The development of the nation's oldest operating civilian hospital-sponsored aeromedical helicopter service

The Vietnam War heightened civilian awareness as to the use of helicopters for medical evacuations. This led to the initiation of federally funded projects aimed at determining whether helicopters were practical for civilian aeromedical transports. In 1972, a Department of Transportation (DOT) summary concluded that helicopters for civilian medical transports were largely economically prohibitive and provided limited medical benefits in limited locales. Despite this report, in 1972 St. Anthony Hospital initiated a hospital-based emergency medical helicopter service (HEMS). This paper provides a historical review of the individuals and events responsible for the early success of the nation's longest operating civilian hospital-sponsored helicopter service. The author concludes that the early success of this program was due in part to the selection of an affordable, high altitude, helicopter; rapid response times to the scene of injury; the development of excellent EMS communications systems; the use of specialty trained flight crewmembers; and integration of HEMS into the existing EMS system.     

Integrating emergency medicine residents into a well-established helicopter program

INTRODUCTION: The institution of an emergency medicine residency in a university-affiliated Level 1 trauma center in July 1993 provided a challenge to develop a curriculum and on-line learning experience for emergency medicine residents in a well-established helicopter program. The purpose of this study was to survey flight crew members, emergency medicine at tending physicians, and emergency medicine residents on the anticipated roles and educational experience of integrating the emergency medicine residents from a new emergency medicine residency into the flight crew of a well-established helicopter program. METHODS: A survey consisting of multiple choice, Likert scale, and open-ended questions was distributed to flight crew members (RN, RT, pilots, communication specialists, EM attendings, and EM residents [n=72]). RESULTS: 92% of surveys were returned. These surveys identified specific issues of concern and those areas believed to be of academic importance for the emergency medicine residents. CONCLUSIONS: The results of this study allowed for the creation and implementation of a progressive flight experience for EM residents that incorporates increasing responsibility on the flight crew as experience is gained.     

Aircrew perceived stress: examining crew performance, crew position and captains personality

This study was conducted at NASA Ames Research Center as a part of a larger research project assessing the impact of captain's personality on crew performance and perceived stress in 24 air transport crews (5). Three different personality types for captains were classified based on a previous cluster analysis (3). Crews were comprised of three crewmembers: captain, first officer, and second officer/flight engineer. A total of 72 pilots completed a 1.5-d full-mission simulation of airline operations including emergency situations in the Ames Manned Vehicle System Research Facility B-727 simulator. Crewmembers were tested for perceived stress on four dimensions of the NASA Task Load Index after each of five flight legs. Crews were divided into three groups based on rankings from combined error and rating scores. High performance crews (who committed the least errors in flight) reported experiencing less stress in simulated flight than either low or medium crews. When comparing crew positions for perceived stress over all the simulated flights no significant differences were found. However, the crews led by the "Right Stuff" (e.g., active, warm, confident, competitive, and preferring excellence and challenges) personality type captains typically reported less stress than crewmembers led by other personality types.     

The effect of an in-flight, emergency training program on crew confidence

INTRODUCTION: Despite some progress, the air medical transport profession continues to experience widely publicized accidents that result in injuries and death to crew members and patients. An air medical crew member's experience, training and confidence may affect his or her ability to deal effectively with an in-flight emergency, and may also affect his or her behavior before and after the emergency. SETTING: A hospital-based, rural rotor- and fixed-wing program flying approximately 890 flights per year. Seventy-seven percent of these flights are interfacility. METHODS: A pretraining survey evaluated the experiences of air medical crew members and pilots. A 20-question assessment tool based on a 5-point Likert scale evaluated how confident the individuals were in their ability to react to in-flight emergencies. An extensive in-flight emergency training program was then conducted. Personnel were asked to complete the same questionnaire one month and six months after the training. RESULTS: On the pretraining questionnaire, flight crew members with neither prior training nor actual experience in in-flight emergencies showed the lowest level of confidence. Those with prior training, actual in-flight emergency experience or both, responded with higher levels of confidence. The mean confidence scores of the study participants increased from 82 pretraining to 89 at one month post-training and remained at the increased level six months after training. CONCLUSIONS: A training program focusing on in-flight, aircraft-related emergencies can increase the crew's confidence during such situations. This increase in confidence is most noticeable in those without previous training or experience and is maintained for at least six months. Several other benefits occur from the training program.     

Helicopter emergency medical service in Spain

No studies had been conducted about Spanish HEMS programs, so we conducted a nationwide survey by phone from January to June 1999. We identified 18 HEMS programs in 13 regions, which transported 4870 patients in 1998. The primary/interhospital missions ratio was 51.25/48.75. In 78% of responding programs, the medical crew was a physician and a nurse. Only 33% of HEMS had standard medical equipment; most lacked noninvasive blood pressure monitors, and one-third of the medical personal were correctly protected with flight helmets and flight suits. It is necessary to study the cost-effectiveness of the Spanish model of HEMS.     

Method for rehabilitation of the alcohol-addicted pilot in a commercial airline

Based upon data available from the National Council on Alcoholism and encouraged by the emerging concept of alcoholism as a disease responsive to the multidisciplinary approach to its management, a program to assist alcoholic employees was instituted in 1968 at the United Airlines Maintenance Operations Center in San Francisco. This program was developed through the tripartite efforts of management, union and the medical department. Using this basic model, a similar effort to assist flight crew members of our San Francisco pilot domicile emerged in 1970. The method is oriented to the three-fold process of identification, referral for treatment, and followup. The mechanism of identification includes an intervention process. Treatment is accomplished in a specialty hospital embracing the principles of Alcoholics Anonymous. The essential monthly followup is continued for 2 years. Twenty-five pilots in United's system have been returned to flight deck duties after treatment and recertification.     

Influence of helicopter flight on temperature of helicopter EMS crewmembers

Introduction

Thermoregulation of critically ill patients during helicopter emergency medical service (HEMS) transport can be influenced by the flight, increasing the risk of hypothermia. However, the literature is unclear as to whether temperature decrease among those patients is affected by the flight itself or by the patients' clinical status and therapies. We evaluated the effect of helicopter flight on the body temperature of the healthy members of the HEMS crew of the Friuli Venezia Giulia region, Italy.

Methods

From August 12 to September 3, 2009, and from February 12 to April 1, 2010, tympanic temperature was measured, on a voluntary basis, before and after the flight among the crewmembers. The effect of flight and personal characteristics on temperature after the flight was analyzed through multivariate regression.

Results

Ninety-five records were analyzed. On average, the temperature increased by 0.2 ± 0.5°C. In 29.5% of the cases, however, it decreased. The only factors that were significantly associated with the temperature after the flight were temperature at liftoff and mountain rescue flights.

Conclusion

Among healthy subjects, the helicopter vibrations may induce an increase in body temperature. Small sample size and lack of information on a number of potential confounders prevented the identification of the possible determinants of a temperature decrease among some subjects.     

Aircraft coordination training in the U.S. Air Force Air Training Command

Coordinated action among the various members of a multi-crew aircraft is essential for safe flight. Aircrew coordination problems typically fall into one of three broad categories: 1) improper task prioritization, 2) ineffective communication, or 3) lack of coordinated action. The airlines and the Military Airlift Command have very successful crew coordination training programs. The Air Training Command (ATC) will soon transition to a specialized pilot training program where pilots destined for large multi-place aircraft will be trained differently from those who will fly fighter aircraft. Under this new training program, ATC will help establish a crew mind-set early in the new multiplace pilot's career by providing initial crew coordination training.     

Influence of the helicopter environment on patient care capabilities: flight crew perceptions

INTRODUCTION: Flight crew perceptions of the effect of the rotary-wing environment on patient-care capabilities have not been subject to statistical analysis. We hypothesized that flight crew members perceived significant difficulties in performing patient-care tasks during air medical transport. METHODS: A survey was distributed to a convenience sample of flight crew members from 20 flight programs. Respondents were asked to compare the difficulty of performing patient-care tasks in rotary-wing and standard (emergency department or intensive care unit) settings. Demographic data collected on respondents included years of flight experience, flights per month, crew duty position and primary aircraft in which the respondent worked. Statistical analysis was performed as appropriate using Student's t-test, type III sum of squares, and analysis of variance. Alpha was defined as p < 0.05. RESULTS: Fifty-five percent of programs (90 individuals) responded. All tasks were significantly rated more difficult in the rotary-wing environment. Ratings were not significantly correlated with flight experience, duty position, flights per month or aircraft used. CONCLUSIONS: We conclude that the performance of patient-care tasks are perceived by air medical flight crew to be significantly more difficult during rotary-wing air medical transport than in hospital settings.     

The role of aeronautical adaptability in the disqualification of a military flyer

INTRODUCTION: Possessing a stable personality plays a critical role in crew coordination, mission completion, and safety of flight in aviation. Presented is a naval flight officer whose personality traits were a threat to these key tenets and ultimately warranted removal from flight status. CASE REPORT: A naval flight officer was twice referred to Human Factors Boards (HFBs) after concerns were raised about her emotional stability in and out of the cockpit. Her history revealed multiple clinical presentations revealing personality characteristics that should have raised immediate concern about her aeronautical adaptability. Formal psychiatric evaluation after her second HFB confirmed the presence of personality traits incompatible with aviation duty, but not until she had served nearly 4 yrs. as an aviation officer. DISCUSSION: Aeronautical adaptability is a U.S. Naval term used to describe an individual's ability to work successfully in the aviation environment. Naval aviation personnel are considered not aeronautically adaptable/adapted if diagnosed with a "personality disorder or prominent personality traits that adversely affect flight safety, mission completion, or crew coordination". The Federal Aviation Administration, the U.S. Air Force, and the U.S. Army endorse similar concepts. Except for the U.S. Navy definition, aeronautical adaptability does not include formal DSM-IV-TR diagnoses, and, thus, flight surgeons and aviation medical examiners often make difficult aeromedical dispositions based on vague and subjective criteria. CONCLUSIONS: Determining aeronautical adaptability is not a simple, solitary process. It requires heightened suspicion, continual surveillance of suspect aviators, and collaboration from aviation medical professionals to ensure aviation safety.     

Training of flight nurses on fixed-wing air ambulance services

Introduction: The purpose of this study was to determine the background of fixed-wing air ambulance nurses, what level of training they receive before assignment as a flight nurse, and how closely supervised these fixed-wing air ambulance programs are by their medical directors.

Methods: In 1993, a retrospective statistical questionnaire was sent to 113 fixed-wing air ambulance programs. Chief flight nurses for all 113 fixed-wing air ambulance transport companies were requested to complete a written survey consisting of 17 multiple choice and fill-in-the-blank questions about previous experience, flight nurse qualifications, and content covered in their initial training program.

Results: Of 113 surveys, 72 (64%) responded. The majority (87%) of the flight crew were 30 to 39 years of age. The crew mix is RN/EMT-P in 49%, RN/RN in 25%, and RN/RT in 25%. Experience before flying showed emergency department/intensive care unit in 87% with 13% specialized to a specific type of patient care. The initial training in classroom hours was less than 21 hours in 50% of programs. Training programs were taught by the chief flight nurse in 75%, the medical directors in 74%, and outside organizations in 30%. Fifty-five percent of programs use pilots or other flight crew members to supplement initial training. Only eight of the programs did not have yearly refresher classes. Programs providing more extensive training appear to be affiliated with hospital-based services. Medical directors were involved with the everyday running of air medical transports in 35 of the pro grams (50%), 20 medical directors (28%) did monthly chart reviews only, and 12 (17%) were not involved with their programs. There were three responses to “Other” and two with no responses.

Conclusions: Although fixed-wing flight nurses appear to be medically experienced personnel with previous intensive care unit or emergency department experience, this survey would suggest that fixed-wing flight programs are variable in the amount of initial training, level of instructors, ongoing medical education, and involvement of the medical director. This survey indicates the need for increased standardization of continuing education, as well as increased involvement of medical directorship in fixed-wing air ambulance services.     

Personality preferences for radiation therapy students in New Zealand

IntroductionThis study investigated the learning styles and personality preferences of undergraduate Bachelor of Radiation Therapy (BRT) students at the University of Otago, Wellington in New Zealand from 2014 to 2018. The implications of these findings for radiation therapy education and the profession were also explored.MethodsAll students enrolled in the first year of the BRT degree during this time were invited to participate in the research. The test tool was the Paragon Learning Style Inventory (PLSI), which is a standardised questionnaire adapted from the Myers Briggs Type Indicator (MBTI). All students who participated in the workshops consented for their data to be used for this project.ResultsThe BRT student participants (n = 130) were more likely to have a preference for Introversion and/or Judging in their personality and learning style profiles, relative to the population norms. No statistically significant preferences were present in the Thinking/Feeling, or Sensing/Intuition dichotomies relative to the norms given with respect to published MBTI data.ConclusionThe study has indicated that the students currently studying radiation therapy at the University of Otago exhibit learning style and personality preferences that are well suited to radiation therapy clinical practice. However, some deficits could compromise a balanced professional profile, teamwork and future professional development.Implications for practiceRT students are likely to show particular characteristics when stressed, anxious or fatigued that may compromise classroom and clinical dynamics. The integration of peer group supervision to the BRT has the potential to help students reflect on their feelings, develop solutions and improve their clinical practice.     

空军新人校飞行学员MBTI人格类型分析

目的 探讨新人校飞行学员的MBTI人格类型特征,为飞行人员的心理评估、健康教育与干预策略提供理论依据. 方法 1100名新人校飞行学员,根据入学时考试成绩分为甲、乙、丙3个班.应用修订后的中文版MBTI人格类型量表,对新人校飞行学员进行测试. 结果 新入校飞行学员在外向(E)、感觉(S)、思维(T)、判断(J)偏好上的得分均高于内向(I),直觉(N)、情感(F)、知觉(P)偏好上的得分;外倾感觉思维判断(ESTJ)人格类型最多,其次为内倾感觉思维判断(ISTJ)、外倾直觉思维判断(ENTJ)、外倾感觉情感判断(ESFJ)人格类型,内倾直觉情感判断(INFJ)、外倾直觉情感判断(ENFJ)、内倾直觉情感知觉(INFP)和内倾直觉思维知觉(INTP)人格类型人数最少.甲、乙、丙班学员在E、S、T、J偏好上的得分均高于I、N、F、P偏好:3个班中,百分比最高的人格类型均为ESTJ;百分比最少的人格类型,甲班、丙班为INFJ,乙班为ENFJ;比较甲、乙、丙班学员MBTI人格类型分布,差异均有统计学意义. 结论 新人校飞行学员大多为E、S、T、J偏好,这与军队的特殊环境和军事飞行人员所肩负的责任要求相适应;仍有少数飞行学员易发生各种心理健康问题;因在飞行学员中表现有不同的人格特征,应有针对性地进行心理卫生教育、指导和保护工作.     

Pilot safety survey 2005: what pilots are saying

The PSS 2005 gave HEMS pilots an opportunity to candidly voice their views and concerns about flight safety. Their overwhelming response has provided the air ambulance industry with valuable insights from the people who deal with air medical safety issues on a daily basis.We know from the survey data that HEMS pilots are a highly experienced group. They are straightforward about accepting responsibility for aircraft accidents, citing poor pilot decisions as the primary cause of HEMS accidents. They also understand that the industry needs to provide better training to assist pilots in making good decisions, along with the equipment to back it up. Pilots are convinced simulators and NVGs will greatly enhance safety, along with other improvements in technology.In other words, pilots understand the need to make good decisions, but has the industry given pilots the tools and support they need?Pilots also want to know that management will back up their no-go decision, without regard to financial or competitive pressures. They know that even good decisions to fly can sometimes be overridden by weather conditions or inadequate weather reporting. When things do go wrong, pilots want the tools and the training to bring the aircraft and their crew home safely.The pilots have spoken. The question is, will the HEMS industry commit the resources necessary to supply the IFR training, NVGs, and other equipment that line pilots believe so strongly are needed to reduce accidents?     

Results and recommendations from the helicopter EMS pilot safety survey 2005

INTRODUCTION: In 2005, the Pilot Safety Study Group (PSSG), consisting of members of the Association of Air Medical Services Research Committee, wrote, distributed, and analyzed a survey of helicopter pilots regarding their knowledge, attitude, and perspectives on safety in the field of air medical transport. METHODS: The Pilot Safety Survey 2005 (PSS2005) was based on another survey--one that was sponsored by Helicopter Association International (HAI) and National EMS Pilots Association (NEMSPA) and administered to pilots in 2001. The PSS2005 pared questions down so that the survey could be completed in 15 minutes on the internet, and the answers were organized in a manner to simplify analysis. An electronic link to the survey was distributed in a non-randomized fashion to HEMS pilots using the mailing lists of various operators and HEMS programs. Questions were clustered into eight groupings of safety, with a majority of responses being categorical, lending themselves to cross-tabulations. RESULTS: The information gathered indicated that Helicopter EMS (HEMS) pilots are very experienced, with the average pilot logging 6,625 flight hours. Collectively, they took responsibility for HEMS accidents; with 92% of total respondents citing "pushing weather minimums" and 82% citing "pilot decision making" as the main reasons for crashes. Crew resource management (CRM) was well appreciated by the pilots; there appeared to be a positive correlation with programs that offer their employees CRM and the pilots' general perspective on safety. The survey was also clear that amongst 40% of the respondents, mission-oriented training needs improvement, and 74% responded that more realistic training in flight simulators would improve safety overall. Finally, 57% of the pilots both desired night vision goggles or devices (NVG/NVD) and believed that their usage would improve safety in the field of air medical transport (55% vs 45%, P = .0025). CONCLUSIONS: Although the recommendations from the PSS2005 are lacking in definite evidence for a decrease in HEMS crashes, we consider the direct input from pilots as critical in the absolute elimination of crashes in Helicopter EMS (Vision Zero). Pilots are, after all, the very ones held responsible for HEMS crashes. Based on these findings, the PSSG hopes that the HEMS community will incorporate the following recommendations into their standard practices. We recommend that all HEMS operators have annual and regular CRM training. We recommend that all HEMS pilots have annual and regular training in realistic flight simulators. Finally, we recommend that all HEMS aircraft be in possession of NVGs, and if this is not possible (eg, light pollution from a highly urbanized region or cost-benefit issues), then to have annual and regular mission-oriented nighttime training.     

Transcranial oximetry as a new monitoring method for HEMS (Helicopter EMS).

INTRODUCTION: Transcranial oximetry (TCO) is a new method to measure continuous changes in brain blood oxygen saturation (rSO2) by using near-infrared spectroscopy (NIRS). To our knowledge, no studies about TCO in air medical transport have been published. METHODS: Twenty healthy volunteers (HEMS medical crew) were investigated during flight missions without patients. We measured oxygen saturation (SpO2), cardiac rate, and rSO2 with an INVOS 4100 Cerebral Oximeter at sea level and at each 1000 feet until we reached a flight level of 5000 feet. RESULTS: The oximeter did not produce any interference with medical or aeronautical equipment. Subjects' SpO2 showed a slight decrease with altitude (P < 0.010), but rSO2 remained constant (P = 0.28), with little delay in the physiological correction of SpO2 and rSO2 values. CONCLUSION: TCO may play an important role in the development of new monitoring methods for critical patients in air medical transport. Further studies with large sample sizes and patients are necessary to generalize findings.     

载人航天的安全保证

载人航天对于人类文明的发展有着巨大的意义。然而,人类走向空间之路充满着无数的坎坷和危险。安全保证是载人航天发展的生命线。这不仅仅是因为它直接关系到航天员的生命安全和经济上的损失,而且还涉及到可能发生的事故对整个社会产生的冲击和影响,也就直接关系到载人航天计划的生存和发展。美苏载人航天的历史已经充分证明了这一点。安全问题     

Pilot study for predicting appropriate use of air medical helicopters. Part 1: Interfacility transports

Introduction: Appropriate use of rotor-wing aircraft is an important issue to the emergency transport industry. The purpose of this pilot study was to test criteria for their ability to accurately identify patients for whom interfacility helicopter transport is appropriate.Methods: Flight data collected from 219 flights included measures of physiological status, interventions, and need for timely care. Appropriate and inappropriate flights were compared using chi-square, Mann-Whitney U, and Wilcoxon matched-pairs signed rank tests. Logistic regression was used to evaluate how well information at critical decision points distinguishes between appropriate and inappropriate flights.Results: Statistical difference occurred between appropriate and inappropriate flights for the variables of preflight cardiac status, preflight interventions, preflight total score, flight crew vital signs, flight crew cardiac status, flight crew interventions, flight crew total score, need for surgical intervention, and need for complex critical care. No statistical difference existed between appropriate and inappropriate flights for the variables of preflight vital signs, preflight neurologic status, and flight crew neurologic status. Logistic regression models showed that coefficients for preflight total score, flight crew interventions, flight crew total score, need for surgical intervention, and need for complex critical care were significant. All other coefficients were not significant. Patients requiring emergent surgical intervention were more than four times likely to be considered an appropriate use of the aircraft, and patients requiring complex critical care were almost eight times more likely to be considered an appropriate use of the aircraft. Odds ratios for preflight and flight crew total scores revealed an increase in the likelihood of appropriateness as the total score values increased.Conclusion: Development of a gold standard to determine appropriate use of the aircraft and measurable criteria on which to base that decision is important. The instrument used in this pilot study now must be revised given statistical findings and input from the emergency transport industry.     

"Soiuz-Apollo" experimental flight. Preliminary results of medicobiological studies, carried out during the flight of "Soiuz-19" spaceship]

The paper presents brief information on the Apollo-Soyuz test mission, its program biomedical investigations to be carried out in flight and specific medical aspects. It discusses the main tasks of the joint US-USSR experiments and Soviet experiments. It gives and analyzes preliminary results of medical monitoring and postflight examinations of the crew members.