Neonatal Transport

(Experience in Western Australia)

Speaker: Ms Diane Coad

Senior Registered Nurse
Women and Newborn Health Service WA
KEMH/(PMH)PCH
 Disclaimer
• The advice and information contained herein is
provided in good faith as a public service.
• However the accuracy of any statements made is
not guaranteed and it is the responsibility of
readers to make their own enquiries as to the
accuracy, currency and appropriateness of any
information or advice provided.
• Liability for any act or omission occurring in
reliance on presentation or for any loss, damage
or injury occurring as a consequence of such act
or omission is expressly disclaimed.
 NETS WA
Neonatal Emergency Transport Service
Western Australia: Mobile intensive care for babies.
Purpose:
• Advice on neonatal investigation, management and care to
the state of WA.
• Transport of neonatal patients to tertiary centres and help
return patients to hospitals close to their homes.
• Outreach education programs to the many rural and remote
healthcare facilities across WA.
Scope:
• < 44 weeks corrected gestation.
• <6kg current weight.
 NETS WA
Western Australia is
the largest state in
Australia to cover in
conjunction with RFDS
and 2 NETS van, each
available to carry 2
babies, and St John’s
Ambulance Service.

Retrieval service for sick and

preterm newborn babies by air
or road transport: 2 teams
available 24 hours/7 days a
weeks for local, rural, regional,
interstate and sometimes
international transfers.
Neonatal Emergency Transport
Service WA (NETS WA)

Flight time
in hours
from Perth
NETS office and Conference call centre
Cots available: 5 Mansell, 2 Side-loader, 6 Voyager;
Ventilators available: Stephan, Hamilton T, Fabian;
Suction, Nitric oxide inhalation, TCM, VSM.
 Voyager Cot on Mansell lifter
Hamilton T-
Ventilator
needs
Air and
oxygen
cylinders.

Powered by
AC
DC and
Battery.

Nitric inhalation Cot /phototherapy 5 pumps

Suction / TCM VSM Ventilator CPAP, SIMV, SIPPV,
HFO, HHF
 Mansell Neo-cot and sled used for
RFDS and interstate flights.
VSM

Stephan Ventilator-
IMV/CPAP/HHF:
only carry oxygen
cylinders +/- Nitric
inhalation

Powered 3 pumps Cot plus 1 set

by Battery, Suction radiant of bags
AC/DC heater on
trolley
Neonatal Emergency Transport Service
WA (NETS WA) Own dedicated Ambulance and
drivers for NETS WA transfers by
road: Mon-Fri 0630-2400 hrs.
RFDS or Medical Air: fixed wing
or rotary flights

Transport infants up to 6 kgs:

23 weeks gestation to post term.
Local, regional, interstate and international
for infants requiring NICU and Back
transfers for ongoing management closer
to home.
 What’s in the bags:
everything for basic stabilisation
Bag 1: most common items used-
Paperwork, Stethoscope, thermometer,
blood gas equipment, insertion of
OGT/NGT and IVT, pacifier, respiratory
support: ETT/ CPAP/ HHF/PBF.
 What’s in the bags:
everything for basic stabilisation
Bag 2: Equipment for UAC/UVC; insertion ICC & Heimlich drains; Spare
syringes & needles; Miscellaneous- Replogle tube, drawstring bags, spare
batteries, intra-osseous needle; Medications and IV fluids .
 Things to add
Cold drugs: Survanta, Curosurf, Suxamethonium, Pancuronium, Alprostadil.
IV Fluids: Heparinised Saline, Saline 0.9%, 10% Glucose

ISTAT Machine + cartridges,

Grasby pump, Transilluminator

For specific cases add:

Cooling equipment for HIE: Icepacks,
rectal thermometer, cooling mattress.
Prem Pack for less than 32 weeks
gestation : smaller bonnets, nappies,
mini IV splints, covers for vent tubing,
small BILI nests, Neowrap.
Things to know before you go:
• Maternal history
• Gestation, ? Multiple birth
• Newborn’s condition
• What has been done to stabilise baby
• What needs to be done before team arrival
• What still needs to be done when team arrives
• Conference call with consultant & others
• Give possible ETA to referral team
 When Retrieval team arrives:
• Introduce yourselves
• Take handover from referral team
• Assess baby- observe before touching
• What else needs to be done
• Conference Call consultant with update
• Load baby into transport cot when stabilised
• Collect Maternal blood & placenta
• Collect Photocopy of baby’s notes/Xrays
• Talk/visit to parents/family support
• Complete documentation
• ETA for destination
 Things to do when you arrive
at destination:
• Handover baby to receiving hospital
• Transfer baby to warmer/incubator/cot
• Complete documentation
• Return to NETS office- debrief if required
• Clean cot and equipment/restock
• Return unused cold drugs to fridge
• Restock bag items
• Complete filing of Data & Management sheets
 Information and Resources
• Website: www.netswa.net.au

• Every set of NETSWA bags has a manual of all the

drugs and equipment for use, as well as, our
guidelines and protocols.
• The most vital resources you have is the people in
your team. All the transport nurses are neonatal
trained and are very experienced.
• The consultant on call is always available through the
conferencing system- even in flight for advice
Outcome of outborn infants at the borderline
of viability in Western Australia:
A retrospective cohort study
• By Kirsten Thompson, Jacqueline Gardiner and Steven Resnick.
• Published 2016 in Journals of Paediatrics and Child Health.
Comparison of outborn infants to those born in WA sole tertiary perinatal
centre 2001 to 2011.
Outborn infants >23 to <25+6 weeks gestation who survived to be transported
to NCCU were matched to the next inborn of comparable gestation and
weight. Comparison of morbidity and mortality was made using intra-
ventricular haemorrhage, necrotising enterocolitis, chronic lung disease
and the Griffiths General Quotient scores at 1 year of age.
54 outborn and 519 inborn births during study period: 65% were transported
and of those 39% survived to discharge compared to 72% of inborn infants.
There was no differences in short term and developmental outcomes in
surviving infants.
Outcome of outborn infants at the borderline
of viability in Western Australia:
A retrospective cohort study

• In Conclusion:
Outborn extremely preterm infants <26 weeks
gestation have higher mortality than inborn
counterparts. However, those transported to a
tertiary NICU have similar morbidity and
developmental outcomes.
 Stats for 2018
• Total number of calls: 1064 (average 3 calls a day)
• Advice calls: 21
• Road transports: 683 local/rural; 28 Regional
• Air Transports: 165
• Back transfers: 166
• Interstate transfers: 11
• International transfers:0
• Range in time for retrievals: 20mins- 21 hrs
 NETS WA: 2018
900

800 Respiratory distress 25% General surgical 6%

Cardiac 8% NEC 2%
700 Sepsis 7% Hypoglycemia 4%
Preterm 7% Apnea 4%
600 Seizures 6% RSV 2%
HIE 5%
500 Jaundice-possible
exchange transfusion road

400 air

300

200

100

0
Total Metro Reg Interhosp 2 teams Back TF Interstate
NETS WA Retrieval areas:
WA is 1/3 of Australia= >2.5 million
square kilometres
Total WA hospitals 32

Number of metropolitan hospitals 16

Country regional hospitals 19 Flight centres

Nursing posts 1 near SA border

Interstate tertiary hospitals 5

Off shore retrievals Christmas Is

International retrievals Bali, PNG

Lists of time/Distant to transport and
equipment available at referral hospital
 Advantages of Transfer
• Access to appropriate care & tertiary facilities
• Diagnosis
• Improved patient outcome
• Early link up with support groups and
networks
 Disadvantages of Transfer
• Increased stress for parents
• Maternal child bonding issues
• Parents may be separated from each other
• Parents may be separated from other children
• Takes away the “interesting” patients from the
staff – reduces interest and incentive
• Cost
 Cost of NETS WA
Employment Costs Level FTE $ Other Goods and Services $
Drug Supplies 6,339
Medical DIRECTOR Consultant 1.10 307,522
Medical, Surgical & Diagnostic Supplies 37,787
ASSISTANT DIRECTOR Consultant 0.54 143,430
SENIOR REGISTRAR 1 YR 1 0.95 135,144 Provision for Careflight - 7 transports 420,000
SENIOR REGISTRAR 2 YR 2 0.82 253,892 Equipment (Non Capital) 6,785
REGISTRAR YR 7 1.89 290,076 Repairs & Maintenance 10,000
Total Medical 5.30 Patient Transport 299,558
1,130,064
Other Expenses 9,679
Nursing
SENIOR REG NURSE NEAS04 1.00 151,385 Depreciation & Amortisation Expenses 111,621
CLINICAL NURSE NEA024 1.00 151,385 Other Asset Expenses 17,633
Total Nursing 2.00 302,770 Escalation for CPI 22,996
Total Other Goods and Services 942,398
Hotel Services
Overhead Factors
DRIVER HW4043 1.04 50,689
Workers Compensation Premium 44,506
Total Employment Costs 8.34 1,483,523
TOTAL OPERATIONAL COSTS
AUD$ 2,470,426
 Infant mortality in Australia
has reduced from 70 % to 3.3 %
per 1000 over 100 years
Since the first retrieval in WA of Janie, who was
26 weeks gestation and weighed 790gms in
1975, we have come a long way……

Terima kasih
Any questions?