Peter Maglidt RRT-NPS

Paul Fenwick RNC-NPT

Kapi‘olani Transport Team

Delivering our Keiki Safely over

Land/Water

Disclosures

We have no relevant financial or nonfinancial

relationship(s) with the products or services

discussed in this presentation.

Objectives

• Overview of the Kapi’olani Transport Team;

training/ configuration/ scope of practice

• Review relevant transport statistics.

Kapi‘olani’s Transport Team

• Program started in 1989

• RN/RT Configuration

• + MD for select transports

Sheree Kuo MD

Neonatal

Transport

Medical Director

Kon Xoinis MD

Pediatric Transport

Medical Director

Melody Kilcommons

RNC, BSN

Director of

Transport Team

Team Training/Requirements

• KMC Transport Internship/Certification

• Annual FAA Required Safety Training

• Annual Competency Skills Training

• Critical Care Simulation Training

• Water Egress Training

• NRP, BLS, PALS, ACLS requirements

• NRP, PALS, BLS Instructors

Team Training/Requirements

• Neonatal, Pediatric, Critical

Care Professional

Certifications

• Neonatal Pediatric

Specialization (NPS-RRT)

• Critical Care Registered

Nurses (CCRN, RNC-NPT)

Annual Competency Skills Training

• Intubation

• Needle Decompression

• Chest Tube Insertion

• Umbilical Line Placement

• Intraosseous Placement

• Pericardiocentesis

Simulation Practice

Water Egress

In Hospital Responsibilities

• Attend KMCWC High

Risk Deliveries

• Rapid Response Team

• Trauma Response Team

• Code Blue Response

Team

• Liaison / Resource for the

Hospital

Our Equipment;

• Age and weight appropriate equipment

• ETCO2

• Ventilators:

– Different ventilator modalities

– Blended gases (Oxygen, Air, iNO)

– Nitrogen

• Blood

Analyzer

Equipment

• Defibrillator/ AED

• Monitors

• IV pumps (drug libraries)

& Medications

Specialty software for

neonatal and pediatric dosing

standards/safety limits

• ECMO

NEONATAL ISOLETTE

CRITICAL CARE / ECMO SLED

Respiratory Modalities

• NC/ HFNC/ SFM/ NRB

• Neonatal/Pediatric CPAP-BIPAP

• Neo/Peds Invasive Ventilation

Respiratory Modalities

• High Frequency Ventilation

• Nitric Oxide

• Nitrogen

Positive Pressure Cannula

18

Cannula for CPAP and NIPPV

19

• Simple and cost effective

• Soft curved prongs

• Uses nasal cannula design with large diameter distal end connector (15mm) adaptable with multiple modes respiratory support: Ventilators including HFOV, T-Piece resuscitators, Neo Tee, and bubble CPAP. There is an adapter to use with 02 tubing.

• Can deliver CPAP, PPV, IMV and continuous high or low flow 02

Transport Planes

20

Twin Turboprop Air Ambulance

21

Aft view

22

Forward view

23

Med Jet Air Ambulance

24

Aft view

25

Neonatal Isolette

26

Critical Care/ ECMO Sled

27

HYDRAULIC LIFT SYSTEM

Neonatal Isolette and loading system

29

Medical Transport Jet

30

Interior

31

Who We Travel With? • Hawaii Life Flight

• LifeSave Kupono

• American Medical Response (AMR)

• Commercial Airlines

• Emergency Airlift

• Premier Jets

Challenges of Transporting in Hawaii

• Weather

• Limited resources

• Plane/ Ambulance

• Team Availability

• Rural Locations

Challenges During Transport

34

• No doctor at altitude to discuss pt.

• No consistent communication

• Clinical decisions on our own

• Unstable environment

• Limited resources-equipment/medical gas supply

• Limited space

• Possibility of being diverted to different patient

• Time constraints/ vehicle availability

• Pt deteriorating during transport

Challenges of Transporting in HawaiiAccording to the US Census Bureau (2017):

• Total Population for the state of Hawaii is 1.42 million

– Oahu: 992,000

– Big Island (Hawaii) 195,000

– Maui: 163,000

– Kauai: 70,500

• A total of 9.3 million visitors came to Hawai‘i in 2017

• With single Level I Trauma Center

• Certified Transport Team members: 12

Waimea, Hawai‘i - 2017

36

Hilo Airport, 2018

37

Kauai

174 km

1 hr 30 min

Maui

151 km

1 hr 40 min

Big Island

Waimea 256 km

Kona 267 km

Hilo 329 km

1 hr 50 min - 3 hrs

Molokai

88 km

20min

Lanai

117 km

25 min

How Remote is Hawaii?

Oahu to California

2535 miles

5.5 - 7 hours

Transports Annually

300

350

400

450

500

550

600

650

7002

00

6

20

08

20

09

20

10

20

11

20

12

20

13

20

14

20

15

20

16

20

17

Total Transports

Pediatric vs. Neonatal Transports

0

100

200

300

400

500

600

700

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

Pediatric

Neonatal

Air vs. Ground Transports

0

50

100

150

200

250

300

350

400

450

500

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

Air

Ground

Mainland Transports

05

1015

2025

3035

4045

50

2010

2011

2012

2013

2014

2015

2016

2017

Total Mainlands

Quality Improvement

Case Review – Debrief

• Policy Review

• Formally placed into practice

Special Thanks

• Kapi’olani Team and Medical Support

• AMR Crews

• Hawai‘i Life Flight

• LifeSave Kupono

• Our Sending Facilities Staff

Philanthropy

• Kapi‘olani Health Foundation

• Children’s Miracle Network

• Costco

• Walmart

• Generous Donations from the Hawai‘i Community

Call (808) 983-6555

24 HOUR HOTLINE

Kapi’olani Transport Team

Questions?

48