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Thanks for the question. I've seen some of the replies already
which seem very unhappy about moving this patient. In our country
the survival rate is halved by this baby at this gestation being born in
the referring hospital.
We would ascertain the facts about the gestation, parity,
cervical dilatation, tocolysis, complications etc. at the original call. If
this information was only ascertained by the transporting team on 'arrival', our
process wouldn't work. There is no mention of whether steroids have been given
or, if not given, have been recommended. Although the delivery may be imminent,
it is our experience that many hours (or even days) may elapse, allowing
significant lung maturation to occur.
Our process involves the requesting physician being connected
'in conference' with both our transport attending and the high-risk obstetric
attending at the preferred destination hospital. The transport team members and
other parties can join this conference call at will.
Being a neonatal paediatrician by training, I wouldn't presume
to give obstetric advice but participation in these conferences has demonstrated
to me (and our teams) that the behaviour of the cervix at these early gestations
is very different from > 30 or 32 weeks. We have moved large numbers of women
at apparently advanced dilatation whose contractions have been suppressed. We
use salbutamol and/or nifedipine but the same can be achieved with
MgSO4.
We might well send a neonatal transport team with the vehicle
(in addition to our planned escort, a flight midwife). However, we re-triage the
case with the key clinicians once the team has arrived at the referring hospital
and make a final decision then about whether to transfer
undelivered.
Our practices have resulted in a nearly 50% reduction in
preterm neonatal transports in our region (population 6.8million). This despite
a steady increase in preterm delivery.
In examining the risk of in utero delivery, it is vital to
balance the risk of outborn delivery and subsequent compromised
outcome.
We have had only two deliveries in transit during the 12 year
period this policy has been in evolution.
You may be interested to know that one occured in a BO105 and
the delivery, although awkward, was achieved successfully. The baby, although 30
weeks gestation, did well and is now normal and attending high
school.
The second occured in a situation where the obstetric expert
determined that the 'window of opportunity' to move the patient was about 3-4
hours. The departure of the patient from the referring hospital was delayed for
unclear reasons and she delivered during loading into a fixed wing. The baby was
taken back to the referring hospital and subsequently transported by a specialty
team and is doing well.
We regard the risk of one occasional 'in-transit' delivery as
a reasonable cost of achieving substantial improvements in outcome in terms of
survival and quality of survival for 100-200 cases of the sort described in your
question.
Dr Andrew Berry Andrew.Berry@nets.org.au
State Director NETS (NSW newborn & paediatric Emergency Transport Service) www.nets.org.au Hotline +61 1300 36 2500
Warmline +61 1300 36 2499 Facsimile +61 1300 36 2498 Personal +61 (0)2 9633 8770
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>>> dsharpe@calstar.org 4/08/2003 4:20:15 >>> Ok folks, here's a scenario for you. Your service flies a BO-105 aircraft, and has an agreement with a local OB receiving facility to provide transport for high-risk OB patients. On these flights, you send the aircraft with one Flight Nurse to the receiving facility to pick up a Labor and Delivery Transport Nurse as part of your team, then respond to the sending facility 20 minutes away (90 minutes by ground). Upon arrival, you find a 26 week pregnant, G1P0 patient whose cervix is dilated to 10 cm with intact but bulging membranes. She came in the day prior with contractions which were controlled with a MagSo4 drip at 3gm/hr. She is no longer having contractions. The sending physician wants her transferred to the receiving specialty center to manage her pre-term labor, but does have the capability to resuscitate a preemie newborn if necessary. 1.) Would you transport this patient? 2.) For the sake of discussison, lets stipulate that you're not comfortable with transporting the patient, but the L&D specialty nurse and the receiving Perinatologist feel the patient is stable enough to transport by air, and is not in danger of delivering precipitously enroute. Given this information, would you then transport the patient? _______________________________________________ Flightmed mailing list To unsubscribe or change your email address, go to http://www.pairlist.net/mailman/listinfo/flightmed |