This is another concerning question; concerning because the agency for which my correspondent works should have answered this and the fact that they have to ask me makes me question the professionalism of the agency. Today’s correspondent works
… for a hospital as a Patient Transport Officer. I have a position description which is silent on what interventions with patients is required of me.
The vehicle is fitted with a defibrillator and a first aid kit. If a patient requires CPR, am I required to ventilate the patient? If so, by what method as a minimum would this entail (‘Laedal’ type mask with filter, Bag Valve mask)?
I also transport 2 day old infants to another facility with the mother. If the infant was to respiratory arrest, what actions would be required of me apart from requesting an emergency ambulance?
I presume that a patient transport officer has, at least, a current first aid certificate and ideally a Certificate III in Non-Emergency Patient Transport which would include advanced first aid training (see https://www.myskills.gov.au/courses/details?Code=HLT31115). Failure to have that sort of training makes the person a ‘driver’ but not a ‘Patient transport officer’.
As the driver of people with a medical condition and as part of the hospital the driver, and the hospital, have a duty of care to their patient. That duty must be a duty to provide ‘reasonable care’. If the driver doesn’t know what that means, you have to ask what sort of training and quality assurance does the employer hospital have?
Whether CPR requires ventilation is a matter of what is reasonable. The Australian Resuscitation Council Guideline 8 on Cardio-Pulmonary Resuscitation says ‘All rescuers should perform chest compressions for all those who are unresponsive and not breathing normally … those who are trained and willing to give breaths do so for all persons in cardiac arrest’. It is noted that this is a ‘weak recommendation [with] very low quality of evidence’ ([3.1]).
But what is concerning is that my correspondent doesn’t feel trained or confident trained to give breaths nor trained and equipped with appropriate PPE whether that is a face mask, a soft bag or an oxygen resuscitator.
So the answer to the question ‘am I required to ventilate the patient?’ depend on the training received and equipment supplied. At the end of the day it’s not going to make much of a difference, If the patient has a cardiac arrest and dies it’s going to be impossible to say that the absence of ventilations made a difference; but it’s a bad look if patient transport officers aren’t willing to provide the best care for their patients which prima facie includes ventilation. Patient transport officers should be trained and drilled to ensure that they are both competent and proficient in such basic skills and they should also be equipped to ensure that they can provide optimal care.
With respect transporting a 2 day old infant who has a respiratory arrest, what would be required is the application of appropriate first aid in accordance with the officer’s training, which should include first aid and resuscitation. Standing by and watching the child die, whilst saying ‘I’ve run triple zero, that’s all I have to do’ is not going to pass the tabloid test of acceptable care, even if it wouldn’t have made a difference.
To return to my starting point, what really concerns me is that this correspondent had to ask the question. If he or she doesn’t have appropriate training then he or she is a taxi driver not a ‘Patient Transport Officer’ (and even taxi drivers probably have a first aid certificate). Their employer should not only require them to have the training they should be given opportunities to practice their skills (refresher drills) and equipped to ensure that they are confident to perform CPR and other first aid should it be required. Patients wouldn’t expect the transport officer to just look on whilst patient’s die and that would not be ‘reasonable care’ from a hospital which includes the hospital operated patient transport service.
If my correspondent isn’t trained, confident, equipped and given a position description or procedures that does explain what is required of him or her, of have someone other than me they can turn to for answers, it makes me question the professionalism of the institution he or she works for.