Policy for Emergency Obstetric & Neonatal Referrals.

Description Each Perinatal Referral Centre has an obstetric admitting officer (with backup from a consultant obstetrician) and also a neonatal ICU registrar (with backup from a consultant neonatologist). There are neonatal ICU registrars at the Children's Hospitals. In addition, there is a feto-maternal specialist and a NETS consultant on call for the whole state, to solve difficult perinatal transfer problems.

Ideally, referring staff should expect to make only one phone call. The referring medical officer should contact the Base Hospital or regional centre for 'medium risk' problems (obstetric or neonatal) according to regional guidelines. The appropriate telephone numbers for these centres should entered in the appropriate box on the chart.

Procedure For high risk obstetric problems or a baby requiring intensive care, the preferred Perinatal Referral Centre or Children's Hospital should be contacted. They will offer assistance, including acceptance of the patient for transfer or arrange an alternative suitable destination. The referring doctor should not have to 'ring around' for a bed.

NETS should be called when a neonatal retrieval is contemplated. NETS can link multiple parties by telephone to discuss a clinical problem and will arrange an appropriate clinical escort. The statewide feto-maternal consultant is available through NETS (NETS Line) or the Ambulance Adult Medical Retrieval Unit (AMRU). NETS will contact the Ambulance to ascertain what vehicles are available. Referring hospitals may be asked to 'book' the ambulance transfer (click for telephone numbers), providing demographic information about the patient. Tertiary hospitals may contact NETS if they are unable to obtain a bed in either their own hospital or a suitable alternative hospital for a patient referred to them.

The appropriate vehicle and escort for emergency transfer of an obstetric patient should only be decided after immediate treatment requirements are fully discussed with an obstetric consultant.

Escorts The type of clinical escort required for the patient should then be determined. A medical retrieval team can be made sent by any vehicle (road, helicopter or fixed wing). Clinical escorts are available for emergency obstetric transfers as follows:
 

Vehicle or Usual Team	"Standard" staffing	Additional staffing possibilities
Road Ambulance	Ambulance officer or Paramedic	Referring hospital midwife
Fixed wing Air Ambulance	Flight nurse/midwife	Adult retrieval doctor  or NETS team
NETS team	Pædiatric, anæsthetic or neonatal snr registrar. PICU/NICU Nurse	Adult retrieval doctor +/-  Midwife
Adult Retrieval Service	Critical care, anæsthetic or emergency medicine doctor plus Paramedic	NETS team

Obstetric staff are available from the John Hunter Hospital in certain circumstances to participate in patient transport in the Hunter region of NSW.

Vehicles In emergency obstetric transfers, helicopters are not usually used for their time advantage over road or fixed wing aircraft. If delivery is considered imminent, it is better not to risk birth in the helicopter. When an undesirably long road journey is involved or there is no available fixed wing aircraft, a helicopter may be appropriate for obstetric transfers. Remember, the time a patient takes to reach the destination is determined more by how long it takes to leave the referring hospital than the time spent in transit.

The choice of vehicle for a medical retrieval (usually for a newborn rather than an obstetric patient) will be made according to published guidelines which take clinical urgency, distance, patient condition, team and vehicle availability, access to referring and receiving hospitals and other factors into account.