Critical Care Transportation by Paramedics: A Cross-sectional Survey

Raynovich, William; Hums, Jason; Stuhlmiller, David F.E.; Bramble, James D.; Kasha, Ted; Galt, Kim

doi:10.1016/j.amj.2013.05.008

Cited by 13 publications

(6 citation statements)

References 17 publications

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“…Paramedics' training and certification explicitly emphasizes the skills and knowledge required for emergency, on scene care, which is predominately focused on trauma, resuscitation, and acute medical concerns, not behavioral health training. 16,17 Additional training to appropriately respond to and work with individuals experiencing behavioral health emergencies will better serve the individuals in crisis, as well as paramedics and other emergency providers.…”

Section: Implications For Behavioral Healthmentioning

confidence: 99%

Behavioral Health Emergencies Encountered by Community Paramedics: Lessons from the Field and Opportunities for Skills Advancement

Keefe

Carolan

Wint

et al. 2020

J Behav Health Serv Res

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Section: Implications For Behavioral Healthmentioning

confidence: 99%

Behavioral Health Emergencies Encountered by Community Paramedics: Lessons from the Field and Opportunities for Skills Advancement

Keefe

Carolan

Wint

et al. 2020

J Behav Health Serv Res

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“…In line with this, there were 12 requests for physician’s assistance in the nurses group prior to transport. These requests were based on the nurses’ opinion that the complexity and/or instability of these patients exceeded the professional limits of critical care nursing and indicative for their careful pretransport evaluation [ 30 – 32 ].…”

Section: Discussionmentioning

confidence: 99%

Nurses versus physician-led interhospital critical care transport: a randomized non-inferiority trial

et al. 2016

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Purpose Regionalization and concentration of critical care increases the need for interhospital transport. However, optimal staffing of ground critical care transport has not been evaluated.MethodsIn this prospective, randomized, open-label, blinded-endpoint non-inferiority trial, critically ill patients on mechanical ventilation transported by interhospital ground critical care transport were randomized between transport staffed by a dedicated team comprising a critical care nurse and paramedic (nurses group) or a dedicated team including a critical care physician (nurses + physician group). The primary outcome was the number of patients with critical events, both clinical and technical, during transport. Clinical events included decrease in blood pressure, oxygen saturation, or temperature, blood loss, new cardiac arrhythmias, or death. Non-inferiority was assumed if the upper limit of the two-sided 90 % confidence interval (CI) for the between-group difference lies below the non-inferiority margin of 3 %.ResultsOf 618 eligible transported critically ill patients, 298 could be analyzed after randomization and allocation to the nurses group (n = 147) or nurses + physician group (n = 151). The percentages of patients with critical events were 16.3 % (24 incidents in 147 transports) in the nurses group and 15.2 % (23 incidents in 151 transports) in the nurses + physician group (difference 1.1 %, two-sided 90 % CI [−5.9 to 8.1]). Critical events occurred in both groups at a higher than the expected (0–1 %) rate. In the nurses group consultations for physician assistance were requested in 8.2 % (12 in 147 transports), all of which were performed prior to transport.ConclusionsThe number of patients with critical events did not markedly differ between critical care transports staffed by a critical care nurse and paramedic compared to a team including a critical care physician. However, as a result of an unexpected higher rate of critical events in both groups recorded by an electronic health record, non-inferiority of nurse-led interhospital critical transport could not be established (http://www.controlled-trials.com/ISRCTN39701540).

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“…Ventilator use in the out-of-hospital environment has generally been limited to the realm of interfacility transfers, with many already managed by nationally registered paramedics who may not have had specialized critical care training. 15 In other cases, critical care paramedics and certified flight paramedics with additional training play critical roles in managing the critically ill patients as members of interdisciplinary transport teams. 16 With a robust training and quality assurance program, non-critical-care paramedics could be trained to safely initiate and manage ventilators in the transport and non-transport settings.…”

Section: Paramedics In the United States Work Within A Nationalmentioning

confidence: 99%

An Emergency Amendment to the National Scope of Practice for Paramedics in the Setting of a Global Pandemic

Boehringer

O’Meara

Wingrove³

et al. 2020

The Journal of Rural Health

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Critical Care Transportation by Paramedics: A Cross-sectional Survey

Cited by 13 publications

References 17 publications

Behavioral Health Emergencies Encountered by Community Paramedics: Lessons from the Field and Opportunities for Skills Advancement

Behavioral Health Emergencies Encountered by Community Paramedics: Lessons from the Field and Opportunities for Skills Advancement

Nurses versus physician-led interhospital critical care transport: a randomized non-inferiority trial

An Emergency Amendment to the National Scope of Practice for Paramedics in the Setting of a Global Pandemic

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