Experiences of emergency care providers conducting critical care transfers in Gauteng Province, South Africa

Abstract

Background Critical care transfer (CCT) involves the movement of high-acuity patients between facilities. Internationally, CCTs are commonly performed by a dedicated team using specialised vehicles and equipment. These transfers comprise a significant portion of the work of local ambulance services; however, there is a dearth of literature on current approaches and practices. Objectives To investigate and describe the experiences of a sample of Gauteng Province-based emergency care (EC) providers conducting CCTs. Methods A qualitative descriptive design used thematic analysis to gather data from 14 purposely selected participants during semi-structured focus group discussions, which were recorded and transcribed verbatim. Data were coded and analysed using ATLAS.ti to generate themes and sub-themes. Results The two dominant themes that emerged from the study were that there is no common understanding or clear definition of a CCT in the local context, and that systemic challenges are experienced. Participants indicated that their undergraduate training did not sufficiently prepare them to conduct CCTs. Local ambulance services appear to lack a common definition and understanding of exactly what constitutes a CCT and how this differs from ‘normal’ ambulance operations. Participants felt undervalued and poorly supported, with several systemic challenges being highlighted. Conclusion The absence of a contextually relevant definition of what constitutes a CCT, coupled with potential curriculum deficits in undergraduate EC programmes, negatively impacts on the experiences of EC providers conducting CCTs. Acknowledging CCT as an area of specialisation is an important step in addressing some of the frustrations and challenges experienced by EC providers tasked with conducting such transfers. Further research into formal postgraduate programmes in CCT is recommended. Contributions of the study This study provides insights into the experiences of South African emergency care providers conducting critical care transfers (CCTs). The research highlights a need to develop a common understanding and definition accepted by industry of what constitutes a CCT and how CCTs differ from primary response incidents, including the need for additional education and a focus on the conducting of CCTs.