Imagine caring for a critically ill patient with heart failure, sepsis or a traumatic brain injury. Then picture providing that care in a moving vehicle. That’s what critical care transport nurses do every day.
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“Critical care transport encompasses any type of critical care patient who needs to be moved from one facility to another to a higher level of care,” says Wanda Keaton, MHA, BSN, RN, CCRN, CFRN, Nurse Manager of Critical Care Transport at Cleveland Clinic. “We can transport these patients by ground in a mobile ICU, in a helicopter or in an airplane.”
Cleveland Clinic employs about 40 critical care transport nurses (CCTNs), 15 nurse practitioners and nearly two dozen paramedics and emergency medical technicians to assess, monitor, intervene and stabilize critically ill patients during transport. In 2020, they participated in 7,002 transports (excluding the mobile stroke unit), and they were on track to break that number in 2021.
On the ground, in the air
Cleveland Clinic Critical Care Transport works in teams, pairing nurses with paramedics on ground transport and with nurse practitioners in the air.
“We take care of all age levels,” says Keaton. “We have a pediatric neonate team and a mobile stroke unit based at main campus.” The healthcare system also operates two fixed-wing airplanes and one helicopter.
While TV medical dramas often show flight nurses jumping on a helicopter just before it takes off from a rooftop pad, about 75% of Cleveland Clinic’s transports take place on the ground.
“We do what’s in the best interests of the patient. If we can get them there via ground, then we are going to do that,” says Keaton.
No two days alike
The motto of the critical care transport teams is “no patient too sick, no patient too far.” CCTNs work 12-hour shifts, and no two are alike, says Keaton.
“The first patient may be a cardiac patient, the next one neuro and the one after that a trauma,” she says. “You need to be prepared for every type of patient. These are high acuity patients who may be on multiple drips, ventilators and cardiac devices.”
During the pandemic, CCTNs have transported many COVID-19-positive patients in the prone position or on extracorporeal membrane oxygenation (ECMO) machines.
“You are adding all these complexities that nurses typically handle in an ICU, where they might not even move the patient for a CT scan, and we are moving them from one hospital to another, across parking lots wearing PPE,” says Keaton.
To ensure the most qualified nurses are on the job, CCTNs at Cleveland Clinic must have three years of critical care experience in an ICU or emergency department. They participate in additional training, often in Cleveland Clinic’s Simulation and Advanced Skills Center or at the Cleveland Clinic Lerner College of Medicine, which has a helicopter shell and ambulance for simulations.
“Those vehicles simulate what it is like to be in a helicopter or truck with the noises, vibration and outside views,” says Keaton.
Soft skills of a CCTN
In addition to nursing skills, there are several other traits required for critical care transport nursing.
“We look for people who are very flexible and adaptable to changing situations,” says Keaton. “Team members can be on all three modes in one day – truck, helicopter and airplane. So, you need the mindset that whatever call comes in, you can adapt.”
CCTNs also need to be team players, working in collaboration with caregivers from nearly every medical specialty from cardiology to neurology. During orientation, CCTNs shadow caregivers in various ICUs to better understand the care they will provide patients in transport.
“We are one of them – part of the Cleveland Clinic family,” says Keaton. “We are here to support caregivers on the units, as well as patients.
Rewards at the end of the ride
While CCTNs are only with patients for a brief time, the rewards of a job well done are gratifying.
Keaton recalls the clinical coordinator getting a call for an imminent newborn delivery in an emergency department at a hospital without obstetric services. Critical care transport sent adult and pediatric teams to the hospital, where an emergency C-section was performed in the OR. Immediately following the delivery, the pediatric team began resuscitating the infant and placed the baby in an isolette for transfer while the adult team prepared the mother for transfer. The mother and newborn were safely reunited in the mother/baby unit at another hospital.
“All of our nurses feel like they learn something new every day,” says Keaton. “There’s never a dull day for a critical care transport nurse.”