Establishing a neonatal resuscitation team in community hospitals.

Recent national guidelines for neonatal resuscitation state that personnel trained in resuscitation skills should be immediately available for every delivery. Meeting this standard is a challenge for small community hospitals with limited staff and few 24-hour in-house physicians. We have developed a strategy for organizing neonatal resuscitation teams in community hospitals and describe our experience with establishing such teams in our region. Suggestions for implementation include: identifying a project organizer, involving all relevant staff in the decision making, writing a formal protocol, and planning a schedule for implementation. Often team members will be nurses or other professionals in expanded roles, the only stipulation being that they be immediately available and well trained. Recommendations are made for training and scheduling of neonatal resuscitation team members and for the contents of the resuscitation protocol. Barriers to successful implementation are discussed, including liability concerns or lack of confidence among team members, nonacceptance of expanded roles by other professionals, and difficulties with scheduling, equipment maintenance, and risk assignment. Nevertheless, successful establishment of a neonatal resuscitation team can effectively reduce the risk of neonatal asphyxia in small community hospitals.