Training

Preparing a team of professionals, particularly a multidisciplinary team, to reach the level of expertise required to transport critically ill infants and children can be a daunting task.

The guidelines in Chapter 4 include suggested content and format for training programs. By necessity, they are generic but are intended to be adaptable to the wide variety of professionals who participate in neonatal-pediatric transport. They have been developed under the assumption that trainees will have had considerable experience in the care of critically ill neonatal and/or pediatric patients in the inpatient setting, acute care setting, or both. Reaching proficiency in all areas may not be necessary for all team members, as long as at least one team member during each transport has achieved the requisite level of expertise. For example, programs that include intensivists on every transport need not train nonphysician personnel to be the primary providers of advanced airway intervention. However, it is preferable that all members understand the principles and typical process of every technique so that they are best able to offer assistance and complement each other during the transport. The team should also have general medical and trauma stabilization and emergency response skills in the event that these are needed during a transport.

Although the specific requirements of initial training depend on the professional background of team members, their experience, and roles in patient care, the goals and general content of training are the same, regardless of the type of personnel. The team transporting a critically ill pediatric patient should include at least one member who is experienced in assessment, diagnosis, and treatment of life-threatening illnesses or injuries in neonates and children. This team member must understand pathophysiology, pharmacology, and the usual clinical course and complications of common neonatal and pediatric illnesses and the nuances of the transport environment.

Ideally, all personnel have sufficient knowledge, training, skills, and ability to assume the team leader role as required. Cross-training of personnel in this regard will improve the ability to understand roles and should enhance a coordinated team approach. The team leader must also understand the use of appropriate laboratory and radiographic tests as diagnostic aids and have experience in managing neonates and children who require intensive pharmacologic intervention. Other team members must be familiar with pediatric and neonatal critical care so as to provide effectively appropriate support to the team leader.

The team should be capable of performing all standard emergency and stabilization interventions, management, and procedures required in the care of critically ill neonates and children. A high level of expertise in performance of and confidence in procedural decision making and implementation is necessary, because those interventions are often performed under less-than-optimal conditions (in a moving vehicle, with limited lighting and space, and without redundant personnel). Even a low failure rate may be unacceptable if the procedure is potentially lifesaving.

All transport team members should be adept at communication during transport. An essential aspect of communication is an understanding of the milieu of the referring hospital and the sensitivity surrounding a transport. Team members must have finely tuned public relations skills, because they are the “ambassadors” of the receiving facility. Clear, thoughtful, and collegial communications with the referring personnel are essential and occasionally challenging during the stressful situations surrounding the transport of a critically ill child. Open and direct communication among team members also is important. It is essential for all team members to function together as a group to provide safe, competent care. Team members must be clear and precise when discussing actions and plans.

They also must communicate well with families under stress. The team members are often the first representatives from the receiving (definitive) care location that the family will meet and might be the first medical professionals encountered with specific pediatric or neonatal skills. The impressions made at this time will carry forward throughout the patient's hospitalization and beyond.

Reference

1. Karlsen KA, Trautman M, Price-Douglas W, Smith S. National Survey of Neonatal Transport Teams in the United States. Pediatrics. 2011;128(4):685-691

Selected Readings

Commission on Accreditation of Medical Transport Systems. Accreditation Standards. 8th ed. Sandy Springs, SC: Commission on Accreditation of Medical Transport Systems; 2009 Gomez M. Hiring, staffing, and team composition. In: McCloskey KA, Orr RA, eds. Pediatric Transport Medicine. St Louis, MO: Mosby; 1995:89-99

Lee SK, Zupancic JA, Sale J, et al. Cost-effectiveness and choice of infant transport systems. Med Care. 2002;40(8):705-716

Leslie A, Stephenson T. Neonatal transfers by advanced neonatal nurse practitioners and paediatric registrars. Arch Dis Child Fetal Neonatal Ed. 2003;88(6):F509-F512

Giardino AP, Tran XG, King J, et al. A longitudinal view of resident education in pediatric emergency interhospital transport. Pediatr Emerg Care. 2010;26(9):653-658

Warren J, Fromm RE Jr, Orr RA, Rotello LC, Horst HM. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004;32(1):256-262 Woodward GA, Insoft RM, Pearson-Shaver AL, et al. The state of pediatric interfacility transport: consensus of the second National Pediatric and Neonatal Interfacility Transport Medicine Leadership Conference. Pediatr Emerg Care. 2002;18(1):38-43

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Source: AAP. Guidelines for Air and Ground Transport of Neonatal and Pediatric Patients. 4th edition. — American Academy of Pediatrics,2015. — 488 p.. 2015

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