Skills Development for Neonatal-Pediatric Transport
Considerable resourcefulness is required to create optimal procedural training opportunities for pediatric transport personnel. Potential sites of actual patient care training experiences include the pediatric and neonatal intensive care units, the emergency department, delivery rooms, and operating room.
In addition, laboratory and facsimile simulations are available for some procedures. The use of electronic, computer-linked simulators is a promising training adjunct for transport and other health care personnel. This modality is currently limited by availability and the expense to purchase and maintain an educational program. Creative financing and management solutions, such as partnering with other departments, personnel, and institutions, could be considered when approaching how to make simulators cost-effective.Examples of skills appropriate to specific resource locations might include the following:
1. Anesthesia and operating room experience
• Airway assessments
• Identification of airway complications
• Bag-valve-mask ventilation (self-inflating and anesthesia bags)
• Airway management and endotracheal intubation
• Use of laryngeal mask airway and other supraglottic airway devices
• Vascular access, central catheter placement
• Endotracheal intubation under pharmacologic control, including rapidsequence intubation
• Difficult airway management and rescue airway techniques, including video laryngoscopy.
2. Pediatric intensive care experience
• Critical care patient assessment
• Airway management, endotracheal intubation, and tracheostomy management
• Aerosol treatment
• Oxygen therapy
• Ventilator and ventilation management
• Arterial puncture
• Needle thoracostomy
• Vasoactive infusions
• Central catheter placement (including ultrasonography-guided catheter placement)
• Interpretation of laboratory test results and radiographs
• Thoracentesis and thoracostomy tube placement
• Team approach to resuscitation
3.
Emergency department experience• General patient assessment
• Fluid resuscitation
• Medication administration
• Procedural opportunity (intravenous catheters, urinary catheters, nasogastric and orogastric tubes, airway/tracheostomy management, and oxygen therapy)
• Aerosolized medications
• Intravenous and intraosseous access
• Spinal immobilization
• Fracture splinting
• Basic, bedside ultrasonography (FAST [focused assessment with sonography in trauma], cardiac assessment, vascular access and assessment, identification of pneumothorax)
• Burn and wound care
• Interpretation of laboratory results and radiographs
• Team approach to resuscitation
4. Neonatal intensive care and delivery room experience
• Neonatal patient assessment
• Bag-valve-mask ventilation (self-inflating and anesthesia bags)
• Nonintubated positive-pressure assistance and ventilation
• Airway management and endotracheal/nasotracheal intubation
• Delivery room resuscitation
• Arterial puncture and peripheral arterial catheter placement
• Needle thoracostomy
• Vasopressor infusions
• Umbilical venous and arterial catheter placement
• Thoracostomy tube placement
• Peripheral intravenous catheter placement
• Ventilator and ventilation management
• Paracentesis
• Surfactant administration
• Interpretation of laboratory test results and radiographs
5. Laboratory experience (facsimile training)
• Endotracheal intubation
• Intraosseous catheter placement
• Central, including umbilical, catheter placement
• Thoracostomy tube placement
• Cricothyrotomy
• Pericardiocentesis
• Resuscitation management
• Spinal immobilization
Competency testing of academic knowledge and clinical decisionmaking skill might include the following:
• Written examinations
• Transport and clinical case presentations and reviews
• Oral examinations
• Simulator assessment
• Medical record review
• Periodic performance appraisals
• Criterion-based performance evaluation
• Self-assessment instrument
Documentation of satisfactory performance of advanced practice skills, as defined by the transport medical director or other supervisors and assessors, might be based on the following:
• Simulated practice skills laboratories
• Transport faculty-supervised skill sessions
• Outsourced skills assessments (anesthesia staff supervising in the operating room)
• Documentation of the transport team member's review of practice guidelines
• Adherence to accepted standards of care, standards of practice, policies, procedures, job description, and certification requirements
• Quality improvement management findings
• New and updated policy dissemination