When baby arrives by air

BILLINGS, Mont. - Neonatal flight nurse Ruth Atkins and flight respiratory therapist Dora Cardillo, both with St. Vincent Healthcare, saved the life of a 10-day-old infant girl.

They were in a hangar at Billings Logan International Airport, not on a med flight, and the infant was a high-fidelity mannequin, not a human.

But the success the pair achieved could translate into an actual life saved later on, said Dr. Jeffrey Cooper, a neonatologist at Billings Clinic.

"Our hope is as we practice on high-fidelity mannequins that we can learn these hands-on skills for when we get into the field," Cooper said. "It's a great chance to help us work on a good foundation of skills, to build on that."

More than a dozen flight nurses, respiratory therapists and staff of the neonatal intensive care units at both Billings hospitals took part in the NICU Flight Education Day. The specialized training was provided by seven staff members of Children's Hospital Colorado, which has a care alliance agreement with Billings Clinic.

It made sense to include both hospitals in the daylong training, Cooper said, since they occasionally help each other out.

"We service a large region, and if our plane is out doing an adult flight, we've called St. Vincent and they've picked up a baby and delivered it to us," he said. "We've done the same for them."

About 11 percent of all deliveries occur before 37 weeks gestation, Cooper said. The chance of survival outside the womb begins around 24 weeks, which leaves a lot of room for babies to be prematurely born.

So when a small critical-access hospital calls med flight to pick up and deliver a baby to Billings, or sometimes to Denver, "they really need us to respond quickly," he said.

It takes longer to prepare an infant for a flight than an adult, Cooper said. The crew may have to put in a breathing tube, install a chest tube, provide IV access, set up a nutrition drip and put the infant on a ventilator.

"Our flights tend to be an hour to three hours, with an average of two hours," he said.

The day included a combination of lectures, simulations and visits to skill stations that focused on such things as IV access and ventilation, airway and vascular issues. Participants also rotated through different simulations that let them test their skills, coordinated by CHC staff, followed by debriefings that let them know what they did right and what they might do differently.

At one station, Atkins and Cardillo were presented with the scenario of a 10-day-old who was in obvious distress. Christy Tennant, a flight nurse and member of Flight for Life Colorado Children's team, ran the simulation with outreach coordinator Yonnia Waggoner.

The high-tech mannequin let the med flight members hear the "infant's" breath and heart sounds, and feel its pulse. Tennant and Waggoner fed Atkins and Cardillo the young patient's vitals that they needed to assess her condition.

Atkins intubated the baby while Cardillo hooked her up to an IV. As the infant's condition deteriorated, Atkins called for chest compressions.

"I'm worried this child could have cardiac disease," Cardillo said.

Their teamwork eventually stabilized the infant. She was ready to be transported.

"Awesome job," Tennant said.

It turned out Cardillo was right about the baby's diagnosis. She had a heart defect, Tennant said afterward, more specifically, coarctation of the aorta.

The four completed a debriefing session, with the two CHC staff members commending the St. Vincent team on what they did well and offering suggestions on other steps they could take in that situation.

Cardillo said hands-on training is crucial "because we never really know quite know the scenario we're going into."

"This helps us greatly to have the skills and the thought process ahead of time in those situations that you might not see for years, like cardiac anomalies," she said. "And the experience they bring to us, where they have so many more flights than we do, is just invaluable."

A lot of research has been done on simulation-based education, said Joe Darmofal, director of the CHC flight team and outreach education programs.

"We know the more that they practice and do these skills, it creates muscle memory," he said. "So it's real important that we're out there training all the time and keeping these skills sharp."

The CHC team travels in a seven-state area, bringing along the mobile simulation equipment to its alliance partners to make the training as real as possible.

Nationally, about 8 to 12 percent of the people providers treat are children and babies, and even fewer of those have critical injuries or illnesses, Darmofal said.

"So it's really important that we're out there training all the time and keeping these skills sharp," he said.