title: The development and evaluation of a paramedic-staffed mobile intensive care unit for inter-facility patient transport.
abstract: OBJECTIVE
  As the role of paramedics evolves, evaluation of their ability to accomplish an expanded scope of practice is necessary. The objective of this study was to determine whether specially trained paramedics can monitor and treat patients appropriately during interfacility transports that traditionally have required the use of supplemental, hospital-based personnel.
  
  
  METHODS
  A paramedic-staffed mobile intensive care unit was developed as a cooperative program between Huron Valley Ambulance and the Washtenaw/Livingston County Medical Control Authority. This prospective observational study involved 111 patients requiring interfacility transport, conveyed by a paramedic-staffed mobile intensive care unit. A change in the Acute Physiologic and Chronic Health Evaluation (APACHE II) score components of mean arterial pressure, heart rate, and respiratory rate at the beginning and end of the transport was used to evaluate the ability of the paramedics to accomplish the transfer appropriately.
  
  
  RESULTS
  APACHE II scores increased in 20 patients, decreased in 16, and were unchanged in 75. The mean value for the change in APACHE score was 0.11 (95% confidence interval: -0.11-0.33).
  
  
  CONCLUSIONS
  Specially trained paramedics can monitor and treat patients appropriately during interfacility transfers that traditionally would have required supplementation with additional hospital staff.
authors.affiliation: University of Michigan/St. Joseph Mercy Hospital Combined Emergency Medicine Residency Program, Ann Arbor, Michigan, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Domeier
authors.forename: J D
authors.initials: JD
authors.lastname: Hill
authors.forename: R D
authors.initials: RD
authors.lastname: Simpson
mesh_terms: D018806:APACHE; D000328:Adult; D000488:Allied Health Personnel / Q000193:education / Q000706:statistics & numerical data*; D000552:Ambulances / Q000592:standards* / Q000706:statistics & numerical data; D003422:Critical Care / Q000706:statistics & numerical data; D006801:Humans; D008824:Michigan; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D011446:Prospective Studies; D014187:Transportation of Patients / Q000706:statistics & numerical data; D000078329:Workforce