From the Guidelines
Neonatal transport by ambulance is generally safe when conducted by trained personnel using specialized equipment, as outlined in the 2021 joint position statement by the National Association of EMS Physicians and the American Academy of Pediatrics 1. The safest approach involves a dedicated neonatal transport team consisting of healthcare providers with expertise in neonatal care. The ambulance should be equipped with essential equipment for neonatal care, including:
- A transport incubator that maintains appropriate temperature
- Respiratory support equipment, such as oxygen and ventilators
- Monitoring equipment for vital signs, oxygen saturation, and glucose levels
- Essential medications for transport, such as emergency drugs and antibiotics
- Devices for maintaining temperature, such as blankets and heat packs
- A device capable of providing noninvasive positive pressure ventilation
- Self-inflating manual ventilation devices and masks to fit neonates
- Newborn delivery supplies, including umbilical cord clamps and bulb suction.
The risks during transport include temperature instability, respiratory deterioration, and hemodynamic changes due to movement and vibration, which is why specialized equipment and trained personnel are essential to mitigate these risks and ensure safe transfer of these vulnerable patients. Communication between the referring and receiving facilities is crucial to ensure continuity of care, as emphasized in the guidelines for interfacility transport 1. The use of a dedicated neonatal transport team and specialized equipment can help minimize the risks associated with neonatal transport and ensure the best possible outcomes for these high-risk patients. It is also important to note that the mere presence of certain pieces of equipment on an ambulance does not equate to individual EMS provider competence in the use of that equipment or to an EMS program’s practice of high-quality and effective EMS medicine, as highlighted in the 2021 joint position statement 1. Therefore, it is essential to ensure that EMS providers are properly trained and equipped to provide high-quality care during neonatal transport.
From the Research
Safety of Transfer of Neonates by Ambulance
- The safety of transferring neonates by ambulance is a critical concern, with studies indicating that death and morbidity can be associated with the transfer process 2.
- A study from 1990 found that infants who died during transport were more likely to have been of low birth weight, traveled a long distance, been hypothermic, had poor arterial gases, had blood sugars less than 2.2 mmol/l, and had poor referral letters 2.
- In contrast, a more recent study from 2021 found that interfacility neonatal transport for convalescent care can be an effective way to improve regionalized care, with 81% of infants born at the hospital being transferred to other facilities for convalescent care 3.
- The safety of neonatal transport also depends on the quality of care provided during transport, with studies emphasizing the importance of adequate ventilation, temperature control, and monitoring of vital signs 2, 4.
- Advances in neonatal resuscitation practices, such as the use of noninvasive ventilation and high-flow nasal cannula, have also improved the safety of neonatal transport 5, 6.
- However, despite these advances, many interventions in neonatal resuscitation are still performed without robust scientific evidence, highlighting the need for further research in this area 5.