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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