Scope of Practice and Licensure and Certification Requirements
Licensure and certification are requirements used to encourage advanced education among staff members. Many transport teams require various certifications as a method of improving staff competence and ensuring a core knowledge base.
Available courses include but are not limited to the following:• Advanced Cardiac Life Support (ACLS)
• Basic Life Support (BLS)
• Pediatric Advanced Life Support (PALS)
• Advanced Pediatric Life Support (APLS)
• Neonatal Resuscitation Program (NRP)
• Trauma Nursing Core Course (TNCC)
• Emergency Nurses Pediatric Course (ENPC)
• Certified Pediatric Emergency Nurse (CPEN)
• Critical Care Emergency Medical Transport Program (CCEMTP)
• S.T.A.B.L.E. (Sugar, Temperature, Artificial breathing, Blood pressure,
Lab work, and Emotional support)
• Advanced Care of the Resuscitated Newborn (ACoRN)
• Critical Care Registered Nurse (CCRN) Certification in Neonatal/Pediatric Transport (C-NPT)
• Neonatal/Pediatric Specialist Credential (NPS) (respiratory therapy)
• Pediatric Education for Prehospital Professionals (PEPP)
• Advanced Trauma Life Support (ATLS)
• Basic Trauma Life Support (BTLS)
• Pre-Hospital Trauma Life Support (PHTLS)
Each course exposes participants to issues important to the assessment, stabilization, and management of critically ill and/or injured pediatric and neonatal patients. Because the causes and manifestations of respiratory failure, shock, cardiopulmonary arrest, and arrhythmias in children differ from those in adults, it is imperative that teams transporting neonates, infants, and children thoroughly understand the principles of neonatal and pediatric resuscitation. One should not assume or promote competency in neonatal- pediatric transport based solely on personnel attendance and successful completion of certification courses. These courses must be accompanied by significant additional and ongoing education, exposure, and experience to maximize clinical competence and quality of care.
Transport team leadership should determine educational and certification requirements for team members. Teams that transfer only neonatal patients might require certifications specific to their patient population, whereas teams that transfer neonatal patients, pediatric patients, and adults will have additional requirements. Each organization and team member must be committed to the care of critically ill patients. Further education and certifications will provide team members with the necessary knowledge to provide the required care for critically ill children. Registered nurses, respiratory therapists, and paramedics enter their professional life through various educational routes (associate’s degree, bachelor’s degree, or master's degree); many teams are requiring staff to have bachelor’s or master’s degrees.
Attending physicians who provide medical control to the team must be licensed to practice medicine in the state where the base facility is located, and ideally, they will be trained and certified in pediatric emergency medicine, pediatric critical care medicine, pediatric cardiology, or neonatology. If physicians in training (fellows or residents) are part of the transport team, requirements for participation must be developed. Many programs require fellows who participate in transport to have advanced clinical experience in resuscitation and advanced airway skills. Compliance with fellowship training requirements and prerequisite training for clinical transport should be documented by the fellowship training director.
Licensure to practice is a state requirement, and transport team members must be licensed for their profession according to the regulations of the state in which they work. Individual states might require that health care professionals retrieving and treating patients in a state other than that of their base of operations maintain the same credentials as health care professionals practicing in that state or might request a copy of the credentials for the same health care professionals.
Paramedics have the option of national certification, but state licensure is typically still required. Accreditation by The Joint Commission requires the base hospital to maintain records of licensure and certification as part of employment files. Similarly, physician-credentialing files should include evidence that medical licenses, board certifications, and other required endorsements are current.Accrediting bodies such as The Joint Commission may ask hospitals to produce evidence that the programs with which they contract, such as transport services, possess appropriate credentials to provide this service. This typically occurs during their “patient tracer” process, in which they follow a patient through the system from start to finish. Given that it is the referring facility’s responsibility to call an appropriate team, they may ask for evidence that the team a facility calls to perform this service is appropriate. They may ask for evidence of licensure of individual team members or proof that they are capable of caring for individual populations of patients (eg, NRP, PALS, ACLS). It is, therefore, prudent for transport programs to maintain accurate and current credentials of all team members in the event they are audited or one of the transports they completed is chosen for an “individual tracer” by The Joint Commission. Standard operating guidelines, protocols, and scope of practice should be defined for transport team members by the team’s leadership. Protocols allow the team to function if there is a change in a patient’s condition and the medical control physician cannot be immediately contacted. Because changes in condition can occur that require treatment but are not covered by a physician’s orders, standard operating protocols provide consistent guidance until contact with the medical control physician can be reestablished.
The scope of practice defines a skill set for each team member. Periodic assessments of skill to determine competence should be performed and the results documented in personnel records.
If the team is not able to provide an appropriate life-saving (ie, establishing an airway or providing cardiopulmonary resuscitation) intervention because specialty equipment, medications, or personnel is needed, the team should divert to the closest appropriate hospital. Transport team personnel should notify the receiving hospital of the diversion and the patient’s status as soon as possible. No transport personnel should be placed in a position of monitoring, administering a drug, or performing a procedure outside their scope of practice or in an unstable environment.According to the EMTALA, the referring physician has the final responsibility for the appropriateness of the transferring team and personnel (along with mode of transport; see Chapter 7 on legal issues). Ideally, this decision is accomplished in conjunction with the transport team and/or receiving personnel. These decisions must be made on the basis of the severity of the patient's illness, physical assessment findings, treatment requirements, and support requirements. To make the best decisions for patient and employee safety, knowledge of the transport environment and local options for transfer should be understood. At all times, the transport team should be well versed and trained in the care and support of critically ill neonatal and pediatric patients.