Heidi Bates and Robin Cheeseman are both Clinical Resource Transport Nurses. Robin Cheeseman was the assigned transport nurse on duty. When called for a potential transport, she noted that our usual transport partners were out on another call. After consulting the charge nurse, it was determined that the infant awaiting transport was too unstable to wait a prolonged period of time to be picked up. Heidi Bates was also working on this shift and was asked to go as the second transport nurse. When the team arrived they found a premature infant, who had significant facial anomalies (consistent with a syndrome), who was being bagged.
The report they received was that multiple intubation attempts had failed, including attempts by a highly trained anesthesiologist. After assessing the situation, the pair used their in-depth knowledge of the neonatal population and made the decision to prone the infant and place a Laryngeal Mask Airway (LMA) to allow ventilation. In essence, one transport RN held the patient in the air, in the prone position, while the other transport nurse placed the LMA from the underside of the patient. Although this novel approach came from their extensive knowledge of the neonatal population and having cared for other similarly anomalous infants, the decision to take such a bold and unconventional approach was driven by their knowledge that this infant's life literally depended on it.
The infant was transported back on a ventilator via the LMA, another novel clinical decision based on the situation they were presented with. After reviewing the case, the Neonatal Medical Director noted this snap decision likely saved this infant's life. He noted that the team's ingenuity and willingness to "think outside the box" were extraordinary.