Infant Transport Team (ITT)
Infant Transport Team Paramedics (ITT) represent the most highly specialized paramedics in Canada. Currently the BC Ambulance Service ITT is the only paramedic based critical care transport team in the world that provides tertiary care to three distinct specialty patient populations. ITT paramedics are specially educated to provide critical care in the pre-hospital as well as inter-hospital environment for neonatal, paediatric and obstetrical patients. This dedicated group of paramedics are skilled at providing care to critically unwell patients all over the province and into the Yukon. Transport of these teams is by whatever conveyance is available and appropriate. The teams are based at BC Children’s & Women’s Health Centre (C&W) in Vancouver and provide road and air transport services as required. In addition to inter-hospital critical care transport the team does targeted pre-hospital response support for the city of Vancouver and surrounding communities.
The Infant Transport Team has a 38 year history of service within BC. Back in the mid-70s some visionary physicians adopted a group of enthusiastic paramedics (Team 1) for a revolutionary program. This program would see paramedics providing care for neonatal patients that required transport to the Special Care Nursery housed within Vancouver General Hospital. Team 1 completed an adhoc training program that was facilitated and delivered within that special care nursery. As time progressed, so did the vision of the roles and responsibilities the team could assume within the critical care transport realm. After a number of years it was felt that these paramedics could also transport unwell paediatric patients, then the natural evolution to managing high risk obstetric patients occurred. This process was long and carefully planned out by the neonatal, paediatric, and obstetric specialty physicians that have directed the education and provided the clinical oversight for the Team.
To date there have been 9 classes (teams) trained. With each new training program there have been advances in care and educational strategies. The current education program is 18 months long with successful completion resulting in an Infant Transport Team Paramedic license. This license level is unique to BC and does not conform strictly to the National Occupancy Competency Profiles (NOCPs). Since many of the skill and knowledge based competencies are not used within the NOCP framework it is impossible to adhere to the NOCPs for validation. The positive side of this gap in the NOCPs is the need to validate the curriculum and care concepts through an independent outside adjudicator. Exhaustive reviews of the ITT program have been performed and continue to be revisited routinely to ensure that the most up to date and evidence based medicine is being taught and consistent high quality care is being carried out.
Within the current ITT program is the requirement to complete 6 post graduate nursing courses in the 3 specialty areas of critical care; neonatal, paediatric, and obstetric. In addition to the didactic component there is a significant clinical component that is completed during the 5 blocks of training. Each clinical placement builds upon the previous with the final clinical placements being performed in the highest acuity areas of the NICU, PICU and high risk delivery areas of C&W. Direct and constant oversight is provided by the physician group within all of the specialty areas. Inextricably linked within the program are the field practicums. Each field practicum puts the student in a position of responsibility for ever increasing aspects of the patient’s care. These field practicums culminate with the student being solely responsible for all care decisions, while under the watchful and supportive eye of a seasoned ITT practitioner. Following the final field practicum there is a comprehensive examination process that is undertaken with close oversight and scrutiny from the various specialty areas within C&W. Upon successful completion of the examination process, each graduate is enrolled in a 6 month residency process that further supports their growth and development into an expert ITT Paramedic practitioner.
Completion of the recruit training program is the start of a career of learning and development. The team has a long history of support and development as an entrenched part of the critical care family within C&W. All education, whether initial training or continued development focuses on clinical concepts with close attention to pathophysiology and evidence-based medicine. The purpose of this understanding is to allow the ITT paramedic to be the eyes and ears of the intensivists, neonatolgists, and perinatologists that coordinate the critical care transports. There is a close working relationship between the ITT and the physician groups within C&W. ITT has always had the opportunity to participate in educational opportunities within C&W. In the past couple of years a robust program of Maintenance of Competency (MoCOMP) has been implemented for each ITT paramedic to identify, track, and ensure adequate exposure to critical competencies is maintained on an annual basis. ITT has been called upon to support the in-house and transport Extra-Corporeal Life Support program. The perfusionist group has advocated for the inclusion of the ITT into their annual education programs. ITT brings to this program the transport and logistic expertise while being able to support the clinical requirements on these highly complex, life saving transports.
The Infant Transport Team of the BC Ambulance Service are respected and valued members of the critical care health delivery team. Communities around the province have come to respect and appreciate the service that “The Team” has provided with dedication, skill and compassion over the past 38 years.