Inter-healthcare facility transfer of critically ill neonates : the development of a programme for emergency medical care in the South African context

Neonates are considered a vulnerable age group due to a variety of clinical problems that can occur. Critically ill neonates are a high risk population with single or multiple organ system failure that places their lives at risk. They require urgent medical lifesaving intervention and where appropriate care is unavailable, are transferred to a higher level of care to improve their chance of survival. Inter-healthcare facility transfers are the responsibility of Emergency Medical Service, and an integral part of the South African medical system. The Emergency Medical Service serves as an extension of the intensive care unit, but is associated with a very high level of risk due to the stressors of the pre-hospital environment which impacts on the clinical outcomes of the neonate. The aim of this study was to develop a programme for inter-healthcare facility transfer of critically ill neonates in the South African context. Developmental Research and Utilization (DRU) model was the overarching framework, guided by critical realism paradigm that enabled a deeper level of understanding of the context. Developmental research methodology provided a guide to collect data and through predetermined steps, each designed to achieve a specific purpose towards achieving the study aim, using a qualitative approach. The study found that the Advanced Life Support paramedics were inadequately prepared to deal with the neonates and the accompanying family members during the transfer process. Organisational structures and transfer processes were found to be inadequate. Emergency Medical Care lecturers were ill prepared to provide appropriate experimental instruction and the accompanying mothers were neglected during the transfer. A holistic and multi-dimensional inter-healthcare facility transfer programme that was relevant for the local context, with appropriate organisational structures and transfer processes was developed and thereafter appriaised by a group of experts. It included the knowledge and skills required by paramedics and support for accompanying family members during the transfer process.