Survivors Perceptions of Recovery following Air Medical Transport Accidents.

Abstract Objective: Air medical transport (AMT) teams play an essential role in the care of the critically ill and injured. Their work, however, is not without risk. Since the inception of the industry numerous AMT accidents have been reported. The objective of this research is to gain a better understanding of the post-accident sequelae for professionals who have survived AMT accidents. The hope is that this understanding will empower the industry to better support survivors and plan for the contingencies of post-accident recovery. Methods: Qualitative methods were used to explore the experience of flight crew members who have survived an AMT accident. "Accident" was defined using criteria established by the National Transportation Safety Board. Traditional focus group methodology explored the survivors' experiences following the accident. Results: Seven survivors participated in the focus group. Content analysis revealed themes in four major domains that described the experience of survivors: Physical, Psychological, Relational and Financial. Across the themes survivors reported that industry and company response varied greatly, ranging from generous support, understanding and action to make safety improvements, to little response or action and lack of attention to survivor needs. Conclusion: Planning for AMT post-accident response was identified to be lacking in scope and quality. More focused efforts are needed to assist and support the survivors as they regain both their personal and professional lives following the accident. This planning should include all stakeholders in safe transport; the individual crewmember, air medical transport companies, and the industry at large.

Assessing satisfaction and quality in the EMS/HEMS working relationship.

BACKGROUND/OBJECTIVE: Treatment provided to critically ill and injured patients during air medical transport bridges initial local emergency medical service (EMS) treatment and the care provided upon arrival to the emergency department. Transition of care from EMS to air medical service includes multiple elements, many of which have been previously undefined. These include operational details surrounding the handoff and attention to issues of continuity in patient care. The purpose of this study is to pilot the development of survey instrumentation to measure key elements of quality in the interaction between EMS and air medical crews. METHODS: A focus group of 12 individuals, including rural and urban EMS providers, medical directors, administrators, and air medical transport providers, defined the activities involved in the working relationship between EMS and air medical transport. Ideas were refined into statements and placed into a 16-item Likert scale questionnaire distributed to EMS agencies throughout Ohio. Exploratory factor analysis was performed to identify subscales within the questionnaire. RESULTS: 380 questionnaires were returned over 2009, 2010, and 2011. Factor analysis of the initial responses from 2009 revealed themes similar to those identified by the focus group: patient care, user-friendly helicopter EMS (HEMS) operations, response time accuracy, operational feedback, and general system issues. The measure had good internal reliability, with alphas for subscales in the 0.85-0.88 range. A modified questionnaire used in 2010 and 2011 actually performed as a single scale. CONCLUSION: Using qualitative and quantitative approaches, a survey instrument was developed to assess satisfaction with HEMS care from the EMS provider's perspective. Evaluating the EMS perspective on the working relationship with HEMS is a new field of discovery for the air medical transport industry and process improvement activities.

A blueprint for critical care transport research.

INTRODUCTION: An estimated 500,000 critical care patient transports occur annually in the United States. Little research exists to inform optimal practices, promote safety, or encourage responsible, cost-effective use of this resource. Previous efforts to develop a research agenda have not yielded significant progress in producing much-needed scientific study. PURPOSE: Identify and characterize areas of research needed to direct the development of evidence-based guidelines METHODS: The study used a modified Delphi technique to develop a concept map of the research domains in critical care transport. Proprietary, internet-based software was used for both data collection and analysis. The study was conducted in 3 phases: brainstorming, categorizing, and prioritizing, using experts from all aspects of critical care transport. RESULTS: A total of 101 research questions were developed and ranked by 27 participants representing the transport community and stakeholders. An 8-cluster solution was developed with multidimensional scaling and hierarchical cluster analysis to identify the following research areas: clinical care, education/training, finance, human factors, patient outcomes, safety, team configuration, and utilization. A plot characterized each domain by urgency and feasibility. CONCLUSION: The content and concepts represented by the cluster map can help direct research planning in the critical care transport industry and prioritize funding decisions.

Readiness for practice: the senior practicum experience.

Nursing students must be prepared to enter the practice environment ready to competently care for patients. The purpose of this study was to examine factors hypothesized to influence senior nursing students' perceptions of readiness for practice and to determine their level of comfort performing skills independently. This study also validates an investigator-developed instrument, the Casey-Fink Readiness for Practice Survey. Factor loading indicated four components tested by subscales in the survey: clinical problem solving, learning techniques, professional identity, and trials and tribulations. The greatest challenges reported by students were managing multiple patient care assignments, communicating with physicians, and caring for dying patients. Clinical competency, role development, and career planning support were areas in which students desired more assistance during their senior practicum course. Most survey respondents voiced confidence in their ability to problem solve and felt ready to assume the professional nursing role.

Impact of a triage tool on air versus ground transport of cardiac patients to a tertiary center.

INTRODUCTION: The optimum method of transport for acute cardiac patients remains controversial. We proposed a physician-developed triage scheme for appropriate use of air versus mobile intensive care unit (ICU) in the transfer of cardiac patients and sought to determine the impact on the distribution of transport mode for cardiac patients in areas of personal characteristics and clinical factors and whether the triage scheme would be a valuable decision-making tool for physicians referring cardiac patients to tertiary centers. METHODS: This was a prospective, observational study of transport mode for cardiac patients transported to a tertiary care facility. A comparison was conducted with historical controls. The intervention studied was an educational program designed to teach a triage decision tool developed by a receiving cardiologist with input from the critical care transport team. Short-distance (less than 30 minutes) and long-distance transports were examined. A follow-up survey of referring hospitals was conducted. RESULTS: Short-distance transports enjoyed excellent compliance with 41 of 42 patients being transported by mobile ICU. Long-distance transports by mobile ICU increased from 55% to 65% during the study period. However, a third of the mobile ICU patients actually met air transport criteria. Long-distance patients transported by air had significantly higher transport costs, total hospital charges, and direct admission to the catheterization lab. Five of the 10 surveyed emergency department directors found the triage instrument useful in making transport decisions. CONCLUSIONS: A physician-developed triage instrument to select an appropriate mode of transport for acute cardiac transfers was effectively used. Further studies must validate the cardiac triage criteria against clinical outcomes, and more effective dissemination of the triage instrument must be sought. Furthermore, this information must be perceived as useful by referring physicians to gain wider acceptance.