Bring parents along on air transport
Bring parents along on air transport
When a teen-ager was critically injured in a car accident and in full arrest, the mother flew to the ED in the helicopter with her child. "She was present through the entire resuscitation," recalls Janet B. Davis, RN, medical crew supervisor for the University of Kentucky Air Medical Service in Lexington. The child didn’t survive, but the parent was extremely grateful to have been given the chance to be present. "She felt very positively about being there and told us that it helped her so much to work through her grief," says Davis.
When a child needs to be transferred to another institution, it’s terrifying for both the child and the parent, says Reneé Semonin Holleran, RN, PhD, chief flight nurse and clinical nurse specialist at University Hospital in Cincinnati. "People are afraid that this means the child is critically ill, and many times this is true," she notes. "Add a helicopter transport, and it makes it even more stressful."
If the parent can be brought along safely, they should be given the option to remain with their child, argues Diana L Deimling, RN, BSN, CCRN, CEN, CFRN, NREMT-P, flight nurse with University Air Care in Cincinnati. "Having a parent there calms the child," says Deimling. "Emotional support is a major advantage, and the child is much more at ease if he or she knows a parent is coming."
If the child does not survive, you’ll be giving a parent the chance to be with their child for the last time, says Holleran. "That is one of the most important nursing interventions we can provide," she adds.
Here are things to consider when bringing parents along on transport of pediatric patients:
• Give parents a job.
Generally, the parent needs to ride up front with the pilot, but he or she can talk to the child and maintain eye contact. "They can provide comfort for young children by either being in his or her line of vision or talking with him or her through the headset," Holleran says. "I have personally witnessed this calming effect."
This makes your job easier, Deimling notes. "It’s one less thing you have to do for the child, because the parent can constantly reassure him or her. They take over some of that role for you."
There are certain conditions during which you need the child to be as calm as possible, add Davis. "For example, for a child with significant glossitis, agitation can result in a complete airway obstruction," she says. "Having the parents there to hold the hand or visually maintain eye contact is extremely helpful."
• Warn the parent what to expect.
You’ll need to spend a few minutes before takeoff informing parents about what is going to occur, says Davis. "You need to do this before the noise of the engines is impairing," she adds. "Lay out clearly the expectations for what may occur during transport and what you need them to do if any of those things happen."
Deimling recommends warning the parent if the child is very unstable. "I tell them that the worst-case scenario is this child could need CPR or intubation then, and if that happens, don’t get in my way because we are trying to save him or her," she explains.
• Ask for specific medical information.
Parents of children with chronic illnesses such as seizures are very familiar with their children’s care, notes Holleran. They can provide information about allergies, medications, immunizations, and previous medical history, she says.
Parents of children with special needs and extensive pre-existing medical histories are the "experts" in knowing what is normal, says Davis. "That information is invaluable in making decisions during transport," she says. "For example, a parent can tell us whether seizure activity is typical for their child or something different."
• Consider feelings of all the team members.
Transport team members may have very strong feelings about having others in the aircraft, says Holleran. "Their wishes need to be considered," she notes. "In other words, this policy needs to be developed as a democratic decision."
• Consider safety issues.
If a parent may act violently for some reason, that parent may cause a safety risk and should not be allowed to accompany the child, says Holleran. "One red flag is a parent who is too distracted, she adds. "For example, they cannot even look at or touch the child."
Other practical issues to consider is that the size of the aircraft may restrict additional passengers, says Deimling. She explains that at University Air Care, a smaller helicopter was routinely dispatched for pediatric transports, which is not capable of carrying an additional passenger. "So a policy was changed to dispatch our larger helicopter to allow the parent to come along if possible," she says.
If the parent is unable or unwilling to be present during transport, Holleran suggests giving the child one of the parent’s keys. "Have the parents explain that they will be there soon because they need the key, and that seems to comfort the child," she says. "Stuffed animals and pictures of their family may also help."
For more information on bringing parents on transport, contact:
• Janet B. Davis, RN, University of Kentucky Air Medical Service, Emergency Transport Medical Crew Supervisor, Room HA038, 800 Rose St., Lexington, KY 40536-0293. Telephone: (859) 323-6531. Fax: (859) 323-4799. E-mail: [email protected].
• Diana L. Deimling, RN, BSN, CCRN, CEN, CFRN, NREMT-P, University Air Care, 234 Goodman St., Cincinnati, OH 45219-0736. Telephone: (513) 584-7522. Fax: (513) 584-4533. E-mail: [email protected].
• Reneé Semonin Holleran, RN, PhD, University of Cincinnati Medical Center, P.O. Box 670736, Cincinnati, OH 45267. Telephone: (513) 584-7522. Fax: (513) 584-4533. E-mail: [email protected].
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