Dr Mok Yee Hu - Transport of the sick child

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Information about Dr Mok Yee Hu - Transport of the sick child
Health & Medicine

Published on October 20, 2014

Author: RahulGoswami9

Source: slideshare.net

Description

Dr Mok Yee Hui relates her experience and gives a rundown on the complicated task known as paediatric retrieval

1. Transport of the Sick Child Mok Yee Hui Children’s Intensive Care Unit Department of Paediatric Subspecialities 13th April 2014 1

2. Overview 1. Evolution of transport 2. The “need for speed” 3. What’s special about specialized teams? 4. All about us 2

3. 3 The “golden hour”

4. Transport scene • Scene primary medical care facility • Medical care facility specialist centre • ICU Other departments 4

5. Primary and secondary transports • Early goal directed therapy in the ED – Sepsis and septic shock • Early goal-directed therapy in the treatment of severe sepsis and septic shock. Rivers et al. NEJM 2001 • Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Han YY, Carcillo JA, Dragotta MA et al. Pediatrics 2003 5

6. So are all transports the same? • Scene-related trauma vs inter-facility transport • EMS personnel vs specialized personnel • “Scoop and Run” vs “Stay and Play” • Adults vs paediatric/neonates 6

7. Overview • Evolution of transport • The “need for speed” • What’s special about specialized teams? • All about us 7

8. Pediatric specialized transport teams Providing as high a standard of intensive care as is available on the intensive care unit 8

9. 9

10. 10

11. Evidence we should exist? • Less risk of adverse events • Improved survival regardless of time taken or distance travelled • Survival benefit independent of stabilization time 11

12. 12 Paediatric critical care transport

13. Specialized paediatric transport team composition 1. Trained personnel – Individuals with skills and experience that best meets the needs of the patient – Dependent on resources available 1. Specialized equipment 2. Transport vehicles – Ground ambulances, fixed or rotary wing aircraft, water vehicles 1. transport co-ordinator – Emergency care or critical care specialist 13

14. Paediatric critical care personnel • Transport Medicine • Paediatric Medicine • Critical Care medicine • Multi-disciplinary communication skills and ability to anticipate and react to rapid change in a high stress environment 14

15. Transport Medicine 15

16. Transport Medicine 16

17. Kids aren’t small adults • Anatomy • Physiology • Disease processes • Drug doses 17

18. Critical Care experience • Skills • Knowledge – Critical care physiology – Use of invasive monitoring – Mechanical ventilation in children • Equipment – Appropriately sized – Mechanical ventilators 18

19. Pediatric Specialized Transport Teams • Transport physiology • Paediatric specialty experience • Critical care skills 19 • Transport time of specialty team • What service is required • Economics • Risk-benefit ratio

20. Pediatric Specialized Transport Teams • Early goal directed therapy (and stabilization) • Specialized skills and knowledge • Equipment • “Stay and Play” – Extension of the PICU 20 Why?

21. Overview • Evolution of transport • The “need for speed” • What’s special about specialized teams? • All about us 21

22. KKH Children’s Emergency Transport Service (CHETS) 22 <Insert cover image here>

23. International Transports 23

24. • 90-100 missions/year • Local “Out of door”: 15- 30 min • Stabilization: 15 min – 5 hours • “Mobile ICU” 24

25. • 35% of patients required interventions on-site • 7.4% IA lines, 2.7% CVL, 6% ETT change/insertion, CPR 1% • 56% on mechanical ventilation, 12.6% on vasoactive medications 25

26. ECMO transport • development of a formal protocol • currently still case-by-case basis for off-site cannulation • Close co-operation with CTS surgeon and referring hospital team • Capabilities for intra-hospital transfers 26

27. “To improve the outcomes of critically ill or injured paediatric patients who are not in proximity to a hospital that provides the required level of care.” - AAP guidelines on pediatric interfacility transport 27

28. To the dedicated staff who make this service possible 28 Thank You

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