RESUMO
The practice of pediatric/neonatal interfacility transport continues to expand. Transport teams have evolved into mobile ICUs capable of delivering state-of-the-art critical care during pediatric and neonatal transport. The most recent document regarding the practice of pediatric/neonatal transport is more than a decade old. The following article details changes in the practice of interfacility transport over the past decade and expresses the consensus views of leaders in the field of transport medicine, including the American Academy of Pediatrics' Section on Transport Medicine.
Assuntos
Unidades de Terapia Intensiva Neonatal/organização & administração , Transferência de Pacientes/organização & administração , Transporte de Pacientes/organização & administração , Acreditação , Benchmarking , Pesquisa Biomédica , Criança , Comportamento Cooperativo , Planejamento em Desastres/organização & administração , Serviços Médicos de Emergência/organização & administração , Humanos , Recém-Nascido , Capacitação em Serviço/organização & administração , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Diretores Médicos , Encaminhamento e Consulta/organização & administração , Gestão da Segurança , Centros de Atenção TerciáriaRESUMO
Neonatal transport teams comprise multidisciplinary health care providers who are skilled in patient care, communication and customer service, and equipment mechanics. They are extensively trained in resuscitation and stabilization, preparing for accelerating care, and their focus is preservation of life. In any situation focused on caring for critically ill patients, ethical issues and questions may arise. For instance, is it compassionate and/or cost-effective to separate mothers and infants when continuing/accelerating care is futile, and when and how should care be redirected from acute and lifesaving care to comfort care and bereavement support for the family? The knowledge and skills required to address such situations and communicate and participate in a redirection of care may not be adequately emphasized in the preparation of the professionals responsible for stabilizing and transporting critically ill newborns. This article raises issues relating to transport and redirecting care such as eligibility for transport, parental request and consent, separation of mothers and infants, palliative and bereavement care, ethical considerations, competitive transport environment, and customer service. A shared mental model is essential. The focus of this article is not to provide answers to all of these issues, but to highlight the complexity of the topic of redirecting treatment during neonatal transport. Redirecting treatment needs to be discussed, and health care professionals should be prepared during their transport team training. Each family and situation must be approached individually, with the acceptance that there will always be more questions than answers.
