(Laura Simon) [Order this photo]
A helicopter is their makeshift hospital.
They wait around the clock at the Cape Girardeau Regional Airport for the next call to come in, whether it's a premature baby or a child who has been through a trauma.
For years, Cardinal Glennon Children's Medical Center has taken patients from hospitals in Southeast Missouri and Southern Illinois to St. Louis for specialized pediatric care, but now a transport crew is on standby at the local airport.
"It's been frustrating trying to get down there. There's often a lot of fog. Sometimes it would take us two to two and a half hours to get down there," said Karen Zahn team leader of transport services at Cardinal Glennon. "A lot of terrible things can happen in two hours."
Typically, Cardinal Glennon picks up about 150 patients each year at the request of hospitals in Cape Girardeau, Sikeston and Poplar Bluff in Southeast Missouri and Carbondale and Marion in Southern Illinois.
"Cape is just a great location to get to any of those areas," Zahn said.
This winter, Cardinal Glennon began leasing space from the Cape Girardeau Regional Airport to house its first transport team outside St. Louis. The team includes a registered nurse and a respiratory therapist who stay at the airport in a combination living quarters, office and storage space inside the Cape Aviation building.
Airport manager Bruce Loy said this is the first time in several years that a medical transport team has been stationed at the Cape Girardeau Regional Airport. The last team was ARCH Air Medical Service.
"We're happy with them as a new tenant," Loy said. "It's a short-term agreement that we hope will become a long-term one."
Southeast Hospital works closely with Cardinal Glennon's transport team to take patients from its neonatal intensive care unit to St. Louis for more specialized treatment, said Dr. Paul Caruso, neonatologist at Southeast Hospital.
Respiratory difficulties, heart problems and other conditions requiring a pediatric surgeon will prompt Southeast to send a pediatric patient to Cardinal Glennon, Caruso said.
Southeast also contracts with Cardinal Glennon to to pick up critically ill newborns from other hospitals in the region and bring them to Southeast.
"Having the transport team leave from Cape Girardeau, as opposed to St. Louis, significantly shortens the time it takes for those babies to be stabilized and brought to our hospital where they can be cared for in our NICU," Caruso said.
Saint Francis Medical Center has its own neonatal transport team picking up infants from outlying hospitals in Southeast Missouri, Southern Illinois, western Kentucky and northern Arkansas. The team includes a neonatal nurse practitioner, a registered nurse and a respiratory therapist.
Saint Francis transported 130 infants last year from outlying hospitals to its NICU, said Cathy Abrams, director of maternal child services at Saint Francis. It is rare that Saint Francis sends an infant to a St. Louis hospital for treatment, Abrams said, but when it does, the baby goes to St. Louis Children's Hospital.
Cardinal Glennon has three teams that take turns driving from St. Louis to Cape Girardeau for 24-hour shifts. The nurses and respiratory therapists have backgrounds in pediatrics and neonatology and have some advanced skills, including being able to intubate patients. Cardinal Glennon recently hired a few nurses and respiratory therapists from the Cape Girardeau area and they are going through orientation, Zahn said.
Once the patient is stabilized by the Cardinal Glennon team, whether the patient is transported back to a hospital by ambulance or helicopter depends on how critical the patient is and the weather.
When the transport team needs to fly, a helicopter is dispatched from ARCH. ARCH's Sparta, Ill., base is the closest to Cape Girardeau.
"When they're calling us, usually things aren't going well for the patient. Usually you're going into a situation that for whatever reason, they can't handle it at that facility," said critical care nurse Lisa Ruzicka, who has been part of Cardinal Glennon's transport team for 18 years.
Many outlying hospitals in this region just aren't equipped to provide pediatric or neonatal care, she said. Ruzicka carries a suitcase full of tiny supplies specially sized for what she calls "micropreemies." It's not uncommon for her team to get a call from an outlying hospital to transport a baby born as much as 24 weeks early.
Having a transport team based in Cape Girardeau cuts what used to be a three-hour trip from St. Louis to Poplar Bluff in half.
"Now we can at least get our team there to start helping the child or the premature baby. We might have the equipment they need at that hospital or bring special medicines that they don't have for the babies," Ruzicka said.
Other hospitals often don't have the small tubes and equipment Cardinal Glennon nurses bring. Ruzicka has a blood pressure cuff made specially for a one-pound baby.
"It looks more like a Band-Aid than what people think of as a blood pressure cuff," she said.
Ruzicka compares her job to a firefighter's.
"You have some days where you're sitting around and nothing's happening, and then there's other days when you run and you go and go," she said.
Typically, there is at least one trip made each day, Ruzicka said. About two-thirds of the transport team's patients are infants, she said.
Every call presents the team with different challenges.
"You have to really use out-of-the-box thinking on transport because you have a limited amount of supplies and a limited amount of resources. At the hospital there's always going to be more Band-Aids or instruments or syringes," Ruzicka said.
"There's only a certain amount of oxygen. You have to think about what you're going to be doing and how far it's going to last. Once you run out of that, you're in trouble," added respiratory therapist Peggy Arras.
Arras said she can explain to an adult what she's doing and that she's trying to help them but the little ones often don't always understand.
"We try to do developmentally appropriate distraction techniques. We've been known to sing a nursery rhyme or two," Ruzicka said.
They transport babies in a mobile incubator called an Isolette. It includes a warmer to help premature babies maintain their body temperature as well as monitors for blood pressure, oxygen saturation and heart rate all in one compact unit. It includes a tiny Velcro seat belt to hold the baby in place.
"There's everything you would have in your ICU, it's just shrunk down," Ruzicka said.
For older babies, they'll use a car seat strapped to a stretcher. Cardinal Glennon actually cares for patients up to age 21, Ruzicka said, and for older children uses a standard stretcher during transport. Ruzicka doesn't just treat the child, but said she tries to care for the entire family. She's often meeting them on the worst day of their life. Separating parents from their sick child can be an anxious experience. Ruzicka puts herself in their shoes.
"I would want someone who would do everything they possibly could to help my child be there," said Ruzicka, a mother of three. "That's how I think about it."
Cape Girardeau Regional Airport