In an ambulance for a non-emergency service

Observing a neonatal transfer service is a rare opportunity for a medical student. I was initially expecting action-packed ambulance service but the only job I got to observe was a non-emergency transfer service from hospital A to hospital B (real name is not really important). Nevertheless, it was an enriching experience having been able to observe how Dr James carried out his work. There is so much to learn from him - not did he teach me the academic medical knowledge, he also exemplified good communication and soft skills with the team and the family. It was really inspiring how Dr James was so reassuring towards the parents. And his management certainly has allowed the parents to be less worried and concerned. Given the lack clinical exposure that I have and the minimal patient contact, this was a good learning experience for me and Dr James became a role model and his soft skills are something I hope to be able to pick up throughout my medical education.

The reason of the non-emergency transfer was the lack of facility in hospital A. A premature baby born at 26 weeks gestation and was, at the point of transfer, 36 weeks corrected had been having bouts of full abdominal distension and feed intolerance. The baby was transferred to hospital B for surgical consultations, and contrast study. The baby was put in an incubator with all his vital signs monitored and was on low flow nasocanula oxygen as he was transferred in an ambulance to hospital B. The siren was not turned on as this was a non-emergency transfer. However, the feeling of being in an ambulance is eerie and definitely unnerving – especially coupled with the fact that the baby’s mum is on the ambulance with us.

I initially thought that this was going to be a simple and rather uninteresting transfer but I could not be more wrong. The number of people involved in this is really quite surprising. There has to be a proper handover in each hospital; stating at hospital A where Dr James and crew were thoroughly informed and updated on the baby's medical history as well as the family's opinions (not willing to change to the hydrolysed baby formula). For the handover to be smooth and swift, it was extremely crucial that the transfer team was given all the information available starting from the point of delivery of baby. At hospital B, it was Dr James' turn to update the receiving team ensuring that they know all the essential details including the feeding time and others. Therefore, while non-emergency transfer service may not give the similar excitement as emergency trips, it is just as important.

My experience was an eye-opening one, thanks to Dr James who willingly went over the baby's clinical medical history and also went further to teach me on common complications faced by premature babies. Moving away from the academic teaching, we also had a little conversation about ethical problems and NHS in general. A particularly interesting one was the ethical dilemma of informing Muslim or Jewish parents regarding the pig-based surfactant (Curosurf) given to premature babies. Coupled with the fact that families rarely enquire the origin of the medical products, this was one difficult ethical grey area.