referring facility This online “medical control” or “medical command” model enables clinicians to direct care after assessments are transmitted to them Typically, after the transport team makes contact with the patient and completes an assessment, the team contacts the medical command physician to review the management plan and prepare for the transport back to the accepting institution At that time, additional clinical information may be reviewed between the team and the medical command physician Additionally, electronically transmitted data, such as ECGs, and transferred images, including plain radiographs and CTs may be reviewed and discussed real time Online medical command may be particularly important in tertiary and quaternary care patient populations, where patients may require unique interventions (e.g., patients with complex congenital heart disease, or metabolic disorders) Potential drawbacks include additional reporting time spent at the referring institution (can be mitigated by on communications en route), time demands on the receiving medical staff directing care, potential decision-making inconsistency within variable medical control staff, and technical problems with the communications equipment Accomplished efficiently and appropriately, however, direct online communications (in conjunction with off-line training, guidelines, and protocols) can help support the primary goals of interfacility transport, including stabilization, improvement, and seamless transition to next stage of care via improved awareness (by the most experienced clinicians) of current state, response (or not) to interventions, and preparation of needs at next stage/location of care Indirect Medical Control Indirect medical control includes the medical management of a transport system through the use of established care guidelines in place before the call for help arrives The medical director for a service, who is ultimately responsible for every aspect of patient care, authorizes the personnel to utilize standard protocols for the care of patients in order to save time and reduce the variability of orders This has the benefit of saving time in critical situations, as well as reducing interoperator variability in patient assessment and medical decision making In most systems, the option remains for personnel to speak with a clinician for direct medical control, if they have questions, or if the protocol does not clearly apply This may also be necessary for certain procedures or medications considered to be higher risk to the patient In EMS, the protocols may be established by the regional or state EMS authority, while in interfacility transport, these are determined by the transporting service, often in conjunction with physician content experts Medical control physicians should be literate with transport guidelines, protocols, personnel capabilities, medications, and equipment to be able to add the most value in an efficient manner during the transport process Interfacility transport teams often use a combination of care guidelines, orders, and protocols (indirect control), with review by predetermined medical control physicians (direct control) at various points of the transport assessment and care FIGURE 11.6 A–C: Transfer of patient during transport process Patient transfer between vehicles or stretchers can be risky to the patient Tube, line, oxygen, or medication disconnection or disruption, as well as shifts in immobilization, must be avoided (A, C: Used with permission, © The Children’s Hospital of Philadelphia, Philadelphia, PA; B: From Hahnemann University Hospital, University MedEvac, Philadelphia, PA, with permission.) PEDIATRIC TRANSPORT TEAM STRUCTURE AND LOGISTICS There are several common models of pediatric transport teams across the country Dedicated pediatric transport teams are often freestanding teams whose primary responsibility is to transport patients These teams not take on direct patient care assignments, though often assist throughout the hospital during their “downtime.” Many dedicated teams transport both neonatal as well as “pediatric” patients, though some teams are exclusively “neonatal or pediatric.” Another model is the “unit-based” team These teams mobilize team members from clinical units when a transport request is made For example, a NICU nurse is pulled from a patient assignment to go retrieve a patient for the NICU Finally, there are some programs that utilize hybrid models of the above Many types of providers can function effectively as part of a pediatric transport team Nurses, advanced practice providers (NP, PA), respiratory therapists, EMTs, paramedics, and physicians serve on various transport teams In general, the personnel chosen for the transport team should have experience in the care of critically ill infants and/or children, and be competent in the transport environment Excellent bedside clinicians may be less effective in the transport environment if they not know where to find resources in the ambulance or helicopter, how to turn on the oxygen or suction Additionally, motion sickness impairs the clinician’s ability to optimally care for the patient The team may not be ideal if one of the providers is limited in ability to perform specific patient care tasks, such as medication administration and delivery Finally, while the transport environment is a tremendous place to learn patient care in austere settings, space constraints often limit the addition of additional learners The primary mission of the team must be kept in mind when selecting personnel and planning training For example, a team devoted to neonatal transport should consider team members with experience in the care of critically ill neonates, whereas teams that also perform transports from nonhospital locations may want to employ personnel with prehospital care experience Teams that have more broad-based missions, such as those that transport both neonates and older children, should attempt to recruit team members from varied hospital areas, including the NICU, PICU, CICU, and emergency department **By necessity, such teams have to devote considerable time to the medical crosstraining of staff members However, having team members from varied ... Philadelphia, PA, with permission.) PEDIATRIC TRANSPORT TEAM STRUCTURE AND LOGISTICS There are several common models of pediatric transport teams across the country Dedicated pediatric transport teams... “downtime.” Many dedicated teams transport both neonatal as well as ? ?pediatric? ?? patients, though some teams are exclusively “neonatal or pediatric. ” Another model is the “unit-based” team These teams... utilize hybrid models of the above Many types of providers can function effectively as part of a pediatric transport team Nurses, advanced practice providers (NP, PA), respiratory therapists, EMTs,