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of the patient are not to be considered in mak- ing aeronautical decisions, it is impossible for members of the transport team to ignore what the outcome for the patient might be if they fail to complete the transport.


program should have clear and unambiguous written policies that

From the above, it is a given that a flight place considerations of

safety at the forefront of all operations. In addi- tion, this emphasis on safety and prudent deci- sion-making needs to be reflected frequently in routine communications from managers.


borrow a paragraph from a primer on air-med- ical safety, a pilot who might otherwise feel con- flicted at

the point of an important in-flight

decision will be much more likely to opt for safety when … …his Chief Pilot, Director of Operations,

and Program Director all stand shoulder-to- shoulder and tell him, “There is no excuse for

flying in conditions that

are below the mini-

mums established for this program. You are expected to divert or abort when possible, or land and call for help if you cannot maintain minimums.” And, of course, they’ve also told him, “The condition or situation of the patient has no bearing on aeronautical decisions.” This kind of message should be part of ini-

tial training for all new hires, and should be reit- erated routinely during each team member’s annual recurrent training.


A high degree of experience and technical

competency is expected of all team members in air-medical transport programs. Highly experi- enced and qualified pilots and medical crew will enjoy a greater measure of ‘cognitive


while performing their duties. This reserve per- mits an increased awareness of factors in the flight environment that might be significant to their personal safety. We refer to this as situation- al awareness, and reduction or loss of situational


awareness is a major contributing factor in most human error accidents. It should therefore be part of a flight program’s safety management plan to provide regular training in all areas necessary to insure

that crewmembers remain proficient at

their technical skills. A review of NTSB accident investigation reports also reveals that pilot train- ing should include emphasis on and frequent practice of the particular skills required by the specific flying environment where he operates. It is expected the final findings of the OSI-HEMS research project will provide a more detailed dis- cussion of the training deficiencies that have contributed to accidents in the past.

TEAM COMPETENCY In addition to training to insure individual

proficiency, Air Medical Resource Management (AMRM) training is specifically designed to teach all members of the patient transport team how to work together to insure safer operations. The patient transport team includes those who are directly involved with flight

activities: the

pilot and medical crewmembers, as well as those who are indirectly involved: communications specialists, operational controllers, and mainte- nance technicians, when needed.


A description of the substance of a com-

plete AMRM training program for members of an air medical transport program is beyond the scope of this article. Ultimately, it is up to each program to develop and administer that training and to continuously assess and update the sub- stance of it to insure the competency of both individuals and teams. Each of the other three dimensions of safe operations: the cultural, psy- chological, and technological, must be addressed in the substance of the training.


In their book Beyond Aviation Human

Factors, Maurino, et al make plain the need to look above and beyond the sharp end of the accident sequence to identify and control the broader organizational or systemic factors which


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