No medical professional needs to be told that every minute counts when it comes to critical care. But the Critical Care Transport Team at Children’s Hospital of Alabama was acutely aware of that fact whenever the Alabama Lifesaver helicopter they’ve shared since 2000 was already in use, resulting in a delay or requiring another type of vehicle to retrieve a young patient. Now however, the hospital is leasing a dedicated helicopter, enabling it to increase its ability to retrieve children needing the specialized medical attention available only at Children’s Hospital. “Because we take care of kids all over the state, as well as some of the surrounding states, access to care is a big issue,” said Margaret Winkler, MD, medical director of the Critical Care Transport Team. “For those of us who take care of the sickest children, how quickly they get to us makes a big difference in their outcome. So for us to be able to send the team out by helicopter to get there fast is essentially an extension of us. Not only are we getting them quickly and bringing them back quickly, but we’re sending our critical care unit to them, so they get there that much sooner and can intervene to hopefully have a good effect on outcome.” The helicopter, a Bell 206-L4, has been painted red and white to match the Children’s brand with the familiar red dot logo. It is equipped for pediatric and neonatal needs and carries a specially trained staff. The average transport team includes the pilot, a respiratory therapist and an RN. “It’s a unique population of nurses and respiratory therapists that work for the team,” said Beverly Barrett, RN, division director of Critical Care and Emergency Nursing. “They have to be willing to go the extra mile or work the extra hours at the end of their shift, or do something in a setting that’s not very conducive to them taking care of the child. They are a driven and excellent staff.” Winkler added, “They have to be able to think on their feet and work in a tight space and deal with every emergency that comes up way up in the air and make sure they are giving the best care until they can get the patient down on the ground safely.” Another challenge for the team is being prepared for patients of all sizes. They may be transporting a newborn, a toddler or even an 18-year-old who is bigger than they are. And they must care for that patient within the confines of the helicopter, in a space smaller than most closets. “Imagine if you are in that helicopter and the patient weighed 300 lbs.,” Winkler said. “Imagine he was an 18-year-old from a house fire and you’re just trying to do basic care for that patient. You can’t say enough about what a challenge it is.” Patients are not necessarily even stabilized before transport. “If it’s a small town that only sees five kids in their emergency room every year and a sick one comes in, they don’t have the resources to give that child what they need,” Winkler said. “A lot of times they are very unstable when we get them. The hospital may not have a surgeon or an anesthesiologist to help put a breathing tube in. That’s why it’s so important that our team is sent. As soon as they get there, they can begin taking care of them and providing ICU care.” In addition to the helicopter, the transport team has use of a jet and they provide ground transport as well. The weather, distance and nature of the case all play a role in determining which form of transportation is used. The helicopter can make a maximum round trip of 350 miles without refueling, so it is used to transport patients within a 150- to 175-mile radius. The helicopter is not used to retrieve patients from an accident scene, but is strictly for facility-to-facility transfer. The helicopter lands on designated landing pads at local hospitals and returns to the roof of Children’s with the patient and care team. The team averages two to three transports a day, according to Winkler. “In 2007, we made just over 1,000 trips total. Almost 300 of those were helicopter transports.” She expects the percentage of helicopter transports to increase significantly, now that they have sole access to the aircraft. Winkler anticipates that the day will come when there are two calls requiring the helicopter at the same time, but for now, they are happy to have the one dedicated craft in order to provide care for their patients. “Before, we would often have to send a ground crew or wait an hour or two for the helicopter to be available. Now with our own dedicated aircraft, as well as with the additional staff, we have more consistent availability for all the kids who need it.” June 2008