Among the most important factors that count when it comes to medical flight risk assessment according to the Federal Aviation Safety Administration is having an accurate flight risk assessment tool. Such a tool enables the pilots to evaluate the flight risk well in advance and to make an informed decision whether to proceed with the medical flight rescue mission or not. An efficient tool enables the pilot and the flight team to develop a risk mitigation strategy that is effective enough. It includes everything from weather condition assessment to cabin preparation for the patient who will be onboarded. However, there are several other factors, too and often, it is an evolving situation that the risk assessment tool must factor in.
The Changing Medical Flight Risk Landscape
Pandemics, volatile political conditions, conflicts, sudden weather changes – the factors that result in increased medical flight risk are several. The tool must take into consideration all these factors. Of course, the tool must work on inputs received digitally as well as through manual human intervention. There are specialized disciplines when it comes to such assessments today. Not to forget the numerous safety organizations throughout the world. However, sometimes the safety standards of one country can conflict with another.
Medical Flights Across Borders
Crossing certain international borders is considered low risk. For instance, a medical flight company would not think twice before flying a patient between the United States and the United Kingdom. However, the considerations vary vastly when, for instance, when it is between a country like Sudan and the United States. Of course, not all medical flight companies undertake missions in countries that are considered volatile. Having said that there are private medical flight companies today that specialize in undertaking missions from high-conflict nations. It all boils down to the adequacy and the efficiency of the risk models, tools and human expertise that they employ.
According to one research medical flight services run by for-profit organizations had seen, on average, 7 to 8 crashes a year between 1998 and 2012. Of these mishaps, the biggest contributors were those organizations that ran the most medical flights. This raised serious concerns about the safety norms followed by the industry and several studies and investigations were performed simultaneously to make the skies safer for the crew and the patients. The result was some startling revelations. It was seen that the crew was pressured to make as many flights as possible in a day to maintain the profitability of the organizations that they worked for.
What Were the Medical Flight Services Doing?
It was seen that medical flight services were taking orders for new rescue missions even during an ongoing mission. This caused unnecessary operational chaos and instilled a sense of urgency among the crew members. Moreover, it was seen that ground ambulance paramedics were being hired by medical flight services too. This was causing a conflict of interest, wherein the possibility of the paramedics contacting their favored service providers was high. It was also found that some so-called rescues were actually unnecessary as they did not provide any advantage over the ground transportation.
New Safety Laws were Passed
The medical flight industry was subjected to intense scrutiny. Certain safeguards such as maximum permissible hours of work for crew members and laws concerning visibility were put in place. The aging aircrafts had to be replaced by new and safer ones. Upgrades with respect to technology were also made compulsory in certain areas. Better weather reporting and aids for in-flight decision-making were put in place. It can be stated, with confidence, today, that medical flight services are safer and more efficient. The industry and the patients that it serves have benefitted immensely from these developments.
The life of an air ambulance pilot is risky with weather conditions that transform without warning and the ongoing COVID-19 situation. However, it is not impossible to take precautions and prepare for them. Then, there are mindless pranks that are played by miscreants not fully comprehending the repercussions of their acts. One such act is shooting laser lights at air ambulance pilots. Recently, a Wiltshire air ambulance pilot was subject to one such prank that left him temporarily unable to see and the landing had to be aborted. Just imagine being pilot mid-air, in a situation where visibility is suddenly near-zero. Scary, isn’t it?
The Air Ambulance Pilot’s Family is Scared for His Life
The wife of the air ambulance pilot has appealed to people through a video that was posted on one of her social media channels. The woman breaks into tears as she appeals to people to refrain from shooting laser beams at pilots. The pilot is also a father of twin girls. His wife conveyed through her heart-wrenching video message that she loves her husband very much and hopes to see him walking his daughters down the aisle someday.
She Called to Ban Laser Lights
Laser lights can travel up to 50 miles. This humongous range brings almost all aerial vehicles within its range. It is hard to understand why such a tool must be put in the hands of the public. Laser lights are quite affordable and can be bought for as little as a few dollars. The woman has appealed to the government to pass rules that prohibit the sale of this item.
The pilot in question was on a training mission when the incident occurred. However, had it occurred during a live mission, it would have to be aborted putting the patient’s life at risk owing to delayed treatment.
If you are a patient who is in a medical serious condition and fighting for life, would you be okay with an air ambulance professional who is fatigued and has been working a shift of almost 24 hours? Would you perceive this condition to be grave for your life? Although air ambulance personnel these days are not expected to work abnormally long hours, this fact is something you should know about. In this context, one must note that 24-hour shifts were a practice, if not common practice, prior to 1997. We bring you a research conducted in this regard by the US National Library of Medicine National Institutes of Health, which is a part of National Center for Biotechnology Information, a US Government undertaking.
The Findings of the Report were Astounding and Contrary to Popular Belief
The primary objective of the research was to assess the psychomotor agility and skill performance of the air ambulance personnel when they worked 12-hour shifts versus 24-hour shifts. The data gathered pertaining to 24-hour shifts belongs to the pre-1997 era. The data collected was compared with times when the air ambulance industry was mandated to work for limited number of hours as against the time when shifts spanning 24 hours were not alien. Intubation – a critical task that is undertaken routinely – was used as a scale to measure the efficiency of the air ambulance professionals. Surprisingly enough, there was hardly a difference between ‘overworked’ professionals and the ones who worked reasonable hours.
How Do Air Ambulance Professional Manage to Work at Optimal Efficiencies?
The answer may lie in the fact that failure is not an option when lives are at stake. No matter what the level of fatigue, when people who are driven by passion and compassion are put in a situation where the outcome depends on how they perform, the chances are they will try their best and come out winners. The fact is also an ode to the dedication of the professionals belonging to the air ambulance industry.
It might seem that the aviation and air ambulance companies have little in common. While one deals in the mechanics of aviation machines, the other primarily deals with biology and chemistry of the human body. However, when one looks closely, it is easy to spot several similarities between the two. It is these similarities that the air ambulance companies must be aware of and must work on, to improve the safety of medical flights. The risks involved in both industries are very similar to each other. This is why REVA, which is an international fixed-wing air ambulance company, has published a white paper on ‘Just Culture’
What is ‘Just Culture’ and How Does it Apply to Air Ambulance Companies?
This is a highly relevant question. Although one rarely gets to hear about fatal crashes and safety flaws concerning air ambulance companies, such incidents are not unheard of. Apart from this, there are obviously going to be some near misses. The logic behind the ‘Just Culture’ is to treat mistakes as learning opportunities to avoid them completely in the future. REVA released a white paper on the topic recently.
According to Emma Roberts who is the company’s Safety Director, the white paper meant for air ambulance companies, lays down the steps involved in implementation of just culture and explains how this culture increases the degree of safety.
‘Just Culture’ Fosters Transparency in the Way Air Ambulance Companies Function
‘Just Culture’ makes reporting easier for staff who constantly put their lives on the line to protect and serve the needy patients. The culture ensures that these front-line warriors are not punished for the mishaps but are rather encouraged to report them so that apt solutions can be found. The result is improved safety of medical flights and better compliance with medical as well as aviation norms.
In a previous post, we talked about some of the specific guidelines you need to follow when treating patients who have fainted. Also known as syncope, fainting is a common occurrence and as a medical flight paramedic, you may encounter a few patients in this situation. In this post, you’ll get more details about the guidelines released by the American College of Cardiology so you can get a thorough understanding of what to do.
More tips on handling medical flight patients with syncope
The previous post talked about the initial steps you need to take when you encounter a patient who has fainted. And those steps can be used by medical flight paramedics. According to the American College of Cardiology, health care professionals can follow the guidelines below when they have to treat a patient who faints:
- Some patients may have fainted because of irregular heartbeats, which can even be life-threatening. To determine whether your patient is facing this issue, doctors can use an implantable cardioverter-defibrillator to regulate the heartbeats.
- For syncope patients who have heart conditions, beta-blockers can be a good option.
- Health care providers should advise fainting patients to restrict their exercise in the future.
- Patients with recurring fainting spells resulting from very low heart rate might require pacemakers. In case of patients with common faints, drugs may be enough to control the situation.
- In case of unexplained fainting, heart rhythm monitoring is a good option to determine whether or not the patient has intermittent heart rhythm issues resulting in fainting.
The American College of Cardiology also advises athletes with fainting issues to visit an experienced health care provider for a heart assessment. These are some of the basic guidelines that can help in providing the right level of care for people who faint.
When a person is stuck in a challenging environment, nothing else is as effective as air ambulance flights that make use of hoists. Their presence not only ensures quick rescue but also saves a lot of time and effort when compared to a ground rescue, although they too have not been without hoist fatalities. However, that is a risk that the brave rescuers sometimes take. Here are some of the advantages, limitations, and risks associated with air ambulance flights that make use of hoists.
What Limits the Air Ambulance Flights?
- If the winds are moving at a speed greater than 20 miles per hour, if the visibility is poor or the weather is simply harsh, air ambulance flights may not undertake a rescue mission.
- There is a weight limit that comes with hoist operations and if the combined weight of the patient as well as the equipment exceeds 450 pounds, the mission might be abandoned.
- Hoist operations are never undertaken during night hours
- Conducting a hoist operation over water is tough and can be quite limiting.
The Factors taken into Consideration by Air Ambulance Flights
- The nearest location where the aircraft can be fueled
- Availability of landing area
- The location of the nearest command post
- All information related to the patient such as the weight, age, people along with the patient, etc
- Availability of a backup plan in case the mission cannot be carried out
The Different Types of Hoists Used by Air Ambulance Flights
- Rescuer Backpack: This contains hoist equipment that’s best suited for rescue along with some emergency medical equipment in anticipation of the injury.
- Bauman Bag: This equipment is used in winters when the injured patient needs to be kept warm. The bag is a splinter that fits automatically around the patient keeping him or her warm.
- Rescue Net: Here, the patient is placed prone in a rescue net which is then hooked to the hoist.
- Seat Harness: This is used primarily to rescue uninjured patients or to rescue those who have very minor injuries that do not pose any threat to life. Here, the harness is simply placed around the patient and hooked up to be hoisted away.
Carrying out hoist rescue missions requires special approval by FAA which is granted only after a rigorous certification process.
RVSM is an abbreviation that stands for Reduced Vertical Separation Minimum. RVSM-approved medical flights must be fitted with certain gadgets such as autopilot and certified altimeter. These medical flights are allowed to fly 29,000 feet above the sea level.
RVSM allows aircrafts to fly maintaining reduced vertical distance between each other; thus, paving way for more medical flights to share airspace simultaneously and safely. While this may seem quite technical for a layman, there are other distinct advantages of flying above 29,000 feet. It brings speed, comfort and safety. Let’s discuss the importance of RVSM, especially with long-distance medical flights.
Safety of Medical Flights and RVSM
Safety is always the primary concern when you choose an air ambulance. Medical flights coursing at lower altitudes are more susceptible to turbulence. Such turbulences can cause unnecessary anxiety in the patient which is not advisable when the condition of the patient is critical or the patient is already anxious about his or her health.
Speed of Medical Flights and RVSM
Time is always of essence when choosing an air ambulance. Medical flights flying at higher altitudes fly quicker and burn lesser fuel. This means that the air ambulance does not have to stop frequently for fueling. Circling the airport, landing, fueling and resuming flight can be quite time consuming and RVSM approved medical flights avoid/ reduce such hassles greatly.
Comfort of Medical Flights and RVSM
The reduced chances of turbulence, when flying at higher altitudes, make travel comfortable for the patient. The difference in comfort level is not too great but for a patient who has a fragile health condition, the small difference can mean a lot. There is also the peace of mind that comes along when you know that the aircraft carrying you will take lesser time.
Cost is always a consideration when choosing medical flights. The fact that a RVSM approved aircraft burns less fuel could translate into lesser costs for you.
Nursing is a profession that demands passion and the compassion to care. While salaries are not always the best, the job satisfaction is always high as nurses are closely involved in making the lives of those they touch better. If you choose to be an air ambulance transport nurse, your professional life is, no doubt, going to be exciting. Administering medical care on airlifted patients warrants certain specific skill sets. Let’s first discuss the salaries of air ambulance transport nurses.
Salaries of Air Ambulance Transport Nurses
According to the US Bureau of Labor Statistics, registered nurses, on an average, earned $67,930 per annum. The top 10% of this group earned in excess of 94,720 while the bottom 10% earned less than $45,040. Looking specifically at the salaries earned by Air ambulance transport nurses, the salaries varied between $66,560 and $70,500 in 2011; this is in accordance with the data collected by University of Washington.
Outlook for Air Ambulance Transport Nursing as a Career
The US Bureau of Labor Statistics projects excellent demand for nurses in general. The employment growth is slated to hover around 26% until 2020. This growth is excellent and almost twice the projected pace of growth (14%) of all occupations in the United States.
Education of Air Ambulance Transport Nurses
As per Discover Nursing, air ambulance transport nurses need to be RN (registered nurses) first before venturing into air rescues. To become an RN one needs to opt among the following three choices:
- Bachelor’s degree in nursing
- Associate degree in nursing
- Nursing diploma
The next step is to clear National Council Licensure Examination for RN. The employers may demand additional certifications based on the demand of the job. They might expect the air ambulance transport nurse to be:
- Certified flight registered nurse
- Emergency medical technician-paramedic
- Emergency medical technician-basic
To be “certified” flight nurse, one needs to work as a flight nurse for at least two years according to Board of Certification for Emergency Nursing. Working in critical care and emergency units is considered an added advantage for better employment opportunities.
It’s often a long and painful wait for an organ donor, no matter which part of the world you’re from. The number of donors around the world is much lesser than those waiting for a donor. Then, there is the issue of organ suitability. All these issues make finding an organ a prized opportunity. It is also vital that the organ reaches the recipient on time and this is where the air ambulance services often come into picture.
How Do Air Ambulance Services Help?
Air ambulance services help transport organs from the remotest of the places to the recipient in the shortest possible time. While air ambulance choppers are used for short distances, fixed wing medical aircrafts are used for longer distances. The air ambulance services are always available on-call in situations like these where a few minutes can mean the difference between life and death. Air ambulance services are considered 100% safe when transporting organs such as kidneys and liver. There are instances where even heart has been airlifted.
What Makes Air Ambulance Services Ideal for Organ Transport?
Two obvious reasons are the reach and the time taken by air ambulance services. The sophisticated aircrafts also provide a congenial environment for carrying the human organs. Unexpected eventualities like road blocks are virtually nonexistent. The air ambulance services also pave way to carry the patient quickly – with all necessary medical care – to a facility that specializes in organ transplantation. We need to understand that often recipients too are carried to a particular location, depending on factors such as time and availability of specialized hospitals.
The point to note is that most air ambulance services will take complete responsibility of coordinating the entire transport so that the organ reaches safely and on time. There are also insurance covers available to cover such air ambulance services. All it takes is a bit of planning and coordinated effort.