The NSW newborn and pædiatric Emergency Transport Service (NETS) provides emergency retrieval of babies, infants and children on a state wide basis. Teams are located geographically at Westmead from which they travel by road or air to approximately 140 hospitals around the state. Doctors working in the service obtain first hand experience in the following areas:
Clinical Coordinaton
Responsibilities of the clinical coordinator include taking and processing of telephone calls and liaising with key clinical decision makers by way of a conference call to establish and implement the best therapeutic strategy for each specific patient. Clinical coordination provides excellent training in understanding how to negotiate complex medical problems with a variety of parties under pressure of an emergency. Registrars obtain a first hand insight into the complex relationship between hospitals at different levels of the care hierarchy and ancillary services, such as Ambulance.
Retrieval Team Participation
Doctors are rostered such that a doctor/nurse team is on site at all times. The chances of an individual team going out is over 80% during a period of first on-call. This provides continuous work in the acute resuscitation, stabilisation and safe transportation of newborn and pædiatric patients with serious or life threatening disorders. Doctors have an opportunity to practise their skills in a wide variety of environments from tertiary care units through to basic general management in a small hospital. Then, having stabilised the patient, they present the case to the destination consultant, outlining their proposed course of action and justifying their mangement approach. During this process the doctor, nurse team members collaborate and discuss all significant issues as a team.
Preliminary Training
Doctors working at NETS receive pre-transport training and on the job coaching by a consultant on as many individual missions as are jointly decided to be required – usually 3-6. At all times during actual retrievals they are able to make telephone contact with a NETS consultant for support and advice.
Debrief
Two debrief meetings are held each week (neonatal/pædiatric). At these meetings all cases are reviewed in detail. The intention is to critically evaluate all the decisions and management made during a mission and to identify issues for improvement of the system. For specially difficult retrievals – for instance the case of a patient who deteriorates or dies, a critical incident debrief is available for team members.
Prerequisites for medical staff working for NETS are that they be a pædiatric or neonatal trainee at registrar or fellow level, with at least three months experience in ICU or three months pædiatric emergency department experience.
The additional training program includes the following topics: