Expeditious formation of London Health Sciences Centre (LHSC) adult ground critical care transport team in aid of 3 rd wave coronavirus disease 2019 (COVID-19) pandemic in Ontario, Canada

Background: The third wave coronavirus disease of 2019 (COVID-19) infection resulted the highest number of intensive care unit (ICU) admissions in Toronto, Canada, which needed to decant to other hospitals in the Province of Ontario. The interfacility transport of critical and non-critical patients is the responsibility of the municipality Emergency Medical Services (EMS) and the provincially supported private company Ornge Air and Ground Ambulance Services in Ontario. The first time since the establishment of Canada Health Act that an official request from the publicly funded transport services were unable to fulfill all the requests for to offload the over-burdened ICUs to those with available capacity during the COVID-19 pandemic. In partnership with Middlesex London EMS, London Health Sciences Centre (LHSC) established a novel Critical Care Ground Transport (CCGT) team to assist Ornge with the transportation. Case Description: A Strengths, Weaknesses, Opportunities and Threats (SWOT) analysis to assess LHSC's potential to establish two CCGT teams staffed by critical care register nurse (CCRN), registered respiratory therapist (RRT) and ICU physicians were approved on Apr 15, 2021. April 16-May 7, 2021, Ornge requested twenty-five interfacility transports. Twenty-four were COVID-19 positive and all were mechanically ventilated. Twenty-two patients accepted for transport and three were declined. Five major patient adverse events occurred resulted increasing oxygen requirement and three equipment related incidence did not result any limitations with the transportation. All adverse events occurred early during transport and corrective actions taken following daily debriefings post transport. Conclusions: The principles to establish an expeditionary CCGT team requires a clear mission goal with unwavering support from the institution and senior leadership. CCGT team member needs to have strong clinical, organizational, communication skills; the ability to work in small teams and the ability to thrive in extreme conditions.