Recently published in the Air Medical Journal, the course directors Dr Per Bredmose, Dr Jeff Hooper, Dr Sandra Viggers, Dr Cliff Reid, Dr Gareth Grier, and Dr Stefan Mazur described each of the training programs they run in terms of the education methods used, content and assessment processes.
The six courses under comparison were from SAAS MedSTAR in Australia, Gothenburg Hospital in Sweden, NSW Ambulance Aeromedical Operations in Australia, London’s Air Ambulance, UK, LifeFlight Retrieval Medicine, Australia, and the Air Ambulance Department of Oslo University Hospital in Norway.
Below is an overview of the report The full paper can be found online here.
SAAS MedSTAR, Emergency Medical Retrieval, Adelaide, Australia
Participants are senior trainees or consultants generally from a critical care background from emergency medicine, anesthesia, or intensive care medicine and often have no previous prehospital and retrieval medicine (PHRM) experience. Rescue retrieval paramedics and retrieval flight nurses also attend as key components of the PHRM team. An extensive list of prereading material, as well as online vodcasts and learning modules, is required to be completed by participants before course commencement. The course is delivered using a variety of formats with some didactic lectures or short recaps of precourse learning, but a bigger emphasis is on hands-on skill stations, simulations, and scenarios. As well as clinical training, manual handling and aircraft safety/crewing are also incorporated. Post course, participants are required to complete competency sign-off for procedures and undertake a small number of buddy or supervised shifts before independent practice.
Gothenburg Hospital, Gothenburg, Sweden
The course was introduced more than 10 years ago as a reaction to what was perceived as a widespread misconception that existing concept courses delivered gold-standard knowledge. The course’s ideology was to help participants rise above the often quite basic level many of these ‘life support’ franchises taught at the time.
Participants are registrars in anesthesia/intensive care and emergency medicine; very few have PHRM experience. Some specialists attend the course before committing to prehospital positions. The course literature that the participants are expected to study and familiarize themselves with is available before the course starts.
Another course principle is that most specialist physicians taking part in the course will work very little, if at all, in the prehospital environment. On the other hand, all trainees will take part or even lead in-hospital resuscitation efforts. Therefore, one course objective is to deliver knowledge and competence that is applicable and usable, not only in the prehospital environment, but also in resuscitation situations inside the hospital. This is consistent with course ideology that the quality of care should be equal regardless of where resuscitation takes place – an ambition that raises the challenge of delivering high-quality resuscitation care.
Originally, the course was aimed at trainees in anesthesia/intensive care. With the introduction of the emergency medicine specialty in Sweden, the course has opened up for trainees from this specialty as well. This has enriched the course in many ways, but also posed some challenges with participants from a more varied level of clinical background.
NSW Ambulance Aeromedical Operations, Sydney, Australia
Physicians’ specialty background is close to 50 per cent emergency medicine and 50 per cent anesthesia. Some are new to Australia, and many are new to out-of-hospital care. A smaller number of new helicopter emergency medical service critical care paramedics also require training, and some existing critical care paramedics attend for refresher training. The curriculum aims to redress imbalances among these different professional groups in scene management, airway management and anesthesia, critical care, and trauma procedures.
The focus of training is on team performance rather than individual knowledge. Simulation training and all assessments are consequently performed in teams to foster a collaborative mindset from day one.
Interhospital critical care is covered in the first week because this builds on the existing critical care knowledge of the erstwhile hospital-based physicians and allows them to acclimatize to the team structure and systems of governance. Week two introduces prehospital care with an emphasis on safety, scene management, mission momentum, and rapid trauma procedures. Human factors and environmental challenges are introduced into simulation training with incremental stress exposure and perturbation training to build team resilience.
London’s Air Ambulance, London, UK
Flight physicians and paramedics participate in all aspects of the course together. Attendees are from our own and other similar services in the UK and beyond. Lectures related to core clinical subjects are focused predominantly on prehospital trauma care. ‘Hands-on’ work takes various forms including workshops, facilitated moulages, coached moulages, and full moulages.
The material builds in a spiral method during the week. Day six is a simulated 12-hour shift at work in which teams are activated to different simulated missions but with embedded faculty members in support of the team. Candidates are encouraged to take part in the broadest aspects of a day at work, including conversations with simulated families and technical and nontechnical debriefs. Faculty ‘windows’ allow for key teaching to be delivered.
LifeFlight Retrieval Medicine, Queensland, Australia
Trainees are predominately senior emergency trainees (70 per cent) or anesthetic trainees (30 per cent). Most have minimal experience in prehospital care and retrieval. The clinical component focuses on developing new skills in prehospital care and adapting the critical care skills of the candidates to a new environment. Communication, handover, and crew resource management (CRM) skills are reinforced with simulation. Lectures are limited to focus on major concepts (eg, prehospital anesthesia or hemorrhage control); the majority of this is hands-on skill stations and simulation. Local ambulance and fire services are involved in combined extrication training and outdoor simulations at a purpose-built training facility. Trainees have further orientation at individual helicopter bases, sign-off of critical interventions and equipment, and supervised shifts before commencing work for LifeFlight.
Air Ambulance Department, Oslo University Hospital, Oslo, Norway
Participants must have prehospital experience, and over 90 per cent are consultant anesthesiologists already working in prehospital care. The participants come from various prehospital services around Scandinavia. The course is designed to take advantage of participants’ previous and extensive experience, which is emphasized at the beginning of the course. The majority of the teaching is conducted using the experience and knowledge from participants. The number of lectures is kept to a minimum. There are four hours of simulations on all days, as well as several small group sessions. Participants are encouraged to share experiences, especially during evening sessions like ‘Wine and Reflections’.
Review concludes medical training similarities outweigh differences
Following the detailed comparison exercise, the course directors concluded: “We have identified similarities and differences among some well-recognized PHRM courses worldwide. Although independently developed, a similar pattern of course content and teaching methodology has evolved. In many instances, course directors and teachers independently came to the same conclusions about what training is needed for the PHRM clinician and what is an effective format for delivering that education with a higher degree of sophistication. Differences that do exist relate to some aspects of content as well as the background of participants and in some cases the method of delivery. The authors believe that even in the small niche of PHRM, courses should be tailored not only to the participants, but also to the destination of the participants (ie, in which organization and context they will use their skills).”