Physician-led crews score high for perceived patient safety

HEMS teams with a dual medical crew comprising a physician and an assistant rate highest among medical directors for perceived patient safety, according to research published by the Air Medical Journal.

Researchers Dr Kristen Rasmussen, Jo Røislien and Dr Stephen J.M. Sollid, who are affiliated to the Norwegian Air Ambulance Foundation, the Air Ambulance Department of Oslo University Hospital and the University of Stavanger, found that the most common reasons for the choice of crew are ‘tradition’ and ‘scientific evidence’. They commented that crew configuration is believed to affect patient care and safety, but ‘evidence to support the advantages of one crew concept over another is ambiguous’, adding that ‘the benefit of physicians as crewmembers is still highly debated’.

The researchers surveyed medical directors of HEMS providers in Europe, North America, Australia, New Zealand, and Japan, asking what crew compositions their organisations use and the rationales behind the choices, and also to evaluate patient and flight safety within their services.

According to the results, most respondents said they would rather keep their current crew configuration, but some would prefer to add a physician or supplement the physician with an assistant in the cabin. The 66 responses received suggest that differences in medical staffing influence perceived flight and patient safety, said the researchers.

Of 48 services that include physicians on their crews, the most common specialty of the physicians was anaesthesiology (85 per cent) followed by emergency medicine (58 per cent). The three most common staffing models were physician and HEMS crew member (38 per cent), physician and nurse (20 per cent), and nurse and EMT/paramedic (17 per cent). Physicians were single medical care providers in 26 services and had assistants in 22 services. Nurses were single providers in two services and had assistants in 13 services. Paramedic-led services were rare – only two survey respondents used a paramedic alone, and one service operated with a paramedic and an assistant. The researchers found that overall, 30 services (45 per cent) had a single medical provider and 36 (55 per cent) a dual medical crewmember configuration.

Other findings included in the study report include that systems with a single crewmember in the cabin generally assigned lower scores for patient safety during night missions than for daytime missions. In this group, there were significantly fewer respondents with perceived patient safety ‘acceptable or better’ for both night and daytime missions when compared with systems with an assistant in the cabin.

The researchers suggested that future studies should attempt to isolate the effect of different medical crew models on patient safety and flight safety in an experimental scenario.

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