Validity and Reliability of the Transport Triage Tool

Scott Swickard, DNP, PhD, ACNP; Chris Winkelman, PhD, RN, CCRN, ACNP; Andrew Reimer, PhD, RN; Carol M. Musil, PhD, RN


Am J Crit Care. 2019;28(3):202-209. 

In This Article

Abstract and Introduction


Background: Standards for interfacility transport in the United States recommend that each transport request be triaged to ensure that each patient is transported by an appropriate mechanism and by the appropriate clinicians in order to meet the patient's intratransport needs. No instrument currently exists to meet that need. The Transport Triage Tool, a novel instrument, has been designed to determine the clinician (paramedic, registered nurse, or advanced practice registered nurse) who will best meet the patient's needs during transport.

Objective: To assess psychometric elements—that is, validity and reliability—of the Transport Triage Tool when used by health care professionals in determining which clinician is appropriate for interfacility transport.

Methods: A 3-step process was used to initially evaluate the reliability and validity of this tool when assigning a lead clinician during transport. Content and predictive validity were evaluated. Both intrarater and interrater agreement were used to examine reliability.

Results: Predictive validity was supported by an area under the receiver operating characteristic curve of 0.847 and a Youden index of 0.31. Percentage agreement and Cohen κ were reasonable across all periods of testing.

Conclusions: The Transport Triage Tool has acceptable predictive validity and reliability; however, this preliminary evaluation indicates that further refinement is needed. Large tertiary centers that offer variations in transport team composition may be able to use the Tool in its present form to train and evaluate individuals who make decisions regarding interfacility transport, although additional testing and evaluation are recommended.


Professional guidelines for critical care transport (CCT) in the United States indicate that each transport request should be triaged to match the patient with an appropriate clinician and mode of transport, thereby meeting the patient's needs and minimizing the risk of harm to the patient during transport. Currently, however, no widely accepted instrument accomplishes this task.[1,2]

Transport clinicians in the United States have a broad range of licensure or certification. Transport clinicians include emergency medical technicians (with the least amount of formal education), paramedics, registered nurses, and licensed independent practitioners (LIPs) (with the most formal education); LIPs include advanced practice registered nurses (APRNs), physician assistants, and physicians.[3] Noncritical patients may be transported by emergency medical technicians, who can provide basic life support, or paramedics, who can provide advanced life support (ALS). Transporting patients requiring critical care may be beyond the scope of local emergency medical technicians and paramedics. In a survey of CCT services, 100% of air medical transports (on rotary-wing and fixed-wing aircraft) and 97% of surface transports include a registered nurse.[3] Only 4% of CCT agencies surveyed reported staffing transports with an APRN or physician assistant, and 4% reported staffing with a physician.[3]

The Transport Triage Tool, a novel instrument based on the American Association of Critical-Care Nurses (AACN) Synergy Model for Patient Care, has been designed to match the needs of a patient with the skill set of the transport clinician.[2] Through a progressive series of evaluations, this report details the instrument's content validity and predictive validity, as measured by sensitivity, specificity, area under the receiver operating characteristic curve (AUROC), and the Youden index.