THIS PRESENTATION CONTAINS HOW TO TRANSFER BABIES IN EMERGENCY SITUATION ONE UNIT TO ANOTHER OR ONE HOSPITAL TO ANOTHER SAFELY......

1. Mr. SACHIN T. GADADE
M.SC ( N )
BY

2. INTRODUCTION
 Treatment of sick neonate in specialized
neonatal intensive care unit (NICU) has been
associated with decrease in mortality and
morbidity .
 In the early 1960s neonatal transport was
first used to make intensive care accessible to
those who needed it.

3.  If there is an acute storage of neonatal beds
and majority of the sick neonate in need of
urgent admission are dumped in pediatric
ward with Inadequate Infrastructure
 It is also transfer in pre-term delivery ,
prenatal illness, congenital malformation ,
critically ill, this baby need to transfer from
one health facility to another or ward to NICU.

4.  Why transport of sick neonate is necessary
 What is the difference between the organized transport and self transport
 Which baby needs transport
 What are the different types of transport
 How to organize a neonatal transport system
 What special care need to be given for a sick neonate during transport
 what are the different modes of transport
 How to transport in special condition
 What are the equipments required for neonatal transport
 Neonate deteriorates during transport

5.  How should one communicate for neonatal transport.
 What are the medico-legal issues related to neonatal transport
 How the family should be supported during transport
 How will transport a sick child in the absence of ambulance and equipments

6. In India majority of the deliveries still occurs at
home (approximately 60% in rural areas as
per NFHS-3) . Although hospital based
deliveries needs to be promoted, delivery of
sick neonates needing special care will still
take place at place with extremely limited
resources,necessitating need for transport.

7. Organized transport service provides almost
the same level of monitoring and the
quality of care during the transport that is
available in the advanced care facility.
ideally it should have the ability to
provide mechanical ventilation, multiple
fluid infusion therapy and cardio-
respiratory monitoring.

8. In India most sick neonate are transferred by their
parents or paramedical person either in private
vehicles or poorly equipped ambulance. There is
currently no dedicated neonatal services provided
by the states in India
In self transport services can not provided
the quality of care during the transport. In self
transport services can not provided mechanical
ventilation, multiple fluid infusion therapy,
cardio-respiratory monitoring.

9. Infants requiring advance medical and nursing care
exceeding what is available in there current
setting will need transfer to a higher health
facility.
The broad indication for which neonatal
transport should be considered are given,
 Preterm neonate with respiratory distress but
facilities for respiratory support (CPAP,
mechanical ventilation) are not available
 Very low birth weight

10.  prematurity: gestational age <32wks
 respiratory distress or apnea
 cyanosis
 hypoxic ischemic encephalopathy
 jaundice
 active bleeding in any site
 congenital hearth disease
 sever metabolic and electrolytes abnormality
 heart failure
 surgical condition
 requires intubation and ventilation

11.  The neonatal transport can be categorized as follows
1) home to health facility (hospital)
2) intra hospital transport (including delivery rooms,
operation theatres, neuroimaging, special procedure etc. )
3) to facilitate specialist management of the neonates
(movement to a regional center for cardiac, neurological,
renal or surgical opinion )
4) retrieval from a peripheral hospital for ongoing
intensive care (when mothers deliver prematurely without
warning )

12. The preparation would depend whether is from
home to health facility or pick from a health
facility by an organized transport team
ones a decision for transport is taken the
principles of neonatal transport are
 assessment
 stabilization before transport
 care during transport

13. PRE TRANSPORT STABILIZATION
 S.T.A.B.L.E.(sugar, temperature, artificial
breathing, blood pressure, laboratory work,
emotional support. )
 S.A.F.E.R.(sugar, arterial circulatory support,
family support, environment, respiratory
support,)
 T.O.P.S. (temperature, oxygenation, perfusion ,
sugar. )

14. Step I- assessment
assess the baby and depending on facilities check
for temp. airway, breathing, circulation, sugar.
step II- temperature maintenance
KMC by mother or attendant is a useful way to
maintain temperature. KMC care is good method
of temp. maintenance during transport especially
in resource limited condition when transport
incubators are not available

15. Step III – airway & breathing –
Assess airway for presence of any secretion
and position of neck (keep neck of the baby
in slight extension position )
assess for respiratory distress ;
whether baby require ventilation
Step IV- circulation –
check heart rate , urine out put , blood
pressure , etc.
Step V – sugar-
Check sugar with glucometer (if blood glucose
<40mg/dl , given 2ml/kg of 10% dextrose)

16.  The choice of vehicle will depend upon the
clinical urgency , traveling distance , weather
condition and its availability .
road ambulance
rotary wing fixed wing
(helicopter) aircraft

17. ROADAMBULANCE; (for 10 to 200 km)
ADVANTAGES
 adequate room (height and width ) for neonatal system
 transport staff can setting and monitoring
 enough room to perform procedure
 family member can accompany with transport team and
patient
 relatively easily available
 Lower costs or cost effective
 More space , better patient assess
 Can be stopped or diverted to the nearest hospital if any
emergency interventions

18.  DISADVANTAGES
 retrieval time is influenced by speed
limitation
 traffic delays and road conditions
 accidents may accurs

19. ROTARY WING (HELICOPTER) (50 to 300km)
ADVANTAGES
 speedy retrieval
 Better utilization of medical staff
 Less travel time out of hospital

20. DISADVANTEGES ;
 High cost
 Limited space
 Require a landing site close to the hospital
 Limited patient assess
 High noise and vibration level

21. FIXEDWINGAIRCRAFT(more than200 km)
ADVANTAGE
o Good for long distance
o Reasonable space to assess the patient
o family can travel with their baby

22. DISADVANTAGES ;
 require near by airport
 immigration clearance
 retrieval time and assistance with road
transport

23.  The transportation of neonates requires
several equipments
 POWER BACKUP
All the equipments in use should have a battery
backup and should be kept fully charged
sufficient adopters should be available
to make quick changeover to available mode
of power supply.

24.  GAS SUPPLIES
make sure the cylinders are filled
prior to onset of journey and will last the
duration of transport
LIST OF EQUIPMENTS REQUIRED FOR TRANSPORT
1) transport incubators
2) temperature monitor and probes
3) Oxygen and air cylinder

25. 1) Flow meter , oxygen tubing and adopters
2) Pulse oximeter
3) Neonatal positive pressure mask
4) Endotracheal tube
5) Mechanical ventilator
6) Laryngoscope
7) Mucus suction trap
8) Suction catheters
9) Feeding tube
10) Sterile gloves
11) Stethoscope
12) Cardiac monitor
13) Glucometer
14) Intravenous catheter
15) Syringes ,splint, sterile water
16) Micro drip seat
17) Infusion pump
18) Medication (epinephrine, dopamine, morphine,
phenobrbitone)

26.  The most appropriate action depends on the level of
skills of transport team, space, equipments available
in ambulance and distance from the receiving
hospital.
The two major strategies can be used in case of acute
deterioration are
1) Stop the vehicle and done the ET intubation (if skills,
space and equipments are available )
2) Don’t perform procedure in a moving vehicle; stop
the vehicle or get to the nearest hospital before
procedding.

27. Success of transport process depends on the effective
communication between the referral (sending) and receiving
hospital.
Communication for neonatal transport before, during and after
reaching hospital.
Subsequent to decision for transport – communication with parents
or family:
 nature and severity of illness and need for transport
 facility available at receiving hospital
 give example of previous successful transfer and outcomes

28.  type and mode of transport and time needed to
reach the receiving hospital
 name and contact number of key personnel at
referral and receiving hospital
 possible need for emergency procedure during
transport
 the availability of bed should be asked before
starting transport
 referred hospital should be informed to receiving
hospital in advance .

29. most medico-legal problems are a result of poor
communication and provision of inadequate information.
the condition of baby, risks involved during
transport and financial implications of transport and
treatment at the referral center should be discussed with
family and documented and the case record.
Ifbabyis diesduringtransport
 the ambulance should be stopped and CPR should be
performed
 if baby dies on the way , he/she should be first taken on
the higher health facility

30.  casualty admission should be done
 parents should be explained and death
certificate made by the medical person of
higher health facility.
 its responsibility of transporting team to
make death certificate of baby.

31. in absence of availability of proper ambulance and equipments for
the transfer of a sick neonate , some innovative methods used in
the past can be used .
 Thermocol boxes have been used to maintain neonates body
temperature
 in today’s era of air-conditioned cares and taxis, ambient
temperature inside the vehicle can be maintained between 26-28℃
 The accompanying person could provide kangaroo mother care
during transport
 The infant should be given direct breast feeding or supplemental
feeds with spoon during transport to prevent the hypothermia

32. ROLE OF NURSE

33. THANK YOU