By Debbie Bunch
Aug 28, 2024
Hearing the sirens wail as an ambulance rushes up to the door of your ER or feeling the wind lash your face as a Life Flight helicopter lands on the roof of your hospital is enough to get any health care clinician thinking about what it would be like to work in transport.
But what does it really take to join the ranks of these elite professionals? AARC Critical Care Transport Section Chair Jon C. Inkrott, RRT, RRT-ACCS, and Chair-Elect Jenn Watts, MSc, RRT, RRT-NPS, C-NPT, FAARC — both long-time transport therapists themselves — provide some great insights in this interview.
First tell us a little about the transport specialty and why RTs are important to the area.
Jon Inkrott: The transport specialty is a very niche section in the respiratory profession. It is not uncommon to see RTs on NICU and pediatric transports in the United States. What is unique is finding an RT on every single flight, from the neonate to the geriatric to the 40-year-old in extremis needing critical care transport. What we as RTs bring to the critical care transport theater is a continuum of care. We bring the ICU to you, and we know how important RTs are to that dynamic.
Jenn Watts: RTs in the transport world, especially neonatal-pediatric focused, possess critical thinking skills to apply to patient care. Many times, RTs have had to think outside the box when applying their critical thinking skills to an emergent situation. This ability to respond quickly and work with what’s at your fingertips helps to establish the RT as an important member of the collaborative team providing care in a moving environment.
What are the main job responsibilities of an RT who works in this setting?
Jon Inkrott: RTs must be experts in airway management and control and mechanical ventilation, and knowledgeable in all airway and treatment adjuncts. For my patient population and mission profile, we expect experts in hemodynamics, balloon pump management, chest tube management, arterial line insertions and management, and always complimenting the team environment — RN, ARNP, perfusion, MD, etc.
Jenn Watts: The most logical one is airway management, along with mechanical ventilator management — be it invasively or non-invasively. Additionally, treatment intervention to the patient be it medication or inhaled specialty gases.
In the neo-peds transport environment, we are trained in peripheral intravenous access, interosseous access, and needle decompression, just to highlight a few skills. The biggest responsibility pertains to providing collaborative care with not only our nursing partner but also the medical control physician for each transport.
What educational and/or credentialing requirements do people need to meet in order to be considered for a job as a transport therapist?
Jon Inkrott: Our biggest contributing factor is experience. We certainly promote and encourage advanced credentials and education; however, what we have found over and over is strong experience in the critical care environment is key.
Jenn Watts: Our program, neonatal-pediatric transport, requires all RTs to be RRT credentialled. We also require the neonatal-pediatric specialist (NPS) credential within six months of hire, along with certified neonatal-pediatric transport certification (C-NPT) after two years on the team. Each of these credentials springboards the RT deeper into the knowledge base for our specialty — and in our case, two specialties — neo-peds and transport.
What experience requirements are usually required?
Jon Inkrott: Great segue from question three! The average experience of the RTs on the adult teams is roughly 15 years. In our program (and I’d bet others), you will not obtain this position right out of school. It really takes a great deal of experience to be considered for a position.
Jenn Watts: Our team requires a minimum of three years critical care experience to even be considered for a position on transport. I would encourage at least five years to fully engrain into the realm of critical thinking within respiratory care.
Critical care transport is a fast-paced setting where RTs have to think on their feet and without the support of a whole hospital behind them. What personal characteristics does someone need to have to be successful in this specialty?
Jon Inkrott: First and foremost is being a team player. But you will also need to have critical decision-making skills and be able to function in the aircraft or ground ambulance in an austere environment and be able to contribute in this environment. Even with a great deal of experience in the ICU, this environment can be extremely intimidating.
Jenn Watts: The ability to be open to a collaborative approach to care is essential. The RT is only one part of the care team for any patient being transported. The RT needs to be able to communicate effectively and quickly.
Critical thinking and problem solving are important tools for the transport RT to possess. The cramped environment of an ambulance or helicopter can be unsettling, therefore, the ability to process and communicate assessments and plans quickly is a key factor in setting oneself up for success as a transport RT.
What are the biggest challenges and biggest rewards of working in critical care transport and why?
Jon Inkrott: The biggest challenges are the unknown and also working with just one other person. There isn’t a code button behind you. Ten others aren’t going to bail you out. You must go into every situation with a Plan B — and C, D, E, and F!
Jenn Watts: Being part of a small crew can be a challenge. Unlike in the hospital setting, you are not able to yell “I need help in bed 9” and have a squad of people come to your aid. The RT and their crew should always plan for the “what if” scenario.
As to biggest rewards, I would argue getting the kiddo to where they need to be hits the big reward. My team is fortunate enough to be able to receive updates on patient status and progression toward home.
What are your top three tips for anyone who is considering a role in critical care transport and why do you think each one is important?
Jon Inkrott —
- Experience, experience, experience! Get those years under your belt.
- Be engaged and be involved. Be in rounds, contribute to the patient care plan, offer solutions to the critical care team, and be a leader!
- Teach ACLS, BLS, PALS, NRP, FCCS, etc. Educate and be educated. We don’t want the folks who stand by the “this is how we’ve always done it” mantra. We look for problem solvers and thinkers. Strive to learn, learn to teach. Know each other’s weaknesses and strengthen them.
Jenn Watts —
- Get as much critical care experience as possible! If you want to work with one patient population, such as neonates instead of adults, immerse yourself into that world.
- Learn about the whole patient. Don’t focus only on the respiratory system. Focus on how each system interacts with the others.
- Keep up to date on changes in medicine. Just because a practice was great 25 years ago does not necessarily mean it is still the best of practices. Have a questioning attitude!
Ready to take the next step into a career in transport? Learn more about the AARC’s Critical Care Transport Section here and consider joining the group. Membership is open to all AARC members, and it is a great way to connect with those who are already working in this specialty.
