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vital Skill retention and continuing education are best accomplished using a three-part process: basic skills refreshers, formal continuing medical education, and quality improvement work The first piece involves renewal of basic procedural and cognitive skills Such retraining may include didactic or self-directed refreshers and enhanced patient experiences, such as rotations through the operating room to practice airway techniques Laboratory training experiences are useful for interosseous infusion, cricothyroidotomy, and thoracostomy tube placement Simulated team training has become standard at most institutions to augment both didactic and “hands-on” training The second component is formal continuing medical education through regularly scheduled programs, including presentations, journal clubs, and discussions of particularly unusual or difficult patients In addition, such forums may be used to learn about new medical equipment, communication devices, and vehicle issues The final component of an effective education program is quality improvement Quality markers need to be defined (clinical, logistical, delivery, etc.), goals determined, metrics reviewed, and improvement plans initiated Ramnarayan describes processes measuring the performance of an interhospital transport service, while Ratnavel discusses efforts to evaluate and improve transport services Bigham and Schwartz presented a quality metric determination process in their 2013 reviews of this subject Routine periodic case reviews should take place by the transport service in conjunction with other medical experts A formal morbidity and mortality conference may be included as a part of such a program In addition, topics such as response times and parent satisfaction should be presented The focus of these sessions should be on the process of patient transport It is important to focus on ways in which the team’s practices may be changed to improve performance and minimize risk of similar events in the future Although the team’s mission dictates specifics of the cognitive and technical aspects of their training, all teams need to work together in a cohesive fashion This might be particularly challenging for transport teams, as they practice in unique and somewhat isolated environments, which are quite different from the traditional medical hierarchy The interactions and relationships necessary for success in this type of practice may have more in common with other highperformance teams, such as military special forces units and aircraft crews, than with those traditionally found in many other healthcare situations A growing body of evidence from the airline industry as part of a Crew Resource
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