title: Critical care transportation by paramedics: a cross-sectional survey.
abstract: OBJECTIVE
  The purpose of this study was to gather data from paramedics practicing in the critical care transport setting to guide development of the education, training, and clinical practices for certification as a critical care paramedic.
  
  
  METHODS
  A paper survey of 1991 randomly selected nationally registered (NREMT) paramedics was conducted. Nine paramedics with residences in small US Pacific Island territories were not included in the survey.
  
  
  RESULTS
  We received 610 responses (30.6%). Respondents that stated that they provided critical care transport services reported using pediatric skills and equipment the most and intracranial pressure monitoring the least. Paramedics served as the primary provider for pediatric patients (72.5%), 12-lead electrocardiogram (66.3%), intravenous infusion pump (76.7%), mechanical ventilator (66.9%), central line management (63.1%), and chest tube management (63.3%). Paramedics served in a team member capacity most often with neonatal isolette (71.8%), intra-aortic balloon pump (79.2%), and ICP monitoring (64.9%). The majority provided ground critical care transport (249) compared to 44 rotor-wing and 6 fixed-wing. Sixteen respondents reported serving as primary providers on combinations of ground, rotor-, and fixed-wing services.
  
  
  CONCLUSIONS
  Paramedics reported being the primary provider on the critical care transport team and performing skills while using equipment and administering medications that exceeded their education and training as paramedic and, at times, without the benefit of any additional education or training. National appreciation of this reality should spur development of standardized education, licensing or certification, and continuing education to prepare paramedics for their role as critical care medical providers.
authors.affiliation: Emergency Medical Services Medical Education Program, Creighton University, Omaha, NE, USA. billr@creighton.edu
authors.forename: William
authors.initials: W
authors.lastname: Raynovich
authors.forename: Jason
authors.initials: J
authors.lastname: Hums
authors.forename: David F
authors.initials: DF
authors.lastname: Stuhlmiller
authors.forename: James D
authors.initials: JD
authors.lastname: Bramble
authors.forename: Ted
authors.initials: T
authors.lastname: Kasha
authors.forename: Kim
authors.initials: K
authors.lastname: Galt
mesh_terms: D000488:Allied Health Personnel / Q000193:education* / Q000592:standards / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D002568:Certification; D002983:Clinical Competence; D003422:Critical Care / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D019538:Health Care Surveys; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration; D012042:Registries; D014187:Transportation of Patients / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data; D014481:United States