NEONATAL TRANSPORT: NOVEMBER, 2002. NOT PUBLISHED
Decorators try to evoke calmness and serenity on the third floor of Saint David’s Hospital in Austin Texas with paintings of flowers and photographs of babies. It is the place where many in the community spend their first moments in the world and moms and dads get their first look at parenthood.
But entry into this place called “the world” is not always calm and serene. That is where the Neonatal Transport Team and their ambulance come into play. Nurses, medical equipment and a diesel powered ambulance do their best to substitute for mother’s womb. Out by the loading dock the ambulance sits ready and waiting for the little lives that need extra help fighting extra challenges they meet in their first few weeks in of life.
Some babies are born too early or sick making them even smaller and more helpless. On top of that they may be born away from the advanced care they need. “You get your report but by the time you see the baby the picture may have changed,” Neonatal transport Registered Nurse Kim Whitfield said. “You need to think quickly, think logically and be exact,” she added. One of her first runs she arrived to pick up a patient in South Austin to find the baby with breathing problems now had a collapsed lung. The child was transported, survived and is now doing well.
Saint David’s Hospital in Central Austin is one that has a neonatal ambulance as does the Marialice Shivers Neonatal Center at Seton and the Children’s Hospital at Brackenridge. St. David’s team has been transporting sick newborns for several years and in January of 2002 began using their own fully-equipped newborn ambulance. The transport vehicle is not hard to miss with the blown up black and white photo of a newborn covering its sides. The ambulance generally is seen making runs to other hospitals in Austin, Round Rock, Georgetown, Smithville and La Grange, but has also gone further such as Bryan, Fredricksburg and Llano because St. David’s is better equipped to deal with sick and premature newborns than many other hospitals. Rhonda Sageser, coordinator of the 8 person team, said premature birth is the most common issue that requires specialized care and transport. Other emergencies include sepsis and meconium aspiration. In cases of cardiac patients, the child is transported to Brackenridge Hospital. “Cardiac patents are the most challenging,” said Whitfield.
When a hospital needs the services of the team, a call is placed to St. David’s. Then Metrocare Ambulance Service is dispatched from their office in South Austin up to the hospital to do the driving and assist the team. A nurse, a respiration therapist and sometimes a doctor load isoletts onto the ambulance which are rolling chambers for the newborns with temperature control, monitor and a ventilators. The team members carry backpacks with equipment “necessary to perform any and all procedures necessary to save the infant’s life,” Sageser said. Within thirty minutes (traffic permitting), the ambulance is rolling out of the hospital parking lot. The ambulance can hold up to three newborns and twice has taken triplets.
Dr. David Breed, Medical Director for the team, calls the group “outstanding.” Transport nurses receive training other nurses do not so part of Breed’s job is teacher as well as doctor. “They are all eggar students who defiantly excel at all they do,” he said. This kind of nursing “... takes extra drive, has extra rigors, extra work, extra time commitment and extra education,” Breed said. “We are very picky. The application and interview process makes us a very limited club.” Whitfield added, “I think I’m drawn to nursing because there are no two days alike, there is always learning.” When not transporting, the team member on duty assists with high risk births at the hospital.
Glen Carson, a licensed paramedic from Metrocare, remembered a call last Christmas Eve. Twins were born after about six months of gestation. The larger was two pounds, the other was less than a pound and a half. A nurse on duty had stayed with the twins until the team arrived and was on her sixteenth hour at the hospital, Carson said.
The time commitment is something Whitfield, a six year transport nurse, experienced during one of her twelve hour shifts in September. “I spent the whole day doing transports,” she said. She started at 6:45 am, went from the hospital to Bryan, back to the St. David’s, to South Austin, back to St. David’s, then a round trip to Llano.
Traffic stress is often one of Austinites least favorite things about their city. Breed had his traffic frustration with a sick baby waiting added to the equation. “One time I had to run up to Georgetown. There was a traffic accident so we put the truck (ambulance) into four wheel drive and headed up to Georgetown on the median,” he said. He estimated the ambulance drove about two miles off road.
With days like those and knowing everyday at work you hold lives in the balance, stress is an inevitable result. As a director, Sageser tries to deal with stress proactively. She says she tries to be flexible with schedules and help team members with the job and their families by giving time off when needed. Sageser tries to watch the team members closely to be sure the strain of the job is not getting the best of them. “People always ask me ‘how can you do that job isn’t it sad?’ Very rarely is it sad with advances in medical care,” she said. “We have a very good group of nurses and management team that makes the difference,” she added. “That’s what makes or breaks a team,” Sageser said. Whitfield said riding in an ambulance, in traffic, with a life in the team’s hands can be “nerve-racking” but to deal with it, “there’s a lot of humor in the unit,” Whitfield said. As for Glen Carson, he says after 15 years as a paramedic he is not as stressed as he used to be, and the job is even less stressful than his previous position as an Army lieutenant.
Clint Foehner, Emergency Medical Technician with Metrocare said working with the team “is actually kind of fun ... we are able to render service to other people. We are an important part in the birth of that baby,” he said. Another paramedic, Tom Holman, likes the fact the team is on board. Usually an ambulance crew has “half their thoughts taken up with driving the other half with patient care,” he said. But with the neonatal team 100% of their thoughts are focused on getting the patient to the hospital, he said. His wife, Janine Holman, is also a paramedic for Metrocare and has worked with neonatal transport. “Most (of the team) do in record time things I would never dream of,” she said.
The importance of the job that results in stress also adds satisfaction. Whitfield summed up what keeps her going. “The families. The babies. The intensity. It’s very rewarding watching the babies grow up and go home.” Sageser sees “personal satisfaction” in her work and motivating a team for her is not a problem. “Realizing what you are doing is saving the life of a baby is motivation enough,” she said. Janine Holman’s job hit close to home when the wife of a Metrocare employee gave birth to a premature daughter at a suburban hospital and she had to drive the ambulance and the team to St. David’s. Now, according to Tom Holeman, “she’s got a full head of hair and she’s ready to start walking.” The most memorable part of the job, according to Sageser is “the look on a mom or dad’s face when you tell them that their baby is going to make it or when you are about to leave a hospital with their baby and they reach out and grab your hand and ask you take care of their baby - that is why we do what we do!”
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