Nurse vs. Paramedic led transports

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  1. This is a discussion on Nurse vs. Paramedic led transports in Flight Nursing / Surface Transport Nursing, part of Nursing Specialties ... I know that this has been discussed before, but has anyone seen any studies regarding paramedic vs....

    by Oct 25, '08
    I know that this has been discussed before, but has anyone seen any studies regarding paramedic vs. nurse-led transport, particularly pediatric/neonatal critical care? I am in the process of writing a manuscript for publication. The topic is "Patient Safety in Neonatal Transport," but I can use anything anyone might find useful.

    I am particularly interested in the "Golden Hour" concept, which is of recent interest. Any studies you all may have seen would be appreciated. I've found some, but there don't seem to be many.

    Thanks for any help you can offer...


    SteveRN21
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    by SteveNNP Oct 25, '08 5:50 pm
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  3. 8 Comments so far...

  4. Oct 31, '08 by
    Hey Steve,
    I may be out on a limb here, but I bet you'll have a hard time finding any airmed program specializing in peds/neo x-port that are run by paramedics. I used to fly at a program where the peds/neo runs were done by nurses from the respective ICUs and either myself or my partner would fly with them for the safety aspect of the crew (as the peds nurses had little familiarity with the aircraft other than quarterly check-offs).
    I"m sure you're familiar with flightweb.com. You can search individual programs for their configuration and email the ones you're interested in learning more about. One program, DareFlight, in the Outer Banks of NC flies only 2 paramedics. I'm not sure of any other programs that are configured that way, but there might be.
    SteveNNP likes this.
  5. Dec 16, '08 by
    Check with the British Columbia Ambulance Service, they have a long standing Infant Transport Team (neo/pedes to 35kg) that is dual paramedic, no RN or RT.

    Their medical director, Andy McNabb, also has done or been involved in a lot of transport related research/outcome studies.
    SteveNNP likes this.
  6. Dec 22, '08 by
    Hi Steve,

    I see the date of your post and hope that this will still be of some relevance to you.

    I attended a Neonatal and Pediatric transport conference in Utah this past February and I can think of avenues for you to possibly research...

    One of the topics was "Children's Specialty Teams: Do They Make a Difference?" by Dr. Orr. Many of the articles quoted in the presentation addressed Paramedic led transports, for example:

    Paramedic units
    - 1600 hours contact training
    - 3 or 4 lectures devoted to pediatrics
    - Many rescue units did not carry appropriate equipment for children

    - 47% programs had less than 10 hours of didactic pediatric training
    - 55% offered "clinical" pediatric training
    - 24% did not have pediatric BP cuffs
    - 79% did not have pediatric ventilation masks

    Success rate of intubation by paramedics for children requiring CPR
    - 42/63 patients had intubating paramedics at the scene
    - Only 68% patients with an attempted intubation and only a 64% success rate
    - In patients <1 yr, only 38% with an attempted intubation and only a 50% success rate

    EMS study - education of paramedics in pediatric airway management
    - Ability to intubate and provide BVM appropriately deteriorates in 6 months
    - Worrisome: 95% of providers who failed both BVM and ETI reported confidence and lack of anxiety in their ability to provide advanced airway management.
    Dr. Orr also negated the "Golden Hour" concept (originally published in 1973), FWIW.
    As a result of this presentation you will be able to:
    - Recognize the shortcomings in pediatric care in EMS
    - Recognize that the Golden Hour does not exist
    - Review the literature for specialty team outcomes
    If these resources seem viable to you, I'd be happy to either copy the presentation and send it to you, or provide all the Journal article references included in the presentation.

    You can also research Dr. Orr and his own publications:

    http://www.ccm.upmc.edu/archive/faculty/bios/orr.html
    http://www.chp.edu/CHP/Orr,+Richard+A.,+MD,+FCCM
    http://www.ncbi.nlm.nih.gov/sites/en...Author+Name%5D

    Also, if your topic is "PATIENT SAFETY in Neonatal Transport" (or any patient transport for that matter) you should review some of the studies by Dr. Nadine Levick... her information will scare the heck out of anyone involved in patient transport. She is very approachable and full of fascinating, research supported information.

    http://www.objectivesafety.net/

    Hope that helps!
    SteveNNP likes this.
  7. Dec 22, '08 by
    Steve, are you referring to paramedic-led critical care teams or EMS?
  8. Dec 25, '08 by
    Quote from FlyingScot
    Steve, are you referring to paramedic-led critical care teams or EMS?

    Paramedic led vs. RN/NP led transports......


    Thanks, everyone for the awesome leads you gave... unfortunately there isn't a whole lot of research dedicated to neonatal transport out there....I need to go buy the AAP's guidelines among some other books, but I will definitely check out the info you guys gave me.

    I am also interested in finding a transport journal that may consider my manuscript for publication. I already subscribe to several peds/neo journals, but I'm pretty oblivious to the premier transport journals out there. I'd like to have a couple of options in order to maximize the chances of my manuscript getting published...


    Thanks again...


    Steve
  9. Dec 26, '08 by
    Maybe Journal of Air Medical Transport. That's the one that nearly everyone in the business receives - docs, nurses, medics.

    Also, did you pursue this discussion over at Flightweb.com? I think there is a higher concentration there of informed people who work in transport medicine.
  10. Dec 26, '08 by
    I meant Air Medical Journal. Sorry 'bout that...
  11. Dec 27, '08 by
    I did go to Flightweb.... I will have to check it out in detail....