Background. Critical care transfers (CCT) refer to the high level of care given during transport (via ambulance, helicopter or fixed-wing aircraft) of patients who are of high acuity. In South Africa (SA), advanced life support (ALS) paramedics undertake CCTs. The scope of ALS in SA has no extended protocol regarding procedures or medications in terms of dealing with these CCTs. Aim. The aim of this study was to obtain the opinions of several experts in fields pertaining to critical care and transport and to gain consensus on the skills and scope-of-practice requirements of paramedics undertaking CCTs in the SA setting. Methods. A modified Delphi study consisting of three rounds was undertaken using an online survey platform. A heterogeneous sample (n=7), consisting of specialists in the fields of anaesthesiology, emergency medicine, internal medicine, critical care, critical care transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures and medications were needed within the scope of practice of paramedics undertaking CCTs. Results. After three rounds, consensus was obtained in 70% (57/81) of procedures and medications. Many of these items are not currently within the scope of paramedics' training. The panel felt that paramedics undertaking these transfers should have additional postgraduate training that is specific to critical care. Conclusion. Major discrepancies exist between the current scope of paramedic practice and the suggested required scope of practice for CCTs. An extended scope of practice and additional training should be considered for these practitioners. There is currently a critical shortage of intensive and specialist care in South Africa (SA). [1] In fact, 77% of state healthcare facilities and 16% of private healthcare facilities do not have intensive or high-care capacity.[1] Owing to this shortage, adequate district and provincial healthcare might not be available in many areas, [2] necessitating frequent transfer of patients to urban tertiary centres for specialist care.Internationally, paramedics undertaking critical care transfers (CCTs) have extended scope of practice when compared with standard emergency paramedics in order to be equipped for these high-acuity patients.[3] Locally, however, all paramedics registered as advanced life support (ALS) practitioners may undertake CCTs. [4] No extended training or additional scope of practice is given to these paramedics who might need to intervene to stabilise patients for transfer.[4] Studies have shown that adverse events (AEs) during CCTs are significant and proportionate to the level of training and experience of the transferring practitioner. [5,6] A prospective 1-year audit conducted in SA in 2001 focused on CCTs of paediatric patients in a low-resource setting.[7] The study found that the transfers were predominantly undertaken by paramedics (82%) via road ambulance (76%). [7] It was found that a number of technical AEs such as inadequate monitoring, absent venous access, and malpositioning of e...

Background: Critical care retrieval is a nascent field in South Africa. An increasing number of private and provincial emergency medical services are starting to invest in developing and setting up dedicated critical care retrieval services (CCRS). To date, there are no minimum standards or definitions on what constitutes a CCRS in the South African context. The aim of this paper is to describe the development of and propose a consensus definition of CCRS within the South African context. Methods: A literature search was performed to determine the key aspects of CCRS definitions elsewhere. An initial draft definition was circulated to the CCRS working group of the Emergency Care Society of South Africa (ECSSA) for commentary. Comments were collated, and a second round of commentary was undertaken. Finally, a consensus meeting was held through video-conferencing to finalise the definition presented herein. Thereafter, the definition was circulated to key role-players in emergency and critical care, both locally and internationally, for endorsement. The definition, as it is presented, has been endorsed by the ECSSA, the Southern African Society of Critical Care (SASCC), and the International Board for Specialty Certification (IBSC). Results: The proposed definition outlines five equally important aspects that should be demonstrable and interlinked to be denoted a CCRS. These five aspects are: specific patient populations, case selection, dedicated crew with additional training, dedicated equipment, and continuous quality management and training. Conclusion: Numerous questions remain unanswered regarding the best approach for CCRS development in South Africa and internationally. Defining what CCRS is in a South African context is a necessary departure point for further research endeavours to develop a core curriculum and practice standards.