SECTION ON TRANSPORT MEDICINE

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SECTION ON TRANSPORT MEDICINE

SCHEDULE

SUNDAY, OCTOBER 10, 1999

SECTIONONTRANSPORT MEDICINE and SECTION ON EMERGENCY MEDICINE JOINT SESSION

2:00pm-5:00 pm

Room 31,Washington Convention Center

TheEmergency Department and Patient Transport

2:00 pm New Technologies and Transport Medi-cine

David G.Jaimovich, MD,FAAP

Transport Medicine Scientific Abstract Presentations

2:45pm OralPresentation

1) Safe Restraint of Pediatric Patients for Ambulance Transport: Interdisciplinary Collaboration In Pediatric Ambulance Transport

Nadine R. Levick, MD. Johns Hopkins Uni-versitySchool of Medicine, Baltimore,MD

Poster Presentations

2) A Novel Pediatric Residency Transport

Rotation Curriculum: Meeting the RRC Requirements and Beyond.

Robert M. Insoft, MD, FAAP; Anita Carew, RN. Massachusetts General Hospital, Bos-ton,MA

Impact of Not Following Pre-Transport Recommendations onOutcome In Pediat-ricTransports.

M.Bugnitz,D.Newton,P.Hess,M.Quasney. LeBonheur Children's Medical Center, Memphis,TN

Patient Outcomes After Conversion to a Nurse-LedTransportTeam: APreliminary Report.

Robin L. Foster, MD, FAAP; Brent R. King, MD, FAAP; Kathryn McCans, MD, FAAP. TheMedicalCollege of Virginia, Richmond, VA;University ofTexas Houston Medical School, Houston, TX; The University of Medicine and Dentistry of New Jersey, Camden, NJ

TheEffectiveness of SeatBelts at Reduc-ing Injury Severity to School-Age Chil-dren.

Stephen Halman, BASc, MSc, MDCM; Mary Chipman, MSc; Patricia Parkin, MD, FRCP(C); JamesWright, MD, MPH, FRCS(C). Hospital for SickChildren, Toronto, Ontario

PediatricSpecialtyCare Teams are Associ-ated withReduced Morbidity During Pe-diatricInterfacilityTransport.

Karin McCloskey, MD, FAAP; Richard Orr, MD,FAAP; ShekharVenkataraman,Neal Seid-berg, Michelle Dragotta, Janine

Janosky.

Uni-versity of Texas Southwestern, Dallas, TX; University ofPittsburgh,Pittsburgh, PA

AreInfant Transport PatientsatIncreased RiskforlatrogenicRelatedComplications WhileatReferral Facilities?

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GaryB. Zuckerman, MD; Bruce J. Grossman, MD;Frank V.Castello, MD;Patrice M. Greg-ory, PhD.; Robert Wood Johnson Medical School, New Brunswick, NJ

Vehicular Accidents Involving Pediatric and NeonatalTransport Teams.

George A. Woodward, MD, MBA, FAAP; Brent King, MD, FAAP. University of Pennsylva-nia School of Medicine, Philadelphia, PA; University of Texas Houston Medical School, Houston, TX

9) The S.T.A.B.L.E Transport Education Pro-gram: Assessment of Transportability to Regional Centers in the United States. Kristine A. Karlsen,MD;Tracy B.Karp.Park City, UT.

3:00 pm Disaster Planning for Natural and Man-Made Disasters

Fred Burkle,MD,FAAP

3:45pm Break andposter viewing

4:00pm So You Experienced a Disaster: Problem Solving andLessonsLearned

DeeHodge III, MD,FAAP

5:00pm Adjourn

TRANSPORT MEDICINE SESSION

1

SAFERESTRAINT OF PEDIATRIC PATIENTSFOR AMBULANCETRANSPORT: INTERDISCIPLINARY COLLABORATION IN PEDIATRIC AMBULANCE TRANSPORT SAFETY.

Levick, Nadine R., MD, FACEM, Divisionof Pediatric Emergency Medicine Johns Hopkins University School of Medicine, Balti-more,Maryland, USA

Background: Ambulance crash fatalities have been reported in-temationally, someinvolving children. Approximatelyone in ten patient transports involves a child. The special needs of trans-ported pediatric patientsraiseuniquesafetyissuesbeyondthose ofdomesticpediatric transport. Testing standards and design of childrestraintsfor domestic vehiclesarewelldeveloped,however thereisnofederal standardortesting requirementfor ambulance pediatricrestraintdevicesorpractices.Commonlyusedrestraint practicesfor childrenin ambulances havenotbeen subjectedto comprehensivedynamicsafetytestingtovalidate occupantsafety. This study describesin aninterdisciplinary framework, the safety testingofcurrently available devices and practicesinadditionto prototypedevicescurrently beingdevelopedtoaddress this prob-lem.Aims: Topilotdynamicsafetytests of devices forpediatric patienttransport. Methods:Arangeofcurrently usedoravailable restraint devicesfor the transport ofpediatric patientswere as-sembled, as well as prototype devices. A standard ambulance gurneywas secured to an approved sled testrig. All restraint devicesweretested securedtothegurneyas in currentambulance practice. These devicesweretestedinasimulated30mph frontal impact, equivalent to a deceleration force of 24 G. Crash test dummies of 3, 9 and 15 kilograms, were used in the testing. Endpointswere ejectionof the dummyor disruption of the re-straintdevice.High speed video anddigitalimaging and comput-erizedanalysisof the crash impact datawereperformed.Results: Therestraintsystems testedwhichwereavailablefor transportor 3)

4)

5)

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in current use, failed preliminary dynamic testing, some cata-strophically. Outcomes included either ejection of the occupant, disruption of the device or both. Incontrast, newly developed prototype restraintsystems adequately restrained the occupant and maintained structural integrity during testing. Conclusions: This preliminary study suggests that some currently available ambulance pediatric restraint devices may be ineffective.A mul-tidisciplinary approach to the development of such devices is needed, with a focus on clinical needs and safety engineering expertise.The directionof future research and developmentinthe safety of all ambulance patients, occupants and equipment should be reviewed. Videofootagewilldemonstrate testing.

mentsalong with marketplace economic forces have resulted in significantly fewer pediatric residents participating nationwidein interhospital tertiary transport teams. However, to ensure ade-quateresident training in the initial management of critically ill patients, wehaveimplemented anewly-designed curriculum in pediatric transport to complement their required core ICU rota-tions. We feel that this comprehensive rotation addresses the realistic trainingneeds of pediatric housestaff in accordance with the RRC ina cost-effective manner while still maintaining high patient carestandards andenhancing communityphysician and networkaffiliations.

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2

ANOVELPEDIATRIC RESIDENCY TRANSPORT ROTATIONCURRICULUM: MEETING THERRC REQUIREMENTSAND BEYOND.

Robert M. Insoft, MD,FAAPand AnitaCarew, R.N., Pediatric Transport Program, Massachusetts General Hospital, Partners HealthCare Systems and Harvard MedicalSchool, Boston, MA.

Background: The recent policies of the Pediatric Residency Re-viewCommittee (RRC) simply require residentstolearnabout the basicsof "resucitation, stabilization, and transportation of patients tothe ICU's" and participate"indecisionmakinginthe admitting, discharge and transfer of patientsinthe ICU's". Residentsare not required to participatedirectlyinprehospital emergency transport teams. In fact, residents now participatein < 20% of academic medical center teams. Focus currently is on increasing resident rotations inoutpatient primary care settings. However,it is our contentionthattobecomeawell-preparedpediatrician, residents should feelconfidentinthe initialstabilization and management ofcritically illnewbornsandchildren prior tohospital admission. Methods:Inorder to achieveproficiencyinpre-ICU stabilization skills andtoadheretothe RRC mandatedguidelines,wedesigned acomprehensiveclinical and didactic curriculumininterhospital transportfor PL-2 and 3 Pediatric and PL-2, 3 and4Medicine/ Pediatric residents tocomplement their ICUrotations.During one or two separate two week rotations each resident participates directlyinthephysician/nurse ICU transportteamasthe physi-cian teamleader,respondingto amyriadofcritically ill patientsin varying community settings. Untilcoreclinicalproficiencies are met,physician backupisprovided by ICUattendings and fellows. Timeisalso allottedfor the residentstoworkdirectly with pedi-atricanesthesiaattendings intheOR,thereby refiningtheir skills inairway management.The transport program directorprovides individualized resident tutorials covering basic transport topics includingpharmacology, casestudies, literature reviews andan overviewofmedical-legalissues. Adidacticcourseinbasic avia-tionphysiologyisgiven; butresidentsarenotrequiredtoflyon rotor-wing transports, asper hospital policy. Apractical ambu-lanceride-along experience with the Boston City paramedicsisalso available.Tocomplement their clinical training each resident cri-tiques their transportsdailyaswellasleadsateachingconference on pre-hospital or office emergency preparation. Results: Since 1997, 52 residents have finished 66 rotations. Uponcompletion, each resident hasanoral andwrittenevaluation and gives direct feedback.The residents evaluated their overall experience (essen-tial, valuable or not valuable), with 76% responding that this rotation is an"essential" part of training and 20%markingitas a "valuable"partof their residency. Ninety percent of the residents electednot to fly, attributingpregnancy, motionsickness or po-tential safety issues as the major reasons. A random survey of referringnetworkphysiciansreflects continued satisfaction with residents participatingonthe transportteam in aleadership role as long asthereisdirect ICUpersonnel backup available when needed. Also, a rotation syllabus has been compiled which in-cludespoliciesandproceduresaswellasreprints and attending-written coretransportlectures. Conclusions: Revised RRC

require-IMPACT OF NOT FOLLOWING PRE-TRANSPORT RECOMMENDATIONS ON OUTCOME IN PEDIATRIC TRANSPORTS.

M Bugnitz, D Newton, P Hess, and M Quasney. LeBonheur Children's Medical Center, University of Tennessee, Memphis, Memphis, TN.

Background: An important element in pediatric transports is pre-transportstabilization. We wished to determine iffailure of referring physicians to follow pre-transport recommendations would have an impact on flight team ground time, PICU or hospital lengthof stay (LOS) or mortality.

Methods: Weprospectivelystudied allpediatric transports for2 years to determine if pre-transport physician recommendations (i.e. intubation,IVplacement, C-spine immobilization)were fol-lowed. Recommendations and patient demographics were re-corded on pre-transport intake forms. A post-transport report recorded ground time andextent towhich pre-transport recom-mendation werefollowed.

Medical records were reviewed for LOSinPICU/hospital and mortality. Statistical analysiswasperformed using two-tailed T-test.

Results: For transports in which recommendations were not followed,ground timeandPICU LOSwerelonger.Thepatients were younger ontransportsinwhich recommendationswere not followed.

NotFollowed Followed p

Number(N=168) 83 85

-Age(months) 34.9±39.3 54.5±54.7 .009 Ground Time (min) 50.9±20.9 43.9± 18.5 .02 ICU LOS (days) 5.96±11.8 2.93±5.74 .04 Hospital LOS (days) 14.09±19.55 9.89± 17.14 .14

Mortality 12/83 12/85

*Results

reportedas mean + SE

Conclusion:Transportgroundtimes werelongeras wasLOSin PICU when pre-transport recommendationswere notfollowedby referring physicians. Younger age of patient may beafactorin referringMD notfollowingrecommendations.

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PATIENT OUTCOMESAFTERCONVERSION TO A NURSE-LED TRANSPORTTEAM: A PRELIMINARY REPORT.

Brent R. King, MD FAAP, Robin Foster, MDFAAP, Kathryn McCans MD,FAAP. Departments of Emergency Medicine and Pediatrics, The University of Texas Houston Medical School, HoustonTexas.DepartmentofPediatrics,TheMedicalCollegeof Virginia, RichmondVA.Departments ofEmergency Medicine and Pediatrics, The University of Medicine and Dentistry of New Jersey, Camden NJ.

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composi-tion, while somewhat dependent upon the team's mission, re-mainscontroversial. There is little definitive information in the medical literature to help address this question. This preliminary report details patient outcomes after a pediatric and neonatal transport teamconverted from a physician-led team toanurse-led team.In1995-96,thepediatric and neonatal transport team (TT) at St.Christopher's Hospitalfor Children (SCHC) underwenta con-version to anurse-led team. TheTTperforms an average of 1600 patient transports per year. Before the conversion, physicians accompanied the TT on approximately 60% of transports. The remaining 40% were low acuity patients who were transported by one nurse and the ambulance crew.Thephysicianswerepediatric residents and fellows. During weekday daytime hours these were residents on atransport rotation. "Moonlighters" provided cover-age on nights andweekends. The conversion process included, 1) anexpandedTT(6 nursesbefore,14after), 2) didactic and proce-dure trainingfor the nurses, 3) developmentof protocols, and 4) change inthe medical commandfrom Critical Care and Neona-tology to Emergency Medicine and NeonaNeona-tology. This report rep-resentsinformationcollected on 100patients,after the conversion. Methods:Datawasprospectively collected by the transport nurses on all patient transports duringa 3-monthperiod after the con-version.Thisincludeddemographic information about the patient andthe referring center,arecord ofspecifictimeintervals between the callforatransportand the TT's returntothe SCHC, andan assignmentof two Pediatric Risk of Mortality (PRISM) scores; the first based upon information receivedby the referringcenterand the secondbased upon the TT's assessmentatthereferringcenter. Duringthepatient's hospitalizationorafterdischarge, themedical record was reviewed by one of the investigators. The investigators assignedathird PRISMscorebased upon thepatient's condition uponarrival. They also looked forevidence ofpotential morbidity directly related to the transport. This included medical interven-tionsormajortherapeutic changesperformedinthe first6hours after arrivalaswell aspotential diagnostic errors. Thelength of stay (LOS) and patient outcome were also recorded. Results: Nursesaloneperformed 56(56%) of the transports,a 2nurseTT performed36(36%),aphysician accompanied the TTon8 trans-ports (8%) Ages were recorded for91 patients. Therewere 11 neonates,12children over one month but less than one year and 68 children over 1 year old (mean 6 years; range 1-17 years). Sixty-three (63%) children camefrom facilities within5miles of SCHC and 88(88%) from within 20 miles. Seventy-one(71%)were transferred from emergency departments. PRISMscores were as follows: Pre-transportscore:Mean = 2.22; range 0-21, transport score mean=2.25; range=0-36; post-transportscore mean=2.60 range= 0-38.Thereare nosignificantdifferences between these scores.Therewas nomorbidityrelatedtothe transportin97(97%) ofcases.Therewasone caseofpossiblemorbidity.In 2 casesthe datawasnotrecorded. LOSwasrecorded for 86(86%) patients. The mean LOS was 6.5 days (range 1-45 days). Outcome was recorded for 92 (92%). Eighty-six (86%) children went home, 6 weretransferredto other hospitals, and2died.The

Ti

success-fully intubated3patients(no failedintubations), started intrave-nouslines12times(12%), and gave medication notalready started by thereferringcenter6 times.Conclusions:Apediatric/neonatal

Ti

staffed mostly by well-trained nurses with selected use of physicians performs acceptably with regard to patient outcome andinterventional skill.

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THEEFFECTIVENESS OF SEAT BELTSATREDUCING INJURYSEVERITYTO SCHOOL-AGE CHILDREN.

Stephen Halman BASc, MSc, MDCM, Hospital for SickChildren, Toronto, Ontario; Mary Chipman MSc, University of Toronto; Patricia Parkin MD FRCP(C); James Wright MD, MPH, FRCS(C), Hospital for Sick Children, Toronto, Ontario.

Background: Motor vehicle collisions (MVCs) are the leading causeof deathtoschool-agedchildreninNorth America. How-ever, there are no restraints designed specifically for them; in-stead, theyareplacedinadultseatbelts. Thisstudy investigates whichof the adultrestraints(lap-torso beltorlapbelt)isbetter for these children. Specifically, the purpose of this study was to determine (1) if adult restraints reduced injury severitytothese children whencomparedto norestraint,(2)iflap-torso beltswere better thanlap belts, and (3) if childrenwere aswellprotectedas adults. Methods: Linear and logisticmultiple regression analyses were performed using data from Transport Canada's Passenger CarStudyinordertoevaluate the InjurySeverity Score (ISS)for 200 children involved in MVCs, while adjusting for belt type, BarrierEquivalent Velocity (BEV), age, andseatposition. Results: Results for school-age children demonstrated that the lap-torso belt,inthe frontrightseatreduced themeanISSby2.64, from3.42 (95%CI:1.96 to 6.29)to0.78 (95%CI: 0.48to1.18). Similarly,the lap beltinthe rearleft seat reduced themeanISSby 1.07, from 2.05 (95% CI: 1.17 to3.61)to0.98(95% CI:0.58 to 1.55).These reduc-tionscomparedfavourablywith adults whorealizedinjury reduc-tionsof 1.38(from3.03to1.65)and 1.09(2.16to1.07),respectively. The odds ratio of sustainingat leasta moderatelysevere injury

(ISS14)

for unrestrained childrencomparedtochildrenrestrained bythelap-torsobeltwas9.81(95% CI:2.43to39.4)and2.74(95% CI: 1.21 to 6.18 comparedto those wearing the lapbelt. Again, these oddsratios were atleastasgoodfor childrenastheywere for adults(i.e. adult odds ratiosof2.39for thelap-torsobelt,and 2.57for thelap belt).Finally,therewasnostatistical differencein the mean ISSfor children restrainedbythe lap-shoulderbelt in anyseat(ISS= 1.54; 95% CI:0.47 to5.06)asopposedtothelapbelt (ISS = 1.15; 95% CI: 0.70 to 1.83). Similarly, the odds ratio of sustainingatleastamoderateinjury whilewearing thelapbeltas opposedtothelap-torsobeltwas1.35(95%CI: 0.75to2.34),which was not statistically different. Conclusion: The analyses demon-strated thatlap-torsoandlapbeltsprotectedschoolagedchildren betterthannorestraint;however, therewasnodifference between the tworestraints ininjury reduction. Moreover,school-age chil-drenwereaswellprotected asadultsby theserestraints.

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PEDIATRICSPECIALTY CARE TEAMS AREASSOCIATED WITH REDUCED MORBIDITY DURING PEDIATRIC INTERFACILITY TRANSPORT.

KarinMcCloskey, FAAP, Richard Off, FAAP, Shekhar Venkat-araman, NealSeidberg, Michelle Dragotta,JanineJanosky. De-partmentofPediatrics,DivisionofEmergencyMedicine, Univer-sity of Texas Southwestern, Dallas, TX, 75235-9063 and DepartmentofAnesthesiology/CCM&Pediatrics,Clinical Epide-miology& Preventative Medicine, University ofPittsburgh,3705 FifthAvenue,Pittsburgh, PA, 15213.

Background: The benefit of pediatric specialty care transport teamshasnotbeendetermined.Yet,tertiarycentersexpend valu-able critical care resources for the transport of infants and chil-dren, assuming that thisprovides optimal care in the transport environment.Wetested thehypothesisthat transport

performed

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Odds ratios (OR) and 95% confidence intervals were described for the occurrence of at least one unplanned event between PSCT and NST. Results: An unplanned event occurred at least once in 41 patients (3.8%): 25/55 (45.4%) transported by NST vs. 16/1030 (1.5% ) by PSCT[p<0.001; OR 47.9(29.7-77.2)]. For patients whose pretransport mortality risk was < 10%, at least one unplanned eventoccurred in11/35 (31.4%) patients transported by NST vs 7/868 (0.8%) by PSCT[p<0.001; OR 56.4(30.1-105.6)]. When pre-transport mortality risk was 2 10%, 14/20 (70.0%) patients trans-ported by NST had at least one unplanned event vs. 9/162 (5.5%) patients transported by PSCT [p<0.001; OR 23.2 (9.47-56.8)]. Con-clusion: Pediatric specialty care teams may reduce patient morbid-ity in the transport setting. Pediatric specialty care transport teams should be considered for interfacility transport of critically ill children for the provisionof optimal care.

'Pediatrics 1997;99:59-63. Supported by 1-MCH-424003-01-0

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ARE INFANTTRANSPORT PATIENTSATINCREASED RISK FORIATROGENIC RELATED COMPLICATIONS WHILE ATREFERRAL FACILITIES?

Gary B. Zuckerman MD*, Bruce J. Grossman MD*, Frank V. Castello MD*,Patrice M.GregoryPhD',Depts of Pediatrics* and Family Medicine', Robert Wood Johnson Medical School, New Brunswick, NJ

Background: Pediatric patients oftenarrive atnon-tertiarycare facilities requiring transport toa Pediatric Intensive Care Unit. While at the referral facilities, iatrogenic related complications (RF-IRC) may arise. Suchcomplications mayimpactonmorbidity andmortality. Norecently published studies havesoughtto de-termine whether infant transport patients are athigher risk for RF-IRCsthan are their older pediatric counterparts. The objective of this studyis todetermine whether the incidence of RF-IRCsis greater in infants less than 6 months than in the rest of the pediatric transport patientpopulation.

Methods: The charts of all patients, less than 18years of age, transportedtotheRobert Wood Johnson University Hospital Pe-diatric Intensive Care Unit from 7-1-95 through 6-30-98, were retrospectively analyzed. Demographic datawasabstracted and theoccurrenceof RF-IRCs noted. RF-IRCsweredefinedasreferral facility patientassessments ormanagementdecisions whichwere notinaccordance with Pediatric AdvancedLife Support Guide-lines.RF-IRCs were grouped as follows: Triage Errors; Airway, Breathing, Circulation, Neurologic, and Metabolic management errors. Patients were divided into 2groups: < 6 months and 6 months to < 18 years. The average Pediatric Risk of Mortality (PRISM) scoresfor the2groups werecalculated andcompared usingthetTest.Theincidenceof each IRC categorywascalculated andcompared betweenthe2groups using thechi-squaretest. P values of less than 0.05wereconsideredtobestatistically signif-icant.

Results:During thestudyperiod,564patientsweretransported toourfacility.

< 6mos. 6mos to <18yrs

(n=116) (n=448)

PRISM Score 5.9 4.0

TriageErrors (%) 13.8* 7.1*

Airway (%) 12.9 7.6

Breathing (%) 23.3* 12.3*

Circulation (%) 7.8 4.5

Neurologic (%) 1.7 1.1

Metabolic (%) 13.8 8.7

Total (%) 66.4* 38.6*

*P<0.05

Conclusions: The total incidence of RF-IRCs wassignificantly higher for infants than for older pediatric transport patients.

RF-IRCs related to Triage Errors and Breathing management were significantly higher in the infant group. Infants had higher inci-dences of all other RF-IRCs, however, statistical significance was not achieved.This study suggests that infants requiring interhos-pital transport may beathigher risk for RF-IRCs than their older pediatriccounterparts.

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VEHICULAR ACCIDENTS INVOLVING PEDIATRIC AND NEONATAL TRANSPORT TEAMS

BrentR. King, MD, FAAP and George A. Woodward MD, MBA, FAAP.Departments of Emergency Medicine and Pediatrics, The University of Texas Houston Medical School, Houston, TXand Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA.

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THES.T.A.B.L.E. TRANSPORTEDUCATION PROGRAM: ASSESSMENT OFTRANSPORTABILITY TO REGIONAL CENTERS IN THEUNITEDSTATES.

Kristine A. Karlsen and Tracy B. Karp S.T.A.B.L.E. Transport Education Program, Park City,Utah.

Background:Appropriate and timely pre-transport stabilization of sickneonates will reduce morbidity and mortality, therefore communityhospital caregivers must be prepared for this contin-gency.The S.T.A.B.L.E. Transport Education Programis a neona-taloutreach education program thatwasdeveloped for commu-nityhospital staff inthe care of a sick infant in the period between resuscitationof thenewborn and arrival of the transport team. The Program wasdeveloped between 1991 and 1996 and made com-merciallyavailable inMay 1996. The S.T.A.B.L.E. Program does not replace communication and consultation with the tertiary hospital, but provides referralhospital staff with a concise and directive tooltohelp organizethe pre-transport stabilization of the sickneonate.ThemnemonicS.T.A.B.L.E. wasdevelopedtohelp withorganizationof the stabilization process and to assist recall. S.T.A.B.L.E. stands for Sugar, Temperature, Artificialbreathing, Blood pressure, Lab work, and Emotional support for thefamily. Theextensivepre-transportstabilizationcontentbuilt around the mnemonic is presented to the leamer as a one day didactic-interactive seminar.Evaluation includes cognitive knowledge as-sessment measured through pre and post testing. Participants opinionsonacceptability, efficiencyandeffectiveness of the pro-gram areassessedthrough a Likert scale. As part of the program developmentapilotstudy (IRB approved) was conducted involv-ing 49 (25 RN & 24 non-RN) participants from 4 community hospitals. Theone-dayseminars werepresentedby the author of the S.T.A.B.L.E. Program. The pilot study showed significant changeinpreand posttest scoresandhighscoresfor acceptabil-ity,efficiency and effectiveness (8 of 29 sample questions ) of the program (see below). Following pilot testing, the program was commerciallydistributed. The purpose of thisdescriptive study was to assess ifthe results achieved in the pilot study, when taught by theauthor, could be generalizedto alarger population when the programwaspresented by manyinstructors inmany regions.Methods: Inimplementing the S.T.A.B.L.E. program the regional outreach educatorswereencouraged to returnpre and post test scores and program evaluations. Means and standard deviations were calculated on pre and post-test scores and the

evaluation questions. Results: Six programs returned data [Tests N=423(355 RN; 9 MD, 39 RT, 20 LPN); Evaluations N=350]. Pilot and outreacheducators groupsareshownbelow.

n

Pilotgroup [PG] (n = 49) Outreach educator group

[OEG] (n = 423) Selected MeanEvaluation

Scores(n-350) [1 =strong disagree, 5=strongagree] Iwould havepreferred

self-paced learning (no instructor orlecture) Iliked the format ofthis

program

Ifelt program complexity wasappropriatefor my level of expertise Ifelt this program was

thebest waytolearn this material

Ifelt this wasagood use of my time

Ihavelearned things that willhelp withfuture neonatalstabilization Ilearnednewinformation Igained more confidence

inmyability to care for infants needing transport

Recommend the program?: Yes: Eliminate the program: 0%

Pretest rnean score

(SD) (%)

74(11) 83(9)

PG

1.3

4.8

4.2

4.6

4.8

4.9

4.8 4.7

Post test mean score

(SD) (%)

89(7)p< .001

92(5)p <.001

OEG

2

4.4

4.1

4.3

4.4

4.6

4.5 4.4

80%; Yes with revision: 20%,

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1999;104;791

Pediatrics

Thomas Abramo