Table 4 Barriers to transport research and recommendations for future studies

Lack of validated and feasible definitions for many transport-associated complications

Develop a priori definitions for transport-associated complications by expert consensus; validate these prospectively (for example, pilot study) or retrospectively (for example, chart review)

Difficulties consistently documenting pre-transport clinical status across multiple sending facilities

Standardization of pre-transport data collection by centralized form/checklist administered by transport personnel at time of patient retrieval and/or by telephone follow-up following arrival at receiving facility

Limited monitoring (for example, no blood tests or X-rays) and documentation during transport

Standardization of data collection (for example, physiological parameters) during transport by centralized form/checklist administered by transport personnel during transport

Under reporting of adverse events/errors due to a real or perceived culture of blame

Anonymous reporting and independent abstraction of documented adverse events/errors; achieve 'buy-in' from frontline staff through education and involvement in project development

Inability to identify an adequately matched, non-transported comparison group due to heterogeneous patient population transported to tertiary centers and inevitable selection bias of those chosen for transport to these centers

Use of a multi-center, prospective observational cohort study including a broad spectrum of referral institutions; study risk factors for transport-related adverse events