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
Continue to Monitor Infant
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
Continue to Monitor Infant
Prepare transfer to
Level IV Institution
Y
Y
Y
Y
N
N
N
NN
N