Johns Hopkins All Children’s Hospital’s Critical Care Transport Team (LifeLine) expanded its mission on May 1, allowing the hospital’s helicopter service to respond directly to medical and trauma accident scenes.
Additionally, LifeLine is adding an adult-focused paramedic and expanding training to current pediatric flight crew members in order to provide these air transport services to both children and adults in the Tampa Bay area. LifeLine will now be able to accept requests for air support and offer faster response, particularly in the Pinellas and Manatee county areas.
“It’s always been a goal of LifeLine to provide the fastest response and expert care straight to our patients, no matter how big or small,” says Julie Bacon, M.S.N., R.N., program manager of the LifeLine program at Johns Hopkins All Children’s Hospital. “We’re fortunate enough to have a helicopter with the right equipment, and now, the right staff, that can quickly take action to save lives. We also want to be good stewards in the community, and when we can, provide quick, appropriate response to those in need of medical emergency air transport services no matter their age.”
LifeLine’s medical air transport services, in affiliation with Med-Trans Corp., are already equipped with state-of-the-art medical technology to meet the needs of critically ill newborns, infants and older pediatric patients. In addition to the standard equipment, the helicopter also provides special pediatric transport technology, including the ability to provide active cooling to help prevent brain damage, as well as nitric oxide and high frequency ventilation to help with breathing.
Started as a neonatal transport ambulance equipped to bring sick babies from referring hospitals to All Children’s, the program has expanded over the years and has served thousands of babies and children. The program will soon celebrate 45 years of service, which makes it the oldest pediatric transport program in the State of Florida and one of the oldest in the nation.
“When we started, we were just going to Bay-area hospitals and picking up babies primarily by ground using ambulances,” Bacon says. “I don’t know if anyone envisioned the amount of need outside this area. Now we cover the entire west coast of Florida.”
“When we noticed most of these hospitals were also were receiving critically ill children, we started taking those toddlers and school age children that these hospitals did not have the resources to care for on a daily basis and brought them back to All Children’s.”
As All Children’s expanded its coverage area to include hospitals outside the Tampa Bay area, the transport team realized it needed the ability to fly.
“We used the Bayflight helicopter for many years, if it was available, dispatching from the roof of Bayfront Medical Center (now known as Bayfront Health), which was conveniently located next door to (the original) All Children’s. We would have to bring patients from the rooftop helistop through a maze of hallways leading to an underground tunnel, which connected the two hospitals,” Bacon says.
When the new hospital opened in 2010, it included an air transport facility on the 10th floor, with a landing pad designed to accommodate not only medical helicopters, but military-sized helicopters as well. That made a big impact on response time to reach patients and return them directly to Johns Hopkins All Children’s.
Building Our Own Identity
About five years ago the hospital was approached by Med-Trans, which suggested the hospital lease and brand its own helicopter to improve response time.
“With increasing demands to respond to sick patients in further destinations and believing that bringing the resources of Johns Hopkins All Children’s Hospital to the patient as quickly as possible, this seemed to be a perfect fit for the expanding team," Bacon says.
“To be able to quickly reach and transport adult and pediatric patients and work with the skilled team at Johns Hopkins All Children’s is truly exciting for our community. If you can care for a baby that’s smaller than your hand, you can do just about anything,” says Kim Montgomery, COO of Med-Trans.
“We already had the resource here,” Bacon says. “We have highly trained nurses and a helicopter, so it seemed like a natural extension to expand the service to the adult population. We are the only helicopter based in Pinellas County and close for response to Manatee County and the Gulf beaches. It’s an important resource that EMS can have this in their lifesaving toolkit.
“We reached out to the Pinellas County Commission with an idea. We already have a Certificate of Public Convenience and Necessity (COCPN), which is a license to function as EMS in the county. However, our COCPN is limited to pediatric neonatal interfacility transport. With a little more education and training we can provide the highest level of pediatric and adult service to Pinellas County, and they agreed to revise the COCPN with permission to pick up whoever we need to.
“Many kids LifeLine will pick up on scene will come directly to Johns Hopkins All Children’s, as long as it’s the closest most appropriate hospital. On the adult side, there is a great trauma system in place and our dispatchers are very good at knowing the nearest hospital. The crews will make the decision at the time of service where to take an adult.”
Since Pinellas County has good EMS ground resources provided by local fire districts and Sunstar Ambulance, the LifeLine ambulances will not be used for onsite responses. Only the helicopter service will be used.
Benefits of Expansion
In addition to Johns Hopkins All Children’s LifeLine program, there are two helicopter programs in the greater Tampa Bay area, Aeromed and Airlife. But LifeLine is the only helicopter program physically located in Pinellas County.
“It's exciting for Pinellas County because it’s been a long time since they have had a dedicated aircraft that can take care of their adult citizens,” Bacon says. “LifeLine will be first call for Pinellas. There are no restrictions where it can go. It’s all based on availability and what’s best for the patient.”
As a dispatch center, Johns Hopkins All Children’s can plug in the location of the trauma and the computer will find the closest three aircraft. The LifeLine dispatch center will send the aircraft selected right to the scene. For pediatric patients, coming directly from an accident scene to the Johns Hopkins All Children’s pediatric trauma center may have lifesaving benefits.
“There are other air programs that may pick up pediatric patients because they are the closest, but I don’t know any that have nursing staff on board that are pediatric experts,” Bacon says. “In the case of pediatrics, the care that will now be brought to the scene has just skyrocketed.”
Preparing for Expanded Service
“The LifeLine team is excited about this new opportunity, but realize they have some additional challenges to be prepared to meet the needs of this service,” Bacon says. “We envision many of the calls will be motor vehicle accidents. But we could also get calls for seizures, asthma attacks, heart attacks or strokes. It’s a different process responding directly to the scene versus an interfaculty pediatric trauma call.
“It’s not about the size of the patient. It’s about diagnosis. We already move some fairly large pediatric patients. The training will give our nurses the opportunity to learn advanced lifesaving skills that you would do on the scene. We already do this with our neonatal and pediatric transport, so it’s not a big jump for us. But education is a huge piece of it.”
Training to pick up pediatric and adult patients on site involves a combination of classroom study and practicing skills using computer-based simulation training. Nurses will also participate in ride alongs to learn from real situations. They will learn more about the types of diagnosis they don’t see that often in a pediatric transport.