Organization and Mission

Children’s Medical Center Dallas is a 406-bed, non-profit tertiary care center and level I Trauma Center. This includes a 52-bed pediatric intensive care unit (PICU), over 50 outpatient clinics, an emergency department (ED) designed just for children, and a dedicated interfacility transport program. Children’s service area is predominantly north central Texas, but it brings children to the hospital from all over the southwest.

Children’s Transport Team was founded in 1989 when Children’s Medical Center recognized that there were children in the community hospitals that needed pediatric specialized care before they arrived at Children’s. The first year the teams completed 330 missions. In 1999 Children’s Medical Center Dallas Patient Transport Services was the first pediatric transport team to be accredited by CAMTS and the first to be accredited in all three modes of transport: ground, fixed-wing aircraft (FWA), and rotor-wing aircraft (RWA). The program has grown throughout the years: the Children’s Transport Team currently has over 60 staff members, and in 2004 they completed 3,516 transports.

Transfer Center
Children’s Medical Center has established a transfer center that is staffed 24 hours a day with transfer coordinators (TCs) who are trained as EMTs or paramedics. The TCs are also certified flight communicators by NAACS (National Association of Air Medical Communication Specialists).

The Transfer Center coordinates all transfers into Children’s. Transfer coordinators receive the initial phone call from the referring hospital and guide the rest of the process — from identifying an accepting physician to dispatching the team and flight following on RWA transports. Based on the information gathered in the initial conversation with the referral facility, the TC categorizes the patient as BLS (Basic Life Support), ALS-1 (Advanced Life Support), ALS-2, or SCT (Specialty Care Transport). They then determine the most appropriate destination for the child: Emergency Department (ED), Intensive Care Unit (ICU), or inpatient floor. Once this has been determined the TC notifies the appropriate accepting physician and dispatches the appropriate team in the appropriate vehicle. CMC’s goal is to be out the door within 10 minutes of receiving the call.

Children’s Medical Center uses a suite of software to connect the functions within the department. Computer-aided dispatch software is used to document information gathered during the call-taking process and dispatch of the teams. All clinical documentation is done using electronic charting software. The computer-aided dispatch system, the electronic charting system, and a billing system are all connected with a mobile data communication system. This suite of products makes report writing and data collection simple and the possibilities almost unlimited.

Implementation Strategy
Patient Transport Services has reached out to referring hospitals to demonstrate the capabilities of the services and to improve the coordination of the transport, assuring that the referring hospital, the responding team, and the receiving hospital have a common set of expectations.

Patient Transport Services is a separate provider with its own Medicaid/Medicare number and it bills separately for transport services. Billers and collectors work closely with management and the clinical staff to provide payers with all needed information for claims processing.

CMCD decided to set up two levels of transport teams. Based on predefined medical protocols a critical care team consisting of a registered nurse, respiratory therapist, and emergency medical technician – certified emergency vehicle operator (EMT-CEVO) or a team of two paramedics might be dispatched. The paramedic team transports patients who are categorized as BLS or ALS-1 and are within a 60-mile radius of CMCD. All other patients are transported by the critical care teams.

The EMT-CEVO serves as safety officer on all rotor-wing aircraft transports. The CEVO gives position reports, assists the pilots by watching for any obstacles, assists the team with loading and unloading the patient, and briefs the family member prior to flight. All team members are trained as flight crewmembers and follow duty time limits developed by the FAA when flying. Training for both the safety officer’s role and flight crewmembers was developed specifically for the transport staff members by the RWA pilots as a part of the implementation of the RWA program that went into service September 16, 2004.

Evaluation and Results
The dedicated billing function has significantly increased reimbursement with a high percentage of claims being paid the first time they are submitted. This allows Patient Transport Services to document the revenue it generates. Over the years this ability has enabled Patient Transport Services to garner the support for new programs.

Operating two levels of service has enabled CMCD to operate at an efficient volume of cases while keeping personnel expenses in line, due to the significant cost savings found comparing a team of two paramedics with the critical care team. Approximately a quarter of all transports are performed by the paramedic team.

Education and Replication
CMCD is aware that a number of other transport services have adopted the approach of dedicated transport teams and of two levels of teams. Details of that implementation are likely to vary with the particular needs of the operating organization (for instance, hospital-based or free standing) and with the scope of practice regulations in a given State.