When Ariel Ellen Elizabeth Teet was born prematurely at 22 weeks on July 27, 2006, there was no guarantee she would survive.
“They told me, ‘If she doesn’t take her first breath, there is nothing we can do. Her lungs are like tissue paper, and if we blow anything in there, it will destroy her. She’s got to breathe on her own,’” recalls Ariel’s mother, Colleen Teet.
The delivery team at a hospital in Clarksville, Tennessee, 45 minutes northwest of Nashville, prepared to give the baby girl a fighting chance, calling for the Neonatal and Pediatric Transport team at Monroe Carell Jr. Children’s Hospital at Vanderbilt to be ready.
Once born, the team whisked Ariel away to prepare her for transport. “My sister, Kathy, she could see Ariel in the incubator through a tiny hole between all the people. She began to pray, ‘God, put a breath in her. Please put a breath in her, or she’s not going to make it.’ And then her little chest puffed up, and then it did it again,” Teet said.
With the 1-pound, 5-ounce newborn settled in a warming incubator, Teet got a glimpse of her baby as the transport team left to bring Ariel to Monroe Carell. There she would get the critical care she needed.
For five decades, the Neonatal and Pediatric Transport team at Monroe Carell has provided safe and specialized emergency transport, 24 hours a day, for critically ill children and newborns like Ariel. Primarily serving Tennessee, southern and western Kentucky and north Alabama, highly trained care teams transport children from birth to age 21 in what essentially is a mobile intensive care unit. Monroe Carell is the only transport team in Tennessee that is certified by the Commission on Accreditation of Medical Transport Systems.
During a celebration held Aug. 29, the transport team commemorated 50 years, more than 20,000 transports, and more than 5 million miles of helping infants and children receive the care they need.
“What a special milestone for our Neonatal and Pediatric Transport program, sometimes affectionately known as the ‘Angel’ team,” said Meg Rush, MD, MMHC, President of Monroe Carell and who previously worked with the transport team. “This has been a year to truly reminisce about this program not only because of this milestone but also the founders of the program who both passed away this summer: Dr. Mildred Stahlman and Dr. Angela Skelton. I am so proud of and grateful to the teams who do this care, taking our hospital expertise on the road. Countless lives have been impacted because of our ‘Angel’ team.”
Bringing Vanderbilt-level care to the community
The Neonatal and Pediatric Transport team consists of 50 crew members — two day-shift teams, a mid-shift team, and two night-shift teams — who make up to five calls during a 12-hour shift. The program averages about 2,000 transports annually, with about 188 a month.
“There are so many different types of patients that we take care of, and we have a lot of different specialty equipment on which we’re trained,” said Rachel Harvill, who has been a respiratory therapist for the transport team for seven years. “We’re prepared for all scenarios and run off protocols that are implemented as soon as we make patient contact. We’re bringing Vanderbilt- level care to the patient in the community.”
The team currently has six ambulances in its fleet that travel by ground within 250 miles. Each is outfitted with an isolette/incubator or stretcher, a ventilator, humidified high-flow nasal cannula, a cardiac monitor and additional medical equipment and supplies to care for the hospital’s specialized patient populations. All the equipment is similar to what is found in an intensive care unit, though smaller and more durable for a transport.
When a call comes in for a transport, much like the day Ariel was born, the goal is to be out the door in 15 minutes and en route to the patient. The team reviews logistics, plans for the appropriate team member configuration based on patient needs as well as distance, and ensures all equipment needs. While it can vary, the most often-used team configuration includes an EMT, a respiratory therapist, a nurse, and if the patient is a neonate, a neonatal nurse practitioner.
“Once we arrive at a hospital, we usually see a sigh of relief and gratitude, and the same for us in that we’re there and able to help because a lot of these small community hospitals are doing the best they can with the resources they have,” Harvill said.
Teet recalls how quickly the transport team swooped in to help Ariel. “The door flew open, and all these people came in,” she said.
Seeing Ariel for the first time in the Monroe Carell NICU, Teet recalls that Ariel had translucent skin, no lips, no ears and her eyes were covered for protection. With heart valve and intestinal issues, she had four surgeries, and at one time was given about a 1% chance of survival. “I told them I’ll take that 1%,” Teet said. Each day Ariel grew stronger and hungrier.
At 20 weeks old, she finally got to leave the hospital, just in time for Christmas in 2006. Ariel recently turned 18 years old, is a high school senior in Palmyra, Tennessee, and hopes to attend Austin Peay University next fall to become a veterinarian.
“She’s our miracle baby. She surprises me every day with something. Watching her grow and knowing where she came from and how hard she struggled — it’s hard to put into words,” Teet said. “I truly believe without Vanderbilt there, and if they hadn’t come to get her, because she was so early, she wouldn’t have survived,” Teet said.
Giving babies (and then children) a fighting chance
Prior to the first official transport in August 1974, many premature babies didn’t survive because specialized transport to Vanderbilt didn’t exist.
In a 2012 interview about the transport team, Cheryl Major, RNC-NIC, BSN, a now retired, longtime Monroe Carell employee, remembered working in the Vanderbilt NICU in the early 1970s. “The baby would arrive, sometimes dead on arrival, sometimes so cold that it took a lot of time to get the baby warm. There was no oxygen, there was no special care during this transport. Essentially the baby was bundled up and told, ‘They’re expecting you at Vanderbilt.’ That baby could be coming from hours away,” Major said.
The first of its kind in the region, the Neonatal and Pediatric Transport team launched under the direction of Mildred T. Stahlman, MD, a neonatal medicine pioneer who created the first modern NICU in 1961. The goal: to give babies a fighting chance.
Stahlman charged her fellow at the time, Mary Angela Skelton, MD, and Major, who served as Vanderbilt’s first Neonatal Outreach Coordinator, to launch a neonatal transport team. That initial team also included another fellow, Elizabeth Perkett, MD, and three trained drivers.
In addition to transporting critically ill and premature infants back to Nashville, Major led efforts to train physicians and nurses in outlying communities with the skills (like resuscitation) needed to care for those infants until the transport team arrived. Today, that work continues and is led by Mary Lee Lemley, RNC, MSN, Monroe Carell’s Neonatal Outreach Manager and Perinatal Outreach Coordinator.
For that first maiden voyage on Aug.1, 1974, the transport team used a converted bread truck, outfitted with supplies and equipment that functioned as a mobile intensive care unit. The first “ambulance” was named “Angel” after Skelton, a moniker that still exists today on each of the six ambulances.
“As a pioneer in neonatal intensive care, Dr. Stahlman quickly adapted to a ‘regional’ approach to care realizing that babies need to get to Vanderbilt for that care,” said Rush, who trained in neonatology under Stahlman. “Dr. Skelton was a fellow under Dr. Stahlman, and together they decided to build a neonatal transport program. Fast forward to current state. We have steadily grown the program to now include pediatric patients, adjusted the models of care to include highly specialized advanced support like ECMO, and grown our fleet.”
The second ambulance in the fleet was Angel 2, a modified 28-foot Winnebago motor home in 1980, and from there more advanced ambulances were added in the decades that followed. The first custom-built freightliner chassis ambulance, Angel 4, arrived in 1994. Expanding to meet the growing needs of Tennessee and surrounding states, Monroe Carell’s transport team added pediatric patients to their transport services in 2013.
“We’ve absolutely grown,” said Harvill. “We’ve been able to get to more patients quicker with the growth of our team — more staff, more ambulances. We provide such an important asset to the community. I’m very proud to be a part of this team.”
