Factors associated with mode of transport decision making for pediatric-neonatal interfacility transport

Quinn, J. M.; Pierce, M. C.; Adler, M.

Air Med J. 2014 Dec 30; 34(1):44-51


OBJECTIVE: Transport professionals must routinely engage in complex decision making. One challenging decision is the determination of mode of transport. This study explores the decisional factors involved in the determination of mobilizing ground ambulance versus helicopter for pediatric-neonatal interfacility transport. The aim was to gather initial qualitative data to aid in the development of an objective scoring tool that would be used to guide the mode of transport decision for pediatric and neonatal interfacility transport. The focus of the study was to elicit the factors that influence the mode of transport decision among professionals who are involved in this decision. METHODS: This study was conducted in an urban, freestanding children's hospital with a dedicated pediatric/neonatal transport team. Subjects were given written scenarios that represented a phone call requesting transport from a referring hospital. Subjects were asked to choose between 2 modes of transport: ambulance or helicopter. Weather was assumed to be clear. Decision-making factors were gathered and tallied. For group comparison, the Fisher exact, Pearson chi-square, Student t, or Wilcoxon rank sum tests for scale data was used. A multivariate logistic regression was performed to assess factors associated with the mode of transport decision. RESULTS: Responses were received from a total of 19 subjects. Nurses represented 58% (11) of the respondents, and physicians represented 42% (8). The nurses were all either currently employed on the transport team or had left the team within the past 2 years. The physicians were all critical care or emergency medicine fellows and attending physicians who serve in the medical control role for the transport team. All subjects reported a minimum of five years in their respective professions. The decision to mobilize a helicopter for interfacility transport was significantly associated with the provider's level of clinical concern in conjunction with the perceived distance and if neurovascular or respiratory status was in question in both univariate tests and the multivariate logistic regression. The decision to mobilize a helicopter did not differ significantly between professional roles (nurse vs. physician) or concerns about hemodynamic status such as blood pressure and heart rate. Physicians were significantly more likely to overestimate perceived ground travel time to the outside facility. CONCLUSIONS: Health care providers responsible for directing and conducting the interfacility transport of critically ill children are more likely to mobilize a helicopter for transport in the face of neurovascular or respiratory clinical concerns in conjunction with a prolonged transport distance. When the provider's level of concern is lower, then a ground ambulance is consistently chosen even if out of hospital time is prolonged.

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