Prehospital transfusion training in Canada: a national survey of critical care transport organizations
Abstract Background Hemorrhagic shock is a leading cause of preventable death, and prehospital transfusion has been associated with improved outcomes in select trauma and medical patients. In Canada, several Critical Care Transport Organizations (CCTOs) have implemented prehospital transfusion progr...
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| Format: | Article |
| Language: | English |
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BMC
2025-07-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s13049-025-01435-x |
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| author | Pierre-Marc Dion Andy Pan Andrew Beckett Kanwal Singh Adam Greene Axel Benhamed Melissa McGowan Brodie Nolan |
| author_facet | Pierre-Marc Dion Andy Pan Andrew Beckett Kanwal Singh Adam Greene Axel Benhamed Melissa McGowan Brodie Nolan |
| author_sort | Pierre-Marc Dion |
| collection | DOAJ |
| description | Abstract Background Hemorrhagic shock is a leading cause of preventable death, and prehospital transfusion has been associated with improved outcomes in select trauma and medical patients. In Canada, several Critical Care Transport Organizations (CCTOs) have implemented prehospital transfusion programs to reduce geographic disparities in access to definitive care. However, limited evidence exists on how providers are trained to deliver this intervention. While simulation-based education and instructional design features improve skill retention in other contexts, their application in prehospital transfusion training has not been systematically evaluated. This study aimed to assess current training practices among Canadian CCTOs and evaluate their effectiveness. Methods We conducted a cross-sectional survey across all Canadian CCTOs. Data were analyzed descriptively using the Kirkpatrick Model framework, which evaluates training effectiveness across four levels: learner satisfaction, knowledge acquisition, behaviour change, and patient outcomes. Reporting followed the Consensus-based checklist for reporting of survey studies (CROSS) guidelines. Results All seven Canadian CCTOs with active prehospital transfusion programs participated (100% response rate), with respondents including one transport physician, three registered nurses, and three critical care paramedics per organization. Programs represented fixed-wing, rotor-wing, and land-based transport systems operating in urban, suburban, rural, and remote settings. Training approaches varied across CCTOs. Checklists were universally used to assess competency, with four organizations incorporating additional tools such as global rating scales and scenario-based evaluations. Recertification practices were inconsistent: one CCTO required annual recertification, three used bi-annual reviews, and three had no formal recertification process. Using the Kirkpatrick Model, all seven CCTOs demonstrated Level 1 (Reaction) through provision of training; five used structured feedback mechanisms, while two relied on informal feedback. At Level 2 (Learning), six organizations used didactics, practical workshops, and field training, while one relied solely on mentorship. Level 3 (Behaviour) evaluations were conducted by four CCTOs, primarily through structured assessments; three relied on documentation audits or informal peer review. No CCTOs reported Level 4 (Results) assessments through tracking of patient outcomes related to transfusion. Conclusions Considerable variability exists in prehospital transfusion training across Canadian CCTOs. Establishing training standards may support improved provider preparedness and contribute to enhanced patient care, although further evaluation is needed. |
| format | Article |
| id | doaj-art-5dc034e8c4ab467981b7fc3335d325ad |
| institution | DOAJ |
| issn | 1757-7241 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj-art-5dc034e8c4ab467981b7fc3335d325ad2025-08-20T03:06:04ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412025-07-013311810.1186/s13049-025-01435-xPrehospital transfusion training in Canada: a national survey of critical care transport organizationsPierre-Marc Dion0Andy Pan1Andrew Beckett2Kanwal Singh3Adam Greene4Axel Benhamed5Melissa McGowan6Brodie Nolan7Faculty of Medicine, University of OttawaFaculty of Medicine, University of OttawaDepartment of Surgery, St. Michael’s HospitalDefence Research and Development CanadaBritish Columbia Emergency Health ServicesDépartement d’urgence, Hôpital de l’Enfant-Jésus, CHU de Québec - Université LavalFIRST60, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health TorontoOrnge Air Ambulance and Critical Care TransportAbstract Background Hemorrhagic shock is a leading cause of preventable death, and prehospital transfusion has been associated with improved outcomes in select trauma and medical patients. In Canada, several Critical Care Transport Organizations (CCTOs) have implemented prehospital transfusion programs to reduce geographic disparities in access to definitive care. However, limited evidence exists on how providers are trained to deliver this intervention. While simulation-based education and instructional design features improve skill retention in other contexts, their application in prehospital transfusion training has not been systematically evaluated. This study aimed to assess current training practices among Canadian CCTOs and evaluate their effectiveness. Methods We conducted a cross-sectional survey across all Canadian CCTOs. Data were analyzed descriptively using the Kirkpatrick Model framework, which evaluates training effectiveness across four levels: learner satisfaction, knowledge acquisition, behaviour change, and patient outcomes. Reporting followed the Consensus-based checklist for reporting of survey studies (CROSS) guidelines. Results All seven Canadian CCTOs with active prehospital transfusion programs participated (100% response rate), with respondents including one transport physician, three registered nurses, and three critical care paramedics per organization. Programs represented fixed-wing, rotor-wing, and land-based transport systems operating in urban, suburban, rural, and remote settings. Training approaches varied across CCTOs. Checklists were universally used to assess competency, with four organizations incorporating additional tools such as global rating scales and scenario-based evaluations. Recertification practices were inconsistent: one CCTO required annual recertification, three used bi-annual reviews, and three had no formal recertification process. Using the Kirkpatrick Model, all seven CCTOs demonstrated Level 1 (Reaction) through provision of training; five used structured feedback mechanisms, while two relied on informal feedback. At Level 2 (Learning), six organizations used didactics, practical workshops, and field training, while one relied solely on mentorship. Level 3 (Behaviour) evaluations were conducted by four CCTOs, primarily through structured assessments; three relied on documentation audits or informal peer review. No CCTOs reported Level 4 (Results) assessments through tracking of patient outcomes related to transfusion. Conclusions Considerable variability exists in prehospital transfusion training across Canadian CCTOs. Establishing training standards may support improved provider preparedness and contribute to enhanced patient care, although further evaluation is needed.https://doi.org/10.1186/s13049-025-01435-xBlood transfusionAir ambulancesEmergency medical servicesCritical careSimulation trainingMedical education |
| spellingShingle | Pierre-Marc Dion Andy Pan Andrew Beckett Kanwal Singh Adam Greene Axel Benhamed Melissa McGowan Brodie Nolan Prehospital transfusion training in Canada: a national survey of critical care transport organizations Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Blood transfusion Air ambulances Emergency medical services Critical care Simulation training Medical education |
| title | Prehospital transfusion training in Canada: a national survey of critical care transport organizations |
| title_full | Prehospital transfusion training in Canada: a national survey of critical care transport organizations |
| title_fullStr | Prehospital transfusion training in Canada: a national survey of critical care transport organizations |
| title_full_unstemmed | Prehospital transfusion training in Canada: a national survey of critical care transport organizations |
| title_short | Prehospital transfusion training in Canada: a national survey of critical care transport organizations |
| title_sort | prehospital transfusion training in canada a national survey of critical care transport organizations |
| topic | Blood transfusion Air ambulances Emergency medical services Critical care Simulation training Medical education |
| url | https://doi.org/10.1186/s13049-025-01435-x |
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