Transport Qualifications, Performance Expectations, and Assessment

Assessment of the applicant’s qualifications for team membership is based on but not limited to the following characteristics:

• Educational and experiential background

• Clinical and technical competence

• Leadership skills

• Critical thinking skills

• Communication and interpersonal skills (team approach, adaptability)

• Skill in public and community relations

The transport team member will successfully complete an orientation program.

Collectively, transport team members should demonstrate competency in at least the following transport and medical content areas, as indicated for their patient population (see Chapter 3):

• American Heart Association and American Academy of Pediatrics pediatric and neonatal curricula

• Maternal physiologic and pharmacologic factors affecting the neonate

• Pediatric and neonatal assessment

—Physical examination

—Gestational age assessment

— Interpretation of clinical, laboratory, radiographic, and other diagnostic data

• Thermoregulation

• Oxygen monitoring

• Fluid and electrolyte therapy

• Pharmacology, including drug dose calculations

• Anatomy, pathophysiology, assessment, and treatment of

— Acute and chronic respiratory diseases

— Cardiovascular abnormalities

— Surgical emergencies

— Infectious diseases

— Musculoskeletal abnormalities

— Neurological and spinal cord injuries

— Prematurity and postmaturity

— Gastrointestinal emergencies

— Hematologic disorders

— Metabolic and endocrine disorders

— Disorders of the head, eyes, nose, and throat

— Congenital and genetic disorders, congenital heart disease

— Injury (trauma, poisoning, child abuse)

— Aviation and transport physiology

— Psychosocial and bereavement support and crisis intervention

— Mechanical ventilation techniques during transport

• Management of pain and agitation

• Provision of developmentally supportive care

• Transport relations and communication

— With the referring hospital

— With the receiving hospital

— Within the hospital

— Within the team

— With parents, siblings, and significant others

• Problem solving, crisis management, and priority setting

• Medical-legal and ethical issues

— Scope of practice of all team members

— State and federal regulations regarding transport and advanced practice

— Informed consent

— Documentation guidelines and requirements

• Continuous quality monitoring and improvement

• Advanced practice protocols, if applicable

• Transport safety issues

• Orientation to the transport vehicles

• Transport equipment, including troubleshooting and backup systems (Table 4.3)

Table 4.3: Sample Transport Equipment Review and Competency Checklist

Table 4.3: Sample Transport Equipment Review and Competency Checklist, continued

Table 4.3: Sample Transport Equipment Review and Competency Checklist, continued

A/C indicates alternating current ventilation; IV, intravenous; BP, blood pressure; SaO2, arterial oxygen saturation; ECG, elec­trocardiogram; ETc02, end-tidal carbon dioxide; VS, vital signs; CMV, controlled mandatory ventilation; SIMV, synchronized intermittent mandatory ventilation; CPAP, continuous positive airway pressure; PS, pressure support ventilation; IAC, inter­posed abdominal compression.

Specific cognitive knowledge should include the ability to recognize and manage the following potentially life-threatening conditions, as appropriate for the transport population.

• Cardiopulmonary arrest

• Upper airway obstruction

• Respiratory failure

• Air-leak syndromes

• Congenital malformations and associated diseases

• Anatomic abnormalities

• Metabolic disorders

• Birth injuries

• Prematurity

• Status asthmaticus

• Shock

• Congestive heart failure

• Cardiac arrhythmias

• Seizures and status epilepticus

• Altered mental status

• Intracranial hemorrhage

• Increased intracranial pressure

• Multiple trauma and burns

• Toxic ingestions

• Hematologic emergencies

• Metabolic disorders, including diabetic ketoacidosis

• Near-drowning and other global hypoxic-ischemic injuries

• Sepsis, meningitis, and other life-threatening infections

The transport team should have the combined expertise and legal scope of practice to perform at least the following procedures with respect to the anticipated patient population and established program guidelines and pro­tocols, and organizational polices:

• Oxygen administration

• Bag and mask ventilation

• Application of nasal continuous positive airway pressure (CPAP), endo­tracheal intubation, laryngeal mask airway

• Surfactant administration

• Needle aspiration of pleural air or surgical placement of a chest tube

• Initiation and maintenance of mechanical ventilation, including high- frequency ventilation and inhaled nitric oxide if indicated

• Intravenous and intra-arterial access, which might include

—Peripheral venous puncture and cannulation

—Umbilical arterial and venous catheterization

—Central venous access

—Percutaneous arterial catheter placement and puncture

• Intraosseous access

• Venipuncture for laboratory specimen collection

• Cardiopulmonary resuscitation

• Medication preparation and administration

• Hemorrhage control

• Initiation and maintenance of cervical spine and general spinal precautions

• Initiation and maintenance of general immobilization and splinting techniques

At regularly scheduled intervals and on completion of orientation, knowledge and clinical competency will be evaluated and documented.

• Written examinations

• Simulated practice skills laboratories

• Transport faculty-supervised skills and transports

• Case presentations

• Oral examinations conducted by the course faculty, transport team coordinator, and transport team medical director

• Medical record review

Mechanisms to evaluate continued competency of transport team members might include periodic and recurring practice review sessions in the following:

• Cardiopulmonary resuscitation and stabilization

• Respiratory emergencies and ventilation

• Radiographic interpretation

• Management of suspected infection and infection control

• Fluid and electrolytes

• Monitoring equipment and techniques

• New equipment orientation and training

• Transport and client safety issues

• Public relations

• Advanced procedure laboratories for identified low-volume, high-risk proficiency

• Other topics based on annual learning needs survey or practice deficiencies

• Update on policies affecting functions of transport personnel

• Methods of communication with referring facilities, accepting facilities, and families