|
Management
Newborns & Children Need Special Ambulance
There is an urgent need for special ambulances meant for
neonates and children
 "What
struck a chord in my heart was the fact that these babies were not so bad
when they initially started their journey to our centre. They had deteriorated
on the way"
- Dr Ravi Khanna
Director
New Born, Child & Critical-care Centre
Bareilly
|
The decision to transport a critically ill patient, either
within a hospital or to another facility, is based on an assessment of the potential
benefits of transport weighed against the potential risks. Critically ill patients
are transported to alternate locations to obtain additional care, whether technical,
cognitive, or procedural, that is not available at the existing location.
We have been running a tertiary level centre NBCC or New
Born Child & Critical-care Centre since last 20 years. We receive seriously
ill babies within a radius of approximately 150 kms. More often than not we
were receiving babies who were profoundly moribund and in terminal condition,
beyond any help at the time of arrival at our centre. What struck a chord in
my heart was the fact that these babies were not so bad (as per their status
as stated by the referral doctor at the time of reference) when they had initially
started their journey to our centre. They had deteriorated on the way. The curious
feature was that the many of these babies were transported in routine ambulances
but met with the same fate.
Newborns & Children are Not Little Adults
The response of children to disease and injury differ both physically and physiologically
from that of an adult in terms of:
- Airway anatomy.
- Resistance.
- Various lung parameters.
- Oxygen consumption.
- Cardiopulmonary interactions.
- Temperature regulation and
- Drugs doses.
Essentials
The special requirements of a critically sick newborn or a child while being
transported are as follows:
- Maintenance of thermo neutral temperature.
- Asepsis.
- Accurate I/V fluids and ionotrops infusion.
- Monitoring of pulse, BP and oxygen saturation.
- Provision for Emergency medicines / drugs.
- Provision for procedures like -
- Bag 'n' mask ventilation.
- Intubation.
- I/V cath/ intraosseous needle insertion.
- Suction, aerosol therapy.
- Proper illumination for observation/ procedures.
- Prevention of jolting/ untoward movements during
transportation.
|
Provision for oxygen
- We fixed H-Tank (Jumbo) oxygen cylinder
beneath the combo bed with the help of two clamp for immovability.
- We also placed a small portable aluminium
E Class oxygen cylinder which weighs only 3.1 kg for short term use.
Provision for monitoring
- For oxygen saturation and pulse rate, we
placed a hand held pulse oximeter.
- NIBP monitor for blood pressure measurement.
- Radiant warmer temperature probe for skin
temperature.
Provision for infusion of fluid
- We strategically placed and screwed volumetric
infusion pump and syringe driven pump to the ambulance wall for large
volume and for catecholamine infusion respectively.
- A cage for holding IV infusion bottle was
also secured to the roof of the ambulance.
Asepsis during transportation
- Most important aspect as patient may be
lost after three-four days in the nursery / PICU due to sepsis acquired
during transportation.
- Two hand rub antiseptic lotion bottles
placed in a manner that the doctor and accompanying staff can access
it easily in a sitting position.
Battery backup and electricity supply
- We installed one KVA sine wave inverter.
- There are six electrical outlets supplied
by the inverter.
Organisation of ambulance services
- Two drivers were appointed to ensure round
the clock availability.
- Our EMOs doctors were trained extensively
in neonatal and paediatric resuscitation.
- Transport team consists of one doctor,
one staff and one helper.
|
Medico Legal Issues during Transportation
- Vehicle must be registered as 'ambulance' under Motor
Vehicle Act 1988. Speaking plainly, one cannot convert any vehicle to an ambulance
unless originally specified by the manufacturer.
- The insured may not be indemnified if the vehicle
insured is not registered as 'ambulance' in Regional Transport Office (RTO).
- Proper maintenance of the vehicle and the equipment.
- Written consent before transportation.
- Proper documentation before and during transportation.
- Develop a proper transportation team.
- Scoop and run approach by the referring institution
is not taken kindly by Honourable court.
- One is liable for prosecution under CPA if the facilities
in the ambulance are not at par with the care which the baby was receiving
at the referring institution or the hospital.
Advanced neonatal and paediatric ambulance of NBCC having transport
incubator, transport ventilator and other paraphernalia
We installed a radiant warmer in
the roof of the ambulance. To accommodate all sizes of patient viz.
neonates, children and bigger children, we placed a 'Combo bed' beneath
the radiant warmer which is essentially a paediatric size made-to-order
stainless steel stretcher.
For neonates, we then placed a stainless steel tray padded around with
towel and sheet over this combo bed.
|
Our Achievements
Buoyed by the success of saving so many precious lives we have further graduated
to build a more advanced neonatal and paediatric ambulance having transport
incubator, transport ventilator and other paraphernalia (see pic). We have transported
almost more than 2,500 babies/ children. The smallest baby transported being
800 gms and the longest distance covered has been 600 kms. To our delight, there
has been zero medico-legal complications so far and all the patients survived
on the way.
drravikhanna@gmail.com
|
