The role of the flight paramedic in air medical safety and crew resource management.

Abstract

The National Flight Paramedics Association (NFPA) was formed as a nonprofit organization in 1986 and dedicated itself to promoting the global growth and development of the paramedic profession. During the time of NFPA’s formation, the air medical community was plagued by an alarming accident rate that approached nearly 8 accidents per year. With attention drawn to the rising accident rate and public opinion turning, the air medical community began an internal process to attempt to minimize the danger. The NFPA and other air medical associations issued position papers defining the minimal protective equipment for those working in the rotorwing air medical environment. Through the support of a variety of professional associations, including the NFPA, the Commission on Accreditation of Air Medical Services (now called the Commission on Accreditation of Medical Transport Systems) was formed with the intent of improving air medical safety through the creation of voluntary industry standards. Issues such as minimum weather requirements, aircraft safety equipment, and crew safety training were areas of focus both in industry standards and voluntarily by the aviation operators. These efforts toward improved safety yielded an initial drop in the air medical accident rate to nearly 5 crashes per year during the late 1980s to mid-1990s. Unfortunately, the downward accident trend did not continue and subsequently reached a rate of nearly 11 crashes per year in the period of 1998 to 2001. Sadly, adding to this statistic was a crash that claimed the life of flight paramedic Tim Hynes, a founding member and past president of the NFPA. Since that crash in 1998, nearly 60 persons have been killed and over 40 injured in air medical crashes. The growing air medical crash rate has created an immense burden on the air medical carrier insurance underwriters. This burden naturally has manifested itself in rising insurance premiums. The rise in insurance rates, coupled with the resource-scarce managed healthcare environment, has resulted in the closing or downsizing of many air medical operators. With no end in sight to the current trend in accidents, the safety issue must be viewed as one that not only directly threatens the lives of the air medical provider but also threatens to self destruct the air medical community through financial burden and possible loss of public favor. In November 2002, a comprehensive air medical safety document was released as a supplement to the Air Medical Physician’s Handbook. This document, entitled “A Safety Review and Risk Assessment in Air Medical Transport,” represents the most comprehensive review of air medical crash and safety data available to the air medical community. The document was compiled by the University of Chicago Aeromedical Network safety committee and was made available for mass reproduction and distribution through the financial support of many organizations, including the NFPA. This document should be considered mandatory reading for all flight paramedics and represents a valued adjunct to this position paper. One of the greatest factors to control air medical risk identified by the University of Chicago Aeromedical Network safety document was the concept of crew resource management (CRM). The CRM concept requires pilots to involve other team members in making safety-related decisions regarding the flight. The NFPA fully supports the concept of CRM, and this model is a cornerstone of the following position paper. The following is the position of the NFPA regarding the role and responsibilities of the flight paramedic regarding air medical safety and crew resource management: The NFPA believes that the flight paramedic should place the safety of the air medical environment above all other scene and transport priorities. Despite patient condition or personal needs of the flight team, transport into unsafe flight conditions must not commence or continue. The NFPA believes that the flight paramedic should not participate in any behavior that might coerce a pilot into accepting or continuing a flight into weather that the pilot deems may be unsafe for flight. The NFPA believes that the flight paramedic should maintain situational awareness regarding safety at all times and specifically focus on the safety of the flight environment during all critical phases of flight (departures, landings, or as requested by the pilot), regardless of patient condition or other medical-related duties. Position statement of the National Flight Paramedics Association