Code 3 with a doctor on board!?

[onewing393]

I have been on all three sides of the issue discussed, at the refereing facility, at the receiving facility, and on the transport. Blanket discussions of transport priorities should not be based upon team makeup, though, I tend to doubt that an attending physician rides on many transports.

In some cases, ECMO fellows will go along for the ride, just because the child may require ECMO, though, since they are not doing the cannulations, nor were we transporting with running ECMO circuits, I am not sure what they offered the patient.

In one case, I can recall transporting from a Level III NICU to an ECMO center, with a child whose PaO2 was in the 40's. (For those of you not familiar with NICU terminology, they work the exact opposite of trauma certifications, where a Level I NICU MIGHT keep a child on oxygen....) We chose to do the 90 second flight by helicopter, because it was much shorter than the 20 min emergency transport by ground. (No, the child did not survive, but Group B Strep sepsis is pretty deadly....)

Another case was a cardiac baby (either Tetralogy of Fallot or Transposition of the Great Vessels, I don't remember,) who had a heart rate of 250 which we could not convert, and shocking a <750g infant was not on our list of things we wanted to do to the child. As we did not have rotor wing transport available at the time, we opted to do the 60 mile transport with the aid of traffic clearance devices. (That child survived to discharge, and should be in her mid teens by now.)

Back to my original contention. Second guessing transport priorities based upon the presence or absence of team members with varying levels of medical license is rather closed minded.

[steph1030]

the main goal is to get them stabalized and wherre they need to be for care.i dont care what letters are next to your name if you dont have the proper equipment you cant administer the proper treatment to ANY PATIENT what good is those stupid numbers when thats all they are knowledge can only get you so far the proper equipment better helps you save that life that is in the balance in front of you

they need proper care to begin with no matter what be it in the back of the ambulance ,in the referring facility or the recieveing facility doesnt matter

[VentMedic]

The thing our attendings have stressed to our teams (neo, peds and adults) is don't risk our lives or the lives of others for a pt that may or may not have even a 50/50 chance of survival.

Many times if we have an outside transport driver or pilot, they will never be told how sick the baby or child is that we are transporting. We do not want that to influence their driving since emotions and adrenaline run high with children on board.

I have also sat at a gas station with a broken ambulance and a baby so sick that the referring hospital practically threw it at us as we entered the room. You just find an electrical outlet for the isolette and let your education and training do the rest while you try not to attract attention.

L/S should not be a substitute for education and training.

[spenac]

Even when you run L&S it doesn't mean run like a bat out of hell. Slow down and stay alive.