PICU Transport Training Programs

PICNICRN, BSN, RN · Jan 26, 2009

Well, I'd have to say that my "orentation" was pretty informal. Pretty much shadowing transport RNs on ride alongs and lots of practice on procedures- in lab, on animals, and "real pts". I think I shadowed for about 3 months and had to be signed off on procedures before I was on my own. I had bi weekly meetings with the supervisor on my progress. Had to do 6 intubations on kiddos checked off by anesthesia(in same day surg).I was given a manual and checklist for my preceptor to check me off. My orentation would have been extended if needed.

I think I was also concerned with the "lack of structure" but you have to remember- you can only get the experiences that are available at that time. You have to take what you can get and trust that you can handle anything else by your training and experience. The transport orentation was MUCH less structured than an actual PICU orientation, but you have to remember- you should already have the critical thinking part of it--- What needs to be done in a situation. The transport part of it is really just being able to perform a procedure that you alrealy know needs to be done- and all it takes is practice. Do you have a Fellow go on transports with you? I found that my greatest resource was my RT!

Try to just think of it as a new experience- it is NOTHING like working on the floor- YOU have to make the decision on what to do! But, the thing is you already know what to do- its just you are the one who has to do it. That is the hardest thing to get used to. Just remember, you always have protocol to follow and a doc a phone call away.

Keep an open mind- you'll be fine!

tryingtohaveitall · Jan 28, 2009

Our transport training is fairly brief. They're supposed to get in so many runs (the number has slipped my mind, 10?) before they go on their own. We do transport with RT and they're the ones who intubate. There are really only a few skills that our transport service does that our regular PICU RNs don't do, such as IOs and some stabilization equipment that's not necessary in a PICU.

Most of our transport nurses come from our PICU, so theoretically they're already strong nurses with good critical skills. If need be, we'll send a 2nd PICU RN or if the child is VERY unstable, we'll send along a resident or intensivist.

FlyingScot, RN · Jan 30, 2009

Our transport training is fairly brief. They're supposed to get in so many runs (the number has slipped my mind, 10?) before they go on their own. We do transport with RT and they're the ones who intubate. There are really only a few skills that our transport service does that our regular PICU RNs don't do, such as IOs and some stabilization equipment that's not necessary in a PICU.
Most of our transport nurses come from our PICU, so theoretically they're already strong nurses with good critical skills. If need be, we'll send a 2nd PICU RN or if the child is VERY unstable, we'll send along a resident or intensivist.

I'm curious to know on average how many weeks it takes for the transport trainee to get 10 missions in. Do they have any didactic education during that time? I've had many, many years of transport experience and I'm kind of stunned to hear of such a short training period. The nurses don't intubate? What if the RT is unsuccessful? Is this at a free-standing children's hospital with a high transport volume or the occasional random trip to a nearby facility? I'm not meaning to diss your system. Really...I'm not. I just can't imagine transporting without the extensive training that I and my cohorts received. We had to successfully intubate 40 patients of varying ages just to be signed off!!!! As I'm sure you know transport medicine is not just ICU care on wheels and there is so much to learn. Wow!

tryingtohaveitall · Jan 30, 2009

I actually agree with you that our training period should be longer and frankly, I think our transport program should be taken a little more seriously in general by TPTB and some of the staff. Until you have a bad kid crash on you, or worse yet, one you thought was ok crash on you, then you realize that you need to be prepared for anything and everything every time.

At any rate, our therapists are very skilled intubators. I trust them over many/most of the physicians because they do more than the residents and ER physicians. The only ones I'd prefer over the RTs are the intensivists and anesthesiologists, in general.

This is a free standing pediatric facility, though a smaller one, that performs hundreds of pediatric transports a year, with a separate neonatal team that also performs hundreds of runs a year. Some of which are minor and go home, some of which are very unstable.

I'm curious to know on average how many weeks it takes for the transport trainee to get 10 missions in. Do they have any didactic education during that time? I've had many, many years of transport experience and I'm kind of stunned to hear of such a short training period. The nurses don't intubate? What if the RT is unsuccessful? Is this at a free-standing children's hospital with a high transport volume or the occasional random trip to a nearby facility? I'm not meaning to diss your system. Really...I'm not. I just can't imagine transporting without the extensive training that I and my cohorts received. We had to successfully intubate 40 patients of varying ages just to be signed off!!!! As I'm sure you know transport medicine is not just ICU care on wheels and there is so much to learn. Wow!

FlyingScot, RN · Jan 30, 2009

Thanks for not getting totally cheesed off at my questions. I think the difference may lie in that, with the exception of one job 22 years ago, I have always worked on dedicated transport teams. We were not pulled from the units but were a separate team and that was our primary function. Also, both teams I worked for did neo/peds combined. On our downtime we spent literally hours on continuing education by going to x-ray rounds, in-services, skills practice (going to units and placing cnetral lines and such), M and M meetings and case reviews. Not to mention equipment maintenance which took an inordinate amount of time. We also functioned at a higher level than the staff nurses (please note I'm NOT saying we were better than them) as we placed central lines, chest tubes along with IO's and all the other fun stuff that they did not do. Our RT's were also very skilled but sometimes it happens and they just couldn't get a tube. It was 2 tries then someone else attempted. Does your crew have a dedicated MICU or do you contract with an ambo service? Do you fly? Now I'm just being nosy.

tryingtohaveitall · Jan 30, 2009

We have a dedicated MICU per se. We have our own MICUs and drivers, yet our team isn't solely a MICU team. Most of the RNs are based from the PICU, a few from the ER. If we need to fly, we contract that out but we accompany the child and provide the care. A local adult trauma center has helicopters for the bad kids that are a ways away, theoretically. Yet we all know there are times when they're grounded and that's when you'll get the call for the bad kid an hour away by ground.

We don't do CVLs or chest tubes. The helicopter crew does rarely, yet their success rate doesn't seem to be very high.

I have been in the PICU for 18+ years with another year on a peds cardiopulmonary unit. Of those 18 years, I've been doing peds transports of critically ill kids for 17 years. I enjoy going between both jobs as it keeps it interesting. I would say essentially everything I have learned on the job, I have learned from rounding with the intensivists in the PICU with the occasional inservice. Of course, there has been plenty of out of hospital learning on my own.

Again, ITA with you that our program could use more formal education. Unfortunately, those who make the decisions don't appear to feel the same.

ItsTime · Feb 23, 2009

I worked on a pedi transport team six years ago. We had to go through six months of training - some was well organized, some not. Since we did both ground and flight we spent two weeks with the helicopter team - flying with them where ever they went - so we could learn all the safety procedures for the helicopter. We spent two weeks in the OR doing intubations. Two weeks in NICU, two weeks in PICU (most of us were from different hospitals - so we did this to learn their way of doing things). We also had training in PICC line placement. In between all these - we just followed a preceptor. Then for our last month - we did an Acting Internship in the PICU. Basically we acted like a fourth year med student - assigned to a third year resident in the PICU. We had to follow their schedule - 12 hour days, on call every forth day, only four days off for the month. We did complete patient management for our three or four patients - wrote all orders (the third year resident would sign off on all orders). We were the first ones the nurses called for orders when on call. We learned and did all art lines, CVCs and intubations - and occasionally chest tubes. It was a very intense month - but I really learned alot (and I though we RNs had it bad with paperwork - doctors have about ten times more than we do). Our medical director was very supportive and we had very extensive protocols. She wanted us to be prepared for anything. Plus - when we weren't on transport - we helped in the PICU. When they were slammed, we were often using our skills there - starting CVC and art lines and intubating patients. We would often have to run the codes - because the residents were not always capable (once I went to a code where the resident was in the corner crying). I loved it. But I have noticed that not a lot of teams are so progressive. It was a RN - RN team. I have been wanting to do transport again - but I can't seem to find another team that would let me do all my skills.