January 8, 1999

This ‘Angel’ provides safe passage for area’s critically ill newborns

This 'Angel' provides safe passage for area's critically ill newborns

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Jim Altick pilots "Guardian Angel," Vanderbilt Children's Hospital's custom-built pediatric transport ambulance. (Photo by Donna Jones Bailey)

After logging more than 2.5 million miles and bringing more than 8,500 critically ill newborns to Vanderbilt Children's Hospital, the Newborn Emergency Transport Program is celebrating its 25th anniversary this year with a new, custom-designed ambulance and a new name ‹ "Guardian Angel."

The $250,000 ambulance is the fifth in a series of "Angel" transport vehicles that began with a modified milk truck in 1974. That was followed by a Winnebago named "Angel II" and a modular ambulance named "Angel III."

"Angel IV," the first built on a freightliner truck chassis and the first equipped to carry two newborns simultaneously, was put into service five years ago. Guardian Angel, custom-built by a Florida company to the specifications of long-time Angel driver Jim Altick, is yet another improvement, said Dr. Jayant P. Shenai, professor of Pediatrics and medical director of the Newborn Emergency Transport Program.

"This is a state-of-the-art unit, with designed features that are truly unique," Shenai said. "Jim has been the driver supervisor for many years, and he has been on many, many transports. He really knew what could make this ambulance better, just based on his experience. I think he's gone beyond the call of duty to put this together, and it's really very good."

Guardian Angel's improvements include:

o two fully self-contained incubators with all the equipment and supplies necessary to deliver neonatal intensive care built into the console;

o steps that automatically extend when the cabin doors open;

o a larger generator to ensure continuous power for monitors and other equipment;

o a hydraulic lift, necessary to maneuver the heavy incubator unit into the ambulance, that is hidden and separate from the transport compartment, leaving more room for the transport team.

o two additional seats behind the driver's seat, which provides room for medical or nursing staff and students to ride along on a transport.

Altick, who recently celebrated his 20th year with the program, is modest about his contribution.

"I like being able to use my experience to help the kids," he says.

Rather than call the new ambulance "Angel V," a more distinct name was given to avoid confusion in the community, Shenai said.

"When we got Angel IV, some in the community incorrectly thought that meant we had four teams to simultaneously go out for the babies," he said.

The transport program staff brainstormed names among themselves and submitted them to the Board of Children's Hospital to make the final selection. "Guardian Angel" is now displayed on a tag on the front of the ambulance.

The Angel program logs more than 100,000 miles every year to bring about 350 newborns to the Neonatal Intensive Care Unit, accounting for more than a third of total annual NICU admissions. These babies are born at about 40 hospitals within a 120-mile radius of Nashville, including southern Kentucky.

"This is one of the longest-running programs in existence at Vanderbilt," Shenai said. "It truly brings neonatal intensive care to a community hospital where it's needed and as quickly as possible."

The transport team includes a neonatal nurse practitioner or neonatology fellow, a neonatal intensive care nurse and a driver-assistant.

Guardian Angel is one component of a broader program that also offers education for nurses and physicians and transports neonates back to their hometown hospitals as soon it's appropriate.

Outreach education includes courses offered in the communities serviced by the program as well as at Vanderbilt, including a "mini-residency" in neonatology for community doctors. "The physicians and nurses in the community need to know what to do for a baby until we can get there," Shenai said. "We teach them how to stabilize a newborn, how to do resuscitation, how to give intravenous fluids, what medications to give, how to provide respiratory support."

Guardian Angel's back-transport counterpart, "Cherub," returns babies to community hospitals when their conditions improve to the point that their community hospitals are equipped and staffed to take over their care. The Cherub ambulance transports about 380 infants each year ‹ more than Angel because some of these infants were delivered at Vanderbilt.

Returning the babies to their hometowns as soon as it is appropriate is one way in which the newborn transport program supports Vanderbilt Children's Hospital's guiding philosophy of "family-centered care." Rooted in the notion that families are the constant influence in children's lives, family-centered care is designed to involve families in care delivery and decision-making as much as possible.

Shenai described another focus on family: unless unique circumstances preclude it, the transport team makes sure that a mother sees and touches her baby and meets the Vanderbilt staff before Guardian Angel brings the baby to Nashville.

"Many times, a mother may not have seen her baby yet, and because of just having given birth, she may be unable to travel to Nashville right away," Shenai said. "We don't want to just whisk her baby away. We make sure we explain what will happen to the baby and answer any questions."