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Deciding Air Vs Ground


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#1 NubieFlyerRN

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Posted 12 February 2009 - 10:07 PM

Hello All,
This is my first forum post. I've read hundreds of posts and see that you all are wonderful resources! Here is some background info on my program: We are just starting our team. We are a hybrid program meaning that our RW services are contracted and our ground services are hospital based. Our neonatal transport team when going for a ground transport consists of a NNP, RN and RT. When we go by air we take NNP, RN and a flight paramedic. Since we are a new team, the paramedic is mainly there as a "safety officer" to help us learn the ins/outs of air transport. Here is my real question: Who makes the decision to fly vs go by ground? What factors go into that decision? When is the decision made? Does anyone use an algorithm to guide this decision making process? Thanks for any feedback or suggestions you might have!!
~Megan
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#2 Randy L

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Posted 13 February 2009 - 04:19 PM

Not always the easiest question. Within our program the neo, peds and maternal team do 2000+ transports per year. They are a part of a single province wide EMS system meaning the ground, air, adult and neo,ped, maternal team are all members of the same organizaton. They compete with the adult teams for our fixed and rotary wing resources but have their own ground trucks.

The decision to transport is made by the transport physician coordinator at the Childrens Hospital. These are either the peri or neonatologist who is accepting the transport. Once the decision is made to transport they work with our coordination center to determine fixed, rotor or ground. The mode of transport is based on the acuity of the patient, driving times, capabilities of the sending facility and also what other transports (either in the adult world or neo,mats or peds)that might be waiting for the aircraft. These are important considerations as in the rotary world we only have two dedicated helicopters and out of the base where the transport team works, one turbo prop and one jet with one backup jet.

For our program another deciding factor is helipads. Not all referring hospitals have helipads or are located close to airports so quite often, the team will drive to requests based on the fact the combined flying and driving time would show no time benefits for the transport.

The other thing that might be a little different is that because of the great demand on our rotary aircraft for adult transports and scene flights we will at times fly the team out to a sending facility, drop the team and then carryon with other transports. In these situations there is significant communication between the sending physician and the physician coordinator regarding patient needs and transport timing.

A view on transport from north of the 49th
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#3 LearRRT-CCEMTP

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Posted 15 February 2009 - 07:14 AM

I understand that you are a new program but it is strange that you would leave your Flight RT at home for rotor transports. The NNP is already an experience neonatal nurse prior to becoming an NNP so you have a duplication of skills and training in the NNP and RN. It seems that it would make a lot more sense to leave your Flight Nurse and keep the Flight RT for the times you run into complex ventilatory and airway issues. I am aware of several neonatal teams like yours that have an NNP/RN/RRT composition but they all leave the RN for rotor flights and fly NNP/RRT for the above reasons!
Good Luck!
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#4 Patrick Small

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Posted 08 October 2009 - 07:08 PM

We make our transport decision with the use of an flow chart our team developed. Although, it is usually a fairly easy decision to make, based on the acuity of the child, we do have the chart to aid us. It places most of the decision on the ABC's and the chance for decompensation, but also includes factors such as weather, traffic conditions and distance. All in all, it is usually an obvious decision, but when there is some question, we have the flow chart, and always, if there is a gut feeling that a child should be flown for, we will do that too! So, I am sure that this post was no help at all, but there you go. Have a good day!
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#5 flightguy85

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Posted 14 June 2016 - 06:46 PM

I know this is an old thread but thought it made the most sense to add to it as I have some questions/comments. I haven't been at my program that long and I feel that we have a very low threshold to fly. Basically we just look at where it's going to decide. If it's going to an ICU, then it's automatically a flight, as long as there's a helipad and weather is ok. Distance and pt condition are really not looked at, other than to exclude flying. I don't agree with this and have voiced my opinion but am told that because I don't come from a peds/neo background, I don't understand, that it's different than with adults because pediatric and neonatal patients are more time-sensitive and if something happens when going by ground, I will have to defend why I chose to drive instead of fly. Am I crazy for thinking it's not always appropriate to fly a patient just because it's going to an ICU? I mean, we fly patients for a possible ingestion when it's only an 8mi drive. This kid may not have even ingested anything, but because they don't know, that makes it an ICU admission. When you factor in our preparation and startup times, which are quite long, the entire transport could be done quicker by ground. If anything we're saving a few mins on the actual transport. There's one hospital where the helipad is fairly far from the entrance, so when we're getting a neonate, we'll actually send the driver to the hospital to meet the flight crew with the ambulance to drive them to the entrance, and he/she gets there before the helo due to the preflight and startup time!

 

I've also brought up the cost and potential financial burden on the patient/family and am quickly shot down on that because "insurance pays" and if they don't, I'm told we don't go after them. Whether this is true or not I don't know.


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#6 FlightRNEMTP

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Posted 26 November 2016 - 12:48 AM

Interesting Flightguy85. I work for a high volume neo/peds/adult team. We do the exact opposite. While the decision is always at the discretion of the sending provider, our ICU transfers are predominately completed by ground. We send RW for a few exceptions: 1.) the sending physician is adamant about RW transport. 2.) The patient needs a time sensitive emergent treatment at the receiving ICU 3.) The GCCT unit has an extended ETA/pending missions. 

 

Generally for our NICU/PICU transports, the receiving fellow/attending is our requester. 99% of our NICU transports, regardless of patient acuity are completed by ground. The PICU transports can go either way. 


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