ACTS team brings neonatal and paediatric ICU expertise beyond SickKids’ walls

By Ana Fernandes, Intern, Communications and Public Affairs

Transporting patients quickly and safely from community hospitals to a tertiary hospital is no simple feat, especially when considering the complex medical needs of a critically-ill child or a premature baby. Since it began in 1973, the Acute Care Transport Service (ACTS) team at The Hospital for Sick Children (SickKids) has become a leader in this very specialized service in Canada.  

The 28-people team that includes nurses, respiratory therapists, transport coordinators and rotating physicians, is the largest of its kind in Ontario and transports 1,600 children a year. It is responsible for half of all neonatal and paediatric transfers in the province.

“We are really a portable intensive care unit. We take the highest level of expertise and skill from paediatric, cardiac and neonatal ICUs at SickKids, beyond our walls and out to the community,” says Mark LePine, Registered Respiratory Therapist (RRT) who has been with ACTS for 20 years. “Timing is critical. From the moment a call comes in, before we even arrive on the scene, we are consulting with the medical providers on site to determine what type of care is needed.”

In collaboration with local and provincial emergency medical services, including paramedics from the regions of Toronto, Peel, Durham, York, Halton as well as ORNGE air ambulance, the ACTS team provides a specialized paediatric service that complements existing emergency medical services for the general population.

Additionally, the ACTS team represents a unique partnership between nurses and respiratory therapists. ACTS two-year educational program provides cross-training in a way that nurses are prepared to take over RTs’ duties and vice versa.  “It’s the best of both professions coming together. We support each other’s scope and it allows for very seamless patient care. For us, it is like a tango dance - very orchestrated,” says LePine.

Through the Criticall provincial service, ACTS receives about two to four emergency calls per day. Each of these calls are firstly assessed by a SickKids critical care physician and ACTS Transport Coordinator, who will provide advice to a local doctor over the phone and then dispatch the team if needed. Our  physicians and Transport Coordinator will continue to provide phone advice until the ACTS team arrives on scene. Once the team is there, they stabilize the patient and decide whether to transport to SickKids or to another appropriate hospital.

A call can take anywhere from two to eight hours, or even more depending on where it comes from. There are cases when the patient is in difficult-to-reach areas or has a delicate health condition. Not only are ACTS nurses and respiratory therapists collaborating with one another but also with emergency services and medical teams across the province.

This choreographed care dance came to be after SickKids’ long tradition of caring for some of Ontario’s sickest children. Even before the creation of neonatal intensive care units in Canada, clinicians at SickKids were finding innovative ways to safely transport vulnerable babies to the hospital. As described in the book SickKids: The History of The Hospital for Sick Children, a curious invention from 1930 shows an early commitment to getting babies to the hospital for care. Dr. Gar Hamblin created a small wooden box with a mattress suspended in a wire basket over a hot water tank. The contraption is described as the hospital’s first premature baby ambulance.

Over the past few decades, technology has drastically improved, allowing our staff to provide even more precise and specialized care to babies and children.

The ACTS team recently acquired four state-of-the-art incubators that allow the team to better monitor an infant’s heart activity, has integrated electric shock equipment that can be activated in case of arrhythmia, as well as mechanical ventilators that are gentle for babies’ lungs.

"Our experience working day-in and day-out with critically-ill or injured infants and children makes all the difference in the service we can provide, and the equipment and technology also play a crucial role when considering the level of precision required," says Miriam Godfrey, registered nurse who has been part of the ACTS team for 14 years.

From the first premature ambulance to the team's current advanced techniques, innovation continues to be at the core of SickKids' mission to provide the best possible care to kids in the right place at the right time.