Andrew P Reimer, Hans Breitbach, David Kaniecki, Keith Evans, Abigail Brown, Fredric M Hustey, K Melissa Smith Hayes
These findings provide empirical support for the role of NPs in CCT, demonstrating consistent perceptions of their contributions to advanced diagnostic reasoning, complex clinical decision making, and high-acuity patient management. Although institutional scope-of-practice variation influences procedural and role autonomy, respondents across transport roles reported clear benefits to care quality, team collaboration, and operational effectiveness. Overall, the findings indicate that NPs are well positioned to strengthen the capability and clinical care of CCT teams, especially in systems conducting complex interfacility transfers. They also underscore the need for research evaluating objective outcomes, cost implications, and optimal integration models.
BACKGROUND: Nurse practitioners (NPs) are increasingly integrated into critical care transport (CCT) teams, yet limited empirical data describe their functional impact. Previous reports identified potential benefits-advanced diagnostic reasoning, procedural capability, and operational leadership-but these observations were largely anecdotal. Therefore, this report aimed to present the findings of a survey of CCT team members' experiences working with NPs.
METHODS: A cross-sectional survey was distributed from December 2023 to March 2024 to CCT programs employing NPs and to the broader medical transport community. The survey assessed demographic characteristics, perceived influence across clinical and operational domains, and required NP proficiencies. Likert-scale responses were summarized descriptively. Open-ended responses were reviewed to identify recurrent themes.
RESULTS: Seventy-two complete responses were analyzed. Respondents averaged 13.3 years of transport experience and 8.6 years in their current role. Across roles, personnel reported that NPs enhance clinical decision making by contributing advanced pathophysiologic assessment (89%), expanding differential diagnosis generation, and improving management of ventilator titration, metabolic derangements, and hemodynamic instability. NPs were also reported to strengthen education and mentoring (85%), team communication during high-acuity transports (76%), and operational decision making such as scene triage and resource allocation (70%). Finally, 67% of the sample identified that NPs are currently not being used to their full potential in CCT.
CONCLUSION: These findings provide empirical support for the role of NPs in CCT, demonstrating consistent perceptions of their contributions to advanced diagnostic reasoning, complex clinical decision making, and high-acuity patient management. Although institutional scope-of-practice variation influences procedural and role autonomy, respondents across transport roles reported clear benefits to care quality, team collaboration, and operational effectiveness. Overall, the findings indicate that NPs are well positioned to strengthen the capability and clinical care of CCT teams, especially in systems conducting complex interfacility transfers. They also underscore the need for research evaluating objective outcomes, cost implications, and optimal integration models.