Hurricane Harvey: evacuating critically-ill neonates

Fourteen hours and 29 minutes. Ten critically-ill neonates. Seven two-way flights at 425 knots. Amy Gallagher reports
Hurricanes do not discriminate. Not even for critically-ill newborns. Cook Children’s Medical Center and Metro Aviation were ready for the rescue, and Driscoll Children’s Hospital was proactive and prepared. The transport teams at both facilities understood their mission: to evacuate and transport 10 critically-ill neonates before Hurricane Harvey’s 134-mph (216-kph) winds landed in Corpus Christi, Texas, US, where Driscoll is located. 
Up against the clock were transport team members: Ray Crain, fixed-wing pilot, Metro Aviation, Cessna Encore+; Children’s Teddy Bear Transport Team’s programme director Debbie Boudreaux; flight nurse, Lori Hill; and Driscoll Children’s Hospital transport team director, Jeremy Goodman.
Professionals and proactive planning
“I actually become more methodical and slow my flight planning to ensure the crew members are briefed and understand the time constraints,” said Crain, who has flown for the transport team for 29 years. Metro Aviation, one of the largest EMS aviation providers in the US, operates Cook Children’s EC145 helicopter, Beechcraft King Air B200 and Cessna Encore+.
With Cook Children’s Medical Center for 30 years, Boudreaux became programme director of the Teddy Bear Transport Team in 2013. “Pre-empting a hurricane the size and speed of Harvey requires a network of people,” he said.
Through their respective administrative teams, Boudreaux and Goodman began co-ordinating the transports on 24 August. “We had FBO contacts on the ground to secure fuel and a landing in Corpus Christi,” said Boudreaux. A proactive plan was put in place as Boudreaux and Goodman began collaborating with the transport directors of Dallas Children’s Medical Center and Texas Children’s Hospital Houston to secure standby resources, if needed, she added. 
An environment of uncertainty
Working with the National Weather Association, County Emergency Command Center and Regional Advisory Committee, Goodman was informed that Harvey was only hours away and living up to its name, ‘iron strength and battle worthy’. “The storm was rapidly changing, so we prepared for a Category 1/2 storm, then shortly after, were notified that Harvey’s strengthening was imminent,” said Goodman. Harvey was an unpredictable storm that rapidly gained strength, he said. “In the past, we knew what we were going to encounter, but Harvey changed that,” he said. “It was slow moving, but intensified at the last minute, creating an environment of uncertainty. We monitored the storm and were prepared for whatever path it was going to take.”
Time, speed, range and payload
“At approximately 11:00 hrs on 24 August, we were briefed that the storm was likely to become a Category 3, so we began preparing our patients for transport to another location as a precaution,” explained Goodman. 
With any natural disaster, there is a degree of intensity, said Boudreaux. “Since Driscoll was proactive, we had time to plan and co-ordinate our efforts,” she added.
“These types of flights bring unique challenges due to approaching weather and increased operational tempo,” said Crain. “However, the aircraft’s combination of speed, range and payload ... was ideal for these flights.”
With 6,500 flight hours, Crain said on the flight to Corpus Christi, the Encore+ created an easier pathway reaching about 32,000 ft at a speed of approximately 425 knots. “Its advanced airborne weather radar system allowed us to see any convective activity directly ahead of us in real time,” he added.
A mobile ICU for the most critical 
The Encore+ carries six passengers and one patient, and in some cases, two infants on the same stretcher/isolette, said Crain.
Teddy Bear flight nurse Lori Hill began preparing additional supplies for the transport. According to Hill, the plane is essentially a mobile ICU that is equipped with oxygen, suction, monitoring devices and pumps to infuse the same medications patients were receiving at the referring hospital. The team has the ability to transport with high frequency ventilation, nitric oxide and even ECMO if needed, said Hill. “Some patients were ventilated and on nitric with a central line requiring frequent sedation,” she explained.
Fort Worth: a home away from home
Hill’s greatest concern was getting the critically-ill neonates to Cook Children’s. “We were relieved to hand our baby to our NICU staff, who we knew would give excellent care,” she said. Her greatest joy, she said, was, ‘helping out fellow Texans in their time of need’.
On the pilot’s side, everything went according to plan, said Crain: “With a limited window of operations, we stayed within it.”
The last plane landed in Fort Worth safely around 05:20 hrs on 25 August, just hours before Harvey’s landfall in Corpus, according to Boudreaux. “In total, the transport teams of both hospitals conducted seven flights to/from Corpus Christi and Fort Worth,” she added.
Corpus Christi: home sweet home
According to Goodman, the last flight transporting the 10th baby was back ‘home’ at Driscoll on 1 September.
“Each evacuation is an opportunity to renew respect for transport teams that put themselves in harm’s way to ensure the safety of our most fragile patients,” said Goodman. “We have the utmost respect for Cook Children’s.”
Both hospitals share a similar mission to provide access to quality care, while improving the lives of children through hope and healing, he said.
Fourteen hours and 29 minutes
The time to evacuate 10 critically-ill neonates from Driscoll’s NICU to safely tuck all the babies in warm blankets at the NICU Cook Children’s, approximately 400 miles (650 km) northwest of Fort Worth, according to Boudreaux, was 14 hours and 29 minutes. 
“It was such a relief when the last aircraft lifted out of Corpus Christi,” she said. “We were under a time crunch while the storm cell was moving closer. I kept track of planes and the storm on the weather channel and flight tracking system.” 
Although Hurricane Harvey set a new precedent, Boudreaux’s team was prepared. “We learned many years ago, if you’re called to help, it doesn’t matter who needs it,” said Boudreaux. “If you can help, you go. We’ve worked closely with other hospital transport teams and have learned the value of those relationships when making those important phone calls. I just wanted everyone back on the ground in Fort Worth. At the end of the day, we completed our mission of moving 10 infants safely.”