to determine whether that's going to be a flight or a ground.

And a lot of those go by flight because you think of how many hospitals are within an hour range from here. It's much quicker for us to get there by air. But when you get into the P three category, we're looking at decompensation within three to four hours. So then that changes a little bit and we start to incorporate some mileage and times in there.

So if a P three, which is considered to us non-critical in nature, those will be determined by whether the facility that we're going to is greater than two hours away. So if a facility that we're going to is greater than two hours away, then we will fly to get that patient for time sake, to get them back to Le Bonheur and get them the treatment they need in an appropriate timeframe.

P fours and P fives are all those scheduled transports that we do from the med, from other area hospitals. So those are always by ground.

Host: So let's talk about weather conditions. How does that impact the decision to use transport? What alternatives do you consider when the weather's just too bad?

Kevin Whitsell, NR-P, BSHA: So safety's obviously our number one priority. We want to keep not only our patients safe, but our crew safe. And with partnering with Hospital Wing, they've got minimums that they go by when they're checking a flight. So the neat thing that I didn't know when I started here eight years ago, was the fact that pilots don't get to know what's wrong with the patient, so it doesn't affect their transport decision.

Because obviously if you're somebody with a big heart like me and you hear this kid's torn apart and it's horrible and all these things, you immediately go, we have to go. So we try to take that pressure completely out of the equation when we talk about flight versus ground, we want to take all that pressure out of the equation.

One of the things that Hospital Wing does is they have a minimum ceiling, which is how low the clouds are to the ground, and a minimum visibility rate. So visibility rate is how far they can visually see because Hospital Wing's, aircraft pilots are visual pilots, and what that means is they don't fly solely by the instrument panel. They have to be able to see the ground.

So there's those minimums that are in place, but we also operate by a three to go, one to say no mentality, which means if anybody in that team, pilot, paramedic, RT, nurse says, I'm uncomfortable, we're not going. And then if we're not going, or weather plays a big enough factor where the minimums can't be met, then we go by ambulance.

Host: It must be so nerve wracking for the families of these kids. How do you prepare a family for the child's transport with Pedi-Flite? And what should they expect during the process? Can they go with them?

Kevin Whitsell, NR-P, BSHA: Yes, families are allowed to ride with us. The only caveat to that is they have to be in the front seat buckled up. Now, there's a few times when that's nearly impossible and we make decisions, case by case in that, in those areas where there's a reason for the mother or father or, or guardian or whoever to be in the back with the child.

So those are made by administrative level staff once the crew reaches out to us and poses that issue. Parents are always welcome to ride with their child. But what we've found in our experience is that when parents are in the back with children, it usually has a worse effect for the child, than it does with them being in the front seat, because children can feel our anxiety and our worry and our nervousness.

So when we take that away, we typically have better outcomes for the patient during the transport. Saying that one of the things that our transfer center, which is the call center for Le Bonheur, and they're the dispatch center for all the Pedi-Flites. So they're the ones that take the information, gather it all up, put it in a nice little package, and then deliver it to the doctors, the nurses, and the Pedi-Flite team. And what they do is they're really good about telling the referring facility all this stuff. Like, Hey, parents can ride with us. That's totally accepted. Just make sure that they know they're going to have to ride in the front. Or with helicopter transports, which is probably the most nerve wracking piece of what we do, there is no place for a parent to ride. So what we do is we're updating that family the entire time. We get their phone numbers. We're texting them during the flight and we're calling them as soon as we land, letting them know that we got there safely. One of the things that I always used to tell parents is, I know this is a very stressing time. I know that you're worried, but we are going to take the best care that we can of your child. And a lot of times just that acknowledgement that this is worrisome, this is very stressing and anxiety inducing, really puts parents at ease.

Host: Yeah. You're, you're humanizing it, I guess you'd say. So anything else in closing that you'd like to add that you think people should know?

Kevin Whitsell, NR-P, BSHA: I think that when you walk around the halls of Le Bonheur you see our ambulances driving up and down the street, one of the things that I want people to think are that those are the best pediatric clinicians in the business. We do a fantastic job. Our team is made up of some of the highest trained paramedics, nurses, and respiratory therapists that are out there.

I think they do a fantastic job. I'm super proud of the job that we do and the service that we provide and how we represent Le Bonheur. And you'll see us out and about in the community much more, in the coming weeks and months as we go out and really spread the message of, Hey, we're here. We want to transport your child, if you're ever in need of that. We hope that you're not, obviously, but if you're ever in need of that, we're the guys you want doing it. And we certainly want to give a big round of applause to everybody that works day in and day out to make Pedi-Flite what it is. Our providers are literally the best.

Host: It certainly sounds like it. Thank goodness for Le Bonheur, especially as a parent, that's for sure. Thank you so much. This has been so helpful and educational and really fascinating, Kevin.

Kevin Whitsell, NR-P, BSHA: Well, I am so appreciative that you had me on. I'm so happy that you guys decided to spotlight Pedi-Flite and we are just super excited for what the future holds.

Host: Absolutely. Again, that's Kevin Whitsell. To find out more, please visit LeBonheur.org/r-services/emergency-medicine/pedi-flite, F-L-I-T-E, or just start with Le Bonheur.org. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you, I'm Maggie McKay. Thanks for listening to the Peds Pod by Le Bonheur Children's Hospital.