Transport Medicine Programme: Retrieval and Transfer April 2013

TRANSPORT MEDICINE (RETRIEVAL ‐ TRANSFER) PROGRAMME PHECC is an independent statutory body with responsibility for standards, education and training in the field of pre hospital emergency care

TRANSPORT MEDICINE (RETRIEVAL ‐ TRANSFER) PROGRAMME Dr Aine Carroll – National Director of Clinical Strategy and Programmes Dr Geoff King – Lead Steering Committee: Dr Michael Power, Critical Care Lead Dr Una Geary, Emergency Medicine Lead Dr Cathal O’ Donnell, Medical Director, National Ambulance Service Dr Garry Courtney, Lead Acute Medicine Prof Alf Nicholson, Paediatric Lead Dr John Murphy, Neonatology Lead Dr Michael Turner, Obstetrics Lead Dr Bairbre Golden, Anaesthetics Lead Prof Frank Keane, Lead Acute Surgery Office of the Nursing and Midwifery Services Director Others  Primary Care  Patients  Clinical Strategy and Programme Directorate

To oversee o the establishment of a comprehensive Retrieval- Transfer system that:  is integrated with and supports the integration of Model 2, 3 and 4 Hospitals  provides bi-directional inter-facility transport for patients with needs ranging from Intermediate Care to Critical Care  prioritises clinically urgent as well as non-clinically (system) urgent patients o cross Programme participation and collaboration TRANSPORT MEDICINE (RETRIEVAL ‐ TRANSFER) PROGRAMME Steering Committee Aims:

Service Model The service model proposed is fully integrated within the broader healthcare system and is evolved from existing services for pre-hospital emergency care and acute hospital care. The model encompasses Adult, Paediatric and Neonatal Retrieval-Transfer. Context: Reconfiguration of Acute Health Services Small Hospitals Framework Hospital Groups Strategy

TRANSPORT MEDICINE (RETRIEVAL ‐ TRANSFER) PROGRAMME Key deliverables: 1) An integrated system of clinical co ‐ ordination and operational tasking 2) Transport clinical staff who are skilled in the planning and delivery of emergency/critical care medicine 3) Standardised equipment for ground and air transport 4)Collection of transport data for systematic clinical and operational activity review and audit 5) An education programme that supports the programmes objectives.

Retrievals/Transfers Current ADULT MICAS70 Aircorps80 Coastguardsmall number NEONATAL NNTP days, daytime Estimated ADULT > 1,000 total Anticipated 2012 and ongoing PAEDIATRIC 250 NEONATAL Additional 100

What is Required PAEDIATRIC Retrieval-Transfer One 24/7 team in Dublin NEONATAL Retrieval-Transfer One 24/7 team in Dublin ?One 5 or 7 day, daytime team in Cork ADULT Retrieval-Transfer Two 24/7 teams in Dublin, one north-side, one south-side One 24/7 team in Cork One 24/7 team in Galway ?One 5 or 7 day, daytime team in Sligo/Letterkenny ?One 5 day, daytime team in Limerick ?One 5 day, daytime team in Waterford

What is Funded PAEDIATRIC Retrieval-Transfer One 5/7 daytime team in Dublin NEONATAL Retrieval-Transfer One 24/7 team in Dublin ADULT Retrieval-Transfer One 8 to 8, 7 day team in Dublin, Cork and Galway Establishment of IC Ambulances in Dublin, Cork and Galway and also Drogheda, Sligo, Castlebar, Limerick, Tralee, Bantry and Waterford

Currently One 7 day, daytime Retrieval team (NNTP) in Dublin (circa 250 patients per year) NEONATAL RETRIEVAL SERVICE What is funded One 24/7 Retrieval team in Dublin Estimated circa 100 additional patients per year

PAEDIATRIC RETRIEVAL SERVICE Currently No Retrieval team. Estimated circa 250 patients per year What is Funded One 5/7 daytime Retrieval team in Dublin

ADULT RETRIEVAL SERVICE Currently One 5 day, daytime Retrieval team (MICAS) (circa 70 patients per year) What is Funded One 8 to 8 7 day Retrieval team in Dublin What is Funded One 8 to 8 7 day Retrieval team in Cork What is Funded One 8 to 8 7 day Retrieval team in Galway Estimated circa 1000 additional patients per year

ADULT RETRIEVAL SERVICE Currently One 5 day, daytime Retrieval team (MICAS) (circa 70 patients per year) What is Funded One 8 to 8 7 day Retrieval team in Dublin Establishment of IC Ambulance in Dublin What is Funded Establishment of IC Ambulance in Waterford What is Funded One 8 to 8 7 day Retrieval team in Cork What is Funded Establishment of IC Ambulance in Limerick What is Funded One 8 to 8 7 day Retrieval team in Galway What is Funded Establishment of IC Ambulance in Sligo Estimated circa 1000 additional patients per year What is Funded Establishment of IC Ambulance in Drogheda What is Funded Establishment of IC Ambulance in Castlebar What is Funded Establishment of IC Ambulance in Tralee What is Funded Establishment of IC Ambulance in Bantry

AIR CORPS Currently 80 Retrievals - Transfers per annum Anticipated increase in 2012 and ongoing Locations Dublin and Athlone

COASTGUARD Currently Small number of Retrievals - Transfers Anticipated increase in 2012 and ongoing Locations Dublin, Waterford, Shannon and Sligo.

Key Solution Areas/Strategic Opportunities Workforce Model ? Australia/UK ( Adult) versus ? North America (? Neonatal, ? 10 year timeframe) Clinical Co-ordination Neonatal IC “bed bureau” Paediatric IC telephone “bridge” and on-line support

NEONATAL Retrieval-Transfer

Towards A National Neonatal Bed Management System Ann Bowden The National Neonatal Transport Programme (NNTP) March 2012

Method Information gathered through the NNTP website at Each hospital/unit has a unique access code to the webpage Pages individualised for each hospital Information entered each day (ideally!) but can be retrospective Daily/monthly/annual reports instantly available as desired on occupancy, transfers out etc

Information gathered Numbers of babies in each unit at 10 am each day Levels of care required as per BAPM Guidelines 2001, (Now 2011), Reasons if closed for admissions Number of transfers in/out in the last 24 hours: – Hospital to/from, Time, Reason, Birth Wt., Birth Gest., D.O.B., Team. No. of critical transfers not carried out by NNTP and why? No. Antenatal Transfers Accepted /Refused ( Tertiary centres only) – Optional Staffing levels

All Critical Care Transports (n=479): NNTP (n=286), Non NNTP by Reason (n=193)

Infant Age of When Transported 53% (256) were <48hrs old

Critical Care Transports Sep by Reason (n=479) 1. CHD = 21% (101), 2. GIT = 13% (63), 3. Prem.= 13% (61), 4. PDA = 11% (55).

Time of Critical Care Transports in ROI Sept % (209) occurred between hrs and 09.00hrs 44% (209) occurred between hrs and 09.00hrs

NNTP TRANSFERS TO NMH (SEP 2010-SEPT 2011) Mayo Letterkenny Waterford Kilkenny Cavan Sligo Drogheda Tipperary Portiuncula Portlaoise Limerick Wexford Longford/ Westmeath Transfers to NMH Cavan3 Letterkenny2 Limerick Regional1 Longford Westmeath Hospital2 Mayo General Hospital5 Our Lady of Lourdes Drogheda1 Portlaoise Hospital1 Portiuncula Hospital9 Sligo General Hospital1 St Luke's Kilkenny3 Temple Street1 Wexford General1 Waterford Regional Hospital2 Total Transfers32 Returns Our Lady of Lourdes Drogheda1 Portiuncula Hospital1 St Luke’s Kilkenny1 Total Returns3 Temple Street 1-5 Transfers 6-10 Transfers Transfers

NON NNTP TRANSFERS TO NMH (SEP 2010-SEPT 2011) Cavan Cavan General2 Longford Westmeath5 Our Lady of Lourdes Drogheda1 Portiuncula4 Sligo General Hospital1 South Tipperary General Hospital1 Wexford General Hospital1 Total Non NNTP Transfers to NMH15 Portiuncula After NNTP Service Hours NNTP engaged with another call Transport too urgent to wait arrival 2 Drogheda Wexford Tipperary Longford/ Westmeath Sligo 3 4

PAEDIATRIC Retrieval-Transfer

Access to PICU Bed Phone call to designated phone line number: effective February 2012 Bridge phone line: appropriate consultants can be brought in on call Consultant preference for bed will be considered Decision made by Intensivists/medical team as to right place for patient Goal timely access to critical care bed Retrieval team vital for this

IPCCN Web Page: 1 ST access  Welcome page; phone number here Initial log in/ then individual password. Steps for referral Links on page: On-line transfer request form, complete and submit All patient information encrypted/data protected Calculator - drop down menu: drug doses/ wt / E.T.T./Maintenance fluids/oxygen requirements for journey Clinical guidelines – specific conditions

Operational Tasking Centralisation of Ambulance Communication into one/two centre(s) Establishment of a National Aeromedical (sic) Co- ordination Desk by National Ambulance Service in response to HIQA Report Training Funding for the development of a Training /Induction Course - HSE-MET - PHECC

Transport Vehicle Separation of EMS and PTS by the National Ambulance Service; establishment of an IC Ambulance fleet Standardisation of equipment on trolleys, not vehicles X HIQA EMS Response Time Standards Helicopter(s) Establishment of National Aeromedical Co-ordination Group by the HSE in response to HIQA Report. - Aeromedical Service Provider Standards Establishment of a dedicated Air Corps helicopter in Athlone.

Equipment Coroners Report reference to Intra-Aortic Balloon Pumps MICAS hospitals Other centres with interventional cardiology Funding ? Currently 3 funding streams ? Commissioning of services

Governance ? NNTP Committee ? PCCN Implementation Committee ? MICAS Committee National Paediatric Hospital

Summary MICAS and the NNTP collectively provide a platform from which to develop a comprehensive Retrieval - Transfer capability. Implementation is suggested by expanding capability and enhancing access. 1. Expansion of Adult Retrieval in Dublin to 7 days, and establishment in Cork and Galway. 2. Expansion of Neonatal Retrieval to 24/7. 3. Establishment of Paediatric Retrieval in Dublin, 5 days. 4. The aim is to ultimately develop a high quality Retrieval - Transfer system that is accessible to patients and hospitals dispersed across Ireland, and has the capacity to transport several patients simultaneously. TRANSPORT MEDICINE (RETRIEVAL ‐ TRANSFER) PROGRAMME

= other Programmes Goal Optimal utilisation of national health services. Guiding Principle As a general principle the strategic matching of resources to the needs of patients is both effective and efficient. TRANSPORT MEDICINE (RETRIEVAL ‐ TRANSFER) PROGRAMME v other Programmes Programme Service

Right Care, Right Time, Right Place Ensuring a high quality Retrieval and Transfer service for seriously ill babies, children and adults

Thank You Any questions?