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SPECIAL POPULATIONS
NEONATAL PATIENT TRANSPORT
Every year in the world, approximately 15 million babies are born preterm, and this number is rising. Preterm birth complications are the leading cause of death among children under five years of age, responsible for more than 1 million deaths worldwide. Three-quarters of these deaths could be prevented with current, cost-effective interventions. Across 184 countries, preterm birth rates range from 5% to 18% of babies born.
Neonatal and maternal (in utero) transport to tertiary centers is common to facilitate the specialized care of high-risk neonates when childbirth occurs in settings without clinical personnel or equipment. Annually, nearly 70,000 neonatal transports happen in the United States.
A neonate infant baby is a child under 28 days of age from birth. During the first 28 days of life, the full-term child is at his highest risk of dying because their immune systems have not fully developed yet. A full gestation infant’s immune system doesn’t mature until they’re about two to three months old.
A baby’s term is based on his weeks of gestation as follows:
- Premature or Preterm is less than 37 weeks.
- Early term is between 37 through 38 weeks and 6 days.
- Full term is between 39 through 40 weeks and 6 days of gestation.
- Late term is between 41 through 41 weeks and 6 days of gestation.
- Post term is 42 weeks and beyond gestation.
Thermoregulation is essential for all neonates, and it is critical when babies are sick or premature. The ideal skin temperature is 97.7° F (36.5°C). If their skin temperatures drop just one degree, a baby’s oxygen use can increase by 10%. Babies are nose breathers; the only time newborns breathe through their mouths is when they are crying. The incubator or isolette helps monitor and control the neonate’s environment minimizing risks by isolating the baby from germs and keeping them comfortable at the ideal temperature during transport.
Some of the best neonate hospitals in the US are:
- Children’s National Hospital, Washington, DC
- Children’s Hospital Los Angeles, Los Angeles, CA
- Lucile Packard Children’s Hospital Stanford, Palo Alto, CA
- UCSF Benioff Children’s Hospitals, San Francisco and Oakland, San Francisco, CA
- Rady Children’s Hospital, San Diego, CA
- Children’s Hospital of Philadelphia, Philadelphia, PA
- Boston Children’s Hospital, Boston, MA
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
- New York-Presbyterian Hospital-Columbia and Cornell, New York, NY
- Texas Children’s Hospital, Houston, TX
- Children’s Healthcare of Atlanta, Atlanta, GA
Depending on the patient’s condition, the Neonate flight team can be integrated by a combination of a Flight Physician Neonatologist, Critical Care Nurse, Respiratory Therapy of Critical Care Flight Paramedic trained in flight physiology and specialized in the care of newborn children during transport.
As with any specialized transport, the more notice is provided to program these transports, the better because the transport will depend on the availability of the isolette capable aircraft, neonate team, and equipment.
All solutions are provided globally as per availability basis at the time of booking.
PEDIATRIC PATIENT TRANSPORT
Pediatric patients are those 18 years of age and younger.
Caring for pediatric patients is different from adult patients due to anatomical and physiological differences:
- Larger body surface area than adults do. The smaller the child, the greater the ratio of skin surface area to size. As a result, children are at greater risk of excessive loss of heat and fluids. They are affected more quickly and easily by toxins absorbed through the skin.
- Thinner skin and under-keratinized, compared with adults. As a result, children are at risk for increased absorption of agents that can be absorbed through the skin.
- Rapidly dividing cells to assist in their rapid rate of growth. As a result, children are more susceptible to the effects of radiation than adults.
- Higher heart rate and respiratory rate, leading to proportionately higher minute volumes. As a result, children may be more susceptible to agents absorbed through the pulmonary route than adults with the same exposure. Children may also respond more rapidly to such agents. Children’s signs and symptoms may be an “early warning” of a chemical, biological, or radiological incident.
- Immature blood-brain barrier and enhanced Central Nervous System (CNS) receptivity. As a result, children may exhibit a prevalence of neurological symptoms. Nerve agents may produce more symptoms in pediatric patients, requiring levels of treatment for children that are not indicated for adults with the same level of exposure.
- Higher metabolic rate, therefore, are more susceptible to contaminants in food or water and are at greater risk of increased water loss when ill or stressed. Medication doses are calculated based on the child’s weight and body size.
- Immature immune systems have a greater risk of infection and less herd immunity from some infections.
Interhospital transfers are very common for many critically ill or injured children. The primary factor in making any transport decision should always be based on the patient’s best interest.
Pediatric patients needing access to specialists or higher level of care, including Pediatric Intensive Care Units, Heart Center Intensive Care Units, and Level IV Neonatal Intensive Care Units who cannot be safely transported on longer distances by other means, use fixed-wing air ambulance transports with pediatric medical teams.
For Air Medical Transport, having the right pediatric critical care team providing the proper care received during the transport phase is crucial for the acute care continuum.
As for any specialized transport, the more notice is provided to program these transports, the better because the transport will depend on the availability of the aircraft and pediatric team.
GERIATRIC PATIENT TRANSPORT
Although many people age differently, in general, in the medical field, a patient is considered a Geriatric patient after 65 years of age. Globally, the population aged 65 and over is growing faster than all other age groups.
Unfortunately, it is estimated that after the age of 30, our organs lose 1% of function per year, meaning the body is less able to compensate for shock. With depleted calcium levels, our bones can break easier. Superficial burns, lacerations, and abrasions can cause more significant harm, as our skin dermis thins by 20% and the perfusion of blood to the extremities decreases. Additionally, as our brain tissue shrinks, a void is created in our cranial vault, so head injuries are more lethal and can take days to develop.
These and other anatomical and physiological changes increase the importance of having the right medical team for the transport of geriatric and elderly patients:
- Changes in structure, function, metabolism, and blood flow in the aging brain led to cognitive impairments, episodic memory changes, and an increased risk of delirium in the acute setting.
- The geriatric population tends to have higher blood pressure with lower cardiac output and diminished chronotropic and inotropic responses to beta-receptor stimulation.
- Respiratory aging results in changes to mechanical properties of the respiratory system, reduction of arterial oxyhemoglobin saturation, and impaired response to hypoxia.
- Gastrointestinal changes with aging include altered esophageal motility, delayed gastric emptying, and reduction in hepatic metabolism.
- There is a reduction in renal function with age. Changes also occur to the endocrine system, including diminished tissue responsiveness and reduction in hormone secretion from peripheral glands.
Some of the best hospitals in the US for Geriatric patients are:
- Mount Sinai Hospital, New York, NY
- Cleveland Clinic, Cleveland, OH
- Mayo Clinic, Rochester, MN
- UCLA Medical Center, Los Angeles, CA
- NYU Langone Hospitals, New York, NY
- Johns Hopkins Hospital, Baltimore, MD
- New York-Presbyterian Hospital-Columbia and Cornell, New York, NY
- Northwestern Memorial Hospital, Chicago, IL
- UCSF Health-UCSF Medical Center, San Francisco, CA
- Cedars-Sinai Medical Center, Los Angeles, CA
- University of Michigan Health-Ann Arbor, Ann Arbor, MI
- UC San Diego Health-La Jolla and Hillcrest Hospitals, La Jolla, CA
- Houston Methodist Hospital, Houston, TX
As with any air medical transport, the more notice is provided to program these transports, the better because the transport will depend on the availability of the aircraft and team.
All solutions are provided globally as per availability basis at the time of booking.
BARIATRIC PATIENT TRANSPORT
Patients are considered Bariatric when their Body Mass Index is equal to or greater than 40 BMI or, their weight is more than 100 lb. (45kg) over their ideal weight. Transportation of bariatric obese patients could present daunting challenges for the patient and the team on board if they do not have the required training, bariatric patient transport experience, or a complete understanding of the patient’s needs and equipment required.
Compliance with any aircraft’s weight and balance limits is critical to flight safety. Most air ambulances aircraft are designed and engineered with a loading door and aircraft cot to safely transport an average size patient. Each plane has an operational Center of Gravity and a structural floor load limit. The floor load limit is the maximum weight the floor of the aircraft can sustain per square inch/foot. The standard size aircraft stretchers are made to transport an average height patient with a maximum weight of 350 lbs. (159kgs). The average size stretcher mattress has 19 inches width (48.2 cm de ancho).
Bariatric patients may need extra padding to reduce their risk of developing bedsores. Obesity alters adipose tissue metabolic and endocrine function. It leads to an increased release of fatty acids, hormones, and pro-inflammatory molecules that contribute to further obesity-associated complications. Most bariatric patients will require pre-oxygenation before transport because of their large concentration of adipose tissue that contains high levels of nitrogen. With pressure changes, it weakens and may release more nitrogen in the blood leading to increased fat emboli and nitrogen content.
The logistic needs of bariatric obese patients differ from other patients. One size does not fit all bariatric patients. The loading and the off-loading process requires the plane’s door to be wide enough to accommodate a bariatric patient’s large girth safely.
Accurate information and preparation are critical. Therefore, at Air Medical Transport, we request to complete a Fit Assessment form for every bedridden patient that weighs more than 300lb (136kgs) and may not fit on a standard size aircraft and stretcher. The fit assessment proactively assists us in ensuring the patient’s best interest with the safest and appropriate mode of transport to avoid any preventable risks for the patient and the medical personnel. The dimensions of the aircraft loading mechanism and aircraft cot are pre-checked before arranging any transportation.
We recommend getting the exact measurements based on our experience before each Bariatric transport and indicating the patient’s condition and medical requirements to properly coordinate safe care and flowless loading and unloading for these unique patients.
Our Fit Assessment form can be downloaded for each bariatric patient (or caregiver) to fill out if necessary. We look for the prevention, safety, and integrity of each patient and every medical personnel. Please fill out the provided form and document any transport instructions to plan the appropriate fit before transport.
Based on the information from the Fit Assessment, we can correctly quote the proper Bariatric aircraft loading mechanism and stretcher to offer our clients the right air ambulance solution.
As with any specialized air medical transport, the more notice is provided to program these transports, the better because the transport will depend on the availability of the bariatric aircraft and team.
All solutions are provided globally as per availability basis at the time of booking.
