Kapi‘olani Transport Team Delivering our Keiki Safely over ... · Piece resuscitators, Neo Tee,...
Transcript of Kapi‘olani Transport Team Delivering our Keiki Safely over ... · Piece resuscitators, Neo Tee,...
Peter Maglidt RRT-NPS
Paul Fenwick RNC-NPT
Kapi‘olani Transport Team
Delivering our Keiki Safely over
Land/Water
Disclosures
We have no relevant financial or nonfinancial
relationship(s) with the products or services
discussed in this presentation.
Objectives
• Overview of the Kapi’olani Transport Team;
training/ configuration/ scope of practice
• Review relevant transport statistics.
Kapi‘olani’s Transport Team
• Program started in 1989
• RN/RT Configuration
• + MD for select transports
Sheree Kuo MD
Neonatal
Transport
Medical Director
Kon Xoinis MD
Pediatric Transport
Medical Director
Melody Kilcommons
RNC, BSN
Director of
Transport Team
Team Training/Requirements
• KMC Transport Internship/Certification
• Annual FAA Required Safety Training
• Annual Competency Skills Training
• Critical Care Simulation Training
• Water Egress Training
• NRP, BLS, PALS, ACLS requirements
• NRP, PALS, BLS Instructors
Team Training/Requirements
• Neonatal, Pediatric, Critical
Care Professional
Certifications
• Neonatal Pediatric
Specialization (NPS-RRT)
• Critical Care Registered
Nurses (CCRN, RNC-NPT)
Annual Competency Skills Training
• Intubation
• Needle Decompression
• Chest Tube Insertion
• Umbilical Line Placement
• Intraosseous Placement
• Pericardiocentesis
Simulation Practice
Water Egress
In Hospital Responsibilities
• Attend KMCWC High
Risk Deliveries
• Rapid Response Team
• Trauma Response Team
• Code Blue Response
Team
• Liaison / Resource for the
Hospital
Our Equipment;
• Age and weight appropriate equipment
• ETCO2
• Ventilators:
– Different ventilator modalities
– Blended gases (Oxygen, Air, iNO)
– Nitrogen
• Blood
Analyzer
Equipment
• Defibrillator/ AED
• Monitors
• IV pumps (drug libraries)
& Medications
Specialty software for
neonatal and pediatric dosing
standards/safety limits
• ECMO
NEONATAL ISOLETTE
CRITICAL CARE / ECMO SLED
Respiratory Modalities
• NC/ HFNC/ SFM/ NRB
• Neonatal/Pediatric CPAP-BIPAP
• Neo/Peds Invasive Ventilation
Respiratory Modalities
• High Frequency Ventilation
• Nitric Oxide
• Nitrogen
Positive Pressure Cannula
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Cannula for CPAP and NIPPV
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• Simple and cost effective
• Soft curved prongs
• Uses nasal cannula design with large diameter distal end connector (15mm) adaptable with multiple modes respiratory support: Ventilators including HFOV, T-Piece resuscitators, Neo Tee, and bubble CPAP. There is an adapter to use with 02 tubing.
• Can deliver CPAP, PPV, IMV and continuous high or low flow 02
Transport Planes
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Twin Turboprop Air Ambulance
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Aft view
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Forward view
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Med Jet Air Ambulance
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Aft view
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Neonatal Isolette
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Critical Care/ ECMO Sled
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HYDRAULIC LIFT SYSTEM
Neonatal Isolette and loading system
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Medical Transport Jet
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Interior
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Who We Travel With? • Hawaii Life Flight
• LifeSave Kupono
• American Medical Response (AMR)
• Commercial Airlines
• Emergency Airlift
• Premier Jets
Challenges of Transporting in Hawaii
• Weather
• Limited resources
• Plane/ Ambulance
• Team Availability
• Rural Locations
Challenges During Transport
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• No doctor at altitude to discuss pt.
• No consistent communication
• Clinical decisions on our own
• Unstable environment
• Limited resources-equipment/medical gas supply
• Limited space
• Possibility of being diverted to different patient
• Time constraints/ vehicle availability
• Pt deteriorating during transport
Challenges of Transporting in HawaiiAccording to the US Census Bureau (2017):
• Total Population for the state of Hawaii is 1.42 million
– Oahu: 992,000
– Big Island (Hawaii) 195,000
– Maui: 163,000
– Kauai: 70,500
• A total of 9.3 million visitors came to Hawai‘i in 2017
• With single Level I Trauma Center
• Certified Transport Team members: 12
Waimea, Hawai‘i - 2017
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Hilo Airport, 2018
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Kauai
174 km
1 hr 30 min
Maui
151 km
1 hr 40 min
Big Island
Waimea 256 km
Kona 267 km
Hilo 329 km
1 hr 50 min - 3 hrs
Molokai
88 km
20min
Lanai
117 km
25 min
How Remote is Hawaii?
Oahu to California
2535 miles
5.5 - 7 hours
Transports Annually
300
350
400
450
500
550
600
650
7002
00
6
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
Total Transports
Pediatric vs. Neonatal Transports
0
100
200
300
400
500
600
700
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
Pediatric
Neonatal
Air vs. Ground Transports
0
50
100
150
200
250
300
350
400
450
500
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Air
Ground
Mainland Transports
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1015
2025
3035
4045
50
2010
2011
2012
2013
2014
2015
2016
2017
Total Mainlands
Quality Improvement
Case Review – Debrief
• Policy Review
• Formally placed into practice
Special Thanks
• Kapi’olani Team and Medical Support
• AMR Crews
• Hawai‘i Life Flight
• LifeSave Kupono
• Our Sending Facilities Staff
Philanthropy
• Kapi‘olani Health Foundation
• Children’s Miracle Network
• Costco
• Walmart
• Generous Donations from the Hawai‘i Community
Call (808) 983-6555
24 HOUR HOTLINE
Kapi’olani Transport Team
Questions?
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