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Santa Barbara and the Antelope Valley. The team
can easily reach adjacent states such as Nevada
and Arizona by fixed-wing aircraft. In addition,
several critical-care ambulance transports are
made each month on an intra-facility basis from
UCLA Medical Center, Santa Monica to Ronald
Reagan UCLA Medical Center.
For emergency inter-facility transports, a
helicopter lands on the helipad of the Westwood
hospital to pick up the Pediatric Transport
Team and the isolette. Each air-transport team
includes a paramedic or nurse from REACH as
well as a UCLA critical-care pediatric nurse,
pediatric respiratory therapist and, depending
on the patient’s acuity, a pediatric ICU fellow
or attending physician. Once the UCLA team
reaches the referring hospital, it works with
that hospital’s team to transfer the patient to
the isolette, which can then be brought to the
aircraft that brings him or her to UCLA.
Since the new isolette can go between an
ambulance and a helicopter or airplane without
any modification, this saves valuable time and
minimizes any jostling and other stimulation
to the baby. Of particular importance for the
smallest neonates, who tend to be sensitive to
cold, the isolette is fully temperature controlled.
“Especially for premature babies, you want to
minimize the movement and adjustment as much
as possible, and the isolette easily slides in and
out of all three transportation vehicles,” explains
Dr. Kelly. “The enclosure allows us to keep
them warm and minimizes external noise and
exposure, which can predispose them to cardiac
instability or neurological injuries.”
This “mobile NICU” includes the same cardiac
and respiratory monitoring that a typical neonatal
ICU bed would have at a tertiary care center.
Given that most critically ill neonates have
respiratory difficulties, the availability of not only
a conventional ventilator but also a high-frequency
flow interrupter and nitric oxide for infants with
low oxygen saturation is valuable, Dr. Kelly says.
Dr. Kelly notes that the gravely ill newborns
seen at UCLA tend to be premature babies, some
with a gestational age of 23 weeks. Among the
special expertise UCLA brings is the ability to
transport newborns back to UCLA for therapeutic
hypothermia treatment, a new method of cooling
neonates after traumatic births in which they
have experienced asphyxia, which must be
initiated within six hours. Other common
referrals are for cardiac surgery in the case of
infants with congenital heart defects; heart
failure; complex neurology and neurosurgery
interventions; and cases of respiratory failure,
including the need for nitric oxide. The UCLA
team provides complete cardiac and respiratory
support during the transport process. The
critical-care nurse and respiratory therapist on
the team are highly experienced with special
training in pediatric transport.
In an effort to reduce response times, UCLA’s
Pediatric Transport Team forged a partnership
with REACH to transport sick babies to UCLA.
Compelled to modify the isolette to fit into the
company’s aircraft, the UCLA Pediatric Transport
Team worked with REACH for more than a year
on a novel design that would both meet the special
needs of critically ill neonates and fit within the
constraints of modern medical helicopters and
aircraft. Any baby under 5 kilograms should be
in an isolette with ICU-type monitoring during
transport, Dr. Kelly says.
The new isolette is the first
in the nation that can go
between an ambulance and
a helicopter or airplane
without any modification,
saving valuable time and
minimizing any jostling
and other stimulation to
the baby.
“This allows us to extend UCLA’s expertise to
centers that in the past we might not have been
able to reach in poor weather conditions, and it
significantly increases the speed with which we are
able to get to these facilities,” Dr. Kelly concludes.
“That has the potential to save lives.”
9 UCLA Physicians Update