Celebrating Women in Critical Care Transport: Caring for Patients on the Road and in the Air

At Stanford Medicine Children’s Health, we are looking to the sky and the ground as we honor our Critical Care Transport (CCT) program during Women’s History Month. Its all-female led nursing team in obstetrics and neonatology, and (at times) in pediatrics, provides 24/7 coverage of critical care air and ground transports for neonatal, pediatric, and pregnant patients coming to Stanford Medicine from across California and nationwide.

The CCT teams have more than 30 years of experience as mobile intensive care units at Stanford Children’s and Lucile Packard Children’s Hospital Stanford. The critical care teams perform over 1,200 transports annually. They support ill infants, children, and expectant mothers; some ranging from general care for basic oxygen support and monitoring, to transporting patients needing surgical specialists, or lifesaving extracorporeal membrane oxygenation (ECMO). They travel via ground using Stanford Medicine Children’s Health ambulances or utilizing Stanford Life Flight for helicopter, and Reach/Calstar if the fixed wing aircraft is necessary. 

Ana Morales Clark, BSN, RNC, CNIV, was one of the first CCT obstetric nurses to join the team when the program at Packard Children’s started in 1992. She had already been a nurse at Stanford Medicine’s critical care and labor and delivery units for over ten years when she was approached to take part in this new transport program. “I thought it was a good opportunity for me to apply my critical care experience with the pregnant patient population.”

Flying solo

According to Clark, being a CCT nurse is a very autonomous position. She works primarily with pregnant patients who have prenatal or pregnancy complications, or those whose fetus is likely to be born prematurely, for whom the referring hospital cannot provide a high enough level of care. “We generally are single care providers, with emergency medical technicians (EMT) or flight nurses for support,” Clark said. “Once a transport call is accepted, our goal is to activate within 30 minutes.”  

For Amy Freiha, BSN-RN, MSN-NNP-BC, a neonatal critical care transport specialist, it’s the rush, quick-thinking applications, and the constant learning from challenging cases that have kept her in critical care transport for over 20 years. “I was always interested in the autonomy, critical thinking, adrenaline, and teamwork of transport. There is something alluring about being in a mobile ICU trying to give a baby a chance.”         

And sometimes that entails exploring the unknown. “Even when we are given a report from the referring physician or nurse, the clinical situation is often dynamic and may have changed,” said Freiha. “We have to clinically manage what we see, hear, and feel from experience with our team and transport control provider partners. We get to interact with so many medical teams from referring hospitals and make a connection with the families all over the state at a critical moment in their lives.”

Since graduating from nursing school, Lucy French, BSN-RN, CCRN, C-NPT, a pediatric CCT nurse, had always set her sights on joining the team. “I was drawn to the idea of caring for high-acuity patients, working closely within a small team, and really taking on a new challenge to apply my clinical skills after gaining 10 years of experience in the pediatric intensive care unit.”

For her, the job is a constant adventure and learning experience. “I walk into work every day excited for where I might be called out on transport, or what new situation I will have to encounter. It is a job where I will never stop learning because each patient and call have something new to teach you. You really have to use the minimal resources available to you when you are out on a call, and plan for anything and everything that could happen as well as you can. It’s a new and different challenge each day.”

Bridging care

As part of a nationally recognized pediatric and obstetric institution, Packard Children’s critical care transport nurses provide patients the highest level of medical care during transport and upon arrival. In addition to the important patient assessment and equipment preparation for transfer, communication is the top priority. As in a traditional hospital setting, every second matters when a child or pregnant woman is critically ill or injured—and a prompt transport can make all the difference.

Freiha detailed a time when swift communication and clinical experience helped a baby who had an unknown cardiac defect and was in severe respiratory and circulatory failure. “I knew the parents were terrified and I had less than five minutes to explain the situation and gain their confidence. After I introduced myself and the team, gave them my assessment findings, and the plan for transport, I explained that I must hurry because the only thing that was going to save their baby was a full cardiac evaluation and intervention within the hour. I gave them each a hug and told them this was not their fault, and I was going to do everything in my ability to get the baby safely to Packard Children’s. The baby arrived to the NICU with improved vital signs; physicians from neonatology and cardiology were at the bedside ready to perform an ultrasound and confirm the diagnosis. The patient underwent several emergency operations, and today is a happy and healthy young toddler.”

Pushing the limits

Obstetrics has always been an all-female team, and it’s only been since 2020 that neonatal has been an all-female lead transport team. Pediatrics has mixed-gender leads as a part of the CCT support team construct, from nursing to respiratory therapist and EMT.

But there is a different form of energy one experiences when working with an all-female team.

“Working with an all-female team, you feel empowered by each other, especially in a field where you are dealing with a lot of male-dominated professions,” said French. “It goes without saying that you have each other’s backs, and in those instances where you might be second-guessing yourself, having a female teammate to encourage and remind you that you’ve got the situation under control brings a different dynamic to the role.”