Organization of neonatal transport services in support of a regional referral center.

The high risk infant transport ambulance, which is unique in design, concept, and staffing, demonstrates how a tertiary care referral center can fulfill its regional responsibility in effecting the safe and rapid transport of patients to its door. A systems approach to the support of a referral network resulted in the design of a specialty vehicle with specialized equipment and highly trained and dedicated personnel. The care provided to the critically ill neonate struggling for life is as high a caliber on transport as it is when the patient is admitted to the neonatal intensive care unit at The New York Hospital. Set-up costs and operating costs are high, so this model may be successfully used only in conjunction with a referral network of appropriate patient load. This point is further illustrated when it is realized that the total operating budget of the high risk infant transport services is about the same as the annual personnel costs for staffing one small intensive care unit. Finally, from a health systems planning point of view, the ability to successfully transfer the neonate to specialized medical resources under controlled conditions is of particular interest. Medical planners and providers can see that the neonatal transport service concept described can be extended to other medical disciplines and treatment modalities and can become an important factor in the design of future health care delivery systems.