Newborn Emergency Transport Service (NETS)
132 Grattan Street, Carlton VIC 3053
(03) 9347 7441 (emergency line) (03) 9344 2567 (general enquiries)
(03) 9347 2731 (fax)
e-mail: Stella Mastrakoulis (email@example.com)
The mission of the Newborn Emergency Transport Service is to provide safe transportation of sick newborn infants and continuing education programs in perinatal care to the staff of suburban and country hospitals. In order to further these aims the department also provides advice to medical practitioners, nurses, and para-medical personnel regarding aspects of stabilisation and transport of sick newborn infants and acts as a resource for advice on organisation of facilities for newborn care.
This is a life-saving service provided to move seriously ill infants to special neonatal centres which can care for them.
It has been shown that treatment of sick newborn infants in an intensive care unit increases their chances of survival as well as the quality of survival. However, the special facilities and constant intensive medical and nursing supervision provided by an intensive care unit are only offered in centralized locations.
By the time the need for transfer is apparent, the infant's illness is usually in a critical phase and thus a continuous high level of supportive care is required in order to transfer the infant safely between the referring hospital and the receiving unit. Consequently, it is inappropriate to transfer such infants using local facilities which have inadequate equipment and attendants with little experience in the required level of care. Past experience has demonstrated that transport under such conditions all too frequently leads to deterioration in the infant's condition.
The Newborn Emergency Transport Service was created in 1976 by the Victorian Health Department as a cooperative organisation involving the four Melbourne hospitals with neonatal intensive care units and Ambulance Service Victoria. Over many years NETS has made a significant impact on neonatal mortality and morbidity.
NETS provides a neonatal intensive care team of a trained nurse and, when indicated a consultant paediatrician or a registrar experienced in neonatology, together with a specially equipped transport incubator with intensive care facilities including monitoring equipment, facilities for controlled oxygen administration and assisted ventilation, and for continuous intravenous infusion. After receiving a referral call the team mobilizes as quickly as possible and travels out to the referring hospital to pick up the infant and supervise the transfer. The essence of safe transport is stabilization of the infant before the transfer, and experienced supervision in transit with adequate facilities.
NETS is based at the Royal Women's Hospital and transfers infants to the four Melbourne Hospitals with neonatal intensive care units - The Mercy Hospital for Women, Monash Medical Centre, The Royal Children's Hospital and The Royal Women's Hospital. The service operates within the area covered by the Ambulance Service Victoria, including the Air Ambulance. The decision to use road or air facilities depends on the availability of vehicles and aircraft, distance, weather conditions and other factors; each transfer is assessed individually. For transfers by road, NETS has an ambulance especially equipped with resuscitation facilities suitable for newborn babies.
A request for transport is made by calling the 24 hour direct line which is reserved for NETS transfer and consultation calls on (03) 9347 7441. The referring physician can arrange transfer and admission by a single telephone call to NETS, who will then arrange the ambulance and notify the receiving unit of the impending admission; alternatively, the referring physician may wish to discuss the case with the receiving unit, in which case the receiving unit can notify NETS who will arrange the ambulance.
Whenever possible the infant will be transported to the hospital of the referring doctor's choice.
The NETS direct line (03) 9347 7441 can also be used for consultation either with a specialist neonatal nurse or a paediatrician, available 24 hours a day on a rostered basis from the four neonatal units.
This depends on the time required for mobilization and travel. As a guide, one should allow 30-40 minutes for mobilization plus the time taken to travel from The Royal Women's Hospital to the referring hospital. The NETS team makes every effort to keep the response time to an absolute minimum.
Is it generally unwise to attempt to move the infant from the hospital to meet the team. Disasters may occur when infants are not adequately stabilized or supported.
There are two teams available at all times. However, when multiple referrals occur simultaneously NETS may ask a referring doctor either to consider using existing transport facilities or assess whether the patient can wait while another transfer is completed.
A NETS transfer costs the same as a normal ambulance transfer. All patients in public hospitals and those in private hospitals with family ambulance insurance are transported free. There is no additional charge for the use of NETS services and equipment.
The decision to transport an infant involves assessing the availability of adequate medical and nursing supervision, diagnostic and other supportive facilities. Those infants who cannot be managed optimally with the facilities available and those at risk of serious complications should be transferred. The final decision regarding transfer rests with the physician in charge. Each hospital varies in level of facilities for newborn care it can offer but the following categories of infants are worthy of consideration for transfer:
While awaiting the NETS team the infant should be kept warm, positioned to allow maximum observation, given sufficient oxygen to maintain a pink colour, and a clear airway maintained by adequate (but not overzealous) suctioning. Whenever possible parents should be encouraged to see their babies while awaiting transfer.
The NETS booklet "Stabilization and Transport of Newborn Infants" provides further details on management. Advice on management can be obtained by ringing the NETS Direct Line on (03) 9347 7441.
The referring staff are asked to provide:
NETS personnel will ask about the infant's condition and request the above forms and specimens. They will assess the infant, record observations, then perform the procedures required to stabilize the infant ready for transport. The NETS team will inform the parents about their management, and show the infant to them. The parents are given an explanation and information booklet concerning the transfer procedure along with the name, address and telephone number of the receiving unit. Usually the NETS team is able to provide the parents with a Polaroid photograph of their infant.
Occasionally it is possible for parents to travel with their baby. This must be decided by the referring doctor, ambulance officers/pilots and the NETS team.
Naturally parents often feel anxious and depressed when their infant is transferred. They should be encouraged to enquire frequently about their infants condition, and visit as soon as possible. The NETS team will endeavour to telephone the parents when the transfer is completed.
Once the worst of the infant's illness is over, and the infant no longer requires a continuous high level of supportive care, it may be possible to transfer the infant back to the referring hospital. The intensive care staff will liaise with the referring physician, referring hospital staff and the infant's parents about this possibility.
The successful transport of newborn infants requires good liaison between NETS , referring doctors, nurses and hospitals, and the receiving units. NETS welcomes any suggestions for improvement of the service in the best interests of the patient.
NETS transfers more than 400 babies every year back to suburban and regional hospitals closer to their familys home, once they no longer require intensive medical assistance.
When baby no longer requires intensive monitoring and medical assistance, he/she will be transferred to a hospital closer to home. This will enable the family to spend more quality time with baby by avoiding unnecessary travel time to city hospitals.
Having baby in a closer facility will also help reduce expenses in relation to telephone call and travel costs.
When the doctors and nursing staff are completely confident that baby no longer requires the concentrated care provided in an intensive care ward, they will talk to the parents about transferring baby to a hospital closer to home.
A parent may wish to accompany baby in the NETS ambulance during the transfer, but please discuss this when the transfer is being arranged as there is limited seating available in this vehicle.
Transfers of this kind take place between 8.00 am and 4.00 pm weekdays (excluding public holidays).
To ensure babys safe transfer, he/she will be cared for by a highly qualified neonatal nurse in the specially equipped NETS ambulance.
Highly sophisticated technology is used to provide the best possible care and monitoring of baby during this time. Equipment available is:
Baby will not be fed during transfer, and the last feed will be emptied from babys stomach, as a precautionary measure to ensure baby will not be sick during transport.
To assist NETS with the transfer, it would be helpful if babys toys could be taken home prior to the transfer day.
If a public patient, the cost of a NETS transfer is covered.
If baby is going to a private hospital, please discuss this with NETS nursing staff.
Copies of these are obtainable from the NETS office
Enquiries/comments to Stella Mastrakoulis. Page last updated 16 November 1999.