Pediatric critical care transport: Is a physician always needed on the team?

We conducted a retrospective study of the interventions performed by physicians in 191 transfers by our pediatric critical care transport team. Currently, the team always includes a pediatrician or pediatric resident, a pediatric emergency department nurse, and a pediatric respiratory therapist. Procedures performed during transport were divided into those done only by physicians in our institution and those also performed by nurses or respiratory therapists. Physician procedures were performed in 9% of transports. Medications given during transport were divided into three categories. Category 1 included drugs used only in our ICU and therefore with a physician present. Category 2 drugs were usually given in the ICU but were occasionally administered on the floor with close physician involvement. Category 3 included drugs routinely given on the floor with rare physician involvement. Category 1 drugs were required on 19% of transports, category 2 was the highest level used on 15%, and category 3 drugs alone were used on 20%. No medications were administered on 46% of transports. At the completion of each trip, the transport physician was asked if he believed the transport would have been successful without a physician but with an experienced pediatric ED nurse and respiratory therapist. The answer was “yes” in 46% of the cases (n = 166), “no” in 43%, and “unsure” in 11%. In 91% of the transports, no procedures were performed that required a physician. In 66%, no medications were used that required physician presence. In at least 46%, the physician believed his expertise was not required for the transport's success. These data suggest that it may not always be necessary to send a physician as part of the critical care transport team.

critical care transport, pediatric

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