Medical Transport Systems Research Articles

Education and Certification for Patient Transport

The 10th edition of the Commission on Accreditation of Medical Transport Systems (CAMTS) Accreditation Standards was published in October 2015. The publication of these standards coincided with the 25th anniversary of CAMTS. An integral part of these standards are the Orientation, Training, and Continuing Education Requirements for patient transport. In order to ensure and evaluate competent and safe patient care before, during, and after transport, these particular standards provide a framework for transport programs to develop orientation and ongoing education. It is important that the education and training of all transport members reflect the mission and scope of service of the transport program. The patients we transport and the colleagues we work with should expect nothing less than the best care possible when requiring our services. Eileen Frazer, RN, CMTE, is the CAMTS executive director. She can be reached at [email protected] and (864) 287-4177. Renee S. Holleran, FNP-BC, PhD, CEN, CCRN (emeritus), CFRN, CTRN (retired), FAEN is a CAMTS Board member representing Emergency Nurses Association (ENA).

LO094: Mass casualty incident training for rural Canadian municipalities: a mobile education unit initiative

Introduction / Innovation Concept: The Shock Trauma Air Rescue Society (STARS®) is a charitable, non-profit organization that is dedicated to providing a safe, rapid, highly specialized emergency medical transport system for the critically ill and injured. The STARS® Mobile Education Unit (MEU) is comprised of a high fidelity simulation suite that mimics a hospital emergency room, installed in a specially equipped motorhome (SEM) that can wirelessly operate a high fidelity human mannequin. The MEU provides an excellent opportunity to combine continuing medical education for resuscitation and MCI management. At present, no formal MCI education process exists in Saskatchewan. Curriculum, Tool, or Material: The Saskatchewan STARS® MEU delivers a phased MCI education initiative to rural and regional centers within the province. The educational initiative is sub-divided into three stages: 1. pre-exercise knowledge translation using a flipped classroom approach, 2. on-site tabletop exercise (TTX) and, 3. high-fidelity simulation session with a review of MCI management principles . Sites perform a Hazard Vulnerability Analysis (HVA) following stage 2 and the highest identified site-specific risks are utilized during the development of the simulated scenarios for stage 3. During stage 2, participants also complete a pre and post-exercise survey. The survey evaluates the educational component, the tabletop exercise component and the perceived pre and post tabletop exercise competencies for the management of MCI. In the pilot project, two regional sites completed the tabletop exercise. The pre-exercise survey evaluated perceived MCI and disaster preparedness for the region. Only 8% and 25% of participants at each site respectively, reported that their disaster plan had been trialed in tabletop, full exercise or real activation within the past three years. Participants strongly agreed that the tabletop exercise was a valuable experience (86% and 88% respectively). More robust data will become available as the initiative transitions out of the pilot stage to formal operations. Conclusion: A formal MCI training program implemented through the STARS® MEU for rural Saskatchewan municipalities enables participants and their organizations to both review and enhance their current emergency management plans. This initiative will aim to establish a foundation for future collaboration at the provincial and national level for rural MCI training and preparedness.

A retrospective analysis of the occurrence of accidents during 20 years of neonatal transport in Liguria region, Italy.

Our article focuses on a retrospective analysis of the occurrence of accidents relating to 20 years of activity of Neonatal Emergency Transport Service (NETS) in Liguria region, Italy. The objective of this study is to determine the vehicle accident rate for a specialized emergency medical services-NETS transport system between 1995 and 2015. We reviewed 5035 medical records related to the activity of our NETS from its beginning, in February 1995 to June 2015. We identified the occurrence of three road accidents (rate ∼1 : 1600 transports; 1 : 170 000 driven km), no helicopter accidents and only one technical problem during helicopter use; our service was not involved in any crashes resulting in injury. We discussed some reasons possibly explaining these good results.

Introducing CAMTS EU

The Commission on Accreditation of Medical Transport Systems (CAMTS) recently registered CAMTS EU in Europe and Switzerland. CAMTS EU is a stand-alone nonprofit organization that will be based in Switzerland with the same mission, vision, and values as CAMTS. This new organization will provide availability and focus on international policies and practices. CAMTS EU was created to serve our constituents outside of North America, recognizing not only cultural differences but government restrictions and laws of other countries while maintaining the integrity of the process in the United States and Canada. Eileen Frazer, RN, CMTE, is the CAMTS executive director. She can be reached at [email protected] and (864) 287-4177.

Board Proceedings

Many have questions about how decisions are made regarding accreditation. The Commission on Accreditation of Medical Transport Systems (CAMTS) board of directors works very hard to be consistent and true to our values in determining whether a medical transport service is in substantial compliance with the accreditation standards. This is not an arduous process, but it is a process with steps along the way to make sure we maintain the dignity of the service we are reviewing and the integrity of the decision-making process.

Case study of medical evacuation before and after the Fukushima Daiichi nuclear power plant accident in the great east Japan earthquake.

IntroductionIn Japan, participants in the disaster-specific medical transportation system have received ongoing training since 2002, incorporating lessons learned from the Great Hanshin Earthquake. The Great East Japan Earthquake occurred on March 11, 2011, and the very first disaster-specific medical transport was performed. This article reviews in detail the central government’s control and coordination of the disaster medical transportation process following the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant Accident.Case descriptionIn total, 124 patients were air transported under the coordination of the C5 team in the emergency response headquarter of the Japanese Government. C5 includes experts from the Cabinet Office, Cabinet Secretariat, Fire Defense Agency, Ministry of Health, Labour and Welfare, and Ministry of Defense. In the 20–30 km evacuation zone around the Fukushima Daiichi nuclear power plant, 509 bedridden patients were successfully evacuated without any fatalities during transportation.Discussion and evaluationMany lessons have been learned in disaster-specific medical transportation. The national government, local government, police, and fire agencies have made significant progress in their mutual communication and collaboration.ResultsFortunately, hospital evacuation from the 20–30 km area was successfully performed with the aid of local emergency physicians and Disaster Medical Assistance Teams (DMATs) who have vast experience in patient transport in the course of day-to-day activities. The emergency procedures that are required during crises are an extension of basic daily procedures that are performed by emergency medical staff and first responders, such as fire fighters, emergency medical technicians, or police officers. Medical facilities including nursing homes should have a plan for long-distance (over 100 km) evacuation, and the plan should be routinely reevaluated with full-scale exercises. In addition, hospital evacuation in disaster settings should be supervised by emergency physicians and be handled by disaster specialists who are accustomed to patient transportation on a daily basis.

Optimization and Control of Cyber-Physical Vehicle Systems.

A cyber-physical system (CPS) is composed of tightly-integrated computation, communication and physical elements. Medical devices, buildings, mobile devices, robots, transportation and energy systems can benefit from CPS co-design and optimization techniques. Cyber-physical vehicle systems (CPVSs) are rapidly advancing due to progress in real-time computing, control and artificial intelligence. Multidisciplinary or multi-objective design optimization maximizes CPS efficiency, capability and safety, while online regulation enables the vehicle to be responsive to disturbances, modeling errors and uncertainties. CPVS optimization occurs at design-time and at run-time. This paper surveys the run-time cooperative optimization or co-optimization of cyber and physical systems, which have historically been considered separately. A run-time CPVS is also cooperatively regulated or co-regulated when cyber and physical resources are utilized in a manner that is responsive to both cyber and physical system requirements. This paper surveys research that considers both cyber and physical resources in co-optimization and co-regulation schemes with applications to mobile robotic and vehicle systems. Time-varying sampling patterns, sensor scheduling, anytime control, feedback scheduling, task and motion planning and resource sharing are examined.

Air medical transport system

We describe the importance of establishing air medical transport systems linked to emergency medical services in Sri Lanka.

Supporting dispatch decisions in interfacility medical transfers: Understanding the roles of uncertainty and reliability

Efficient transfer of patients between facilities is a key component of regionalized critical care systems, but interfacility transfers pose added risks to patients. We created a decision support tool for dispatchers in medical transportation systems which provides estimates of the time to definitive care, the time between receiving the transfer request and patient handoff, which is a key component of dispatch decisions. This tool provides point-estimates of transfer times that are more accurate than the dispatchers own estimates, to support resource allocation and medical triage decisions. However, additional information about the uncertainty of these estimates may further improve dispatcher decision making. This paper describes an observational study conducted with 2 expert and 2 novice dispatchers in a medical transportation service on usage of our prototype decision support tool. In particular, we focused on whether these dispatchers use uncertainty information in their decision process, and how this information should be presented in a tool. We found that uncertainty, as represented by of the spread of possible transfer times (i.e., variability of times), is not currently considered by dispatchers. However, our observations suggest that reliability information (i.e., the trustworthiness of the tool's estimates) would be used. Expert dispatchers would use information about the reliability of estimates to build their trust in the system, while novices should use reliability information to calibrate their trust.

The impact of precipitation on land interfacility transport times.

Timely transfer of patients among facilities within a regionalized critical-care system remains a large obstacle to effective patient care. For medical transport systems where dispatchers are responsible for planning these interfacility transfers, accurate estimates of interfacility transfer times play a large role in planning and resource-allocation decisions. However, the impact of adverse weather conditions on transfer times is not well understood. Precipitation negatively impacts driving conditions and can decrease free-flow speeds and increase travel times. The objective of this research was to quantify and model the effects of different precipitation types on land travel times for interfacility patient transfers. It was hypothesized that the effects of precipitation would accumulate as the distance of the transfer increased, and they would differ based on the type of precipitation. Urgent and emergent interfacility transfers carried out by the medical transport system in Ontario from 2005 through 2011 were linked to Environment Canada's (Gatineau, Quebec, Canada) climate data. Two linear models were built to estimate travel times based on precipitation type and driving distance: one for transfers between cities (intercity) and another for transfers within a city (intracity). Precipitation affected both transfer types. For intercity transfers, the magnitude of the delays increased as driving distance increased. For median-distance intercity transfers (48 km), snow produced delays of approximately 9.1% (3.1 minutes), while rain produced delays of 8.4% (2.9 minutes). For intracity transfers, the magnitude of delays attributed to precipitation did not depend on distance driven. Transfers in rain were 8.6% longer (1.7 minutes) compared to no precipitation, whereas only statistically marginal effects were observed for snow. Precipitation increases the duration of interfacility land ambulance travel times by eight percent to ten percent. For transfers between cities, snow is associated with the longest delays (versus rain), but for transfers within a single city, rain is associated with the longest delays.

Successful Airtraq Use in an Air Medical Transport System

IntroductionThere is a large body of literature that shows that the AirTraq device achieves equal or superior rates of successful intubation in all classes of user. A recent prospective human trial of the device questioned the first pass success rate and whether effective training could occur outside the Operating Room (OR). The purpose of this study was to investigate the first pass success rate for intubation with the AirTraq (AT) device utilizing only mannequin training in an air ambulance setting from Aug. 1 2009 to Aug. 1 2012 and compare it to direct laryngoscopy (DL). HypothesisWe hypothesize that the AirTraq device will be as effective overall as direct laryngoscopy, and that this requires no OR training to achieve. MethodsA retrospective chart review of 161 intubations by air ambulance flight nurses from Aug. 1, 2009 to Aug. 1, 2012 was conducted. Data regarding date of service, devices used, number of attempts, rescue device use, and complications was gathered and analyzed. The generalized estimating equation and the chi-squared test were used to evaluate the data. Results161 intubations were reviewed. 135 met inclusion criteria. Overall first pass success rate for AT was 82% (68/83) and DL was 74% (35/47). Overall first use success rate for AT was 79% (71/90) and DL was 70% (43/61). The overall success rate of intubation for any patient in which either AT or DL was attempted is 96% (130/135). ConclusionAirTraq was shown to be as effective as direct laryngoscopy. All air crew training for the AirTraq device was performed on mannequins. The successof the device compared to DL shows that mannequin training is sufficient to implement the AirTraq device for pre-hospital intubation.

The Case for Aggressive Management in Traumatic High-Grade Cervical Dislocations

raumatic cervical high-grade spondylolisthesis is a devastating injury, and spondyloptosis represents the most T extreme form in this spectrum. Although most patients have sustained a complete or near complete spinal cord injury, there are now many case reports in the literature with neurologically intact or incomplete patients with spondyloptosis (1-3, 5-7). This situation has been possible because of posterior element fractures that allow expansion of the spinal canal as well as advances in the emergency medical transport system. At the present time, there is no consensus on the management of cervical spondyloptosis owing to the rarity of published cases on the topic. A previous review by Dahdaleh et al. (2) found only 8 reported cases of spondylolisthesis in the English literature before 2011.

Myths and Beliefs

It is amazing how many times I am approached with interpretations of Commission on Accreditation of Medical Transport Systems (CAMTS) standards and policies that are completely false but are held as common beliefs by some constituents. I am not quite sure how these myths get started, but as Mark Twain said, “A lie can travel halfway around the world while the truth is putting on its shoes.”

Supporting Air Versus Ground Vehicle Decisions for Interfacility Medical Transport Using Historical Data

Patients undergoing interfacility transfers are at potentially greater risk of adverse or critical events than those in hospital, and efficient transfers play a significant role in reducing mortality and morbidity. Medical dispatchers rely on accurate estimations of transfer time in determining the most appropriate method of transportation, often either a helicopter and/or land ambulance, in situations that are characterized by high time pressure and uncertainty. In this paper, we propose the design of a data-driven decision support tool to improve dispatcher transport mode decision making. We studied the dispatch process of the air and land medical transport system in Ontario, Canada through onsite observations and developed a tool which generates transfer time estimates based on historical data. We found that dispatchers have large estimation errors, and are biased toward higher degrees of underestimation for air transfers compared with land transfers. In contrast, the proposed tool produced estimates that had significantly less error than dispatcher estimates. The estimation error for the tool was on the average 21 min less: a practically significant difference in urgent patient care. Through onsite observations and the relevant literature, we also identified factors that may influence the collaboration between the dispatcher and the tool. This research is a first attempt to study how decisions are made for interfacility medical transfers and for evaluating the accuracy of human operator estimates of these transfer times. It is also the first to demonstrate a tool's utility in comparison to existing procedures for estimating transfer times.

Safety and Quality in Medical Transport Systems

Safety and Quality in Medical Transport Systems

Book Review: Safety and Quality in Medical Transport Systems

Review of Safety and Quality in Medical Transport Systems, John W. Overton, Jr. and Eileen Frazer (Eds.)

Safety Culture Surveys

Since 2009, the Commission on Accreditation of Medical Transport Systems (CAMTS) has been conducting a safety culture survey each time a program submits a Program Information Form (PIF) before a site visit. The CAMTS office will request E-mail addresses and send an electronic survey to each employee as soon as the PIF is received. The surveys are formatted through Survey Monkey and returned to CAMTS anonymously so that the only identity we are aware of is the discipline of the respondent (such as nurse, paramedic, MD, pilot, manager, mechanic, and so on).

Site Surveyor Training

The Commission on Accreditation of Medical Transport Systems (CAMTS) will conduct its 8th site surveyor training class in March at the Bell Training Center, Fort Worth, TX. As site surveyors retire or move away from medical transport onto other career opportunities, we need to replace and expand the pool of surveyors, maintaining about 60 professionals with various backgrounds and experiences. In 2013, we invited 17 applicants to attend the 3-day course. There are 6 registered nurses/managers, 4 paramedic/managers, 4 pilot/managers, 1 aviation consultant, and 2 physicians. Many have backgrounds in rotor wing, fixed wing, and ground medical transport, and most have over 10 years of current experience and are employed by programs that are CAMTS accredited. One of the physicians is from an accredited service in London, and 1 of the pilots is from Swiss Air Rescue.

Education Requirements and Opportunities

It is obvious from our pages and lists of education requirements for medical personnel in the standards that the Commission on Accreditation of Medical Transport Systems (CAMTS) process places great emphasis on initial and continuing education. Each time standards are revised, as they were in October 2012, we review our current criteria to ensure they are still pertinent and not just a check-off list.

Current status of emergency medical transport system for children in Fukuoka metropolitan area

Current status of emergency medical transport system for children in Fukuoka metropolitan area