Summer 2005

UCSF Acquires Pediatric Critical Care Ambulances

Two ambulances specially equipped to provide intensive care for critically ill infants and children are the latest addition to the transport program at UCSF Benioff Children's Hospital.

"The transport team brings the UCSF intensive care unit to the patient's bedside at the referring hospital and maintains that level of care throughout the transport," explains Christa Thomas, RN, assistant transport program manager.

Fully Equipped

The two new critical care ambulances, designed with help from the UCSF Benioff Children's Hospital transport team, are equipped to handle children of all ages. "It is not uncommon to transport a delicate, 800-gram premature infant, followed by a 12-year-old in septic shock," Thomas says. The ambulances carry state-of-the-art equipment, which may include one of two critical care transport isolettes housing ventilators, suction apparatus, IV infusion pumps and cardiorespiratory and pulse oximetry monitors. Each also has the ability to provide nitric oxide therapy in transport. A pediatric critical care gurney provides similar equipment to older infants and children. This equipment also can be used during air transport via fixed-wing air ambulance with the full UCSF team.

Each transport team is equally high level, including a pediatrician or neonatal nurse practitioner, an experienced transport nurse and two emergency medical technicians (EMTs). The UCSF Benioff Children's Hospital team provides one of the highest levels of care and experience available for pediatric transport in Northern California. The service currently includes 26 transport nurses working in 12-hour shifts. Each has approximately three to five years of pediatric or neonatal critical care experience, plus intensive transport training provided through the program. Many of the nurses are qualified to care for both pediatric and neonatal patients. There are six neonatal nurse practitioners and six transport physicians, augmented by PICU and NICU fellows.

Smoothing Transitions

The American Academy of Pediatrics recommends that children and infants be transported in specially equipped and staffed ambulances, but relatively few have the kind of equipment and staff available in the UCSF Benioff Children's Hospital vehicles, according to Thomas, who has been with the program since 1988.

"Our goal is to stabilize the child before we leave," she adds. "Children are most at risk during transport. We talk about 'swoop and scoop' for most ambulances, but we spend as much time as we need stabilizing the child at the hospital before we start transport; what might be called 'stay and play.' The staff and physicians at our community hospitals play an important role in the initial stabilization of the patient. The relationships we have established with our colleagues at the referring hospitals provide a smooth transition of care for the patient and family.

Family-Centered Care

Thomas also points out that just as family centered care is important in the hospital, it also is a mainstay of the transport service. "This is a critical and stressful time for families," she says. "When possible, we will bring a parent back with us in the ambulance or plane. It can be very frightening for the child and parent if they have to be separated at this time.

"We are taking care of the whole family," Thomas says. "If possible, we help initiate bonding between a mom and a new baby. We take the baby to see the mom before departing. We make sure the baby photo is taken with a digital camera that we can print at the bedside to keep. We become part of their team."

The ambulances also are designed to reassure the sick child. Glow-in-the-dark stars and planets decorate the ceilings. Bright, colorful decals are in the interior. Children who are well enough can use the ambulance's virtual reality goggles to watch DVDs, or can play with one of the washable toys on hand. Each child receives a special teddy bear, dressed in a transport uniform, to keep.

The transport team brings about 750 pediatric patients a year from as far as Oregon to the north, Nevada to the east, and San Luis Obispo and Fresno to the south. The service also arranges transports for more than 300 patients who use regional ambulance services. About 60 percent of the patients in the Pediatric Intensive Care Unit and the Intensive Care Nursery arrive via the transport service. UCSF Benioff Children's Hospital has contracts with 19 regional hospitals to provide pediatric and neonatal tertiary and quaternary care.

A new pediatric access center is being implemented to streamline all pediatric transports, transfers and urgent admissions to UCSF Benioff Children's Hospital. The access center provides one-phone-call admission acceptance to UCSF and access to UCSF physicians for consultations.

For more information, contact the UCSF Children's Hospital Pediatric and Neonatal Transport Service at (415) 353-1246. To arrange for pediatric and neonatal critical care transport services call (877) UC-CHILD or (877) 822-4453.

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