perinatal transport standards - in.govindiana perinatal transport standards page 3 of 20 definitions...

IndianaPerinatalTransportStandards

DevelopedbytheIndianaPerinatalQualityImprovementCollaborative,SystemDevelopmentCommittee

EndorsedbytheIndianaPerinatalQualityImprovementCollaborativeGoverningCouncilMarch26,2014


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STANDARD TITLE

I. Certification

II Maternal‐FetalQualityAssurance

III Maternal‐FetalCompetencies

IV MaternalFetalTransportEquipment

V Maternal‐FetalMedication

VI NeonatalQualityAssurance

VII NeonatalCompetencies

VIII NeonatalTransportEquipment

IX NeonatalMedication

X PerinatalTransportPersonnelLicensure,Certification,andEducation

XI PerinatalSafetyMeasures

XII PerinatalPoliciesandProtocols


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DEFINITIONS

Adebriefisadiscussionamongallcoordinatedresponders,medicaldirectorsandphysicianstoconductarootcauseanalysis.

Thedispatchtimeisdefinedasthetimefromacceptanceofthetransporttonotificationofthetransportservice. Theenroutetimeisdefinedasthetimefromnotificationoftransportservicetothetimewhenentirecrewisonboard

thevehicleandstartingtotravel. JustCultureisdefinedasanerroranalysistoolthatrecognizesthatindividualpractitionersshouldnotbeheld

accountableforsystemfailingsoverwhichtheyhavenocontrol.Ajustculturealsorecognizesmanyindividualor“active”errorsrepresentpredictableinteractionsbetweenhumanoperatorsandthesystemsinwhichtheywork.However,incontrasttoaculturethattouts“noblame”asitsgoverningprinciple,ajustculturedoesnottolerateconsciousdisregardofclearriskstopatientsorgrossmisconduct.(FromtheAHRQGlossary)

Aperinataltransportteammaytakethreeforms:o Hospital‐based:thevehicle(airorground)isownedbythehospitalandallstaffingisprovidedbythehospital;o Contracted:thevehicle(airorground)andstaffingareexternaltothehospitalo Combination:thevehicle(airorground)iscontractedandstaffinsidethepassengercompartmentarehospital

based. Apre‐transportbriefingisadiscussionofthestatusofthepatientandallissuesidentifiedonthepre‐transport

checklistprovidedbythestatepriortothedeparture. Asentineleventisanunexpectedoccurrenceinvolvingdeathorseriousphysicalorpsychologicalinjury,ortherisk

thereof.Seriousinjuryspecificallyincludeslossoflimborfunction.Thephrase,‘ortheriskthereof"includesanyprocessvariationforwhicharecurrencewouldcarryasignificantchanceofaseriousadverseoutcome.

RootCauseAnalysisisdefinedasanerroranalysistoolinhealthcare.AcentraltenetofRootCauseAnalysisistoidentifyunderlyingproblemsthatincreasethelikelihoodoferrorswhileavoidingthetrapoffocusingonmistakesbyindividuals.(FromtheAHRQGlossary)


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StandardI:CertificationAllcontractedorcenter‐basedperinataltransportteamsthatconductinter‐facilitytransfersofhighriskmaternal‐fetalorneonatalpatientsshallbecertifiedbythecommissionasanambulanceproviderorganization.("commission"meanstheIndianaEmergencyMedicalServicesCommission(836IAC1‐1‐1(15)).ThefollowingstandardsreflecttheadditionalstandardsnecessaryforMaternal‐FetalandNeonatalTransport.

StandardII:Maternal‐FetalQualityAssurance2.1Inadditiontocomplyingwithallreportsandrecordsrulesin836IAC1‐1‐5,thecertifiedprovideroftheMaternalFetalTransportProgramshalltrackthefollowingbenchmarks:

a. Delivery≤30minutesfromarrivalatreceivinghospital;b. Diversionoftransportduetomaternalandorfetalstatuschangeinroute;c. Incidenceoflossofcommunicationwithmedicalcontrolforanythinglongerthan5minutes;d. Changeintransportasset(groundtoairorviceversa);e. Deliveryinroute;f. Incidenceofsentinelevents;g. Transportcrewmemberinjuryduringtransport;h. Anyreasonfortransportdelay:

i. Accident—MotorVehicleAmbulance,flight;ii. Delayinunscheduledtransportdispatchtimeis>15minutes;iii. Delayinunscheduledtransportenroutetimeis>15minutes;iv. Mechanicalfailureofambulanceoraircraftthatleadstoatransportdelay;v. Equipmentfailure;vi. Weatherorroadrelated(constructions,accidents)issues;vii. Crewmember;

h. Maternalfetalinjuryduringtransport;andi. Maternalandorfetalstatusdeemedunstablefortransportatsendingfacility.

2.2Whenasentineleventoccurs,theperinataltransportteam,medicaldirector,andmedicalcontrolphysicianmusthavea


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StandardII:Maternal‐FetalQualityAssurancedebrief.Thedebriefmustbeinitiatedwith72hoursandtherootcauseanalysiscompletedwithin5workingdays.2.3Teamsarerequiredtohaveapre‐transportbriefingregardingthepatient(s)conditionpriortoassumingcareofthepatient(s).2.4Eachperinataltransportteamshallhavewritteninternalqualityreviewprocedures/protocols.2.5EachhospitalwithanperinataltransportteamshallimplementaroutinescheduleofQualityImprovementmeetingsandarecordofminutesmaintained.2.6Transportteamsmustconductquarterlyreviewsofthefollowingelementsandmaintaindocumentationofthereviewsincompliancewith836IAC1‐1‐5(c):

a) Transportindication(s);b) Medicaland/ornursinginterventionperformedormaintained;c) Timeofintervention:

a. patientresponsetointerventions;andb. appropriatenessofinterventionperformedoromissionofneededintervention

d) Patientoutcomeatarrivalofdestination;e) Patient'schangeinconditionduringtransport;f) Timelinessandcoordinationofthetransportfromreceptionofrequesttoliftofforambulanceenroutetime;g) ReviewofPre‐transportinspectiondocumentationh) Safetypracticesdocumented;i) Operationalcriteria:

a. numberofcompletedtransports;b. numberofabortedorcanceledflights/transportsduetoweather;c. numberofabortedorcanceledflights/transportsduetomaintenance;d. numberofabortedorcanceledflights/transportsduetopatientconditionandalternativemodesof

transportation;ande. numberofabortedorcanceledflights/transportsduetounavailableteam.

j) Communicationscenterororganizationmustmonitorandtrack:a. InstrumentFlightRules(IFR)/VisualFlightRules(VFR);


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StandardII:Maternal‐FetalQualityAssuranceb. Weatherattimeofrequestofthereferringandacceptingfacilityandduringtransportifchangesoccur;c. Transportacceptancetoliftofftimesortheroadtimes;andd. Allabortedandcancelledtransportrequests‐times,reasonsanddispositionofpatientsasapplicable.

StandardIII:Maternal‐FetalCompetencies3.1Nursing:InadditiontocompliancewithIC25‐23andIAC848,Maternal‐FetaltransportnursesshalladheretotheAssociationofWomen'sHealth,ObstetricandNeonatalNurses(AWHONN)Basic,HighRiskandCriticalCareIntrapartumNursing:ClinicalCompetenciesandEducationGuide.Thedocumentationofcompliancewiththestandardsmustbemaintainedintheemployeepersonnelfiles.3.2EmergencyMedicaltechnician/Paramedic:Mustmeetand/orexceedstherequirementsestablishedin836IACArticle4.3.3Maternal‐FetalTransportMedicalDirector:

a) MustbeBoard‐certifiedorbeanactivecandidateforBoardcertificationinObstetricsorMaternal‐FetalMedicineandisresponsibleandaccountableforsupervisingandevaluatingthequalityofmedicalcareprovidedduringaMFtransport.

b) Mustbelicensedandauthorizedtopracticeinthelocationinwhichthemedicaltransportserviceisbasedandhaveeducationalexperienceintheareaofhighriskobstetricsorutilizeamaternal‐fetalmedicinespecialistasaconsultantwhenappropriate.

c) Musthaveknowledgeofcurrentconceptsofappropriateuseoftransportassets‐annuallymustincludebutisnotlimitedtothefollowing:

a. “JustCulture”:Highlyreliablestandardsofpatientsafety;b. Patientcarecapabilitiesandlimitations;c. Continuingeducationintransport;d. Crewresourcesmanagement;e. Stressrecognitionandmanagement;andf. Infectioncontrol;

d) Musthaveexpertiseinriskmanagementandsafetytraining.


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StandardIII:Maternal‐FetalCompetencies3.4ClinicalCareSupervisor:

a) Responsibleforsupervisionofpatientcareprovidedbythemembersoftheteamdirectlyemployedbythetransportprogramandworkscollaborativelywiththemedicaldirector;

b) Overseesqualityinitiativesoftheprogram;c) Musthire,train,andprovidecontinuingeducationfortheservice;d) Responsiblefortheevaluationofthecrewmemberse) Mustmaintaindocumentationofcompetenciesineachemployee'spersonnelfile.

3.5ProgramManager:a) Theprogrammanagerwillberesponsibleforthemanagementandoversightofthematernal‐fetaltransportprogram.b) Competencies:

a. Humanfactors;b. Justculture:Highlyreliablestandardsofpatientsafety;c. Sleepdeprivation;d. Stressrecognitionandmanagement;e. Safetyandriskmanagement;f. Qualitymanagement;andg. Knowledgeofnational,regionalandlocalstandardsofclinicalpractice,aviationandgroundregulationsas

appropriate.c) Documentationofcompetenciesmustbemaintainedintheemployee'spersonnelfile.

StandardIV:MaternalFetalTransportEquipment4.1Theambulanceusedformaternal‐fetaltransportmusthaveemergencycareequipmentasidentifiedin836IAC1and/or2.WhichleveloftransportisuseddependsonpatientacuityasdeterminedbyISDHestablishedalgorithms.Inaddition,eachhospitalwithamaternal‐fetaltransportteammusthavethefollowingequipmentoritsequivalent:

a) Filterneedles;b) Blueportcaps;


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StandardIV:MaternalFetalTransportEquipmentc) Syringes;d) Pumptubing;e) Piggybacktubing;f) Stopcocks;g) Stopcockextensionset;h) Yportswithbluelocks;i) IVstartkits;j) 18gangiocaths;k) Blueluerlocks;l) SterileWaterflushes;m) IntegrativeTherapies(optional):

a. Musicdevice;b. Earbuds;c. Essentialoils;

n) Minifan(optional);o) Activatedchemicalinfantthermalmattress;p) AdultStethoscope;q) Sterilegloves(varietyofsizes);r) NeonatalResuscitationProgrampouch:

a. Babystethoscope;b. Self‐inflatingbag;c. Regularnewbornmask;d. Preemiemask;e. Infantpulseox;f. Polyethyleneorplasticbarrier;g. Blankets;h. Syringe;


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StandardIV:MaternalFetalTransportEquipmenti. Cordclamps;j. Hat;k. Diaper;

s) Vaginalexampouch:a. Sterileexamgloves;b. Peri‐pads;c. Lubricatinggel;

t) Fetalmonitor:a. Monitorpaper;b. Powercables;c. Tocodynomonitor;d. Fetalheartrateultrasoundmonitor;e. TransducerGel;f. Fetalmonitorbelts;g. HandheldDopplerdevicefordetectionoffetalheartrate;andh. IVpump;

StandardV:Maternal‐FetalMedication5.1Theambulanceusedformaternal‐fetaltransportmusthavemedicationasidentifiedin836IAC1and/or2dependingonpatientacuityasdeterminedbyISDHestablishedalgorithms.Inaddition,thefollowingmedications,oranalternativeasdeterminedbythematernal‐fetalmedicaldirector,mustbecarriedbythematernal‐fetaltransportteam:

a) CalciumGluconate;b) Tumscalciumcarbonate;c) Furosemide;d) Hydralazine;e) Indomethacin;


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StandardV:Maternal‐FetalMedicationf) Labetolol;g) Misoprostol;h) Morphine;i) Nifedipine;j) Ondansetron;k) Oxytocin;l) Terbutaline;m) Magnesium;n) Oxytocinpre‐mix;ando) LactatedRingers.

StandardVI:NeonatalQualityAssurance6.1Inadditiontocomplyingwithallreportsandrecordsrulesin836IAC1‐1‐5,theCertifiedProvideroftheNeonatalTransportProgramshalltrackthefollowingbenchmarks:

a) Unplanneddislodgementoftherapeuticdevices;b) Radiographverificationoftrachealtubeplacement;c) Averagemobilizationtimeoftransportteam;d) Firstattempttrachealtubeplacementsuccess:

a. visualizations;b. attemptsatplacement;

e) Rateoftransport‐relatedpatientinjuries;f) Rateofmedicationadministrationerrors;g) RateofCPRperformedduringtransport;h) Incidenceofsentinelevents;i) Unintendedneonatalhypothermiauponarrivaltodestination;j) Transportcrewinjuryduringtransport;and


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StandardVI:NeonatalQualityAssurancek) Standardizedpatientcarehand‐offperformed(sitespecificprotocolused).

6.2Whenasentineleventoccurs,theneonataltransportteam,medicaldirector,andmedicalcontrolphysicianmusthaveadebriefthatisinitiatedwithin72hoursandtherootcauseanalysiscompletedwithin5workingdays.6.3Teamsarerequiredtohaveapre‐transportbriefingregardingthepatient(s)conditionpriortoassumingcareofthepatient(s).6.4Eachperinataltransportteamshallhavewritteninternalqualityreviewprocedures/protocols.6.5EachhospitalwithaneonataltransportteamshallimplementaroutinescheduleofQualityImprovementmeetingsandarecordofminutesmaintained.6.6TheneonataltransportteamconductsaQuarterlyReviewofthefollowingelementsandmaintaindocumentationofthereviewsincompliancewith836IAC1‐1‐1‐5(c):

A. Reasonfortransport;B. Mechanismofillness;C. Medicalinterventionperformedormaintained;D. Timeofinterventionconsistentlydocumentedfor:

a. patientresponsetointerventions;andb. appropriatenessofinterventionperformedoromissionofneededintervention;

E. Patientoutcomeatarrivalofdestination;F. Patient'schangeinconditionduringtransport;G. Timelinessandcoordinationofthetransportfromreceptionofrequesttoliftofforambulanceenroutetime;H. Pre‐transportcheckofambulancebyEMTonTransportrecords;I. Operationalcriteriatoinclude,ataminimum,thefollowingqualityindicators:

a. numberofcompletedtransports;b. numberofabortedorcanceledflights/transportsduetoweather;c. numberofabortedorcanceledflights/transportsduetomaintenance;d. numberofabortedorcanceledflights/transportsduetopatientconditionandalternativemodesoftransport;

J. CommunicationsCenteroforganizationmustmonitorandtrack:e. InstrumentFlightRules(IFR)/VisualFlightRules(VFR)


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StandardVI:NeonatalQualityAssurancef. weatherattimeofrequestandduringtransportifchangesoccur;andg. allabortedandcanceledtransportrequests‐times,reasonsanddispositionofpatientsasapplicable.

StandardVII:NeonatalCompetencies7.1Nursing:InadditiontocompliancewithIC25‐23andIAC848,NeonataltransportnursesshalladheretothenationalneonatalstandardsassetforthbyAAPandAWOHNNinNeonatalNursing:ClinicalCompetenciesandEducationGuide.Thedocumentationofcompliancewiththestandardsmustbemaintainedintheemployeepersonnelfiles.7.2EmergencyMedicalTechnician/Paramedic:Mustmeetand/orexceedtherequirementsestablishedin836IACArticle4.7.3NeonatalTransportMedicalDirector:

A. MustbeBoard‐certifiedorbeanactivecandidateforBoardcertificationinNeonatologyandisresponsibleandaccountableforsupervisingandevaluatingthequalityofmedicalcareprovidedduringaneonataltransport.

B. Mustbelicensedandauthorizedtopracticeinthelocationinwhichthemedicaltransportserviceisbased.aC. Mustbeknowledgeableofcurrentconceptsofappropriateuseoftransportassets‐annuallymustincludebutisnot

limitedtothefollowinga. "JustCulture":Highlyreliablestandardsofpatientsafety;b. Patientcarecapabilitiesandlimitations;c. Continuingeducationintransport;d. Crewresourcesmanagement;e. Stressrecognitionandmanagement;andf. Infectioncontrol

D. Musthaveriskmanagementandsafetytraining.7.4ClinicalCareSupervisor:

A. Responsibleforsupervisionofpatientcareprovidedbythemembersoftheteamdirectlyemployedbythetransportprogramandworkscollaborativelywiththemedicaldirector;

B. Overseesqualityinitiativesoftheprogram;C. Responsibleforhire,train,andprovidecontinuingeducationfortheservice;


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StandardVII:NeonatalCompetenciesD. Responsiblefortheevaluationofthecrewmembers;andE. Mustmaintaindocumentationofcompetenciesforeachemployee.

7.5ProgramManager:A. HasoverallresponsibilityforaprogramB. Mustdemonstratethefollowingcompetencies:

a. Humanfactors;b. Justculture:Highlyreliablestandardsofpatientsafety;c. Sleepdeprivation;d. Stressrecognitionandmanagement;e. Safetyandriskmanagement;f. Qualitymanagement;andg. Knowledgeofnational,regionalandlocalstandardsofclinicalpractice,aviationandgroundregulationsas

appropriate.C. Mustmaintaindocumentationofcompetenciesineachemployee'spersonnelfile.

7.6Atleastonememberoftheneonataltransportteamthatisinthepatientcompartmentmustdemonstratethefollowingcompetenciesataminimumonaquarterlybasis.Iftheskillisdemonstratedinthequarter,documentationshouldbemaintainedinthelogalongwithsuccessrate.Thedemonstratedcompetenciesmustusepatient‐basedsimulationasacomponentintheirtrainingaminimumofeverysixmonthswhereappropriate.

A. Arterialaccess;B. Glucometerand/orPointofCareBloodGasanalyzer;C. Nasogastric/Orogastrictubeinsertion;D. Bag/valve/maskventilation/capnographyand/orendtidalCO2;E. Radialsticks;F. Oxygendeliverymethods;G. LaryngealMaskAirway;H. Oral/nasalairways;I. Useandabilitytotroubleshootequipmentsuchastransportisolette,medinfusionpumps,ventilators,Cardiac/Apnea


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StandardVII:NeonatalCompetenciesmonitor;

J. Suctioningofpatients;K. Medicationadministration;L. Surfactantadministration;M. Umbilicallineinsertionandmanagement;N. Transportventilatormanagement(RT);O. Highfrequency(HF)ventilatormanagement(ifhospitalusesHFtransport)P. Needledecompressionandchesttubemanagement;andQ. Urinarycatheterplacement.

7.7Thefollowingcompetenciesarerecommendedbutnotrequired:A. Centrallineinsertionandmanagement(PeripherallyInsertedCentralCatheter(PICC)orcutdown;B. Tracheotomymanagement(requiredifcentertransports/managestracheotomypatients);C. Nitricoxideadministration(requiredifcenterusesintransport);andD. Coolingblanket,coolingcap(requiredifcenterusesintransport).

7.8Arecordofcompetencytrainingforalltransportteammembersmustbemaintained.7.9Inadditiontothecompetencies,acomponentofeachofthefollowingtopicsshouldbeincludedinthefollowingneonataleducationalmodulescompletedeachquarter:

A. Informationpertainingtomaternalphysiologic/pharmacologicissuesrelatedtotheneonate;B. Neonatalassessmenttoincludemodulesonallsystems;C. Assessmentofgestationalage;D. Interpretationofdiagnosticdatatoinclude:

a. labvalues;andb. radiographbasics(pneumothorax,diaphragmatichernia,pneumoperitoneum,Endotrachealtubepositioning);

E. Thermoregulation;F. Arterialbloodgasinterpretationandventilatormanagementbasics;G. FluidsandElectrolyteBalance;H. Ambulance/Aircraftsafetyandorientationanduseofequipmentwithinambulance/aircraft;


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StandardVII:NeonatalCompetenciesI. Ambulance/Aircraftphysiology;J. Family‐centeredcare;andK. ProfessionalismandTeamwork.

StandardVIII:NeonatalEquipment8.1.TheambulanceusedforneonataltransportmustbeataminimumALSandhaveemergencycareequipmentasidentifiedin836IACArticle2.Inaddition,theneonataltransportteammustcarrythefollowingequipment:

A. Cardiopulmonarymonitor;B. Pulseoximetry;C. EndtidalCO2detectororcapnographyD. Portabletransilluminators;E. Heimlichvalves;F. Suction,includingstandalonebattery‐powereddevicewithadjustablepressure;G. Chesttubes;H. Umbilicalcathetersupplies;I. Transportventilator;J. Transportincubator:K. Airwaymanagementtools:

i. Ambubag/Flow‐inflatedbag;ii. Laryngoscope;iii. Endotrachealtubes;iv. LaryngealMaskAirway(LMA);andv. Oxygenblender

L. Oxygenandaircylinderswithvolumecapableofdeliveryfortwotimestheanticipateddurationofthetransport;M. Inhalednitricoxide(optionalbutconsideredstandard);N. Temperaturemonitoring;


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StandardVIII:NeonatalEquipmentO. Infusionpumpscapableofdeliveringneonatalvolumes;P. Defibrillator(neonatalpads);andQ. Pointofcaretesting:

i. glucometerordevicecapableofprovidingglucosemeasure;andbloodgasanalyzer.

StandardIX:NeonatalMedications9.1Theambulanceusedfortransportmusthavemedicationasidentifiedin836IACArticle2.Inaddition,thefollowingneonatalmedications,oranalternativeasdeterminedbytheneonatalmedicaldirector,mustbeavailableandcarriedbytheneonataltransportteam:

A. Weightdosetablesforcodedrugs,dripsandantibioticsshouldbeavailabletofacilitateadministration;B. Drugcardsshouldbemadebyeachteamtoassistinmixingandadministrationofmedications;C. IVF:

i. D10W;ii. D5W;iii. NSand1/2NS;

D. Ionotropicagents:i. Epinephrine;ii. Dopamine;iii. Dobutamine;andiv. considerNorepinephrineandMilrinone;

E. Codemedications:i. Epinephrine;ii. Naloxone;iii. Lidocaine;iv. SodiumBicarbonate;v. Adenosine;and


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StandardIX:NeonatalMedicationsvi. Atropine;

F. Paralytic‐shorthalf‐life;G. Furosemide;H. Antibiotics:

i. Ampicillin;ii. Gentamicin;iii. Cefotaxime,iv. Cefazolin;andv. Acyclovir

I. Prostaglandin(asindicated);J. Sedation:Midazolam;K. PainMedication:

i. Morphine;ii. Fentanyl;

L. Surfactant;andM. Anticonvulsant.

StandardX:PerinatalTransportPersonnelLicensure,CertificationandEducation10.1Alltransportpersonnelmustbecertified/licensedinthestateappropriatefortheirjobtitle(i.e.RN,RT,EMT,MD,APN,PA).10.2Thematernal‐fetaltransportteammusthaveaminimumstaffof: A.maternal‐fetaltransportnurse;and

B.oneofthefollowing:i. Paramedic;ii. Nurse;iii. NursePractitioner;or


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StandardX:PerinatalTransportPersonnelLicensure,CertificationandEducationiv. Physician.

10.3Allmaternal‐fetaltransportstaffinthepatientcompartmentshallhavethefollowingcurrenteducation:A. BasicLifeSupportHealthCareProvider(BLS)B. NeonatalResuscitationProgram(NRP);C. TheLearnerSTABLEProgram;andD. AdvancedCardiovascularLifeSupportorObstetricAdvancedLifeSupport(ACLS,OB‐ACLS)E. Competencytestingofacademicknowledgeandclinicaldecision‐makingskill,whichmayincludebutisnotlimitedto:

a. writtenexaminations;b. Transportandclinicalcasepresentationsandreviews;c. oralexaminationsconductedbythecoordinatorormedicaldirectorofthetransportteam;d. Medicalrecordreview;e. Currentnationalcertificationspecifictothepatientpopulationserved;andf. intranetorinternetmodules.

ForRNs:NationalCertificationCorporation(NCC)credentialinInpatientObstetrics(RNC)isencouragedbutnotrequired.

A. APNsorPAswithanexpertiseinmaternalfetalassessmentwithcurrentnationalcertificationwithconsummateIndianacredentialsandstatelicensure.

B. AcertificateofaddedcredentialsintopicssuchasElectronicFetalMonitoringisencouragedbutoptional.C. Allmaternal‐fetaltransportteammembersshallcomplete24hoursofareaspecificdidacticand/orcontinuing

educationonanannualbasis.The24hoursincludethemaintenanceofcompetenciesabove.10.4Theneonataltransportteammusthaveaminimumstaffoftwoqualifiedneonatalproviders.Theprovidersmustbefromthefollowingcategories:

A. RespiratoryTherapist;B. NeonatalNurse;C. NeonatalNursePractitioner;andD. Physician.

10.5Allneonataltransportstaffinthepatientcompartmentshallhavethefollowingcurrenteducationordocumentationof


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StandardX:PerinatalTransportPersonnelLicensure,CertificationandEducationsuccessfulcompletion:

F. BasicLifeSupportHealthCareProvider(BLS)G. NeonatalResuscitationProgram(NRP);andH. TheLearnerSTABLEProgram.

10.6Neonataltransportteamnursespresentinthepatientcompartmentshallhaveoneormoreofthefollowingcertifications:

a) NationalCertificationCorporation(NCC)credentialinNeonatalIntensiveCareNursing(RNC);b) Neonatalcertificateofaddedqualificationinneonatal‐pediatrictransport,c) CertifiedEmergencyNurse(CEN)d) CertifiedFlightRegisteredNurse(CFRN),e) NationalCertificationCorporation(NCC)credentialinCriticalCareAdult,NeonatalandPediatricNursing(CCRN).

CertificationisexpectedwithinthreeyearsofhireunlessNNP/PAstatusiscurrent.Certificationshallbemaintainedduringtenureasatransportteammember.APNsorPAs:CurrentnationalcertificationwithconsummateIndianacredentialsandstatelicensure.RTs:CRT/RRTcredentials,Neonatal‐PediatricSpecialistcredentialIftheserequirementscannotbemet,aneonatologistorNNP‐BC,oraPAwithtraininginneonatologyandneonataltransportmedicineadequateforindependentdecisionmakingandadministrationofproceduresmustbeinthepatientcompartment.10.7Inthecaseofbacktransport(maternal‐fetalorneonatal)thestaffingforthepatientcompartmentisuptothediscretionofthetransferringhospitalbasedonthepatient'spresentingcondition.

StandardXI:UniversalSafetyMeasures11.1Eachhospitalwithanin‐housetransportteammustensurethefollowingsafetymeasuresareinplace:

A. Criteriaforemergentvs.non‐emergentstatus‐protocoldriven;


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StandardXI:UniversalSafetyMeasuresi. trackpercentageofemergenttransportsasportionofQIprocess;ii. protocoldriven;andiii. canbeoverriddenbyanymemberoftheteam;

B. Documentpre‐transportcheckofgroundambulanceoraircraftbyEMTonTransportrecords;C. Returnbygroundtransportwithlightsandsirensreviewedforappropriateness;D. Recordofsafetymeetingsandminutesshouldbemaintained;E. Trainingfordriverorpilottorecognizeaircraftorambulancetampering;andF. Securitypolicyinplacetoaddressaircraftorambulanceifleftunattendedonahelipad,hospitalramp,orunsecured

parkinglot.

StandardXII:UniversalPoliciesandProtocols12.1Eachhospitalwithanin‐housetransportteammusthavewrittendocumentationforthefollowing:

A. Standardizeddepartureprotocol;B. Protocolforcommunicationwithreferringfacility:

i. receivingfacilityshouldprovideupdatetostaffandphysicianswithin24hoursofadmission;ii. Follow‐upshouldincludeoutcomeoftransport,therapiesinitiatedatadmissionandcurrentstatusofinfant;

C. Ifpossible,referringphysiciananddeliveringphysicianshouldbenotifiedofinfantstatus.

Maternal Fetal Transport Algorithm

> 23 Weeks with Viable Fetus

On Magnesium Sulfate

Active Labor

Other Maternal Co-morbidities

Surgical Candidate

Potential for Maternal and/or Neonatal

complications at delivery

Currently requires continuous Maternal Fetal

Monitoring

Maternal Fetal RN lead Ground or Flight

Transport

Consider Flight for:• Maternal admission to an adult intensive care unit• High risk of delivery before the ground unit would return with patient• Maternal trauma• Ground team unavailable

Patient receiving intermittent Maternal Fetal Monitoring but not

required during transport

Post partum, fetal demise and/or <23 weeks, maternal status stable

Y

Y

Y

Y

Y

N

N

N

N

Y

N

Y

Basic Life Support (BLS) orAdvanced Life Support

(ALS) Transport

Consider private care if mother and fetus are stable and require no immediate

actionY

Post partum, fetal demise and/or <23 weeks,

unstable maternal status

Consider Maternal Fetal ground, Advanced Life

Support (ALS) or air transport depending on

acuity and distance

Y

Neonatal Transport Algorithm

LEVEL I NURSERY

Infant less than 35 weeks gestation

Requires supplemental oxygen and/or respiratory

support

Failed Cyanotic Congenital Heart Disease

Screen

Possible Sepsis or Chorioamnionits

Other clinical concerns not supported by the

Institution

Continue to Monitor Infant

Prepare infant for transfer to Level III or Level IV

Institution

LEVEL II NURSERY

Infant less than 32 weeks gestation or birth weight

less than 1500 grams

Failed Cyanotic Congenital Heart Disease

Screen without availability of Newborn

Echocardiography

Likely or Need for Prolonged Respiratory

Support (greater than 24 hours)

Y

Y

Y

Y

Y

Y

N

N

N

NOther clinical concerns

not supported by the Institution

Congenital anomaly requiring surgical

intervention


Y

Y

Y

Y

Y

N

N

N

N

LEVEL III NURSERY

Cyanotic Congenital Heart Disease

Severe Pulmonary Hypertension potentially requiring ECMO if iNO is

not available or failing iNO

Pediatric Surgery need not supported by

Institution

Other Medical or Surgical need not supported by

the Institution


Prepare transfer to

Level IV Institution

Y

Y

Y

Y

N

N

N

NN

N

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