For Holly Christensen, RN, a NICU nurse at Children's Hospital & Research Center Oakland, transporting children from neighboring communities for specialized care is nothing new. A 23-year veteran of the hospital, she has accompanied critically ill patients for 20 years.
But until recently, these routes were firmly routed on terra firma. Now, through a partnership between Children's Hospital Oakland and REACH air transport services, she finds herself in the domain of flight nurses.
Charged with the safe transport of neonates as young as 24 weeks and tiny as 2 kg in the confines of a helicopter - with a limited ability to hear and even more limited space - there is definitely a thrill in the air.
After more than six transport flights, Christensen has become accustomed to the unique challenges involved, but she recalls the steepest part of the learning curve. Although the neonates are of comparable acuity to those she sees in the NICU at the hospital, the transport "staff" - just the NICU nurse and the REACH flight nurse - means both nurses' skills are crucial.
"Most of the kids we've taken by REACH have been ventilated," she explained. "If we were doing a regular transport by ground, I'd have a doctor with me and a respiratory therapist, but when we do this via REACH transport, there's only the two of us.
"I found we really had to rely on each other. She relies on me for my neonatal expertise, and then I really rely on her because she's the one who knows about the ventilator."
Need for Speed
The complementary expertise of the two nurses is the key to what makes the program successful, according to Tess Estocapio, RN, transport coordinator at the hospital. Though REACH nurses are highly skilled, the expertise of the hospital's NICU nurses means the "hybrid" program expands the service capacity.
"Initially they were doing most of the neonatal transports for us, but they had certain criteria - the babies had to be stable and they had to be more than 2 kilograms," Estocapio explained. "Then we discovered they couldn't support us better because we were getting sicker and sicker infants, which means we were going on ground transports and it was taking longer to bring those infants to Children's.
"Two years ago, we started a discussion about doing a hybrid program where they would come down and get one of our nurses to go with them."
Getting the program aloft wasn't easy. "It was a difficult sell with the nurses because it's totally outside of their comfort level," Estocapio acknowledged. "This is a totally new program and we're working with a different company; the REACH nurses are from a different institution, a different provider from what we're used to."
However, Estocapio knew the importance of providing the service would help the NICU nurses overcome their apprehension. Calls to transport neonates were coming in from Redding and Modesto - a 90-minute ride from the hospital each way by ground, totaling 5-6 hours to bring the infant to the facility. She began a campaign to involve nurses in the first step, FAA safety training, to drastically quicken transport. A group of 16 highly experienced nurses agreed to participate in the program, a 4-hour safety class that included both didactic and hands-on instruction, as well as acclimation to the tiny workspace within the helicopter.
"We spent a day at the airport and they talked about the physiology of being up in the air and the mechanics," Christensen said. "Then we actually got to go to the base and load and unload the Isolette.
"It's challenging in there because you're wearing this big helmet and you can't hear anything, so you're really relying on the monitors and how the baby looks," she continued. "You can't hear the ventilator alarms, but you can watch the pressure manometer."
After the safety orientation, the next step was a mock run-through that would give the team an opportunity to evaluate what further preparation would be needed. But it's not until a "live run" that the real learning takes place, Estocapio said. "We waited for a call where we actually had an infant we could bring in."