A premature island baby and a guardian angel
While many of us were glued to our televisions on Sunday, January 20, 2019, watching the New England Patriots beat the Kansas City Chiefs in the AFC championship game, a different kind of emergent story was unfolding at Cape Cod Hospital. Albert Fantasia, RRT, NPS, director of respiratory and pulmonary services at Cape Cod and Falmouth Hospital, was preparing to fly to Nantucket to help a newborn in distress.
The four-hour-old premature infant born at Nantucket Cottage Hospital had Respiratory Distress Syndrome, a condition often seen in premature infants because their lungs are not fully developed.
While the Nantucket hospital staff was able to provide basic support, they did not have the specialized equipment to sustain the infant for a long period of time. Transporting the baby to Boston for further treatment via medical helicopter was out of the question, due to bad weather.
Jane Johnson, RN, BSN, Cape Cod Hospital nurse manager of critical care and trauma services, was covering the hospital as house supervisor that Sunday and Fantasia had come in to assist Jeffrey Spillane, MD, FACS, a Cape Cod Hospital surgeon, with a bronchoscopy.
This was very uncommon because the two managers don’t normally work weekends.
“We saw each other in the halls a couple of times that day and were joking about not usually being at the hospital on the weekends,” said Fantasia.
Teamwork at its Best
The call for help came in around 5 p.m. with a request for additional equipment to help the baby’s breathing, according to Johnson. While the weather was rainy and windy with a predicted flash freeze, the ferries were still running. The plan was to send the much-needed equipment to the island on the 6 p.m. boat.
“I didn’t know a lot about what was going on with the baby,” said Johnson. “I just knew we had equipment they needed.”
The Nantucket supervisor requested a CPAP (continuous positive airway pressure) mask, which Fantasia thought was a little odd because they use the mask for short-term therapy to deliver oxygen, not long term.
“I figured they didn’t need a mask, they needed nasal prongs (plastic tubing placed in the nose), which we do long-term with newborns,” said Fantasia. “True CPAP, in newborns, is done with nasal prongs, this is more effective because babies are nose-breathers. Utilizing a mask for too long may cause air to get in their belly, which increases the chance of vomiting and other complications. The prongs help avoid this.”
Fantasia knew they also needed a “circuit” (special tubing to deliver the CPAP) that helps makes the system portable, more efficient and better ensures a positive outcome for the baby.
As 6 p.m. approached, Johnson was told the ferry was canceled. She suggested the Nantucket supervisor contact the Coast Guard to fly the baby to Boston, but they were unable to fly the baby to Boston without someone certified in neonatal resuscitation.
“I called Al and told him they couldn’t get the baby off the island because the Coast Guard didn’t have anyone certified in neonatal resuscitation,” she said. “Without even taking the time to think about it, Al (who is a Neonatal Resuscitation Program instructor) told me he would go.”
Logistics of the Trip
Meanwhile, Johnson made calls to Cape Cod Hospital administration to get permission for Fantasia to make the trip, and the Nantucket Cottage Hospital supervisor did the same. By this time, Fantasia was home cooking dinner, which is an hour’s drive from Cape Cod Hospital. Once he had the all clear to go to Nantucket, he drove to the hospital, picked up the equipment and headed to Barnstable Municipal Airport to meet the Coast Guard. But his traveling was not yet over.
The Coast Guard notified Fantasia they couldn’t land at the airport because of the wind and ice so he would have to drive to Joint Base Cape Cod in Bourne to meet the helicopter. After he made it through the checkpoint at the base and arrived at the Coast Guard hanger, it took another hour or so to take off because of systems checks of two helicopters.
When they landed at the airport on Nantucket, an ambulance took Fantasia to the hospital. The Coast Guard was pressed for time because there was a small window of opportunity to fly to Boston, due to changing weather conditions, and pressed Fantasia to keep them updated on how long it would take to get the baby.
“I told them it could be quick, or it could take an hour, depending if the baby was ready to go,” he said.
Once he arrived in the Nantucket Cottage Hospital emergency department, he needed to make some adjustments to the oxygen flow, connect the circuit to the CPAP and apply the nasal prongs. It took about one hour and 15 minutes to get the baby stabilized and prepared for the transport.
“I had to make protective ear coverings for the baby because of the noise of the helicopter,” Fantasia said.
With the baby safely in an incubator, which they had to strap down in the helicopter, and a travel nurse (to assist Fantasia with the baby) and the baby’s mother on board, the team finally took off for Boston.
The transport was successful, and a medical team was waiting for them on the roof of Massachusetts General Hospital when they arrived. The baby survived and is doing well, Fantasia said.
All About Community
Upon landing back at Joint Base Cape Cod, Fantasia’s day was still not done. The Nantucket travel nurse needed a ride to Hyannis to grab a ferry back to the island. It was an extra hour of travel for him, but he said he felt it was important to make sure she could get back to Nantucket. By the time he got home, it was 4 a.m.
Fantasia said he did not think twice about helping that day.
“Our medical community is pretty small. When you’re dealing with a sick child, it becomes even smaller. A child born sick already has one strike against them; you need to help them out.”