Arranging a NNTP Transport
Inclusion Criteria for NNTP Transports
At present there is one team on-call for NNTP transport at any given time. In order then to ensure that the NNTP is available to those who would best benefit from the service, certain criteria for acceptance to transfer apply.
1.Infants must be 0 days to 6 weeks (corrected gestational age) AND weight less than 5.5 kg
2. Infants for NNTP transports must require INTENSIVE/HDU care management by a Neonatal Registrar/Consultant and Neonatal Intensive Care Nurse. Although most infants in this category do require ventilatory support, being intubated/or nCPAP is not necessarily a precondition for acceptance to transport.
3. Repatriation of patients who still require INTENSIVE care is generally accepted - subject to consultant decision. The NNTP is unable to conduct routine back transfers (repatriations) or routine transfers for investigative procedures.
4. The NNTP is not routinely available for repatriations of patients who require palliative care. Exceptions are subject to direct Consultant to Consultant referral.
5. The NNTP cannot be booked in advance but it is reasonable to inform the NNTP team of a possible upcoming transport ahead of bed confirmation. However, as another more urgent transport may occur in the interim, the NNTP team will be unable to guarantee its availability until the receiving hospital bed has been confirmed.
NNTP Referral Process
1. Only referrals made by the Consultant, Registrar or Neonatal Nurse Practitioner responsible for the infant can be accepted by the NNTP to transport. Calls made by other team members will result in unnecessary delays as they will require further verification by one of the above named clinicians.
2.The decision to accept the transport is made by the NNTP team in consultation with the transport consultant on call.
How to initiate a NNTP transfer
Transports to one of Nationís Level 3 NICUs:
The doctor in the referring hospital can call the NNTP directly on 0818300188 and the NNTP will facilitate/assist with the location of the bed. When the referring hospital does not have an established network or preferred receiving hospital, the hospital on call for the NNTP that week, also serves as the receiving Hospital on call in the first instance . See NICU bed-state
Transports to one of the Dublin PICUs (OLCH or CUH):
The referring hospital doctor must source a bed with the receiving hospital prior to referral to NNTP via the standard pathways (1890 213 213 /www.PICU.ie)
Time critical, Unstable patients:
Time critical patients are typically:
- Birth or imminent delivery of a patient < 27 weeks gestation in non-tertiary unit
- Acidotic/unstable infants with suspected duct dependent congenital heart lesion
- Infants requiring therapeutic cooling
- Infants requiring urgent, time critical surgery/surgical care in paediatric tertiary centre (e.g. patients with gastroschisis, tracheo-oesophageal fistula on ventilator, suspected volvulus or diaphragmatic hernia)
- Other critically ill/unstable infants requiring urgent tertiary ICU care
In these cases, please call the NNTP as soon as possible to request transfer. The bed in the receiving NICU/PICU should be requested, however this does not necessarily have to be confirmed prior to NNTP team mobilisation but MUST be finalised prior to leaving the referring hospital with the patient.
Note: it may be appropriate to transport time critical, deteriorating patient using local resources - this is at the discretion of the referring team/consultant. Factors like NNTP availability, severity of illness, distance, local human resources may play role. The NNTP team can assist with the decision.
Which mode of transport will the NNTP use?
The NNTP utilises two modes of transport
- Road ambulance
- Rotary wing (helicopter)
The majority of NNTP transfers are by road as this is usually the most practical mode of transport for the distances travelled in Ireland. The NNTP has two custom fitted ambulances and a back up vehicle dedicated to our service equipped with:.
Rotary Wing (helicopter)
- Complete transport incubator system including: Ventilator (SIMV/CPAP), suction, vital signs monitor, syringe pumps
- Nitric Oxide delivery system
- Portable Blood Gas Analysis system
- Locking device and tracking to secure incubators
- Forward style seating
- Hydraulic lift for incubator
- Generator to provide AC power
- O2 and Air supply >10 hrs
- Capacity to transport 2 incubators simultaneously
- Seating for extra personnel
- Work top space
- Powered cool box
- Intercom/ camera / driver alert system
Helicopter transfer is the preferred transport mode when:
1.there is an urgency of transport in relation to distance(>170 kms).
2.there is an urgency to provide a higher level of medical care than is available at the referral centre
3.adverse road conditions impede ground transport
It is important to note that although helicopters provide a means of rapid transport, distance alone should not influence the choice to transfer by air.
- The NNTP has developed a specific transport module for air transport that integrates into the Irish Air Corps' EC135 and AW 139 helicopters.
- This lighter weight incubator/ventilator system and trolley can be loaded safely and accommodated securely in these aircraft and also into NNTP and other national ambulances
- The infant may not be suitable for air transport as he/she can be adversely affected by the increased risks associated with air transport which include: hypothermia, hypoxia, increased gas pressure, air leaks, noise and vibration
- Unstable infants who are likely to require interventions en route are also unsuitable for air transport in the EC 135 aircraft as access to the infant is restricted. Access is much less restricted in the AW 139
Air transport may be affected by:
- weather conditions (eg: high wind or fog)
- availability of suitable landing site
- unavailability of aircraft
- unavailability of an ambulance that can accommodate the NNTP incubator to transfer between landing site and referring hospital
How soon will the NNTP arrive?
- The NNTP team is ready to mobilise from its hospital base within 45 minutes from the time of acceptance of the infant to transfer.
- If more than one transport request is received simultaneously, priority is given to the most critically ill baby and/or the baby in a hospital with limited personnel/resources to provide care for extended periods of time.
- En route the team will phone the referring hospital with an estimated time of arrival
- Departure times however may be influenced by:
- A concurrent transfer
- Availability of rotary wing aircraft for air transport
- The time taken by the NNTP team to travel to Baldonnell airport for air transport (usually >60 mins from time of referral call to departure from Baldonnell airport)
- Arrival time may be further affected by:
- Traffic and road conditions
- Weather conditions (rotary wing aircraft)
What to do before the arrival of the NNTP team.
It would be is of great assistance to the NNTP if, in conjunction with infant stabilisation procedures, the following checklist was prepared prior to the arrival of the team at the referring hospital:
- Complete NNTP Referral History Form as appropriate (Copies sent to all units and also available as download on this site).
- Maternal antenatal and perinatal records
- Neonatal records ( ie .history, diagnosis, treatment, orders, times drugs given, PKU, etc.)
- Relevant social history
- Parental contact information
- Consent to transfer ( NNTP consent forms are completed when NNTP team arrives)
- Make photocopies of relevant records and laboratory results (maternal & baby's)
- Make copies of X rays, if originals are to remain at the referring hospital
- Collect 10 ml of maternal blood in a plain tube and label appropriately (This is only necessary for some accepting hospitals-please consult with NNTP team)
- Ensure infant has two identity bands in situ
- Ensure that all infusions are administered via syringe pumps
- EBM for transfer with the infant should be placed on ice.
- Encourage parents to be present when NNTP team arrive in order to discuss the transfer and also to sign the NNTP Consent for Transfer and Treatment Sheet - if parents are unavailable then contact details are required in order to obtain a witnessed verbal consent
- Take photos of the infant for the parents
- Facilitate as much as possible that parents see and touch their infant
- If possible attend to any religious or cultural rites requested by the parents
- Identify appropriate support persons as necessary
After the NNTP Team Leaves
- Encourage and initiate expression if the mother wishes to breast feed
- Offer to call the receiving hospital and facilitate communication with the nursing and/or medical staff
Where is the responsibility of care during an NNTP transport?
- The stabilisation of the infant prior to transfer does not only begin when the transport team arrive at the referring centre but rather is an ongoing process from when the transport is accepted.
- It is the responsibilty of the referring hospital, in consultation with the transport team, to stabilise the infant before the NNTP arrive at the referring hospital.
- On arrival of the NNTP, the responsibility of care is shared between the referring hospital and the NNTP team. The NNTP teams keep records of any interventions they conduct, but the referring hospital should also keep their own records while the infant is still in the hospital.
- The NNTP is not a 'Swoop and Scoop' Service. The team must be satisfied that the infant is stable prior to transport and will carry out that which is necessary to stabilise the infant at the referring hospital. During this time the NNTP team rely on the staff at the referring hospital to work in collaboration with them (i.e. giving history, helping with procedures etc.).
- Consultant responsibility follows the same order as above. The transport team refer to the consultant on call in their parent hospital or with the receiving hospital and with the referring consultant while the infant is still in the referring hospital.