Team Composition
The patient population defined as pediatric is diverse and ranges from preterm newborn infants to adults receiving care for conditions developed during childhood. Pediatric transport can be limited to interfacility or might include prehospital medical and trauma locations.
Various health care providers participate in the care of these patients and might be considered candidates for participating in the transport team (Table 3.1):• Specialty-trained attending physicians (eg, intensivists, emergency medicine physicians, pediatric cardiologists, neonatologists)
• Transport physicians (eg, pediatricians with or without subspecialty training, hospitalists)
• Physicians in training (eg, fellows, residents [see Chapters 2 and 4])
• Advanced practitioners (eg, nurse practitioners, physician assistants)
• Critical care, emergency, or neonatal nurses
Table 3.1: Potential Advantages and Disadvantages of Various Personnel for Neonatal-Pediatric Transport Teams
| Transport Personnel | Advantages | Disadvantages |
| Specialty-trained attending physician | Expertise; public relations; critical care training and skills | High salary cost; limited availability for fulltime coverage; care and supervision limited to 1 patient at a time |
| Non-intensive care-, nonneonatology-, or non-emer- gency medicine-trained attending physician | Expertise; public relations | High salary cost; limited availability for fulltime coverage; care and supervision limited to 1 patient at a time; critical care skill acquisition as needed |
| Fellow | Expertise; valuable training experience | Transport demands might overburden training availability; availability might be limited by ACGME work rules |
| Resident | Valuable training experience; salary cost may be built into the training program | Demands of transport compete with other aspects of training and education; limited clinical experience; availability might be limited by ACGME work rules |
| Advanced practice neonatal or pediatric nurse practitioner | Expertise; consistent quality of care, public relations, knowledge of ICU staff | High salary costs; usually limited to discipline for which they are trained (eg, neonatal nurse practitioner vs pediatric nurse practitioner); acceptance as specialized provider by referring care team can be an issue if community expectations are for physician-led team |
| Critical care nurse, physician assistant | Availability; expertise with appropriate training; uniform quality of care, continuity of care in ICU | Initial acceptance by referring care team can be an issue; requires intensive training to function independently in the transport environment |
| Respiratory therapist | Focused respiratory assessments; knowledge of respiratory equipment; advanced airway and ventilatory expertise | Focused airway training and experience; requires intensive training to expand to more global patient care |
| Paramedic or emergency medical technicians | Expertise in prehospital setting; availability; less costly than other team members | Lesser formal medical and pediatric training and perhaps experience; requires intensive training to assist with other areas of patient care |
ACGME indicates Accreditation Council for Graduate Medical Education; ICU, intensive care unit.
• Respiratory therapists
• Paramedics
• Emergency medical technicians
The choice of a particular type of professional might depend on the level of responsibility one is credentialed for or routinely assumes in the inpatient setting and on the availability of specific types of practitioners and other factors. The responsibilities of individual team members should take into consideration licensure, education, training, experience, and program policies. Many dedicated pediatric (non-neonatal) transport teams traditionally include a resident or attending physician, although there is little published evidence that this configuration results in improved outcome compared with nonphysician teams. A survey of 229 unit-based and 106 dedicated neonatal transport teams in the United States found that 26 different team compositions were used to accomplish transport.1 The 12 most common neonatal team compositions are summarized in Table 3.2. For both unit-based and dedicated teams, the most common composition was registered nurse (RN)-respiratory therapist (RT) (92 teams, 40.2%; and 47 teams,
Table 3.2: Twelve Most Common Team Compositions for Unit-Based and Dedicated Neonatal/Pediatric Transport Teams
| Team composition | Unit-based | Dedicated | ||
| n | % | n | % | |
| RN-RT | 92 | 40.2 | 47 | 44.3 |
| RN-RT-NNP (or PNP) | 44 | 19.2 | 7 | 6.6 |
| NNP (or PNP)-RT-physician | 36 | 15.7 | 8 | 7.5 |
| RN-RN | 15 | 6.6 | 12 | 11.3 |
| NNP (or PNP)-RT | 10 | 4.4 | 4 | 3.8 |
| RN-neonatologist | 5 | 2.2 | 0.9 | |
| RN-RN-RT | 4 | 1.7 | 0.9 | |
| RN-RT-EMT (basic or intermediate) | 3 | 1.3 | ||
| RN-NNP | 3 | 1.3 | 5 | 4.7 |
| RN-RT-paramedic | 2 | 0.9 | 3 | 2.8 |
| RN-paramedic | 0.4 | 8 | 7.5 | |
| 2 | 0.9 | |||
RN indicates registered nurse; RT, respiratory therapist; NNP, neonatal nurse practitioner; EMT-basic or EMT-intermediate, emergency medical technician with basic- or intermediate-level national registration.
Reproduced with permission from Pediatrics, Vol.
128(4), Pages 685-691, Copyright © 2011 by the AAP.44.3%, respectively), followed by RN-RT-neonatal nurse practitioner (NNP) for 44 (19.2%) of the unit-based teams, and RN-RN for 12 (11.3%) of the dedicated teams. The third most common team composition for unit-based teams was RN-RT-physician (15.7%), with neonatologists participating in transport most often (23 teams), followed by pediatric residents (7 teams), neonatal fellows (6 teams), and pediatric hospitalist (1 team). Overall, physicians were regular members of unit-based teams 20% of the time and dedicated teams 9.4% of the time. Many programs that transport a significant volume of older pediatric patients have transitioned to the use of nonphysician transport team members while maintaining the option to include a physician on selected transports. Dedicated teams frequently combine to transport other patient groups, whereas 189 (82.5%) of the unitbased teams were exclusively neonatal. Fifty-three (50%) of the dedicated teams combined as neonatal-pediatric, 8 (7.5%) as neonatal-pediatric-adult, 4 (3.8%) as neonatal-maternal, and 2 (1.9%) as neonatal-adult. Only 39 (36.8%) of the dedicated teams were exclusively neonatal.1
Consideration must be given to the allowable scope of practice of transport team members and established state, local, and program standards when determining team composition. The choice of personnel also might be strongly influenced by the need to fill other workforce needs within the primary facility. For example, these might include the following:
• The need for care providers with advanced skills within intensive care units
• Other care demands within the primary facility
• The need of a particular service to use transport experience as an incentive for hiring personnel
Some pediatric and emergency medicine residency programs require trainees to participate in transport medicine. Most residents report that transport experience is valuable and provides them with an important perspective on differences in care resources and availability outside a specialty or tertiary facility. The intermittent incorporation of rotating trainees can be challenging for a busy critical care team, so it is important that there be discussions in advance about the roles and responsibilities of residents on the team. Limitations imposed by trainees' restricted schedules combined with the unpredictable nature of transport activities might make the residents less available for participation in transport. If residents are to work as members of the transport team, there should be a clear understanding and delineation of the educational goals of the rotation and the role of the trainee on the team (see Chapter 2). Please refer to the following resource for programs that are responsible for educating residents, fellows, and faculty on the various facets of prehospital care and transport: http://www.pemfellows.com/ pem-fellowships/useful-sites.html.