A scoping review of global approaches to education in adult critical care retrieval

TL;DR

This paper reviews global education approaches for critical care retrieval to inform curriculum development in under-resourced settings like South Africa.

Contribution

The study maps global CCR curricula and identifies gaps in training for low- to middle-income contexts.

Findings

Most CCR training studies come from high-income countries.

Seven thematic domains for CCR education were identified, including training needs and quality management.

Standardized curricula for low-resource settings like South Africa are lacking.

Abstract

African healthcare systems remain under-resourced. As a consequence, critically ill or injured patients can find themselves in health care facilities that are unable to meet their complex needs. In such instances, referrals are made to larger, better-resourced facilities for ongoing care. Critical care retrieval (CCR) services are essential for ensuring timely and safe transfer of patients between healthcare facilities. In South Africa (SA), as in many settings, ambulance services are responsible for facilitating interfacility transfers. In high-income settings, CCR is recognised as a specialised area of practice. In African contexts, there is a growing recognition that current approaches to the education and training of EMS personnel to undertake CCR may be lacking. Through this scoping review we attempted to map both local and international CCR curricula as a basis for the development of a contextual CCR curriculum.

An a priori search strategy was applied to identify peer-reviewed literature on adult CCRS training and curricula published between 2011 and August 2024. Databases searched included PubMed and Scopus, supplemented by Google and Google Scholar. Eligible studies were screened, mapped, and categorised into thematic domains aligned with a CCRS definition. Data extraction was conducted using a predesigned matrix, and findings were synthesised under emergent topic areas identified from the data.

Fifty-nine sources were included, with 85 % originating from high-income countries. Seven thematic domains were identified: the need for additional training and expanded scope of practice, call screening for specific patient populations, need for dedicated crew, equipment, quality management, and continuing medical education. There was also considerable variation in the focus, complexity and depth of training, with few standardised curriculum blueprints available that address CCR contexts seen in low- to middle-income settings such as SA.

Findings highlight the need for a standardised, nationally recognised CCR curriculum in SA. Such a curriculum should integrate advanced clinical competencies, non-clinical skills, culturally sensitive education, and role of quality improvement processes. This scoping review provides a foundation for stakeholder-informed curriculum engagements and development to address these emergency care challenges which are common to many healthcare services.

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