Critical Care Transport: Course Planning and Preparation
Critical Care Transport: Course Planning and
Preparation
Introduction
Critical Care Transport (CCT), sometimes referred to as Specialty Care Transport (SCT), is a
level of care designed to meet the needs of critically ill patients during transit from one location
to another. The specialized body of CCT knowledge and the scope of practice of the Critical Care
Transport Provider (CCTP) are beyond the traditional paramedic training level, as defined by
federal and state authorities. CCT most often occurs in the context of transfer between health care
facilities but may also occur in the prehospital environment when CCTP knowledge and/or skills
may benefit a particular patient or within a health care facility when a patient is moved from one
location to another.
CCTP students are often paramedics but may include registered nurses, respiratory therapists,
physicians, perfusionists, and other health care professionals. CCT course design should take into
account the previous education, experience, and knowledge base of the students enrolled.
Course Overview
A CCT course is designed to prepare students to provide intensive care unit (ICU)-level care
during transport to a wide variety of critically ill patients, ranging in age from neonates to adults.
A broad base of emergency and critical care physiology, pathophysiology, pharmacology, and
treatment modalities comprises the most substantial portion of any CCT course. Specific skills,
including advanced airway management; use of mechanical ventilators; invasive and noninvasive
hemodynamic monitoring; cardiac assist devices; administration of blood and blood products;
interpretation of laboratory and diagnostic studies; initiation and titration of multiple intravenous
infusions; and performance of invasive procedures, such as chest tube and central line insertion,
are also an integral part of the CCT curriculum.
Total course length will largely depend on prior student experience and current knowledge as
well as the range of specific skills that students will be expected to achieve competency in. At a
minimum, 80 hours of instructional time will be required; some courses will need in excess of
120 hours to adequately prepare CCTPs. Additional hours spent in clinical settings providing or
observing actual patient care may also be included in the CCT curriculum.
A minimum target for any CCT course should be adequate preparation of students to successfully
pass the Board for Critical Care Transport Paramedic Certification (BCCTPC) certification exam
for Critical Care Paramedic. The BCCTPC credential Critical Care Paramedic-Certified (CCP-C)
designates individuals who demonstrate a level of knowledge necessary for practice in the critical
care transport environment. Successful completion of this exam after attending a CCT course is
an excellent independent reflection on the adequate design and delivery of a CCT course.
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Critical Care Transport: Course Planning and Preparation
Instructor Qualifications
The competencies expected from students in a CCT course lie far beyond those of traditional
paramedic training. They also exceed initial training of nurses, respiratory therapists, and many
other health care professionals. The depth and breadth of anatomy, physiology, pathophysiology,
and pharmacology included in a typical CCT course requires instructors who are not only
extensively experienced in the care of critically ill patients but also content experts in the topic
area they are teaching.
Instructors should be seasoned critical care clinicians, preferably nurses, physicians, nurse
practitioners, physician assistants, respiratory therapists, pharmacists, and surgeons who routinely
care for critically ill patients in a hospital setting. When possible, use of clinicians who have
transport experience will help to facilitate student learning. Not all critical care clinicians can
teach; some are horrific lecturers. Every CCT instructor should be provided with a copy of the
course textbook, a specific outline of the content he or she is expected to deliver, audiovisual
materials and support and be expected to teach in a manner that holds student interest and
facilitates achievement of the expected competencies.
A CCT course taught solely by paramedics, paramedic instructors, or currently practicing CCT
providers will not be a quality program.
Course Preparation
Course Materials
The following materials are suggested for running a CCT course:
 Critical Care Transport textbook
 Critical Care Transport instructor materials (lesson plans, PowerPoint® presentations)
 PowerPoint presentation equipment (LCD projector, screen, etc)
 Video equipment (television, DVD player, etc)
 Student handouts
 Visual aids
 Skill station setups
 Internet access
 Reference material
Course Planning
In addition to budgets, scheduling, arranging for equipment and instructors, and other routine
course-planning activities, the Course Administrator should consider making application for
local, regional, state, or national continuing education credits for currently certified or licensed
providers who attend the CCT course. The ability to obtain continuing education credits can be an
enticement for providers to attend a CCT program, may increase course enrollment, and can
provide added value to the CCT course tuition.
Student Prerequisites
Consideration should be given to prerequisite requirements to enroll in a CCT course. Current
certification or licensure as a paramedic, nurse, respiratory therapist, or other allied health care
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Critical Care Transport: Course Planning and Preparation
professional should be an entry requirement. Some course sponsors require a specific number of
years (often ranging from 3 to 5) of field experience to enroll in a CCT course. Additional
requirements may include certification in some of the related "alphabet" courses, including
ACLS, PALS, ATT, PEPP, GEMS, etc. The extensive anatomy and physiology included in a
typical CCT course has led many sponsors to require completion of the three-credit college-level
anatomy and physiology course as a CCT course prerequisite. Prerequisites help to assure similar
entry-level knowledge among students and limit classroom time spent reviewing basic principles.
Course Enhancements
Although much of the CCT curriculum may appear rather cut-and-dried, instructors should be
encouraged to recommend colleagues as guest lecturers who may have specific expertise in a
topic area, such as a neurosurgeon to lecture on head injuries or a hematologist to discuss clotting
disorders and blood products. Additionally, remind instructors that CCT students often have
limited exposure to critically ill patients in an in-patient setting. Conversely, also remind lecturers
that the students will be operating in a transport environment and inform them of students'
existing knowledge and experience level. Use of teaching adjuncts such as actual diagnostic or
patient care equipment, video, radiographs, and diagnostic imaging is most appropriate and
extremely useful for enriching the classroom environment.
Site visits to a critical care area can also be used to enhance learning if student observations are
related to the content being taught and the visit lends greater value than bringing the equipment
into the classroom would.
Suggested Course Schedule
The total course length will usually range from about 80 to 120 hours and may exceed that if a
particularly large number of clinical skill competencies are included. The course is usually taught
in 3- or 4-hour "blocks" (evening classes for working health care providers) but may use more
concentrated scheduling depending on local needs. Two key considerations for successful
scheduling are to allow sufficient time for students to complete required reading assignments
prior to each lecture and to maintain a continued awareness of the complexity of the material
being taught so as not to overwhelm students with too much material in too short a time span.
Clinical Requirements
Clinical rotations can be invaluable for reinforcing classroom-acquired knowledge and for
learning information and skills beyond those taught in class. Without proper oversight and
availability of clinicians willing to interact with and teach students, clinical rotations can be
wasted time.
The ideal setting for a CCT clinical rotation is in an ICU setting with a critical care nurse and one
or two CCT students. An understanding of the desired observations and goals for the clinical
rotation should be clearly defined, in writing with both the student and clinician, well ahead of the
scheduled rotation. A faculty member from the CCT program should be available during the
rotation should any questions or problems develop.
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Critical Care Transport: Course Planning and Preparation
The clinical setting is not a skills laboratory. Achieving competency with skills requires a
separate skills laboratory setting, preferably using simulation manikins and equipment. Prior to
any clinical rotation, the CCT student should be taught and should demonstrate competency with
each of the skills included in the CCT course. These may include:
 Airway management and intubation using pharmacologic agents
 Advanced airway management techniques and equipment
 Cricothyrotomy (needle and surgical)
 Operation, management, and troubleshooting of mechanical ventilators
 Noninvasive ventilation, including bilevel positive airway pressure (BiPAP) and
continuous positive airway pressure (CPAP)
 Administration of blood and blood products
 Arterial line management
 Insertion and management of central venous catheters
 Insertion and management of chest tubes and chest tube drainage devices
 Operation and troubleshooting of infusion pumps
 Escharotomy
 Cardiac assist devices (intra-aortic balloon pumps, ventricular assist devices)
 Intracranial pressure monitoring and care of ventriculostomy
 Hemodynamic monitoring devices and equipment, include pulmonary artery catheters
 Foley catheter insertion and maintenance
 Temperature-monitoring probe insertion and use
 Umbilical line insertion and use
 Pacemaker use and troubleshooting (temporary and permanent)
 Pericardiocentesis
 Oro/nasogastric tube insertion and maintenance
 Infectious-disease-specific isolation precautions
 Care and maintenance of ostomies and other drainage devices
 Gastric tube and feeding tube maintenance
 Operation and maintenance of an isolette
 Initiation and titration of vasoactive infusions
 Collection of specimens and analysis using portable diagnostic/laboratory equipment
 Evaluation of laboratory, radiologic, and diagnostic studies
 Operation of obstetrical monitoring equipment
 Use and interpretation of ultrasound imaging
Considerable controversy exists about the role of simulation in critical care education, both for
initial learning and as a tool for continuing education. As simulation becomes more sophisticated,
human patient simulators are now available that act and react very much like a human in an actual
clinical setting. One advantage of simulation, and the reason why skills must be initially learned
and practiced in a lab, is that it allows a student to make mistakes and learn without harming a
patient. Sophisticated simulators, such as computerized manikins, are so realistic that they can
help decrease provider anxiety in a controlled setting, enable providers to develop and refine
critical decision-making skills, and make it possible to practice high-risk, infrequently used skills.
Disadvantages of simulation for continuing education, or when used as an alternative to clinical
rotations, include the cost and the need for skilled operators and a dedicated space. With a wellrun simulation session, providers learn how to use the simulator, make mistakes, and be properly
debriefed so learning can occur.
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Critical Care Transport: Course Planning and Preparation
Testing
Pretesting to ascertain baseline knowledge may be helpful. Frequent quizzes and interim exams
derived from a TestBank linked to the course textbook are highly recommended. These tests
provide feedback on student progress, motivate students to keep abreast of required reading
assignments, and serve to evaluate the instruction provided. Interim testing also provides
opportunity to review and fill in gaps where expected competencies may not have been achieved.
Course Objectives
Section 1: Introduction and Overview of Critical Care Transport
1. Define the term critical care.
2. Understand the history of critical care transports, both air and ground.
3. Explain the difference between prehospital emergency care/medicine and critical care transport
medicine.
4. Describe critical care transport team composition.
5. List the qualifications of members of a critical care transport team.
6. Describe the standards of care and criteria for critical care transports.
7. Compare and contrast equipment and supplies used for prehospital advanced life support
(ALS) versus specialty care transport.
8. Compare and contrast differences in prehospital and critical care transport, including patient
preparation, assessment, and invasive monitoring, as well as other patient needs.
9. Identify the modes of transportation used during critical care transports, including mobile
(ground) units, rotor-wing aircraft, and fixed-wing aircraft.
10. Discuss the differences between the modes of transportation.
11. Understand the advantages and disadvantages for each mode of transportation.
12. Understand the responsibilities of the critical care transport dispatcher and the role of dispatch
in determining the mode of transportation.
13. Review dispatch and triage criteria to compare and contrast basic life support (BLS), ALS,
and specialty care transport, as well as ground versus air (fixed or rotor) transport.
14. Explain critical care transport protocols and their purpose.
15. Understand the role of medical control in the critical care transport environment.
16. Identify the duties and origin of medical control for critical care transport in different service
configurations (ie, EMS-based, hospital-based, etc).
17. Explain the differences and purposes for online and off-line medical control in critical care
transports.
18. Identify when transfer of medical control occurs.
19. Identify stresses specific to the critical care transport professional and their signs.
20. Discuss state and national standards for critical care transport including recommendations for
team configurations and educational requirements from the American Association of Critical
Care Nurses (AACN), American College of Emergency Physicians (ACEP), the Society for
Critical Care Medicine (SCCM), and other national organizations.
21. Discuss reimbursement criteria and their relevance to critical care transport.
22. List the documentation and patient records required before, during, and following critical care
transport including sending facility records, labs, and imaging reports.
23. Understand the importance of interpersonal communications with the patient and family
members.
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Critical Care Transport: Course Planning and Preparation
24. Explain the process of quality assurance and improvement, and understand the importance of
maintaining skills and knowledge.
25. Discuss the role of critical care transport professionals in emergency medical services.
26. Recognize the impact of specialty/critical care on the health care system.
27. Summarize the Health Care Financial Administration (HCFA) requirements for specialty care
transport reimbursement and various team configurations.
28. Describe priorities for patient care during critical care transport.
Section 2: Medical-Legal Issues
1. Discuss the Emergency Medical Treatment and Active Labor Act (EMTALA), its implications
for critical care transport, and the potential consequences of violating the law.
2. Describe the requirements and obligations of the sending medical facility under EMTALA.
3. Explain the role, requirements, and obligations of the transport team under EMTALA.
4. Describe the EMTALA requirements of the transporting team for stable and nonstabilized
patients.
5. Describe how the transport provider's certification level and scope of practice affect the steps
of planning and executing a critical care transport.
6. Recognize and discuss patient rights and the legal risks and liabilities they pose in critical care
transport.
7. Describe the legal principles of consent, negligence, and abandonment.
8. Discuss the major steps and pertinent issues in accepting a patient transfer.
9. Discuss the major steps and pertinent issues in assessing and preparing for transfer of a patient.
10. State the responsibilities of CCTPs during transport.
11. State the role of other health care providers who accompany the patient during transport.
12. Discuss the ways in which communications capabilities and agreements about medical
direction affect medical decision making in the transport environment.
13. Describe advance directives such as do not resuscitate (DNR) orders, the necessary
requirements and conditions for DNR order validity, and the responsibilities of the transport team
for a patient with a DNR order.
14. Discuss the major steps and pertinent issues in transferring care to the receiving facility.
15. Explain the concept of jurisdiction as it applies to transport across state and national borders.
16. Identify areas of potential liability for CCTPs and the transport agency.
17. State how risks can be minimized in the critical care transport environment.
18. Discuss the general concepts established by current EMTALA case law.
Section 3: Air Medical Transport Fundamentals
1. Explain the role of the Commission on Accreditation of Medical Transport Services (CAMTS)
and the concepts of visual flight rules, instrument flight rules, and a sterile cockpit.
2. Discuss the concept of flight following.
3. Describe the various types of air medical helicopters that have been used and that are currently
in use.
4. Describe the advantages and disadvantages of the use of rotor-wing aircraft.
5. Describe the advantages and disadvantages of the use of fixed-wing aircraft.
6. Briefly discuss the emphasis of the air medical role to facilitate critical care transports.
7. Summarize Federal Aviation Administration guidelines that are pertinent to air medical
transport.
8. List standards created to enforce safety.
9. Summarize crew resource management.
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Critical Care Transport: Course Planning and Preparation
10. Understand the importance of taking safety precautions, including an understanding of crash
and survival skills.
11. List techniques for safety and survival in the aircraft environment.
12. Discuss common employment criteria for medical flight team members.
13. Discuss the critical care provider certifications that are prevalent and required flight crew
training.
14. Describe the various crew configurations used by air medical programs.
15. Describe accreditation of the air medical program.
Section 4: Flight Physiology
1. Describe the composition of the atmosphere.
2. List the three physiologic zones in the atmosphere.
3. Discuss the seven primary gas laws affecting flight physiology.
4. Define the four types of hypoxia.
5. Describe the four stages of hypoxia as they relate to altitude.
6. Recognize the signs and symptoms of altitude-induced hypoxia and the appropriate treatment.
7. Summarize the advantages and disadvantages of pressurized and nonpressurized aircraft.
8. Recognize the physical and physiologic effects of rapid cabin decompression.
9. Define the effective performance time and the time of useful consciousness.
10. Describe the primary forces that act on an aircraft.
11. List the primary stressors of flight and their physiologic impacts.
12. Define the factors affecting tolerance of the stressors of flight.
13. Identify different dysbarisms and trapped gas disorders.
14. Describe assorted exacerbations of medical conditions due to altitude.
Section 5: Patient Assessment
1. Understand the advantages and disadvantages of prehospital and in-hospital assessment models
when used in the critical care transport setting.
2. Define differential diagnosis and how it is used in the critical care transport setting.
3. Compare assessment at a scene transport with assessment at an interfacility transport.
4. Describe the evaluation of assessment information and the process for assessment at a scene
transport.
5. Discuss the considerations for packaging a patient at a scene transport.
6. Describe the evaluation of assessment information and the process for assessment at an
interfacility transport.
7. Discuss the steps for packaging a patient at an interfacility transport.
8. List the components of a hospital transfer sheet.
9. Define normal and abnormal parameters of the critical care assessment.
10. Describe how to gather the necessary information for a critical care transport.
11. Describe and perform the assessments required for critical care transports, including the
following:
 General appearance
 Cardiovascular assessment
 Respiratory assessment
 Neurologic assessment
 Gastrointestinal assessment
 Genitourinary assessment
 Musculoskeletal assessment
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Critical Care Transport: Course Planning and Preparation
 Psychosocial and emotional assessment
12. Discuss how to determine patient condition utilizing assessment skills.
13. Discuss transferring a patient to a receiving facility appropriately, including proper
communication and documentation.
14. Understand how to interpret patient complaints, signs, and symptoms to determine patient
condition and anticipate changes in condition.
Section 6: Respiratory Emergencies, Airway Management, and Ventilation
1. Summarize the anatomy and physiology of the respiratory system.
2. Define the five requirements for normal ventilation and oxygenation.
3. Explain the physiology of pulmonary function values, including:
 Inspiratory respiratory reserve
 Inspiratory capacity
 Expiratory reserve volume
 Residual volume
 Functional residual capacity
4. Identify parameters indicating patient candidacy for mechanical ventilation.
5. Describe positive and negative pressure ventilation.
6. Differentiate pressure, volume ventilators, and flow- and time-cycled ventilators.
7. Identify components of mechanical ventilation equipment and their functions.
8. Differentiate invasive and noninvasive ventilation.
9. Describe the effects of mechanical ventilation on the pulmonary and cardiovascular systems,
including barotrauma, cardiac preload, afterload, and output.
10. Identify the components of a ventilator circuit.
11. Define normal settings for the following transport ventilator parameters:
 Tidal volume
 Mode
 Mechanical sigh
 End respiratory pressure
 Respiratory rate
 Ratio of the length of expiration to inspiration (I:E) ratio
 Fraction of inspired oxygen (FiO2)
 Peak flow
 Positive inspiratory pressure (PIP)
 Minute ventilation
 Pressure limit
 Pressure support
 Positive end expiratory pressure (PEEP)
12. Describe the clinical uses, precautions, and limitations and adverse effects of the following
standard modes of ventilation:
 Controlled mandatory ventilation (CMV)
 Assist control (AC)
 Intermittent mandatory ventilation (IMV)
 Synchronized intermittent mandatory ventilation (SIMV)
 Pressure support ventilation (PSV)
 Continuous positive airway pressure (CPAP)
 Bilevel positive airway pressure (BiPAP)
 Positive end expiratory pressure (PEEP)
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Critical Care Transport: Course Planning and Preparation
13. Explain the use of PEEP.
14. Troubleshoot low pressure (disconnect), high pressure, power failure, and other common
alarms.
15. Describe the effects of patient activity on mechanical activity.
16. Demonstrate assessment and calculations of adult tidal volumes and pressures.
17. Discuss basic airway management strategies.
18. Describe implementation of a failed airway algorithm.
19. Explain indications and contraindications for tracheostomy.
20. List equipment and supplies needed for tracheostomy management.
21. Describe management of tracheostomies during transport, including potential complications.
22. Explain indications and contraindications for needle cricothyrotomy.
23. Explain the equipment and supplies needed and procedure for performing a needle
cricothyrotomy.
24. Describe management of a needle cricothyrotomy during transport and potential
complications and interventions.
25. Explain indications and contraindications for surgical cricothyrotomy.
26. Describe advantages and disadvantages of surgical cricothyrotomy.
27. Explain the equipment and supplies needed and the procedure for performing a surgical
cricothyrotomy.
28. Describe management of a surgical cricothyrotomy during transport and potential
complications and interventions.
29. Differentiate between obstructive and restrictive diseases.
30. Assess a respiratory cycle.
31. Identify and interpret normal and abnormal breath sounds.
32. Identify abnormal respiratory patterns.
33. Review the breath sound assessment technique used in critical care transport patients.
34. Define tidal volume, vital capacity, and peak flow.
35. Describe how pulse oximetry, capnometry, and capnography can be used to monitor
respiratory function.
36. Identify the parameters measured in arterial blood gas monitoring and identify which
parameter reflects the effectiveness of ventilation and oxygenation.
37. Describe particular clinical events that alter the functioning of the respiratory system in the
critical care patient.
38. Describe how ventilation and perfusion abnormalities affect blood gas values.
39. Perform a basic respiratory assessment for adequacy of ventilation and oxygenation using
inspection, auscultation, palpation, and noninvasive monitoring.
Section 7: Critical Care Pharmacology
1. Outline the principles of medication administration for CCTPs, including patient and
medication selection, predicted and desired responses, absorption and elimination principles, side
effects or adverse medication reactions, and transport and monitoring considerations.
2. Identify and discuss reliable resources for medication and pharmacology information.
3. Discuss the significance of medication pharmacokinetics and pharmacodynamics in the critical
care transport setting.
4. Identify airway management medications used during critical care transport, including
indications, contraindications, dosages, side effects, and interactions.
5. Identify respiratory management medications used during critical care transport, including
indications, contraindications, dosages, side effects, and interactions.
6. Identify cardiovascular system medications used during critical care transport, including
indications, contraindications, dosages, side effects, and interactions.
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Critical Care Transport: Course Planning and Preparation
7. Identify medications for neurologic conditions that are used during critical care transport,
including indications, contraindications, dosages, side effects, and interactions.
8. Identify medications affecting the gastrointestinal system that are used during critical care
transport, including indications, contraindications, dosages, side effects, and interactions.
9. Identify any miscellaneous medications that are used during critical care transport, including
indications, contraindications, dosages, side effects, and interactions.
10. Understand the sequence for medication infusion and know how to infuse medication with an
infusion pump during transport and through changes in altitude.
11. Given a medication order, correctly calculate the correct dosage for administration.
12. Describe how to evaluate actions, pharmacokinetics, indications, contraindications, correct
routes of administration, adverse effects, drug compatibilities and incompatibilities, and
interactions for safe administration of multiple medications to a single patient.
Section 8: Laboratory Analysis and Diagnostic Studies
1. Understand the overall principles of laboratory analysis.
2. Understand the difference between sensitivity and specificity.
3. Discuss the difference between specimen culture and sensitivity.
4. Understand relevant basic chemistry and physiology.
5. Recognize the most commonly ordered laboratory tests done in the emergency department and
in the intensive care unit.
6. Understand the importance of abnormal laboratory results as they relate to patient condition.
7. Discuss the causes of abnormal laboratory results.
8. Recognize blood typing and blood groups.
9. Understand the proper procedure for collecting blood specimens.
10. Identify the proper test tubes used for collecting blood specimens.
11. Identify the common errors in specimen collection.
12. Understand the basics of diagnostic imaging, including the standard radiograph, computed
tomography (CT), magnetic resonance imaging (MRI), and ultrasound.
Section 9: Shock and Multiple Organ Dysfunction Syndrome
1. Discuss oxygen transport and utilization of oxygen by the cell.
2. Discuss cellular respiration.
3. Discuss the pathophysiology of shock and its stages: initial, compensatory, progressive, and
refractory.
4. Describe the clinical manifestations associated with the various shock states.
5. Discuss the classification of shock: hypovolemic, cardiogenic, distributive (neurogenic),
anaphylactic, and septic.
6. Identify from a patient presentation what type and stage of shock the patient is experiencing.
7. Define the following terms: infection, sepsis, sepsis syndrome, systemic inflammatory
response syndrome (SIRS), severe sepsis, septic shock, and multiple organ dysfunction syndrome
(MODS).
8. Describe the etiology and pathophysiology of shock, sepsis, SIRS, and MODS.
9. Describe the history and incidence of sepsis relative to mortality.
10. Describe the risk factors considered important in the development of sepsis.
11. Describe the new theory in the development of SIRS, including the four response stages.
12. Explain the pathophysiology of SIRS.
13. Describe the mediators involved in the development of sepsis.
14. Recognize the individual organ manifestations related to the development of SIRS.
15. Identify the signs and symptoms that describe the patient in shock, sepsis, SIRS, or MODS.
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Critical Care Transport: Course Planning and Preparation
16. Discuss lab values of the septic or MODS patient.
17. Discuss assessment and management of the shock/MODS patient.
18. Discuss the pathophysiology, treatment, and prevention of adult respiratory distress syndrome
(ARDS).
19. List the parameters necessary to monitor during the transport of a critical patient experiencing
shock, sepsis, SIRS, or MODS.
20. Select from a list those interventions necessary during transport of the critically ill patient
experiencing shock, sepsis, SIRS, or MODS.
21. Discuss pharmacologic agents used in the treatment of the shock/MODS patient.
22. Describe the anatomy, purpose, function, and physiology of the hematologic system,
including:
 Bone marrow
 Liver
 Stem cells
 Red blood cells
 Platelets
23. Explain ABO and Rh blood grouping.
24. Compare and contrast the indications and contraindications for and the benefits and
drawbacks of the administration of whole blood and various blood products.
25. Explain the process of blood and blood-product administration.
26. Predict the consequences of the administration of blood and blood products incompatible with
the recipient's blood type.
27. Recognize the signs and symptoms of a reaction to the infusion of blood and blood products.
28. Given a clinical scenario of a patient experiencing a reaction to an infusion of blood or blood
products, develop a plan of intervention.
29. Explain indications, contraindications, precautions, and complications of using the following
blood products:
 Packed red blood cells (PRBCs)
 Whole blood
 Platelets
 Albumin
 Fresh frozen plasma
 Cryoprecipitate
30. Describe the method of administering the following blood products, including required
equipment, size of intravenous (IV) access, fluid required, volume in one unit, and rate of
infusion, as well as steps for safe administration and monitoring requirements during and after
transfusion with:
 PRBCs
 Whole blood
 Platelets
 Albumin
 Fresh frozen plasma
 Cryoprecipitate
31. Describe requirements for transporting the following blood products:
 PRBCs
 Whole blood
 Platelets
 Albumin
 Fresh frozen plasma
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Critical Care Transport: Course Planning and Preparation
 Cryoprecipitate
32. Explain indications, contraindications, precautions, and complications that arise from
transfusion of the following blood products:
 PRBCs
 Whole blood
 Platelets
 Albumin
 Fresh frozen plasma
 Cryoprecipitate
33. Describe the mechanism, signs and symptoms, timing, and treatment for the following blood
transfusion reactions:
 Hemolytic
 Anaphylactic
 Febrile
 Circulatory overload
Section 10: Trauma
1. Understand the CCTP's impact on preventing trauma deaths by performing proper prehospital
care and transporting to the appropriate trauma center.
2. Understand the significance of trauma management on morbidity and mortality.
3. Understand the various trauma scoring systems, including the Glasgow Coma Scale, the trauma
score, the revised trauma score, the abbreviated injury scale, the injury severity score, and the
trauma injury severity score, and how they are used.
4. Understand Newton's first, second, and third laws of motion and how they relate to patterns of
injury.
5. Discuss the types of trauma.
6. Describe the steps of the assessment process that are specific to critical care trauma patients.
7. Explain the concept of triage and standard triage systems (START and JumpSTART).
8. Discuss the classifications of trauma centers defined by the American College of Surgeons'
Committee on Trauma, including level I, II, III, and IV trauma centers.
9. Discuss the American College of Surgeons' Committee on Trauma patient classifications.
10. Understand how to assess a trauma critical care patient.
11. Know how to recognize, assess, and manage the most common critical care injuries, including
pneumothorax (open, tension, and simple), hemothorax, flail chest, pericardial tamponade, aortic
dissection, myocardial contusion, diaphragmatic rupture, tracheobronchial disruption, pulmonary
contusion, esophageal perforation, and traumatic asphyxia.
12. Know how to recognize, assess, and manage critical care ear, eye, neck, throat, and thyroid
injuries.
13. Understand how and when to use diagnostic imaging, including the standard radiograph,
computed tomography, magnetic resonance imaging, ultrasonography, intra-abdominal pressure
monitoring, and related transport considerations.
14. Know the signs and symptoms as well as how to manage abdominal and pelvic injuries,
including both hollow and solid organ injuries.
15. Recognize the different types of fractures and know how to manage them.
16. Know how to recognize, monitor, and manage compartment syndrome, crush injuries, and
rhabdomyolysis.
17. Understand pharmacology as it relates to trauma and know the specific treatments and
medications.
18. Understand the specific trauma considerations for special populations.
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Section 11: Neurologic Emergencies
1. Describe the major anatomic structures of the central and peripheral nervous systems and their
physiology as pertinent to the CCTP.
2. List the components of a focused neurologic assessment and differentiate between normal and
abnormal findings. Describe how to perform a neurologic assessment, including the following
specific assessments: mini-mental exam; assessment of speech abnormalities, cranial nerves,
eyes, motor function, and sensory function, reflex testing, and evaluation of meningeal irritation.
3. Discuss the pathophysiology of traumatic brain injury, including primary and secondary brain
injury.
4. Explain the significance of cerebral perfusion pressure and mean arterial pressure.
5. Discuss the pathophysiology of specific neurologic injuries, including scalp injuries, skull
fractures, facial fractures, epidural hematoma, subdural hematoma, and diffuse axonal injury.
6. Discuss lab values relevant to neurologic emergencies and their interpretation.
7. Define intracranial pressure (ICP) and explain its pathophysiology.
8. Define and explain cerebral perfusion pressure (CPP) and cerebral blood blow (CBF) and
describe their relationship to ICP and mean arterial pressure (MAP).
9. Discuss clinical manifestations of increased ICP, including brain herniation.
10. Discuss the concept of ICP monitoring, including indications, contraindications, methods,
devices, waveforms, complications, procedures, adverse reactions and interventions, and postprocedure care.
11. Explain the function, purpose, and differences between various ICP monitoring devices,
including intraventricular cannula, subdural or subarachnoid screw/bolt, fiberoptic tipped
transducer probe, and epidural and subdural catheters.
12. Describe normal ICP and CPP values and causes of increased and decreased values.
13. Discuss the relationship between intracranial volume and intracranial pressure.
14. List special considerations when transporting a patient with ICP monitoring.
15. Describe how to drain cerebrospinal fluid (CSF) using a monitoring catheter.
16. Discuss management of ICP during transport.
17. Describe spinal injuries, including primary spinal cord injury and secondary spinal cord
injury, and their assessment, management, and complications.
18. Discuss types of stroke, their assessment, transport management, and thrombolytic and
fibrinolytic therapy.
19. Describe the pathophysiology of subarachnoid hemorrhage, its assessment, and its
management, including neurologic diagnostics.
20. Discuss seizures and epilepsy, including transport management.
21. Discuss transport considerations for patients with neurologic injuries.
22. Discuss considerations for managing neurologic emergencies in flight.
23. Interpret data collected from neurologic assessment and monitoring devices and integrate
findings to formulate an impression of the patient's clinical status.
24. Predict probable physiologic consequences using serial assessment of the patient's neurologic
status.
25. Construct a treatment plan for a critically ill patient with a neurologic disorder.
26. Explain the common treatments and potential complications during transport of patients with
the following conditions:
 Subarachnoid hemorrhage
 Epidural hematoma
 Subdural hematoma
 Hydrocephalus
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






Cerebral neoplasm (brain tumor)
Intracranial aneurysms
Arteriovenous malformations
Acute stroke
Spinal cord injury (SCI)
Status epilepticus
Guillain-Barre syndrome
Section 12: Burns
1. Describe the layers and functions of the skin.
2. List the major causes of burn injury.
3. Describe the anatomy of a burn.
4. Explain the process of the body's systemic inflammatory response to a burn.
5. Explain the factors that determine the classification of burn injury, including body surface area
and burn depth.
6. List the classifications of burn injuries, including superficial burns, partial thickness burns,
deep partial thickness burns, full-thickness burns, subdermal burns, as well as minor burns,
moderate burns, and major burns.
7. Identify the methods for calculating the total body surface area burned, including the rule of
nines and the Lund and Browder chart.
8. Describe how to evaluate a burn patient and what constitutes a pertinent history.
9. Discuss assessment considerations for a burn patient's airway, breathing, and circulation.
10. List situations in which the CCTP should suspect an inhalation injury.
11. Discuss the roles of edema and compartment syndrome in relation to a burn injury.
12. Describe the process of stopping a burn, including irrigation, cooling, decontamination, and
special considerations.
13. Discuss management of a burn patient's airway, breathing, and circulation.
14. Discuss special considerations for patients who may have carbon monoxide poisoning or
cyanide poisoning in conjunction with a burn injury.
15. Explain various fluid resuscitation formulas, including the Parkland formula and the
Galveston formula, and describe parameters for adjusting the infusion rate.
16. Describe how to manage and dress burn wounds.
17. Discuss pain management of burn patients.
18. Recognize which patients require transport to a burn center or unit.
19. Discuss special situations relating to burn injuries such as hypothermia, the need for gastric
decompression, renal failure, and rhabdomyolysis.
20. Discuss management of specific burns, including ocular burns, facial burns, ear burns,
circumferential burns, hand and foot burns, genitalia burns, pediatric burns, electrical burns, and
chemical burns.
21. List the types of burns that may suggest potential child maltreatment.
22. Discuss toxic epidermal necrolysis (TENS) and Stevens-Johnson syndrome (SJS) and the
similarity between their management and the management of severe burn patients.
Section 13: Cardiovascular Disorders
1. Explain how to correctly place leads from a 12-lead electrocardiographic (ECG) monitor.
2. Explain how to correctly place additional precordial leads for diagnosing right ventricular and
posterior infarctions.
3. Explain how to determine the heart's electrical axis.
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4. Discuss the step-by-step systematic approach that should be used when interpreting an ECG.
5. Describe how to monitor a patient by using an ECG machine during a critical care transport.
6. Explain the assessment process for a patient undergoing ECG monitoring during a critical care
transport.
7. Describe how to identify a hemiblock on an ECG.
8. Explain the management of a patient with a hemiblock during critical care transport.
9. Describe how to identify a bundle branch block on an ECG.
10. Explain the management of a patient with a bundle branch block during critical care transport.
11. Describe the significance of ST- and T-wave changes and how they are identified on an ECG.
12. Describe complications that can occur with a cardiac patient during critical care transport.
13. Describe different criteria for determining the presence of left ventricular hypertrophy (LVH),
right ventricular hypertrophy (RVH), and the presence of strain.
14. Using various criteria, identify cases of LVH and RVH on a 12-lead ECG.
15. Describe the clinical significance of LVH.
16. Identify criteria suggestive of right and left atrial enlargement, and describe the clinical
implications of such enlargement.
17. Describe the ECG changes that indicate the presence of Wolff-Parkinson-White syndrome.
18. Identify ECG changes that could indicate conditions such as pericarditis, acute pulmonary
embolism, and early repolarization variant.
19. Describe the potential implications of a prolonged QT interval.
20. Describe how to identify ventricular tachycardia on an ECG, including when it occurs in
conjunction with wide complex tachycardia.
21. Explain the management of a patient with ventricular tachycardia, including when it occurs in
conjunction with wide complex tachycardia.
22. Describe ECG changes associated with drug and electrolyte disturbances, hyperkalemia,
hypokalemia, hypercalcemia, and hypocalcemia and the clinical implications of these conditions.
23. Generally describe the field of electrophysiology, including its purpose and capabilities.
24. Describe the spectrum of therapeutic options for patients with cardiac arrhythmias.
25. Briefly discuss the general categories of cardiovascular drugs and their actions and
indications.
26. Describe the pathophysiology, etiologies, symptoms, and treatments for patients with the
following cardiovascular conditions:
 Coronary artery disease
 Angina pectoris.
 Myocardial infarction
 Heart failure
 Cardiac arrhythmia
 Myocarditis
 Pericardial disease
 Infective endocarditis
 Cardiomyopathy
 End-stage heart disease
 Mitral insufficiency
 Mitral stenosis
 Aortic insufficiency
 Aortic stenosis
 Hypertensive crisis
 Aortic arterial disease
 Peripheral vascular disease
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27. Understand the basic concepts underlying cardiac pacemaker technology, including the
following:
 Pacing circuits and impulses
 Leads and electrodes
 Single-chamber demand pacemakers and dual-chamber pacemakers
 NASPE/BPEG Generic (NBG) codes for describing pacemaker functions and
capabilities.
28. Describe the general steps in pacemaker troubleshooting and the specifics of identifying and
resolving problems with electromagnetic interference.
29. Recognize single- and dual-chamber pacing systems by their ECG characteristics.
30. Understand the purpose and function of the atriobiventricular pacing device.
31. Describe the components and function of implantable cardioverter defibrillators (ICDs).
32. Understand the purpose of an atrial tachycardia ICD.
33. List the types of therapy an ICD can deliver and their indications.
34. Discuss the general types of ICD malfunction, including the following:
 Historical factors that may play a role or offer diagnostic clues
 Common reasons for malfunction
 The role of the “doughnut” magnet in managing ICD malfunction
35. Briefly list the special considerations related to external defibrillation when an ICD is present.
Section 14: Hemodynamic Monitoring
1. Discuss the principles of and indications for invasive hemodynamic monitoring.
2. Interpret the following hemodynamic values and discuss their meaning:
 Central venous pressure (CVP)
 Systolic blood pressure (SBP)
 Diastolic blood pressure (DBP)
 Mean arterial pressure (MAP)
 Pulse pressure
 Pulmonary artery pressures (systolic, diastolic, and mean)
 Pulmonary capillary wedge pressure (PCWP)
 Cardiac output (CO)
 Cardiac index
 Pulmonary vascular resistance (PVR)
 Systemic vascular resistance (SVR)
 Stroke volume (SV)
 Mixed venous saturation (SvO2)
3. List normal hemodynamic values for the various types of invasive hemodynamic
measurements.
4. Describe the significance of each pressure reading used in patient management.
5. Describe how a central venous line works and list the sites where it may be placed.
6. Describe the types of catheters used for central venous lines.
7. Discuss indications, contraindications, and complications for central venous lines.
8. Describe the equipment and steps for inserting a central venous line.
9. Explain how to troubleshoot problems encountered when inserting a central venous line.
10. Describe how an arterial line works and list the sites where it may be placed.
11. Describe the types of catheters used for arterial lines.
12. Discuss the indications, contraindications, and complications for arterial lines.
13. Describe the equipment and steps for inserting an arterial line.
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14. Discuss the concepts of preload, afterload, and the Frank-Starling curve.
15. Demonstrate the proper placement of and zeroing procedure for a pressure transducer.
16. Describe proper transport procedures for invasive hemodynamic monitoring.
17. Describe troubleshooting procedures for common problems with invasive hemodynamic
monitoring during transport.
18. Discuss flight considerations related to invasive hemodynamic monitoring.
Section 15: Intra-Aortic Balloon Pumps and Cardiac Assist Devices
1. List the five phases of the cardiac cycle and describe the associated events that affect:
 Blood volume in the heart chambers
 Coronary perfusion as it relates to the cardiac cycle
 Myocardial oxygen demand
 The arterial pressure waveform
 The physiologic effects of heart failure
2. Generally describe the setup and operation of an intra-aortic balloon pump (IABP).
3. Describe the mechanics of the IABP, including the following:
 Basic design and functions of the IABP
 Catheter structure and function
 Balloon structure and function
4. List indications for IABP therapy.
5. List contraindications to IABP therapy.
6. Describe methods and locations of insertion.
7. Discuss complications from IABP insertion.
8. Discuss timing of balloon inflation and deflation.
9. Explain modes of IABP timing.
10. Define these primary physiologic effects achieved by inflation and deflation of the intra-aortic
balloon:
 Diastolic augmentation
 Systolic afterload reduction
 Improved coronary flow
11. Identify improper balloon inflation timing and discuss the hemodynamic effects and
corrective action during each of the following stages:
 Early inflation
 Early deflation
 Late inflation
 Late deflation
12. Discuss transport considerations and potential complications of IABP therapy.
 Altitude changes
 Cardiac arrest during transport
 Depletion of helium
 Console failure
 Balloon rupture
 Limb ischemia
 Insertion site bleeding
13. Discuss cardiac-assist devices, including:
 Extracorporeal membrane oxygenation (ECMO)
 Implanted left ventricular-assist device (LVAD),
 right ventricular-assist device (RVAD), and
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
biventricular-assist device (BiVAD)
Section 16: Gastrointestinal and Genitourinary Emergencies
1. Understand the anatomy and physiology of the gastrointestinal system, including the
alimentary canal and accessory organs.
2. Understand the anatomy and physiology of the genitourinary system, including the urinary
system and the male and female reproductive systems.
3. Differentiate between upper and lower gastrointestinal bleeding.
4. Understand the pathologies related to common disorders of the gastrointestinal system,
including peptic ulcers, gastritis, esophageal varices, Mallory-Weiss syndrome, diverticulitis,
angiodysplasia, inflammatory bowel disease, and ulcerative colitis.
5. Properly assess the signs and symptoms as well as describe the management of the various
gastrointestinal conditions.
6. Describe laboratory results as they relate to specific gastrointestinal system disorders.
7. Describe gastrointestinal system imaging, including endoscopy, colonoscopy, angiography, and
scintigraphy, as well as other in-hospital assessment and management techniques.
8. Understand the pathologies related to diseases of the gastrointestinal system, including acute
abdomen of unknown origin, intestinal obstructions, inflammatory bowel disease, ileus, liver
disease, acute gastrointestinal bleeding, choledocholithiasis, and pancreatitis.
9. Understand the pathologies related to common disorders of the genitourinary system, including
both acute and chronic renal failure, urinary tract infections, testicular torsion, penile fracture, and
priapism.
10. Properly assess the signs and symptoms as well as describe the management of the various
pathologies discussed.
11. Discuss different renal therapies, including hemodialysis; renal replacement therapies, such as
continuous hemofiltration; and peritoneal dialysis.
12. Describe assessment and care of the following dialysis devices: arteriovenous shunt,
peritoneal catheter, external hemodialysis catheter, and tunneled hemodialysis catheter.
13. Describe genitourinary system laboratory results as they relate to the specific disorders.
14. Describe various gastrointestinal- and genitourinary-related feeding and drainage tubes,
including their assessment, maintenance, and potential complications. Examples include various
feeding tubes, different types of urinary catheters, ostomies, Jackson-Pratt drains, and T-tubes.
15. Describe the rationale and method for insertion of nasogastric (NG) and orogastric (OG) tubes
and care of tubes during transport as well as potential complications and interventions.
16. Describe types of feeding tubes, including percutaneous endoscopic gastrostomy (PEG) and
jejunostomy tubes.
17. Explain feeding tube assessment prior to transport.
18. Describe feeding tube management during transport.
19. Understand flight considerations for patients with feeding or drainage tubes.
20. Understand acid-base physiology.
21. Examine how the body's chemical buffer system mitigates acid-base imbalances.
22. Describe how to interpret blood gas samples.
23. Understand the pathologies related to an imbalance of acid-base, their clinical features, and
their treatment. Pathologies include metabolic alkalosis, metabolic acidosis, and renal metabolic
acidosis.
24. Understand flight considerations for patients with gastrointestinal and genitourinary tract
complications.
Section 17: Endocrine Emergencies
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Critical Care Transport: Course Planning and Preparation
1. Describe the anatomic structures of the endocrine system and their physiology.
2. Discuss the pathophysiology, assessment, and critical care transport management of conditions
related to diabetes, including hypoglycemia, hyperglycemia, diabetic ketoacidosis, and
hyperosmolar hyperglycemic nonketotic syndrome.
3. Discuss the pathophysiology, assessment, and critical care transport management of pituitary
disorders, including central diabetes insipidus, pituitary lesions, acromegaly, and gigantism.
4. Discuss the pathophysiology, assessment, and critical care transport management of adrenal
abnormalities, including adrenal insufficiency, Addison's disease, Cushing's disease,
pheochromocytoma, aldosteronism, and amyloidosis.
5. Discuss the pathophysiology, assessment, and critical care transport management of thyroid
abnormalities, including hyperthyroidism, hypothyroidism, myxedema coma, thyrotoxicosis,
Hashimoto's disease, and thyroid cancers.
6. Discuss the pathophysiology, assessment, and critical care transport management of lipid
disorders, including metabolic syndrome.
Section 18: Environmental Emergencies
1. Discuss risk factors for environmental emergencies.
2. Describe the process of thermoregulation, including the concepts of thermogenesis and
thermolysis.
3. Explain the process of heat transfer, including radiation, conduction, convection, evaporation,
and absorption.
4. Discuss signs, symptoms, and transport management of heat cramps.
5. Discuss signs, symptoms, and transport management of heat syncope.
6. Discuss signs, symptoms, and transport management of heat exhaustion.
7. Discuss signs, symptoms, and transport management of heat stroke.
8. Discuss signs, symptoms, and transport management of frostbite.
9. Discuss signs, symptoms, and transport management of hypothermia.
10. Discuss signs, symptoms, and transport management of drowning and submersion.
11. Discuss signs, symptoms, and transport management of diving injuries.
12. Explain the purpose of hyperbaric therapy and when it might be used.
13. List flight considerations relating to environmental emergencies.
Section 19: Infectious and Communicable Diseases
1. Describe the differences between eukaryotic and prokaryotic microorganisms.
2. Describe the types of immunity and the components of humoral and cell-mediated immunity.
3. Describe the physiology of the immune response.
4. Understand the types of anaphylaxis and state the signs, symptoms, and treatment of
anaphylaxis.
5. Discuss the implications of transporting patients with immunodeficiencies.
6. Discuss the differences between normal, opportunistic, and pathogenic organisms.
7. State the virulence factors found in pathogenic organisms and how they can be spread from
bacterial cell to bacterial cell.
8. Describe the portals of entry for infectious organisms and the process of infection once entry is
gained.
9. Compare the effects of bacterial endotoxins and exotoxins.
10. Describe viral pathogenesis.
11. Give examples of reportable or notifiable infectious diseases.
12. Differentiate infectious versus communicable diseases.
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13. Discuss epidemiology, including reservoirs of infection and transmission of infectious
disease.
14. Discuss the etiologic agents, mode of transmission, signs and symptoms, and treatment of the
following:
 Meningitis (bacterial and viral)
 Respiratory syncytial virus
 Necrotizing fasciitis
 Epiglottitis
 Tuberculosis
 Pneumonia
 Fungal diseases
 Influenza
 Various herpesviruses
 Viral hepatitis
 Human immunodeficiency virus
 Severe acute respiratory syndrome
 Escherichia coli O157:H7
 West Nile virus
 Helicobacter pylori
 Methicillin-resistant Staphylococcus aureus and vancomycin-resistant S aureus
 Vancomycin-resistant enterococci
 Rickettsial diseases such as Rocky Mountain spotted fever
15. Understand acquired immunodeficiency syndrome–defining conditions.
16. State the recommendations for use of standard precautions in all health care settings.
17. Understand how the overuse and misuse of antimicrobials leads to resistant infectious
organisms.
18. Discuss the appropriate and correct use of personal protective devices (both donning and
doffing).
19. Understand the vaccinations needed for CCTPs and health care workers in general.
20. State universal precautions and discuss situations when these should be used.
21. State isolation, airborne, and droplet precautions and discuss situations when these should be
used.
22. Discuss the importance of handwashing and use of hand sanitizers and/or hand antiseptics in
preventing contamination and transmission of infectious diseases.
23. Understand decontamination chemicals and techniques appropriate for cleanup after
transporting patients harboring various infectious diseases. Include decontamination of equipment
and vehicle surfaces as well as uniforms (clothing and shoes) and personal protective equipment.
24. Discuss actions to take after blood exposure.
Section 20: Toxicologic Emergencies
1. Identify issues that may adversely affect the health and safety of critical care transport
professionals during the treatment and transport of patients experiencing a toxicologic
emergency.
2. Describe priority interventions and considerations common to all patients following a
poisoning or overdose.
3. Discuss the assessment findings associated with the various toxidromes and medication
reaction syndromes encountered in the critical care environment.
4. Describe the management of a patient experiencing a toxicologic emergency.
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Critical Care Transport: Course Planning and Preparation
5. Discuss situations in which decontamination is required or indicated following a toxic exposure
or overdose.
6. Identify which chemicals or medications require enhanced elimination (removal of absorbed
toxins) from the body.
7. Discuss the risks and benefits of and the techniques for administration of various antidotes.
8. Identify the clinical presentation, mechanism of toxicity, and treatment of poisoning or
overdose situations commonly encountered or requiring specialized management by critical care
transport professionals.
9. Discuss hazardous materials response and critical care transport considerations.
10. Discuss radiation emergencies and critical care transport considerations.
Section 21: Obstetric and Gynecologic Emergencies
1. Discuss the anatomy of the female reproductive system.
2. Recognize the physiologic changes during pregnancy.
3. Describe the changes that occur in the cardiovascular, respiratory, gastrointestinal, renal, and
endocrine systems.
4. Discuss dermatologic changes that occur during pregnancy.
5. Discuss special areas of concern when performing a critical care transport of a pregnant
patient.
6. Describe the management of the pregnant patient who is in cardiac arrest.
7. Discuss potential maternal cardiovascular complications exacerbated or induced by pregnancy.
8. Discuss fetal oxygenation and heart rate, including conditions associated with fetal distress
during labor.
9. Discuss how to assess a fetus during a critical care transport.
10. Describe several methods of fetal monitoring during critical care transport of a pregnant
patient, including electronic fetal monitoring.
11. Explain how to use a Doppler device.
12. Define the complications of pregnancy, including spontaneous abortion and causes of
bleeding.
13. Recognize and treat abruptio placenta, placenta previa, and uterine rupture.
14. Discuss medical conditions that can exist during pregnancy, including pregnancy-induced
hypertension, preeclampsia, eclampsia, and HELLP syndrome, and how to manage them during
critical care transport.
15. Discuss medications used in treating pregnancy-induced hypertension, including labetalol and
hydralizine.
16. Understand the concerns regarding preterm labor and premature delivery.
17. Discuss the use of tocolytic agents to interrupt labor.
18. Recognize fetal malpresentations of delivery, including frank breech, complete breech,
incomplete breech, footling breech, and umbilical cord prolapse.
19. Discuss how to manage fetal malpresentations during a critical care transport, including frank
breech, complete breech, incomplete breech, footling breech, and umbilical cord prolapse.
20. Describe shoulder dystocia and how to manage this complication during a critical care
transport.
21. Discuss multiple-birth deliveries and how to manage these during a critical care transport.
22. Briefly discuss postpartum care of the mother and infant during a critical care transport.
23. Describe potential postpartum complications and their management during critical care
transport, including amniotic fluid embolism and postpartum hemorrhage.
24. Recognize and discuss how to manage gynecologic issues and emergencies during critical
care transport, including ectopic pregnancy, pelvic inflammatory disease, toxic shock syndrome,
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Critical Care Transport: Course Planning and Preparation
ovarian cysts, pathologic cysts, ovarian torsion, and gynecologic trauma including vulvular
hematoma and sexual assault.
25. Discuss flight considerations that pertain to a critical care transport of a pregnant patient or a
patient with a gynecologic emergency.
Section 22: Neonatal Emergencies
1. Define the terms newborn, neonate, and term newborn.
2. Discuss the roles of the CCTP when caring for a neonate.
3. Recognize anatomy and physiology unique to a neonate, including differences in
thermoregulation, respiratory structure and function, oxygen transport, cardiovascular function,
renal function, fluid and electrolyte balance, central nervous system, and the skeletal system.
4. Understand how problems with transitional circulation can result in neonatal emergencies.
5. Describe developmental aspects of pain in the neonate.
6. Discuss anatomic and physiologic differences in the premature infant and how these relate to
management.
7. Discuss medical complications for which late preterm infants are at risk.
8. Identify important antepartum and intrapartum factors that can affect labor, delivery, and the
neonate, and understand the pathophysiology that is associated with these factors.
9. Identify when a CCTP would use the APGAR score in caring for a newborn.
10. Discuss neonatal assessment, stabilization, and management.
11. Discuss how to prepare for and provide neonatal resuscitation, and identify situations in
which it should be performed.
12. Explain the initial steps in resuscitation of a neonate.
13. Describe methods that can be used to improve airway and breathing in a neonate with
inadequate respiration.
14. Determine when vascular access is indicated for a neonate and appropriate fluid selection.
15. Describe appropriate assessment technique for examining a neonate.
16. Describe free-flow oxygen delivery and appropriate assisted ventilation for a neonate.
17. Describe appropriate endotracheal intubation technique for a neonate.
18. Determine when an orogastric tube should be inserted, and describe how to insert an
orogastric tube in a neonate.
19. Describe appropriate chest compression and ventilation technique for a neonate.
20. Discuss indications for medications, dosage, and routes of administration for a neonate.
21. Discuss the use of ventilators during neonatal transports.
22. Distinguish between primary and secondary apnea, and list causes, assessment, and
management.
23. Describe how to perform needle thoracentesis for pneumothorax decompression for a neonate.
24. Discuss the pathophysiology, assessment findings, management, and treatment plan of the
following respiratory emergencies in a neonate: meconium aspiration, apnea, pneumonia,
pneumothorax, respiratory distress, and respiratory failure.
25. Recognize congenital anomalies that may lead to compromise of the neonate.
26. Discuss the pathophysiology, assessment findings, and management of the following
cardiovascular emergencies in a neonate: cyanosis, tachyarrhythmias, and bradyarrhythmias,
bradycardia, cardiac arrest, persistent pulmonary hypertension, acidosis, shock, and anemia.
27. Describe how to perform umbilical vein catheterization in a neonate.
28. Discuss the pathophysiology, assessment findings, and management of the following
gastrointestinal emergencies in a neonate: gastroschisis, omphalocele, gastrointestinal obstruction
and vomiting, acute intestinal perforation, hematemesis and bleeding from the rectum, volvulus,
intussusception, and diarrhea.
29. Discuss management of infectious diseases and sepsis in the neonate.
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30. Discuss management of hyperthermia and hypothermia in the neonate.
31. Discuss management of toxic exposure in the neonate, including the appropriate treatment for
the neonate with narcotic depression.
32. Discuss the pathophysiology, assessment findings, and management of the following trauma/
birth injuries in the neonate: head and neck injuries, nerve injuries, bone injuries, and abuse/
maltreatment.
33. Discuss the pathophysiology, assessment findings, and management of the following
neurologic conditions in the neonate: seizures, hypoxic ischemic encephalopathy, and lethargy.
34. Discuss the pathophysiology, assessment findings, and management of the following
metabolic conditions in the neonate: hypoglycemia, hypocalcemia, and inborn errors of
metabolism.
35. Discuss the use of an incubator.
36. Recognize the emotional impact and the need for information, empathy, and compassion for
the parent/guardian during a critical care transport.
37. Discuss risks associated with critical care transport, including factors unique to air transport
of a neonate.
Section 23: Pediatric Emergencies
1. Review the anatomic and physiologic differences between adult and pediatric patients.
2. Outline the differences in the general approach to critical care transport patient assessment
between adult and pediatric patients.
3. Discuss the indications, dosage, and route of administration for medication administration in
pediatric patients in the critical care transport environment.
4. Describe what special pediatric equipment may be needed in a critical care transport.
5. Discuss interfacility transport considerations relating to pediatric critical care transport.
6. Explain considerations when parents and caregivers accompany during a transport.
7. Discuss common medical emergencies in the pediatric population, including respiratory
conditions, cardiac conditions, renal disorders, sepsis, and meningococcal infections, and their
assessment and management in the critical care transport environment.
8. Examine common pediatric trauma emergencies, including head injuries, spinal cord injuries,
related breathing and circulation abnormalities, fractures, and burns, and their assessment and
management in the critical care transport environment.
9. Describe critical care transport management of a pediatric patient with suspected abuse or
neglect.
10. Describe critical care transport management of a pediatric patient with hypothermia.
11. Describe critical care transport management of a pediatric patient with heat stroke.
12. Describe critical care transport management of a pediatric drowning patient.
13. Discuss how to transport a pediatric critical care patient with special health care needs.
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