The Experience of Critical Care Air Transport Teams That Transported Afghan Refugee Children: A Qualitative Thematic Analysis

Introduction: Air Force Critical Care Air Transport (CCAT) teams are 3-person medical crews (physician [MD], nurse [RN], respiratory therapist [RT]) with supplies to transport critically ill adults as part of the aeromedical evacuation system. During Operation Allies Refuge (OAR), critically ill/injured Afghan children were evacuated by CCAT teams despite a lack of pediatric experience or equipment. This study seeks to understand the lived experience of deployed team members who did or could have transported critically ill children during OAR. Materials and Methods: Thirty-six eligible participants with known emails were invited to participate in a qualitative thematic analysis study using open-ended semi-structured interviews. Interviews were transcribed, and using reflexive thematic analysis, responses were categorized to assess personal experiences, perceived preparedness, training gaps, and areas of improved training for pediatric enroute critical care. Results: Seventeen (47%) participants were interviewed (41% MDs, 35% RNs, 24% RTs), with saturation of themes. Participants had a median of 14 years of clinical and 3.5 years of CCAT experience. The following themes emerged from the interviews: Patient Care Challenges, Comfort Level, Suggested Changes, and Perceived Resistance to CCAT Training Changes. The most reported patient care challenges were lack of pediatric equipment (35%) and lack of pediatric experience (35%), which were consistent regardless of clinical role, years of experience, or CCAT experience. Seventy-eight percent of participants lacked previous personal or team experience with pediatric patients. Recommended changes to the current CCAT structure included improving pediatric equipment availability and pediatric equipment training (65%), adding pediatric didactic training (76%), adding pediatric simulations (88%), and improving access to pediatric reference guides (41%). Seventy-one percent of respondents felt there would be little or no resistance in adding pediatric instruction to the current CCAT training. Conclusions: We found that recently deployed CCAT teams lack exposure to pediatric training and do not feel comfortable providing pediatric critical care, despite a requirement to transport critically ill children as seen in OAR. Pediatric equipment was unavailable to CCAT teams, thus challenging pediatric care. Participants reported patient care challenges and were overall supportive of additional pediatric training, especially in the form of simulations. This study can be used to provide insight into training gaps that can help shape and improve pre-deployment training for enroute critical care teams.