Operational Protocols

NETS WA acceptance criteria

  • Preterm neonates (<37 weeks gestational age) until 44 weeks post menstrual age (PMA)
  • Term infants (≥37 weeks gestational age) until ≤ 28 days of age

Request to attend births at a referring hospital

It is not standard practice to attend the birth of a baby. In most cases, a preterm delivery can be delayed sufficiently to arrange an in-utero transfer, i.e., transport the mother to a tertiary centre.  

The referring doctor must contact the on-call obstetrician at the tertiary centre to discuss in-utero transfer. Ideally, a call conference should be set up with referring team, on-call obstetrician, and NETS consultant. 

Occasionally, a NETS team will need to attend deliveries of high risk/preterm neonates in peripheral hospitals when the mother cannot be transferred due to her unstable medical condition or imminent birth of the baby. 

Babies beyond the neonatal period

For babies outside the NETS criteria discuss with the NETS Consultant.

If the baby is to retrieved by NETS the NETS Consultant will be the decision maker and remain in charge of all aspects of the retrieval and will provide advice to the referring and retrieval team.

  • The on-call paediatric critical care (PCC)/Emergency Department (ED) and other subspecialty consultants will be conferenced into the call to provide additional advice to the retrieving team as needed. 
  • Ventilated infants will go directly to PCC on arrival at PCH. A formal handover (ISOBAR) will take place between the NETS team and PCC on arrival.
  • Infants on nasal CPAP. Apnoea/hypoxia not managed by oxygen alone on the retrieval will be either directly admitted to PCC or taken to ED for further assessment regarding removing CPAP. Handover (ISOBAR) will take place between the NETS team and PCC/ED Consultant on arrival.
  • Non ventilated infants will go to ED for further assessment. Handover (ISOBAR) will take place between the NETS team and admitting ED Doctor.

For all other babies outside the NETS criteria the NETS consultant will advise the referring Doctor to call PCH Switchboard (6456 2222) to connect to either the ED or PCC for ongoing advice. 

All calls are managed via the call conferencing system to allow better team communication and an accurate record of the information exchanged (all calls are recorded). 

  • Doctors, nurses, and midwives at referral centres can call the 24/7 NETS advice line (1300 638 792) at any time for management advice, or to arrange a retrieval.
  • The initial referral call will be conferenced in conjunction with the full NETS Team and other subspecialists as appropriate. 
  • Requests for advice or retrieval are documented on the Transport Call Sheet - NETS WA MR400.00 (PDF sample only).

Always document the following information

  • Referring doctor’s name and contact number
  • Advice or request for retrieval
  • Hospital details (patient location, direct contact number)
  • Patient details (name, date of birth, gestation, current age, weight)
  • Clinical details (history, current problem, signs and symptoms, previous and current management)
  • Transport details (urgency, mode, is the mother coming with the baby)
  • All advice given.

Multiple births

The NETS Ambulance can transport two cots at the same time.

All multiple birth transportation will be discussed and decided on a case-by-case basis.

NETS has two ambulances located at PCH and one St John Ambulance Service (SJA) NETS Ambulance Transport Officer (NETS ATO) rostered on for NETS 24/7. The NETS ATO is permitted to drive the NETS ambulance under Priority One circumstances ('lights and sirens'). 

ATO contact numbers

  • Van 200 - 0405 535 000
  • Van 205 - 0466 733 205

For concurrent retrievals contact SJA direct for a 2nd ambulance and paramedic crew. 

Information required

  • Patient name, DOB, diagnosis and hospital to retrieve from and hospital accepting
  • NETS consultant name and number of NETS staff attending 
    • Urgency of the departure time 
    • Priority 1 (state 'immediate dispatch, lights and sirens')
    • Priority 2 (ask for an ambulance to arrive at PCH within 25 min)

Retrieval from centres >200km from Perth are usually undertaken by fixed wing aircraft, utilising the Royal Flying Doctor Service (RFDS).

Process

  1. Request air transport and discuss the urgency and any concerns with the RFDS Clinical Coordinator.
  2. Await a call back from RFDS communications with the departure time. Any concerns with the decision of departure should be discussed with the RFDS Clinical Coordinator.
  3. NETS Retrieval doctor goes to Jandakot airport by taxi to meet the RFDS team (pilot and flight nurse).

Please note

  • For preterm or sick neonates, a NETS nurse will accompany the NETS Doctor and RFDS flight nurse and take a cot equipped with Nitric Oxide equipment.
  • In instances when RFDS are not available in the timeframe needed, discuss with NETS Consultant to authorise and approve tasking of Medical Air: 1300 633 247
 
Equipment preparedness and team communication is needed prior to departure from base.
 
See orientation and credentialing package for full equipment checking and preparation.

Pre-departure checklist

  1. Call sheet: Photocopy
  2. ADM/Medication room: Virtual kit and red drug bag
  3. Pack grey backpack with:
    1.  Standard retrieval Fluid Pack
    2. Astodia trans-illuminator
    3. Alinity iState and cartridges
    4. EZIO - Intraosseous Kit
    5. Nitric First Aid Kit
  4. Do we need to cool? If yes, take esky and contents
  5. If FiO2 >40%: Consider Nitric
  6. If <32 weeks: Take prem Fluid Pack
  7. Priority 1: P1 Fluid Pack, consider extra team member
  8. Confirm mode of transport: Road or Air - NETS ATO, SJA, RFDS, Medical Air
  9. Call to referring hospital: NETS team onroute, ask for maternal blood, placenta, copies of all notes.
  10. Plan: Vocera NETS group aware of retrieval/staff departure.
  • All subsequent calls from the NETS Team and/or referring hospital are to be made through the call conference system so additional advice and management can be documented on the Transport Call Sheet-NETS WA MR400.00 (PDF sample only).
  • Discuss issues and emergency plans with the ambulance and flight crews. 
  • Ensure both the receiving medical and nursing teams are updated on a regular basis.

Leaving referring hospital checklist

A

Assemble Team (ATO/Dr/Nurse)

Airway Current status:

  • Ventilated - SLAM-D 
  • Secretions - Are the tapes wet or soiled?
  • Length - Is the ETT at requested depth? 
  • Attached - Are the tapes attached? Are they lifting? 
  • Movable - does the ETT move more than 0.5cm.
  • Done correctly - taped securely. Doubts - confirm placement via ETCO2 detector.  
  • CPAP - prongs secure, good seal, adequate fit.
  • Back up-plan: Self inflating bag & mask, suction available, red intubation roll on cot

B

Breathing: Visual chest movement, ventilator/CPAP settings, FiO2 and humidity (39°C), check water level and top up if required.

Monitoring/Vitals: Respiratory rate, SaO2 connected and working.

C

Circulation: Colour/perfusion, vitals - HR, BP

D

Drugs: IV maintenance fluids, IV infusions correct rate & dose.

IV access: Accessible and secure.

Emergency Drugs: Red intubation roll (bolus, adrenaline 1:10000)

E

Environment: Temperature, noise reduction/protection, patient secure in harness.
Equipment: Packed (nothing left behind).
EBM: Maintain a cold chain during retrieval, drug bag cool section/soft foil esky, labelled correctly.

F

Family & ‘fone’ numbers: Paperwork, final destination hospital aware.

Ready to go?

  • All subsequent calls from the NETS Team are to be made through the call conference system so additional advice and management can be documented on the Transport Call Sheet -NETS WA MR400.00 (PDF sample only).
  • Communicate who has ‘eyes on patient’ during transition of switchover of power & gas. Confirm baby stable, support continues.
  • Survey the room to ensure no equipment/documentation been left behind
  • Verbalise whilst escorting through doorways, lifts, corridors and patient loading.

Miscellaneous

  • Maternal blood (EDTA) and signed pathology request form
  • Placenta (if available) and other specimens (gastric aspirate, blood culture, etc.)

Parents

  • Keep parents informed about their baby’s condition and ensure where possible they have the opportunity to see or hold their baby before departure.
  • Ensure parents contact details are obtained and provide the NETS information brochure. Obtain consents as listed on the Observation Management Chart - NETS WA MR400.01.

Documentation

  • Copies of maternal notes, baby’s notes and x-rays.
  • Complete observations every 10-15 minutes and document changes in the baby’s care or condition as they occur.
  • Complete the NETS Data Sheet and file all paperwork as per orientation manual.

Arrival to hospital

Handover to the receiving team using ISOBAR.

Last Updated: 01/10/2021