maternal transports

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    I work in a small community hospital which handles mostly low risk pregnancies. We transport high risk stuff...especially preterm moms to a tertiary center about 1 1/2 hours away. Of course being stable is of the utmost importance for transfer, but lately the whole process is giving me the heebees. I personally don't go on the transports because of a medical condition that prevents me from riding in the back of anything....but I do have to find staff to go on many occasions. My question is....does anyone do this kind of transfer...and who goes? We literally find a nurse (OB trained) who can go, and put her in the back of an ambulance with a big bag and two ambulance drivers and that is it. Though these moms are stable, we all know that ANYTHING can happen at anytime, and I have nightmares about being in an ambulance with no help, delivering a 30 week kid...and having a post partum bleed or something. I know that is dramatic, but hey....it can happen. Just want to get a sense of what others do, and if there is some standard of care for transporting moms. Thanks!!
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    We don't transport out, but we get transports in. We have a whole team of flight nurses (4 I think) that are always on call. These nurses go in either a plane or helicopter to go get mom's. We live in a rural state so flight is the fastest and easiest way to get people. This is all pre-arranged through the MD's who will be trasporting and accepting these mom's. There are only RN's on the flight with paramedics. These RN's go thorugh extensive training to do this job, they are the best of the best! These mom's are usually stabe, but we have had very sick PIH and HELLP mom's, we usually don't get that many pre-termers, I think they will go to another facility first even though we have a level 3 NICU, must be some sort of argeement through the hospitals.
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    Does your tertiary center have a OB/neonate transport team? Often specialty teams will have their own means of ground transport and contract with a local air ambulance service for calls requiring fixed or rotor wing transport.

    These transfers fall under EMTALA regulations and your transport policies may need further examination.
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    Sounds similar to my previous hospital- they would ship out pretermers below the facilites cut-off gestational age and really sick moms, all had to be stablized first as the receiving facilities were 1 1/2-2hrs by ambulance. Super critical moms (or more often, babies that were born at the hospital to moms who couldn't be stablized enough for transport) would be lifeflighted out, with the flight team taking over the patient before they left our hospital. Anyway, standard of care in the ambulance was the same as in hospital; we monitored vital signs and fetal heart tones (by doppler) according to the facility's high-risk labor/antepartum guidelines. Pretermers might be contracting but all transports had to be stable in terms of no cervical change or arrested cervical change prior to transport. The OB team would determine prior to transport what level of care the pt required- usually 2 people from the ambulance company, 1 of whom could intubate (if necessary) and 1 experienced nurse. Usually it would be 2 nurses though, if 2 could be spared; one very experienced and 1 newer nurse being oriented.

    The transport bag had an emergency delivery kit, baby ambu bag & mask, IV kit/extra IV stuff, BP cuff, steth, doppler, doppler gel, a few meds like pitocin, and a few dollars to buy a snack on the way home If mom's condition changed on the way and delivery was anticapated, there were a few lower-level hospitals along the way- preference being to deliver in any hospital vs back of the ambulance. There were a few close calls but there was never an ambulance delivery in my time and I can't remember anyone ever talking about one that happened before I started...
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    We usually take moms to our referral hospital about 20 miles away by ambulance. We have guidelines for transport. If they just have an IV, then an RN goes w/ them. If they have Mag or something else, then a paramedic (not EMT) is also supposed to go w/ the RN. If no paramedic is available, then another RN must go. In truth, even w/ Mag, often 1 RN goes (we get a doctor's order to transport this way-like that might save our hide). I don't agree w/ this and I bend over backwards to find that other nurse or paramedic. No one wants to get into a bad situation alone. If our usual referral facility is not available to us, we have others about 50 miles away. I think transports are a sticky situation. I do enjoy going on them, but feel it is a high liability for me. I made a dr. go along once. She didn't think it was necessary. The patient was sectioned before we returned to our facility. Then she changed her tune.
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    I am at a level 3 regional care center and we go and pick up our maternal transfers. I have not done this on my own yet and hope not to any time soon! I have had some good training, though. We send one nurse and have an EMT driver. Depending on the situation, we may send two nurses and/or maybe one of the residents. I know it is a routine practice as we get A LOT of transefers, but I also know that even the very experienced nurses that have done it for many years are always nervous about them. You just never know what you will find when you get out there.
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    We do not do our own transport. The maternal transport team from the tertiary center picks them up. For neonates requiring transfer, they are picked up by a NICU team and transported.
  10. 0
    Maternal transfer team/ambulance takes mom (or baby) to the nearest Level III facility for us.


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