Re: High risk OB transports

[Wildmedic75@cs.com]

Steve:
     
I wholeheartedly agree that "Daily experience in any given area lends to 
improved clinical skills and patient care". However, unfortunate as it may 
be, the level of care is not the only factor at play when looking at the 
issue of "specialty teams vs. the regular flight crew".
       
The program I work for does not use a specialty team for OB calls, but we do 
for neonatal and pediatric transfers (which make up a significant percentage 
our our total responses).

While these teams (ped RN/RT or ped RN/MD) certainly bring a higher level of 
skill and experience than our normal RN/EMT-P crews can provide, I seriously 
think that the significantly extended response times (it routinely takes them 
45-60 minutes to be ready to be picked up after we receive a request for a 
ped trauma transfer) and "at location" times (again, anywhere from 45-120 
minutes at the referring facility; vs the average 20-45 min for our normal 
crews) offset any benefit provided by the higher level of care, ESPECIALLY 
when you consider that I have NEVER seen the pediatric team perform any 
interventions that were beyond the scope of a well trained RN/EMT-P crew. 
Consider, also, the number of potential on-scene calls that we are not 
available for during a 3-hour pediatric transfer.

Aircraft safety is another issue. We send the flight medic along on these 
calls as a safety officer/crew chief, but there is little the medic can do 
when dealing with team members who seem hell bent on doing things their own 
way. The specialty teams are required to attend annual aircraft safety / 
operations / flight phys training, but many of them don't fly often, and for 
the most part, they just don't seem to have enough respect for the airmedical 
environment.

These teams are not employed by the flight service; they come from the closer 
of the two  pediatric trauma centers in our region. A trend that we have 
recently noticed is that many of the small, outlying hospitals in our service 
area who used to send most of their ped traumas to this hospital are now 
sending them (almost exclusively, in some cases) to the other ped trauma 
center, which in most cases is a little further away, but does not require 
the transferring hospital to wait for their specialty team to arrive before 
the patient is transported there. Most of the transferring (and receiving) 
physicians are very happy with the level and quality of care that our normal 
crews provide, and they don't want to deal with the added 60-120 minutes that 
it takes to get the kids out of their ER and on their way to definitive care. 
 

I have the utmost respect for the knowledge and experience that "specialty 
teams" can bring to critical patients, and I harbor no illusions that being 
PALS or NRP trained makes me as qualified as a ped RN or MD, but again, there 
are other important factors (speed and safety) that need to be addressed. I 
know that the literature in general supports the use of specialty teams, but 
I imagine that most of these studies were looking at either relatively stable 
(non-trauma or non-time sensitive) transports, and the specialty teams 
studied must have had much lower response times than ours do. 

For what it's worth, our normal flight crews do alot of on-scenes with peds 
(scene calls make up about 60-65% of our total call volume); I don't know if 
this makes us more comfortable with kids or not, but everyone I work with is 
very confident with their pediatric assessment and treatment skills.          
            

Just my lowly little flight paramedic opinion.......any comments?


Allan
Flight Paramedic 


> << I enjoy the posts here on this listserve and find them very informative 
> but from time to time some statements are made that beg response.  The 
> comments below regarding "specialty teams" not know their aircraft etc is 
> was what got my attention.   All the issues mentioned, it comes down to 
> training  provided by the transport service.  At the program I am currently 
> working at, all "team " members are given annual safety trainning and are 
> familiarized with aircraft operations.   We also take a regular flight 
> nurse with us on the helicopter as a resource.  
>  The literature supports specialty teams in pediatrics and neonatal verse 
> one team fits all.  No one can know everything and as it was stated it is 
> the best interest of the patient that we must strive to meet . Following 
> properly set guidelines for high risk maternal transports reduces the risk 
> to the child , mother and potential litigation issues.   Your course sounds 
> very interesting and beneficial but some consider that just taking a course 
> then makes them experts and there lies the trouble.  Daily experience in 
> any given area lends to improved clinical skills and patient care .  So 
> there is my two cents worth. >>