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Neonatal transport
Semin Neonatol 1999; 4: 217
Neonatal transport David Field Neonatal Unit, Leicester Royal Infirmary, Leicester LE1 5WW
Of the many areas of medicine that can be described as ‘high cost and low volume’, neonatal intensive care is one of few that is genuinely an ‘emergency specialty’. However, early neonatologists seemed to accept, quite readily, that because of financial considerations intensive care facilities would never be available at every delivery site. Therefore, when neonatal intensive care units first emerged during the 1960s and 1970s, the need for rapid and effective transport became readily apparent. Perhaps because of the nature of the clinicians involved, they appeared to relish this additional challenge. Of course, the scale of the problem confronting different countries (i.e. the need to cover 20 miles or 200 miles, or more) varied, as did the rate at which comprehensive neonatal services became widely available, but the link between neonatal intensive care and good transport services is still present throughout the world. Many aspects of transport practice remain controversial. For example, various studies have considered whether the process of transport inevitably produces worse outcomes or whether it simply selects a group of infants at particularly high risk of
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bad outcome. Whilst this is a matter of debate, there seems to be no doubt that poor care during transport increases both mortality and morbidity. Equally controversial is the issue of whether, where possible, transfer should occur in utero or after delivery. Again, it is not possible to answer this question in simplistic terms. It is also important to remember that by the nature of emergency transfers there is significant risk to accompanying staff. Many readers will be aware of incidents in which medical attendants were either injured or killed during a neonatal retrieval. Such incidents have occurred in relation to both road and air transfers. In Europe, safety has been a major driver in the development of new regulations in this area. In this edition of Seminars in Neonatology we hope to address many of these issues relating to neonatal transport. Because of the extent to which ‘local factors’ govern how individual services are set up and run it is not possible to recommend a single model. Our aim is to present a broad overview of the topic, using insights from services around the world, in the hope of providing new information and ideas that can be incorporated more widely.
© 1999 Harcourt Publishers Ltd
Neonatal transport David Field Neonatal Unit, Leicester Royal Infirmary, Leicester LE1 5WW
Of the many areas of medicine that can be described as ‘high cost and low volume’, neonatal intensive care is one of few that is genuinely an ‘emergency specialty’. However, early neonatologists seemed to accept, quite readily, that because of financial considerations intensive care facilities would never be available at every delivery site. Therefore, when neonatal intensive care units first emerged during the 1960s and 1970s, the need for rapid and effective transport became readily apparent. Perhaps because of the nature of the clinicians involved, they appeared to relish this additional challenge. Of course, the scale of the problem confronting different countries (i.e. the need to cover 20 miles or 200 miles, or more) varied, as did the rate at which comprehensive neonatal services became widely available, but the link between neonatal intensive care and good transport services is still present throughout the world. Many aspects of transport practice remain controversial. For example, various studies have considered whether the process of transport inevitably produces worse outcomes or whether it simply selects a group of infants at particularly high risk of
1084–2756/99/040217+01 r12.00/0
bad outcome. Whilst this is a matter of debate, there seems to be no doubt that poor care during transport increases both mortality and morbidity. Equally controversial is the issue of whether, where possible, transfer should occur in utero or after delivery. Again, it is not possible to answer this question in simplistic terms. It is also important to remember that by the nature of emergency transfers there is significant risk to accompanying staff. Many readers will be aware of incidents in which medical attendants were either injured or killed during a neonatal retrieval. Such incidents have occurred in relation to both road and air transfers. In Europe, safety has been a major driver in the development of new regulations in this area. In this edition of Seminars in Neonatology we hope to address many of these issues relating to neonatal transport. Because of the extent to which ‘local factors’ govern how individual services are set up and run it is not possible to recommend a single model. Our aim is to present a broad overview of the topic, using insights from services around the world, in the hope of providing new information and ideas that can be incorporated more widely.
© 1999 Harcourt Publishers Ltd