There should be nurse-to-nurse communication from the referring facility to the receiving facility. If this cannot be accomplished, a member of the transport team may provide a report. A copy of the medical record and relevant laboratory and radiographic studies must accompany the patient. Technology in some areas of the country may allow these studies to be transmitted ahead of the patient. Preparation of documents should never delay patient transport. If time is of the essence, critical information will need to be communicated verbally. Policies and procedures should exist within transport programs that assist in directing how communication will be initiated and followed up between the referring and receiving facilities. Health Insurance Portability and Accountability Act (HIPAA) guidelines must be followed when communicating protected health care information.

The team members that accompany a patient will be determined by the condition and level of care that the patient requires. CAMTS standards⁷ outline the required team members for BLS, advanced life support (ALS), and critical care transport. Two team members at a minimum along with the vehicle operator should accompany the patient. For critical care transports CAMTS recommends that one member of the team be an appropriately educated and competent registered nurse. Other members of the team may include a physician, paramedic, respiratory therapist, or another registered nurse. All should be competent in the transport process.

If a physician is not part of the transport team, the team should operate using protocols and have the ability to communicate with a command physician to provide medical direction if there is a variation from protocol or a problem develops.

Transport team configurations are many and varied. Transport nursing has developed into a subspecialty of emergency and critical care nursing. Transport nurses now go through specific and rigorous training before joining a transport team. The Air Surface Transport Nurses Association (ASTNA), formerly the National Flight Nurses Association, has developed a flight and ground transport nursing core curriculum to provide standardized education and training in such areas as flight physiology, stabilization, communications, and medicolegal issues. ⁶ Initial training should include classroom and clinical experiences, including advanced airway management, invasive skills, and critical and emergency care. Preceptor programs are frequently used to allow the new transport nurse exposure to the transport environment. Recurrent training is needed to maintain skills, update information regarding current therapies, and review policies and procedures. Monthly transport reviews provide performance improvement opportunities and promote shared learning experiences among staff. Continuous performance improvement should be one of the guiding principles of transport nursing practice.

Nurses should be advanced cardiac life support (ACLS) verified with training and continuous evaluation of advanced airway management skills and other invasive skills such as chest tube insertion, needle thoracostomy techniques, and intraosseous needle insertion. Depending on the capabilities of the program, additional education should include invasive line management and intraaortic balloon pumps. Many programs also require advanced trauma life support (ATLS) credentials. Development of the Transport Nurse Advanced Trauma Course (TNATC) demonstrates ASTNA’s commitment to improving educational opportunities available to transport nurses. Development of the certified flight nurse examination encourages flight nurses to achieve certification in flight nursing (CFRN). In addition, there is now a certified ground transport nurse (CTRN) for those transport nurses who provide critical care transport by ground.

Transport team members work under a unique set of circumstances. Interactions with the patient are short and often rushed. The patients who are transported are at an increased risk for further injury or death because of circumstances necessitating transport. Transport personnel must remember that they are often the only contact the family has with the receiving hospital. The team should try to make contact with the family, explaining interventions and other procedures that may be needed for transport. Maintaining contact and follow-up with referring personnel also provides the transport team with opportunities to communicate patient status. Fostering collegial relationships instills a sense of commitment and pride in the transport nurse role, as well as providing an opportunity to improve patient care.

State regulations generally dictate what equipment should be on both surface and air transport vehicles. However, there are some general guidelines recommended by CAMTS, the National Association of Emergency Medical Services Physicians (NAEMSP), the American College of Emergency Physicians (ACEP), the American Academy of Pediatrics, and the American College of Surgeons for equipment that should be available for transport. ^{2.7.15. and 17.}

The mission, size of the transport vehicle, and patient clinical condition are factors that influence the equipment carried during transport. General equipment should include equipment used to monitor and manage airway, oxygenation, and vital signs, as well as devices necessary for resuscitation and stabilization such as a defibrillator and external pacemaker. Medications for advanced life support and pain management should also be included.

All equipment should be routinely evaluated to see if it functions properly. Annual preventive maintenance checks should be dated and visible for team members to view. Medications must be checked for expiration and stored at the appropriate temperature. Policies and procedures must be in place to ensure that team members receive the proper education and training as to how to use the equipment. There should be an established method of removing and replacing malfunctioning equipment. Documentation of this process is imperative.

As technology continues to advance, many pieces of equipment are becoming multifunctional and longer lasting. In addition, advanced procedures such as extracorporal perfusion can now be continued during transport. Box 9-3 contains a sum-mary of some of the equipment that may be used during transport.