A Night With the Critical Care Team

By Daniel Leutsch, BSN, RN, CCRN, TCRN

The pager went off before I even had time to sip my energy drink.

No warm-up, no easing into shift. Just the vibrating hum of urgency and PULSE notes telling us we had a balloon pump transfer—ASAP. The patient was teetering between compensation and collapse. We were the bridge.

This is ground critical care transport. Three clinicians—an EMT, a paramedic, and a nurse—responsible for safely moving the sickest of the sick. There’s no code team behind us. No ICU backup down the hall. Just our hands, our minds and what we can carry.

While I called the facility and took a detailed report, reviewing balloon pump settings and MAP (mean arterial pressure) goals, the EMT prepped the monitor and cleared our route. The medic configured the ventilator with the precision of someone who’s done it under fire.

Inside the hospital room, tension hung heavy. Everyone was looking to us—not because they didn’t care, but because we were trained for this. In moments like this, we don’t just take over—we become the momentum.

There’s something surreal about moving a patient whose survival depends on perfect augmentation. Each beat, each inflation, must sync with mechanical precision.

We monitored arterial line waveforms like lifelines. Every bump in the road could throw timing off. But we didn’t miss a beat.

Before we even cleared paperwork and charting, the phone rang (communications supervisor giving us a heads up). Another call—this time an Impella transfer- STAT. The sending facility was finishing up the procedure in the Cath Lab.

When we arrived, the staff looked relieved. I could tell from the eyes behind the masks: they needed us to lead.

The Impella was active but the patient was borderline. Flow support was minimal, purge pressures fluctuating, BP labile. I secured the console, verified connections and stayed locked on the vitals. The medic dialed in the vent settings based on waveform readings, ETCO₂ and breath synchrony.

The EMT managed routing, coordinated unit access, and monitored vitals. Every one of us had a role, and every role was vital. There was no spare capacity. No backup. Just execution.

No hesitation. No overlap. Just fluid coordination. This is what a real CCT team looks like—each person acting independently yet in perfect rhythm with the others. If I falter, they step up. If they need a hand, I’m already reaching.

We barely had time to restock before the next call hit: post–cardiac arrest. ROSC achieved, but the patient was now hemorrhaging, vented and maxed on pressors.

These are the moments where time compresses. The transport is only 18 minutes long, but every one of those minutes carries decisions that could tip the balance.

Sedation titrated. Hemodynamics reassessed. Ventilator fine-tuned for protective strategy. Blood infusing en route. There’s no margin for error. No autopilot. This isn’t a handoff to ICU—we are the ICU, in motion.

The medic watched every vent reading like a hawk. The EMT updated the receiving hospital, cleared the ER bay, and secured access before we arrived. I stayed focused on the MAP, pressors, and waveform integrity.

Each of us in our own lane, scanning for threats. When we rolled that stretcher in, we weren’t just delivering a patient. We were handing off a trajectory.

And the gravity of that isn’t lost on any of us.

What people outside the rig don’t see is how much happens in that moving 80 square feet. They don’t see the checklist mindset, the whispered confirmations, the unspoken communication of a team that has been forged through repetition, chaos, and pressure.

They see the flashing lights. What they don’t see is the clinical chess game we play at highway speed.

Critical care transport isn’t about adrenaline. It’s about control in the face of it. It’s taking a patient who’s one misstep away from decompensation and keeping them not just alive—but stable, secure and improving en route.

That’s why the truck matters. That’s why the roles matter. The EMT isn’t “just driving”—they’re managing traffic, rerouting us around delays, coordinating radio reports, checking vitals, updating receiving teams and troubleshooting gear.

The paramedic isn’t just a tech—they’re ventilator specialists, pharmacology experts, and second eyes when yours are buried in lines or documentation. And as the RN, I don’t lead this team—I work with it. I bring my scope, but so do they. And the outcomes belong to all of us.

We don’t measure success in applause or headlines. We measure it in waveform stability. In a pressure that holds steady. In silence—not from resignation, but from a team so locked in, words aren’t needed.

When we finally pulled back into the station after our fourth call of the night, the sun was rising. The truck smelled like disinfectant and diesel. We were tired—but wired. Bags under our eyes, hearts still racing. Not a word needed to be said.

Because the quiet at the end of a night like that?

It speaks louder than any siren.

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About the Author

Daniel Leutsch is a critical care transport registered nurse with a background in intensive care and trauma. He specializes in high-acuity ground transport of critically ill patients. Daniel is passionate about advancing prehospital care, clinical team dynamics and the role of nurses in mobile ICU environments. His writing draws from real-world experience on the front lines of emergency medicine.