PubMed · 10139462
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T Evans. 1995. War without glory.. https://pubmed.ncbi.nlm.nih.gov/10139462/
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INTRODUCTION: Neonatal transport is difficult and often associated with problems. In 1998, the Neonatal Intensive Care Unit, University Hospital of Copenhagen, H:S Rigshospitalet, set up a neonatal transport team. The aim of this study was to assess whether a better quality of high risk transport could justify the increased consumption of time. METHOD: The schedules for observation and assessment filled in by the transport team were collected and compared with records of the transport of high-risk neonates by local transport. The comparison consisted in the number of infants, severity of the problems, interventions carried out either locally or after arrival at the Neonatal Intensive Care Unit, and the condition of the infants judged on the pH, blood sugar level, blood pressure, and body temperature. RESULTS: The neonatal transport team fetched 68 high-risk infants, whereas 140 high-risk infants were brought by local transport. Infants fetched by the transport team were more sick, both before and during transport, than those brought to us. On arrival at the Neonatal Intensive Care Unit, more infants brought by local transport had problems (31% vs 16%): 12 (9%) transports had more than one critical problem, in contrast to none of the infants fetched by the transport team. The transport team carried out 71 interventions on 44 of the 68 infants (65%). These interventions explain the better condition of the infants on arrival. Acute interventions soon after arrival at the Neonatal Intensive Care Unit were carried out on 91 of the 140 infants brought by local transport (65%). DISCUSSION: Neonatal transport of extremely ill infants is difficult. A specialised (transport) team with local stabilisation and transport reduces the frequency of complications. The number of high-risk neonates transported is so small that it is improbable that adequate expertise can be built up and maintained locally.
OBJECTIVE: To study the availability of antidotes in French emergency medical aid units (SAMU). METHODS: The physicians or nurses responsible for antidotes in French emergency medical aid units (SAMU) were interviewed by phone. The study involved 102 SAMU in metropolitan France. Four answers on availability of 37 antidotes were possible: the antidote was available in the emergency vehicle used for interventions; the antidote was available in the hospital-located SAMU; the antidote was available in the referral hospital (emergency unit, intensive care unit, operating room, pharmacy); the antidote was not available or not known to be available. RESULTS: Adrenaline and atropine were available in all the intervention vehicles. Nine other antidotes were available in more than two-thirds of the vehicles: 30% glucose (101/102), isoprenaline (100/102), dobutamine (98/112), sodium bicarbonate (97/102), naloxone (95/102), calcium chloride or bicarbonate (89/102), flumazénil (83/102), sodium lactate (77/102), and magnesium sulfate (66/102). Among the other antidotes, hydroxocobalamine and propranolol were available in 24/102 intervention vehicles and activated charcoal in 22/102. Antidigitalic antibodies and 4-methylpyrazole were not available in any vehicle, and were available in less than 25% of the hospitals. CONCLUSION: There is a great disparity of antidote availability. Certain essential antidotes, for which there is no alternative, are not available in emergency intervention vehicles and even in the hospital. The SAMU should develop an economically acceptable departmental management scheme for exceptional-use antidotes.
A 4-year-long experience is reported on mobile neonatal emergency transport service for pathological newborn babies from referral hospitals to the NICU level III. The area covered by the NICU consists of three counties with a total population of 1 million. Distance of the hospitals from the NICU ranges 0.5-115 km, transport time varies from 0.5-5.0 hours. In the transport staff are dedicated neonatal team from the NICU III, the driver and the emergency medical technician are the employee of the National Ambulance Service. During the study period 385 patients were transported. Clinical condition and characteristic laboratory parameters of the babies at departure and arrival are analysed and compared to evaluate the efficacy and quality of the system. Furthermore, some questions regarding organisation, transit time and response time and legal aspects are discussed.