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 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.