Abstract
Background. Critical care transfers (CCT) refer to the high level of care given during
transport (via ambulance, helicopter or fixed-wing aircraft) to patients who are of high acuity.
In South Africa (SA), Advanced Life Support (ALS) paramedics undertake CCTs. The scope
of ALS in SA has no extended protocol regarding procedures or medications in terms of
dealing with these CCTs.
Aim. The aim of this study was to obtain the opinions of several experts in fields pertaining
to critical care and transport and to gain consensus on the skills and scope of practice
requirements of paramedics undertaking CCTs in the SA setting.
Methods. A modified Delphi study consisting of three rounds was undertaken using an
online survey platform. A heterogeneous sample (n=7), consisting of specialists in the fields
of anaesthesiology, emergency medicine, internal medicine, critical care, critical care
transport and paediatrics, was asked to indicate whether, in their opinion, selected procedures
and medications were needed within the scope of paramedics completing CCTs.
Results. After three rounds, consensus was obtained in 70% (57/81) of procedures and
medications. Many of these items are not currently within the scope of paramedics’ training.
The panel felt that paramedics undertaking these transfers should have additional
postgraduate training that is specific to critical care.
Conclusion. Major discrepancies exist between the current scope of paramedic practice and
the suggested required scope of practice for CCTs. An extended scope of practice and
additional training should be considered for these practitioners.