Download PDF
CC BY-NC-ND 4.0 · J Pediatr Intensive Care 2023; 12(03): 235-242
DOI: 10.1055/s-0041-1731681
Original Article

Safety and Feasibility of Long-Distance Aeromedical Transport of Neonates and Children in Fixed-Wing Air Ambulance

Alex Veldman
1   Jetcall Air Ambulance, Idstein, Germany
2   Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany
3   The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia
,
Stefanie Krummer
1   Jetcall Air Ambulance, Idstein, Germany
2   Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany
,
Dirk Schwabe
1   Jetcall Air Ambulance, Idstein, Germany
,
Michael Diefenbach
1   Jetcall Air Ambulance, Idstein, Germany
,
Doris Fischer
1   Jetcall Air Ambulance, Idstein, Germany
2   Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany
,
Sophie Schmitt-Kästner
2   Department of Pediatrics, St. Vincenz Hospital, Limburg, Germany
,
Cornelia Rohrbeck
1   Jetcall Air Ambulance, Idstein, Germany
,
Ruby Pannu
1   Jetcall Air Ambulance, Idstein, Germany
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

In cases of critical injury or illness abroad, fixed-wing air ambulance aircraft is employed to repatriate children to their home country. Air ambulance aircraft also transport children to foreign countries for treatment not locally available and newborns back home that have been born prematurely abroad. In this retrospective observational study, we investigated demographics, feasibility, and safety and outcomes of long-distance and international aeromedical transport of neonates and children. The study included 167 pediatric patients, 56 of those preterm neonates. A total of 41 patients were ventilated, 45 requiring oxygen prior to the transport, 57 transferred from an intensive care unit (ICU), and 48 to an ICU. Patients were transported by using Learjet 31A, Learjet 45, Learjet 55, and Bombardier Challenger 604, with a median transport distance of 1,008 nautical miles (NM), median transport time of 04:45 hours (median flight time = 03:00 hours), flight time ≥8 hours in 15 flights, and transport time ≥8 hours in 29 missions. All transports were accompanied by a pediatric physician/nurse team. An increase in FiO2 during the transport was documented in 47/167 patients (28%). Therapy escalation (other than increased oxygen) was reported in 18 patients, and technical adverse events in 3 patients. No patient required CPR or died during the transport. Clinical transport outcome was rated by the accompanying physician as unchanged in 163 transports, improved in 4, and deteriorated in none. In summary, international, long-distance transport of neonatal and pediatric patients performed by experienced and well-equipped transport teams is feasible. Neither major adverse events nor physician-rated clinical deteriorations were observed in this group of patients.

Keywords

pediatric - neonatal - transportation - air ambulance

Supplementary Material



Publication History

Received: 21 March 2021

Accepted: 27 May 2021

Article published online:
16 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Minnaert L. US family travel survey. 2017 . Accessed October 12, 2020 at: http://2ks7od1dgl654aorxx98q3qu-wpengine.netdna-ssl.com/wp-content/uploads/2018/01/FTA.NYU_.2017-Consumer-Family-Travel-Survey.pdf
    PubMedGoogle Scholar
  • 2 Sand M, Bollenbach M, Sand D. et al. Epidemiology of aeromedical evacuation: an analysis of 504 cases. J Travel Med 2010; 17 (06) 405-409
    CrossrefPubMedGoogle Scholar
  • 3 Mortamet G, Harrington K, Raffin H, Menat Y, Oualha M, Renolleau S. Aeromedical transport in children: a descriptive analysis of 96 cases. Pediatr Emerg Care 2020; 36 (01) 31-33
    CrossrefPubMedGoogle Scholar
  • 4 Broman LM, Holzgraefe B, Palmér K, Frenckner B. The Stockholm experience: interhospital transports on extracorporeal membrane oxygenation. Crit Care 2015; 19: 278
    CrossrefPubMedGoogle Scholar
  • 5 Tissot C, Buchholz H, Mitchell MB. et al. First pediatric transatlantic air ambulance transportation on a Berlin Heart EXCOR left ventricular assist device as a bridge to transplantation. Pediatr Crit Care Med 2010; 11 (02) e24-e25
    CrossrefPubMedGoogle Scholar
  • 6 Whyte HE, Jefferies AL. Canadian Paediatric Society, Fetus and Newborn Committee. The interfacility transport of critically ill newborns. Paediatr Child Health 2015; 20 (05) 265-275
    CrossrefPubMedGoogle Scholar
  • 7 Swartz MF, Cholette JM, Orie JM, Jacobs ML, Jacobs JP, Alfieris GM. Transfer of neonates with critical congenital heart disease within a regionalized network. Pediatr Cardiol 2017; 38 (07) 1350-1358
    CrossrefPubMedGoogle Scholar
  • 8 Löllgen RM, Woods P, Wall M, Berry A. Oxygen desaturation in infants during aeromedical transport. N Engl J Med 2014; 371 (16) 1560-1561
    CrossrefPubMedGoogle Scholar
  • 9 Jackson L, Skeoch CH. Setting up a neonatal transport service: air transport. Early Hum Dev 2009; 85 (08) 477-481
    CrossrefPubMedGoogle Scholar
  • 10 Anderson CD, Webb E, Lampe GE, Clark T, Williams HL, Hillman NH. Interhospital transport of infants on bubble continuous positive airway pressure via ground and air. Air Med J 2020; 39 (06) 458-463
    CrossrefPubMedGoogle Scholar
  • 11 McAdams RM, Dotzler SA, Pole GL, Kerecman JD. Long-distance air medical transport of extremely low birth weight infants with pneumoperitoneum. J Perinatol 2008; 28 (05) 330-334
    CrossrefPubMedGoogle Scholar
  • 12 Tursch M, Kvam AM, Meyer M, Veldman A, Diefenbach M. Stratification of patients in long-distance, international, fixed-wing aircraft. Air Med J 2013; 32 (03) 164-169
    CrossrefPubMedGoogle Scholar
  • 13 Wikipedia. NACA Score. Accessed December 12, 2020 at: https://en.wikipedia.org/wiki/NACA_score
    PubMedGoogle Scholar
  • 14 Orr RA, Felmet KA, Han Y. et al. Pediatric specialized transport teams are associated with improved outcomes. Pediatrics 2009; 124 (01) 40-48
    CrossrefPubMedGoogle Scholar
  • 15 Miller JO, Thammasitboon S, Hsu DC, Shah MI, Minard CG, Graf JM. Continuing medical education for air medical providers: the successes and challenges. Pediatr Emerg Care 2016; 32 (02) 87-92
    CrossrefPubMedGoogle Scholar
  • 16 Kingman CE, Economides DL. Travel in pregnancy: pregnant women's experiences and knowledge of health issues. J Travel Med 2003; 10 (06) 330-333
    CrossrefPubMedGoogle Scholar
  • 17 Laughon SK, Albert PS, Leishear K, Mendola P. The NICHD Consecutive Pregnancies Study: recurrent preterm delivery by subtype. Am J Obstet Gynecol 2014; 210 (02) 131.e1-131.e8
    CrossrefPubMedGoogle Scholar
  • 18 Karam O, Roy M, Barrington K, Janvier A. Long-distance air transport of an infant weighing less than 500 g: is it in the patient's best interest?. Paediatr Child Health 2011; 16 (02) 79-81
    CrossrefPubMedGoogle Scholar
  • 19 Arora P, Bajaj M, Natarajan G. et al. Impact of interhospital transport on the physiologic status of very low-birth-weight infants. Am J Perinatol 2014; 31 (03) 237-244
    PubMedGoogle Scholar
  • 20 Bellini C, Serveli S. A L. et al. Long-distance, nonstop neonatal transport from Shanghai, China, to Genoa, Italy. Air Med J 2018; 37 (01) 67-70
    CrossrefPubMedGoogle Scholar
  • 21 Jones HP, Karuri S, Cronin CM. et al; Canadian Neonatal Network. Actuarial survival of a large Canadian cohort of preterm infants. BMC Pediatr 2005; 5: 40
    CrossrefPubMedGoogle Scholar
  • 22 Plante V, Cyr C, Lamontagne A, Tremblay-Roy JS. Parental presence in pediatric interfacility critical care transport: a descriptive study of children, parents, and health care professionals' opinions. Air Med J 2020; 39 (04) 257-261
    CrossrefPubMedGoogle Scholar
  • 23 Curley MA, Meyer EC, Scoppettuolo LA. et al. Parent presence during invasive procedures and resuscitation: evaluating a clinical practice change. Am J Respir Crit Care Med 2012; 186 (11) 1133-1139
    CrossrefPubMedGoogle Scholar
  • 24 Osmon S, Harris CB, Dunagan WC, Prentice D, Fraser VJ, Kollef MH. Reporting of medical errors: an intensive care unit experience. Crit Care Med 2004; 32 (03) 727-733
    CrossrefPubMedGoogle Scholar
  • 25 Gilmour D, Duong KM, Gilmour IJ, Davies MW. NeoSTRESS: study of transfer and retrieval environmental stressors upon neonates via a smartphone application-light. Air Med J 2020; 39 (02) 97-102
    CrossrefPubMedGoogle Scholar
  • 26 Carreras-Gonzalez E, Brio-Sanagustin S. Equipo de transporte. [Prevention of complications in the air transport of the critically ill pediatric patient between hospitals]. An Pediatr (Barc) 2014; 81 (04) 205-211
    PubMedGoogle Scholar
  • 27 Hon KL, Olsen H, Totapally B, Leung TF. Air versus ground transportation of artificially ventilated neonates: comparative differences in selected cardiopulmonary parameters. Pediatr Emerg Care 2006; 22 (02) 107-112
    CrossrefPubMedGoogle Scholar
  • 28 Israëls J, Nagelkerke AF, Markhorst DG, van Heerde M. Fitness to fly in the paediatric population, how to assess and advice. Eur J Pediatr 2018; 177 (05) 633-639
    CrossrefPubMedGoogle Scholar
  • 29 Skeoch CH, Jackson L, Wilson AM, Booth P. Fit to fly: practical challenges in neonatal transfers by air. Arch Dis Child Fetal Neonatal Ed 2005; 90 (06) F456-F460
    CrossrefPubMedGoogle Scholar
  • 30 Stroud MH, Trautman MS, Meyer K. et al. Pediatric and neonatal interfacility transport: results from a national consensus conference. Pediatrics 2013; 132 (02) 359-366
    CrossrefPubMedGoogle Scholar
  • 31 King BR, King TM, Foster RL, McCans KM. Pediatric and neonatal transport teams with and without a physician: a comparison of outcomes and interventions. Pediatr Emerg Care 2007; 23 (02) 77-82
    CrossrefPubMedGoogle Scholar
  • 32 Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated pediatric risk of mortality score. Crit Care Med 1996; 24 (05) 743-752
    CrossrefPubMedGoogle Scholar
  • 33 Marcin JP, Pollack MM. Review of the acuity scoring systems for the pediatric intensive care unit and their use in quality improvement. J Intensive Care Med 2007; 22 (03) 131-140
    CrossrefPubMedGoogle Scholar