As a locum tenens provider, most of my jobs are in smaller rural areas, sans one or two rarities in the bigger cities. With limited resources, there have been endless times I have needed to call for transport of patients I do not have the ability to care for. The work flow becomes the same, albeit riddled with challenges and innovative obstacles I’ve written about in other posts: stabilize the patient, call the transfer center for my nearest higher level of care hospital, and keep them alive waiting for the transport team to get there. It’s often scary and has given me so much perspective to what it’s like being the one to ask for help instead of give it from the ivory tower; but, one aspect that wasn’t as clear to me until I went out on my first Transport Shift as a new Neonatology Fellow was the compassion needed by the medical transport team.

For any patient or family member, it is likely a scary thing to be told that you need to be moved to a new hospital to be cared for, to be whisked away from your home with nearby friends and family to a place that might be even a few hours away, and often times, to be transported alone. Particularly in the world of newborn/neonatal-perinatal medicine, there are many times that a brand new baby is almost immediately separated from it’s parents if escalated medical care is needed shortly after birth. Time and time again I have been forced to send away or to later receive, a baby needing early on resuscitative measures and more significant medical therapies to save it’s life. There is always the fear of the unknown and the anxiety of distance between loved ones, and it is always heartbreaking when that separation is between parents and their child. While generally all attempts are made at keeping the mother-baby dyad (or parent-child situation) together or bringing another caregiver along for the ride, it is not always possible and updates are made only by telephone when possibly critical information is needed in person. In the worst of the worst cases, sometimes an emergent transfer for a critically ill child could mean the possibility of inevitable death during transport. Sometimes, in the shear valiant but futile effort to save a life, a family is faced with the possibility of not having the time to spend with these little lives when too much happens too soon. The transport team is beleaguered with the task of walking into an emotional battleground in a foreign environment, garnering trust amidst chaos, and providing comfort in their attempts to get a patient to the next step in care, which might not always end up going towards a favorable direction.

On the end of the referral facility, the calm of the transport team is needed to ease the fear of those of us asking for help. I constantly keep in mind that when I am called with a request for transport to my “destination medical center,” that it is a cry for help, as I so often cried before. Staying professional, maintaining honesty and sincerity, and providing advice and support fall not only on the physicians and nurses on the receiving end, but every point of contact in between from the EMTs, to the respiratory therapists, to the pilots. It is so easy to discuss needing to transfer a patient for care when we are focused on the medical and physiological/biological needs to continue providing support for a life; however, often we must remember to reflect on the picture that is beyond medicine and encompasses the emotional, social and spiritual needs of families and loved ones. It is important to realize that while we do these things everyday, it is not the everyday doing for others.

And, as I watched the critical care pediatric/newborn transport nurse on my first shift with his team kneel down to sign consents and talk to a 12 year old eye level, I listened to him slow down his words and understand what transport meant to them as I heard the words a mentor once passed on to me, “We signed up for this, and you didn’t. It’s ok to be scared, this is not normal.”

Image: A picture I took from the Helipad