Rethinking the neonatal transport ground ambulance

Abstract

Objectives: This article describes the detailed project aimed to realize a dedicated ground ambulance for neonatal emergency transport service (NETS). To date, the European Community rules specify requirements for the design, testing, performance, and equipping of road ambulance used for transport and care of adult injured or ill patients, completely ignoring neonatal transport.

Methods: The project consisted of electric and gas supply planning, interior design taking into account ergonomic and occupant protection principles, both during travel and during medical care performances.

Results: A detailed project is presented. Main differences between European Type C ambulance and the new proposed Type D neonatal ground ambulance are the presence on board of air compressed cylinder, iNO cylinders and delivery system, phototheraphy, shock adsorbing stretcher support, cooling device, patient's placenta (refrigeration box), and transcutaneous gas analyzer.

Conclusion: The European Community rules specify requirements for road ambulance used for transport and care of adult injured or ill patients, completely ignoring neonatal transport. This study describes the detailed project aimed to realize a dedicated ground ambulance for neonatal emergency transport service. This study demonstrated that it is not possible simply to adapt the currently dedicated ambulance for mobile intensive care and resuscitation services (actual type C European Community) in a modern dedicated NETS ambulance; it is of paramount importance suggesting to European Community to introduce a further ambulance type, to be identified type D, strictly reserved to neonatal transport activities.

Keywords: EU rules; Ground ambulance; Neonatal transport.

Fig. 1

Aerial floor plan projection. Panel a, interior design. Panel b, electric and gas pipeline system. Panel a. The right side is fitted with two rotating seats for neonatal transport team members; seats can rotate 90° towards the left. In front of the seats there is the box containing three oxygen cylinders (10 l/200 bars each); a stretcher and incubator support is fixed to the ambulance floor along the longitudinal axis of the health compartment; this device is equipped with shock absorber featuring efficient hydropneumatic system to reduce the effects of vibrations and impact during long transfers or transport on rough terrain. The support can move laterally to the right by 20 cm, allowing to place it near the rotating seats. The left ambulance wall unit is composed by the boxes containing three air compressed cylinders (10 l/200 bars each), then the neonatal defibrillator, the device for active controlled patient cooling, the blood gas analyzer, and finally the two separated refrigerated boxes to contain drugs and the transported patient’s placenta. Numbers into the square box indicate ambulance dimensions in centimeters. Red emergency transport bag is fastened to the ambulance floor, thus being immediately available (not shown in figure). Panel b. Medical gases (oxygen and medical air) are distributed throughout the ambulance via the pipeline distribution system to provide gases at the terminal units. Socket panel for medical gas is provided by valves and pressure gauges. A separated vacuum pipeline is available also. In the rear right part of the ambulance an air compressor is fitted out; this is a rescue device. An iNO cylinder is stored in the left rear part of the ambulance and a second iNO cylinder is transported by the incubator. A dedicated iNO pipeline works independently by oxygen and air pipelines. Above the cylinder box, in front of seats, there is a television reproducing the video signals from the video-camera positioned on the ambulance cockpit.

Fig. 2

Ceiling and roof projection. Panel a, ceiling view. Panel b, roof section. Panel a. Hi-Lo led dome lights, night blue light, a scialytic lamp, an automatic disinfection system fitted with jets nebulizing nozzles are present. Both driver and health compartment are fitted with own heating and air-conditioning systems which can operated independently. Panel B. Two solar photovoltaic panels for rescue charging the vehicle batteries is activated by control units from the cockpit. Radio, GPS, and WiFi antenna and usual blue led flashing light and siren completed this section

Fig. 3

Curb and street lateral interior views. Phototherapy lamp is illustrated in this section

Fig. 4

Forward interior view (above) and detailed neonatal transport incubator scheme (below). Right forward view shows the transport incubator mounted on the shock adsorbing stretcher support. The schematic design concerns to the neonatal incubator actually in use for our NETS. In detail: #1, incubator; #2 neonatal ventilator; #3 monitor; #4 suction device; #5 infusion pumps; #6 transcutaneous monitor; #7 s neonatal ventilator (twin transport) (8); #8 iNO monitor; # 9 transport heather humidification system; #10 shock adsorbing stretcher support. The neonatal transport module is provided of own gas cylinders