P3.264: Cleared for Takeoff: Advancing Military-Ready Neonatal Air Transport Training

Background: In response to an Air Force leadership request, this study details the development, implementation, and evaluation of a military-unique neonatal air transport course following its inaugural offering in October 2024. Military neonatal air transport is a unique and enduring mission performed by interdisciplinary medical teams which include physicians, nurses, and respiratory therapists. Successful and safe transport mandates individual team members upskill beyond their traditional clinical knowledge and practice. However, training has been inconsistent due to geographically dispersed units, curriculum variability, and inexperienced instructors. Some personnel have even gone extended periods without formal training.

Methods: Between October 2023 and May 2024, neonatal transport experts conducted a needs assessment and developed a 5-day neonatal air transport course covering military transport logistics, ethics, equipment training, altitude and transport physiology (including an altitude chamber flight), emergency procedural skills, and a full day of transport simulations. Many of these topics were previously omitted or inconsistently covered despite their inclusion in national neonatal transport training standards. The course also established collaborations with local aeromedical evacuation, patient staging, adult critical care air transport, and flight physiology personnel.

Eight transport personnel from two military branches, three military treatment facilities, and one civilian program attended the pilot course at Brooke Army Medical Center in October 2024. Participants completed pre- and post-course knowledge assessments, a 7-item confidence survey (Likert scale 1-10), and an anonymous course feedback survey. Knowledge and confidence assessments were repeated three months post-course. Data analysis utilized the Wilcoxon Signed-Rank test for paired, non-parametric data.

Results: The course included three physicians, two nurses, and three respiratory therapists. Knowledge assessment scores improved from 47% to 78% (p < 0.01). Personnel with prior neonatal transport experience improved from 61% to 81%, while those without experience improved from 39% to 75% (p=0.03). Confidence across all areas—including transport equipment use, supply knowledge, coordination, emergency procedures, and transport physiology—increased from 4.5 to 7.8 (p=0.01) (see Figure 1). Even among experienced personnel, confidence rose from 6.5 to 8.3.

At three months, knowledge scores among six respondents declined to 63% (p=0.09), though confidence remained elevated at 7.4 (p=0.02). The sample size for personnel with prior transport experience was too small to assess statistical significance.

Conclusion: This standardized 5-day course effectively improved knowledge and confidence in neonatal transport personnel, including both novice and experienced providers. While knowledge declined slightly in three months, confidence remained elevated despite limited additional transport experience. Future evaluation will include structured interviews and a twelve-month follow-up to assess long-term knowledge and confidence retention. Additionally, feedback on incorrect responses following the post-course knowledge assessment, reinforcement of key concepts in an escape-room style experience, and development of just-in-time training tools are being developed to sustain transport knowledge post-course.