Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
Pediatr Crit Care Med. 2020 Mar;21(3):222-227. doi: 10.1097/PCC.0000000000002184.
To ascertain the national experience regarding which physician trainees are allowed to participate in pediatric interfacility transports and what is considered adequate education and training for physician trainees prior to participating in the transport of children.
Self-administered electronic survey.
Pediatric transport teams listed with the American Academy of Pediatrics Section on Transport Medicine.
Leaders of U.S. pediatric transport teams.
None.
Forty-four of the 90 U.S. teams surveyed (49%) responded. Thirty-nine (89%) were university hospital-affiliated. Most programs (26/43, 60%) allowed trainees to participate in pediatric transport in some capacity. Mandatory transport rotations were reported for pediatric critical care (PICU) fellows (9/42, 21%), neonatology (neonatal ICU) fellows (6/42, 14%), pediatric emergency medicine fellows (4/41, 10%), emergency medicine residents (3/43, 7%), and pediatric residents (2/43, 5%). Fellow participation was reported by 19 of 28 programs (68%) with PICU fellowships, 12 of 25 programs (48%) with pediatric emergency medicine fellowships, and 10 of 34 programs (29%) with neonatal ICU fellowships. Transport programs with greater than or equal to 1,000 annual incoming transports were more likely to include PICU and pediatric emergency medicine fellows as providers (p = 0.04; 95% CI, 1.04-25.71 and p = 0.02; 95% CI, 1.31-53.75). Most commonly, trainees functioned as medical control physicians (86%), provided minute-to-minute medical direction for critically ill patients (62%), performed intubations (52%), and were code leaders for patients undergoing cardiopulmonary resuscitation during transport (52%). Most transport programs required pediatric residents, PICU, and pediatric emergency medicine fellows to complete a PICU rotation prior to participating in pediatric transports. The majority of transport programs did not use any metrics to determine airway proficiency of physician trainees.
There is heterogeneity with regard to the types of physician trainees allowed to participate in pediatric interfacility transports, the roles played by physician trainees during pediatric transport, and the training (or lack thereof) provided to physician trainees prior to their participating in pediatric transports.
确定哪些医师受训者被允许参与儿科医院间转运，以及在参与儿童转运之前，医师受训者应接受何种教育和培训。
自我管理的电子调查。
儿科学会运输医学科列出的美国儿科运输团队。
美国儿科运输团队的领导者。
无。
接受调查的 90 个美国团队中有 44 个（49%）做出了回应。其中 39 个（89%）是大学附属医院。大多数项目（26/43，60%）允许受训者以某种身份参与儿科转运。儿科危重病（PICU）研究员（9/42，21%）、新生儿科（新生儿 ICU）研究员（6/42，14%）、儿科急诊医学研究员（4/41，10%）、急诊医学住院医师（3/43，7%）和儿科住院医师（2/43，5%）需要进行强制性转运轮转。28 个设有 PICU 研究员项目中有 19 个（68%）、25 个设有儿科急诊医学研究员项目中有 12 个（48%）、34 个设有新生儿 ICU 研究员项目中有 10 个（29%）报告了研究员的参与情况。每年有超过或等于 1000 次入院转运的转运项目更有可能让 PICU 和儿科急诊医学研究员担任医疗提供者（p = 0.04；95%CI，1.04-25.71 和 p = 0.02；95%CI，1.31-53.75）。培训生最常见的作用是作为医疗控制医生（86%）、为危重病患者提供每分钟的医疗指导（62%）、进行插管（52%），以及在转运过程中对接受心肺复苏的患者担任首席医师（52%）。大多数转运项目要求儿科住院医师、PICU 和儿科急诊医学研究员在参与儿科转运之前完成 PICU 轮转。大多数转运项目没有使用任何指标来确定医师受训者的气道熟练程度。
在允许参与儿科医院间转运的医师受训者类型、医师受训者在儿科转运期间的作用，以及在参与儿科转运之前为医师受训者提供的培训（或缺乏培训）方面，存在着异质性。
