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Workforce Survey of Pediatric Inter-Facility Transport Systems

Sunday, October 21, 2012: 3:40 PM
Room 211-213 (Morial Convention Center)
Justinn M. Tanem1, David T. Triscari1, Melina D. Chan, M.D.2 and Michael T. Meyer, M.D.1, (1)Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, (2)University of Arkansas for Medical Sciences, Little Rock, AR

Purpose

The inter-facility transport of pediatric patients requires a highly skilled and well-trained workforce, of which little is known.  The primary study purpose is to characterize the current state of pediatric inter-facility transport in the United States including, but not limited to, which team models predominate, what team configurations are used, and team training standards.

Methods

A Web-based survey questionnaire was developed, externally validated by 3 pediatric transport clinical experts, and questions were revised.  The study protocol and survey received exempt approval the Institutional Review Board.  Potential organizations performing pediatric inter-facility transport were identified using the National Association of Children’s Hospitals and Related Institutions (NACHRI), the American Academy of Pediatrics Section of Transport Medicine (AAP-SOTM), the Atlas & Database of Air Medical Services (ADAMS), and the Pediatric Acute Lung Injury & Sepsis Investigators Network (PALISI). 

Results

Each identified organization was contacted by telephone by the investigator; team demographics and point-of-contact information for team management and medical director were obtained; 262 institutions were identified with pediatric critical care resources and 179 had a transport team with pediatric critical care capabilities.  Invitations to participate were sent by electronic mail for each team to complete 1 survey per team.  In total, 111 responses were recorded (Response Rate: 62%).  For survey participants, dedicated teams comprised 81.1% and unit-based teams comprised 14.2%.  Transport of both pediatric and neonatal populations was reported by 73.9% of respondents, while transport of adult and maternal/high risk obstetrical populations was reported by 30.6% and 29.7% of respondents, respectively.  Transport of only pediatric populations was reported by 18.9% of respondents.  Over 60% of respondents reported including an EMT or paramedic on transport, 66% reported using a respiratory therapist, over 93% reported using a registered nurse, while less than 7% reported bringing an associate level provider or physician.  PALS or APLS training was required for nurses by over 96%, NRP by 66.3%, ACLS by 57.6%, and ATLS by 20.7%.  Over 78% required nurses to have critical care or Emergency Department nursing experience prior to transport membership.  Over 55% of respondents reported performing less than 500 pediatric transports per year, less than 20% reported performing between 500 and 999 pediatric transports per year, while 22% reported performing more than 1000 pediatric transports per year.

Conclusion

The team composition and training for inter-facility transport of pediatric patients is a complex and not well-characterized process; furthermore, the varying organizational models, team composition and training requirements for teams have not been previously reported.  These results will aid in the future development of unifying team standards for pediatric transport and help guide further improvements in this field.