It would be devastating if your child was critically ill and you were near a hospital like the renowned Westmead Children’s. Imagine how much worse it would be if you were hundreds of kilometres away in a small town or a remote location.
The Newborn and Paediatric Emergency Transports Service (NETS) is a health service in New South Wales, managed by the Sydney Children’s Hospital Network, and these guys are your lifeline.
NETS is the only service of its kind in New South Wales, and it is critical in keeping babies and children alive. NETS is not a hospital, but an emergency referral and transport service for sick and injured babies, infants and children needing stabilisation and transfer to a specialist perinatal or paediatric centre. It provides expert clinical advice, clinical co-ordination, emergency treatment, stabilisation, and between-hospital transport for seriously ill babies and children.

Action at the base

I spent a couple of hours with Dr Kathryn Browning Carmo (Kath) and her team recently — friendly, professional, confident, approachable — and she proudly showed me around the base and introduced me to the staff. In her practical and hands-on manner she delivered a quick rundown of the teams’ roles and responsibilities, and what happens at NETS. The Clinical Coordination Centre, the hot spot of the base, was mesmerising. Three highly trained specialist neonatal and paediatric nurses with headsets manned the work stations. Their telecommunications equipment, constantly changing screens and a large wall-mounted monitor flashed between screens depicting vital information. One screen showed the details of emergency calls that morning, with the child’s name, condition and location. A second screen showed the exact locations of ambulances, helicopters and planes, plus rescue teams and pilots. The large primary coloured icons could have come from a children’s book but the information the images conveyed was critical and lifesaving information for the NETS team. When a call came in it was all stations go. The communication, coordination, responsiveness and professionalism were astounding. The consultant on duty donned a headset, entered an office opposite the coordinators, and the adjoining room quickly filled with the retrieval team who could hear the conversation between consultant and caller. This room is also equipped with a Vision for Life screen on which the child can be seen. Every conversation is recorded at the base, in case any information needs to be retrieved at a later date. In this particular case the baby was admitted to Westmead Private Hospital and a NETS retrieval team headed over there to discuss the baby’s clinical management with the Westmead paediatrician. Other calls were coming in and coordinator Heather Robb said, “It has been pretty constant today — we’ve had seven calls. We frequently get around 11 calls a day, no day is the same, and when you walk in the door you never know how your shift will go.” NETS’ teams are on call 24 hours a day, seven days a week, enabling lives to be saved every minute of the day. The clinical coordinators are also retrieval nurses, and participate in retrievals so they know exactly what they are dealing with when coordinating the care of the critically ill or injured children and assigning ambulances, helicopters and inter-hospital transport. Kath Browning said, “Every newborn or child in New South Wales should have access to the same treatment they would get inside the Children’s Hospital at Westmead. NETS touches the lives of so many children.” Next stop with Kath was the helipad, with one helicopter in use and the other in the hangar, which also housed ready packed mobile neonatal units to slide in to the helicopter at a minute’s notice. Ground floor of the base followed, where NETS’ fleet of ambulances is housed. They are in fact larger than normal ambulances. These Sprinter models can accommodate two of the NETS life support systems — one can be loaded from the back like a typical ambulance, and one from the side. This allows a baby or infant plus an older child to be transported at the same time. The extra space can also be used for additional staff or a larger supply of oxygen and allows a parent to travel with their child. There is also a DVD player to distract and entertain the paediatric patients.

Kath and NETS

As a child in Coolamon, rural New South Wales, Kath remembers waiting hours and hours for an ambulance, and particularly the time her best friend’s younger brother waited a long time; the ambulance took him away but never brought him back. This left a strong impression on Kath, and she went on to study medicine at Newcastle, and then embarked on a paediatric intensive care career at the Royal Alexandra Hospital for Children. “I heard Dr Andrew Berry speak at a forum for rural doctors in Wagga in 2000 and that was a light bulb moment for me — I realised that I could combine my passion for intensive care with the provision of health care to critically ill or injured rural babies and children.” Kath underwent further paediatric training, worked as a neonatologist, joined NETS and completed more training in Retrieval and Aviation Medicine. Kath summarised NETS’ major strengths: “It has the power to facilitate communication to provide a child in a remote location with expert clinical support in a time-critical way. Without NETS many more babies and children would die prior to accessing the tertiary health care system. Being able to provide an intensive care doctor and nurse with a mobile intensive care unit to a remote site is paramount to enhancing the survival chances of these children.” Despite the great success of NETS Kath said it still faces major challenges. The current aircraft cannot tolerate all weather conditions, and the huge distances between places mean NETS can take three to four hours to reach retrievals in the far corners of the state. ☐

World first service

NETS NSW was the first neonatal emergency transport service in the world to offer the utility of ultrasound assessment to newborns in retrieval. This has been the focus of Kath’s research over the past eight years, and many other services globally have now followed suit.

Did you know?

One in every 49 children will travel with a NETS team sometime during their childhood. In rural areas this is increased to one in 38.
An average NETS mission takes six hours to complete and usually involves road transport, with some use of air and helicopter transport.
NETS provides a service to over 250 hospitals in NSW, ACT and further afield.
NETS staff include neonatologists, paediatric critical care doctors and nurses, emergency vehicle operators, Careflight pilots and aircraft, and biomedical and administrative support staff. They provide a 24-hour, seven-day emergency service. Specialist retrieval nurses are the front line in the Clinical Coordination Centre with ready access to a consultant specialist on call.
In 2014 NETS dealt with 4,169 cases, of which 2,745 were transported by NETS teams.

NETS in brief

1979 — NETS established, different hospital based services
1995 — Individual services merged into a state wide service
2011 — Managed by Sydney Children’s Hospital Network.