Team Models in Interfacility Transport-Building and Maintaining Competencies

Purpose of review Transport teams have evolved their capability to provide mobile intensive care units to optimize patient outcomes in most regionalized systems of health care. Our goal was to review the current literature to determine the best model of practice for interfacility transport and the specific training required to achieve and maintain competencies in transport medicine.Recent findings The literature remains largely consensus based and experiential, and there has been little development in the ‘state of the art’ over the past 5 years. Transport practitioners, regardless of their professional backgrounds, must acquire numerous skills to meet the needs of the patient, owing to the unique and dynamic nature of each transport. The broader their scope of practice, the larger the range of competencies they must acquire. A critical volume of patients is required to maintain standards and performance especially for technical skills. Thus, teams should be specialized in the care of specific patient populations, as well as the field of transport processes, safety, and system design.Summary For teams to be dedicated to the transport service, we often need to combine neonatal, (with or without high-risk mothers) with paediatric volumes, to ensure a critical mass of patients to build and maintain competencies. Ideally, a collaborative practice team model is created to facilitate this, with clinicians from different health care backgrounds and areas of practice. This permits the collective sum of its members’ individual skills and abilities, facilitates cross training of all, and provides maximum flexibility for the team. Teams should be located at tertiary level hospitals for ready access to education and practical skills but should be centrally coordinated and dispatched for greatest efficiencies, and integration of air and land modalities. ‘On-line’ medical control provided by an experienced consultant and expert in transport medicine, together with transport policies and procedures, must be in place to guide performance and ensure optimal outcomes. Regular debriefing, extensive transport reviews, and a database help determine each individual’s educational needs. Trends in key team performance indicators allow for benchmarking and help drive better performance.