Elsevier

Seminars in Perinatology

Volume 40, Issue 7, November 2016, Pages 430-437
Seminars in Perinatology

Simulation in neonatal transport medicine

https://doi.org/10.1053/j.semperi.2016.08.003Get rights and content

Abstract

The safe transport of infants in critical condition requires highly reliable inter-professional transport teams that are equipped with the expertise to provide neonatal care in unfamiliar and resource-limited environments. Increasingly, transport teams are comprised of health professionals from various disciplines. Providing didactic and experiential learning alone is insufficient to fully prepare teams that have limited exposure to rare events. Simulation-based training supplements and reinforces knowledge, skills, and the experiences of team members. This article presents the current use of simulation in the training of neonatal transport teams and critically reviews how simulation methodologies may be further incorporated into curricula and quality improvement to achieve high-reliability teams.

Section snippets

History of neonatal transport medicine

The transport of newborns to the hospital was a necessity long prior to the establishment of modern day neonatal intensive care units (NICUs). Prior to the 20th century, most births occurred in the home. However, neonatal morbidity and mortality was relatively common, requiring hospital resources and specialized care. In the late 19th century, a “portable incubator” or “hand ambulance” was manufactured in Chicago for neonatal transport to the hospital. The design was similar to previous

Accreditation and standards

Five agencies currently provide accreditation for air and ground critical care transport: the Commission on Accreditation of Medical Transport Systems (CAMTS), the Commission on Accreditation of Ambulance Services, the National Accreditation Alliance of Medical Transport Applications, the Joint Commission International, and the European Aero-Medical Institute.18 CAMTS is a peer-reviewed organization invested in transport safety and quality patient care which sets national safety and patient

Team composition

Transport generalists (non-specialized teams) often are readily available but have limited pediatric training and experience with true emergencies in children and infants. Dedicated pediatric specialized transport teams are less common but have extensive specialty-specific critical care training and experience. Over the past 25 years, there has been an accumulation of data that specialized pediatric and neonatal transport teams result in improved transport and patient outcomes, including

Curriculum

It can be challenging to develop effective curricula for pediatric and neonatal transport teams. Transport teams are usually comprised of different types of professionals, with unique educational backgrounds and clinical skill sets. Most transport programs have limited patient training opportunities, budgets, and access to cadaveric or animal models for skills development.32

Traditionally, pediatric and neonatal transport team members have been trained using a combination of standardized courses

Team training

A growing body of simulation research in healthcare supports inter-professional team training, demonstrating significant improvements in team performance, patient care processes, and clinical outcomes.48 However, studies that evaluate the use of simulation-based team training in transport medicine are extremely limited.18 The majority of transport programs focus education on the acquisition and maintenance of knowledge and technical skills through didactic and simulated procedural training. The

Systems issues

Regardless of whether transports occur in an ambulance, helicopter, or fixed-wing airplane, transport teams need to maintain vigilance to anticipate potential problems that may affect the safety of the team and patient. In one study involving 346 neonatal transports, 36% had adverse events, of which 67% were due to human error, 21% to equipment failures and 9% to ambulance problems. Communication failures occurred at every phase of the transport process, especially during handoffs between teams.

Innovation and future directions

Teams specialized in neonatal transports have been shown to reduce the morbidity and mortality of premature infants.25 However, even patient outcomes associated with the use of a dedicated neonatal transport team are not similar to that of infants born at a tertiary or quaternary NICU.25 While the field of transport medicine has made significant progress, educational innovation, quality improvement/assurance projects, and research that demonstrate improved safety and patient outcomes are still

Conclusion

The use of simulation as an educational tool in the training of neonatal transport team members is useful for both technical skills and non-technical skills. Further development of simulation-based curricula and innovation is needed to strengthen experiential learning so that teams are better prepared to deliver care. In addition, simulation may be used to determine and test quality metrics and optimize patient outcomes with the goal to achieve high reliability teams.

References (69)

  • J. Lubin et al.

    The feasibility of daily mannequin practice to improve intubation success

    Air Med J

    (2009)
  • N. Ratnavel

    Safety and governance issues for neonatal transport services

    Early Hum Dev

    (2009)
  • D. Lamb

    Could simulated emergency procedures practised in a static environment improve the clinical performance of a Critical Care Air Support Team (CCAST)? A literature review

    Intensive Crit Care Nurs

    (2007)
  • B.K. Ross et al.

    Simulation for maintenance of certification

    Surg Clin North Am

    (2015)
  • C.L. Jaynes et al.

    A blueprint for critical care transport research

    Air Med J

    (2013)
  • S. Mouskou et al.

    Neonatal transportation through the course of history

    J Pediatr Neonatal Care

    (2015)
  • G.W. Chance et al.

    Transportation of sick neonates, 1972: an unsatisfactory aspect of medical care

    Can Med Assoc J

    (1973)
  • A. Leslie et al.

    Neonatal transfers by advanced neonatal nurse practitioners and paediatric registrars

    Arch Dis Child Fetal Neonatal Ed

    (2003)
  • J.L. Hood et al.

    Effectiveness of the neonatal transport team

    Crit Care Med

    (1983)
  • S. Day et al.

    Pediatric interhospital critical care transport: consensus of a national leadership conference

    Pediatrics

    (1991)
  • American Academy of Pediatrics Committee on Pediatric Emergency Medicine

    Access to emergency medical care

    Pediatrics

    (1992)
  • J. Kattwinkel

    Textbook of Neonatal Resuscitation

    (2000)
  • J. Zaichkin

    Instructor’s Manual for Neonatal Resuscitation

    (2000)
  • Joint Commission on Accreditation of Healthcare Organizations

    Preventing infant death and injury during delivery

    Jt Comm Perspect

    (2004)
  • L. Kohn et al.

    To Err Is Human: Building a Safer Health System

    (2000)
  • J.L. LeFlore et al.

    Effectiveness of 2 methods to teach and evaluate new content to neonatal transport personnel using high-fidelity simulation

    J Perinat Neonatal Nurs

    (2008)
  • H.E. Whyte et al.

    Canadian Paediatric Society, Fetus and Newborn Committee. The interfacility transport of critically ill newborns

    Paediatr Child Health

    (2015)
  • M.H. Stroud et al.

    Pediatric and neonatal interfacility transport: results from a national consensus conference

    Pediatrics

    (2013)
  • Commission on Accreditation of Medical Transport Systems

    Accreditation Standards of the Commission on Accreditation of Medical Transport Systems

    (2015)
  • K.A. Karlsen et al.

    National survey of neonatal transport teams in the United States

    Pediatrics

    (2011)
  • D. Mullane et al.

    Neonatal transportation: the effects of a national neonatal transportation programme

    Ir J Med Sci

    (2004)
  • R.A. Orr et al.

    Pediatric specialized transport teams are associated with improved outcomes

    Pediatrics

    (2009)
  • P.J. McNamara et al.

    Dedicated neonatal retrieval teams improve delivery room resuscitation of outborn premature infants

    J Perinatol

    (2005)
  • G.D. Vos et al.

    Comparison of interhospital pediatric intensive care transport accompanied by a referring specialist or a specialist retrieval team

    Intensive Care Med

    (2004)

    • Cited by (13)

    • Recommendations on the skills profile and standards of the neonatal transport system in Spain

      2021, Anales de Pediatria

    • Using briefing, simulation and debriefing to improve human and system performance

      2019, Seminars in Perinatology
      Citation Excerpt :

      NeoSim was subsequently adopted as the model for the type of training and debriefing espoused by the NRP.13 Since then, simulation has been used to facilitate the acquisition and maintenance of the skills necessary for competent performance in multiple areas of neonatal care including but not limited to assisted ventilation, intubation, extracorporeal membrane oxygenation (ECMO), reduction in central line-associated infections, transport medicine, conducting difficult discussions, and outreach.14–25 In addition, simulation may be used for purposes other than training HCPs; for example, it has also been used to probe new neonatal intensive care unit (NICU) environments for latent failures prior to opening them for the care of actual patients.

    • Neonatal Transport: Current Trends and Practices

      2018, Critical Care Nursing Clinics of North America
      Citation Excerpt :

      The safe and secure transport of infants in critical or unstable condition requires highly dependable interprofessional transport teams. These teams should be competently trained with the necessary equipment and supplies to provide care in inexperienced, often chaotic, and resource-limited environments.5 The coordination of the transport of neonates, some from significant geographic distances, is customarily initiated with a call to a level 3 or 4 neonatal center.

    • Mixed-Reality Simulation for a Pediatric Transport Team: A Pilot Study

      2020, Air Medical Journal
      Citation Excerpt :

      Likewise, the use of competent medical management, specifically standardized resuscitation protocols for the management of critically ill children, has been shown to improve outcomes.26 Simulation using SPs/actors to emphasize communication skills and manikins to emphasize medical knowledge and technical skills is limited to a few studies,9,11-17 despite evidence that experiential and immersive simulation is effective in medical training.2,22,27-32 Experiential learning can help people to manage complex medical situations3; is an excellent methodology for the acquisition of behavioral skills4; and offers a holistic approach that can be particularly effective in addressing cognitive, emotional, and physical aspects of the learner.10

    • Enhancing team success in the neonatal intensive care unit: challenges and opportunities for fluid teams

      2023, Frontiers in Psychology

    • Comparison of four neonatal transport scoring methods in the prediction of mortality risk in full-term, out-born infants: a single-center retrospective cohort study

      2022, European Journal of Pediatrics
    View all citing articles on Scopus
    View full text
    © 2016 Elsevier Inc. All rights reserved.