Training opportunities for air medical crew

Continuing professional development

Safety protocols are one of the main pillars of the service, so by basing our quality policy on continuous improvement, we are constantly developing our practice and assistance service

According to Dr Monica Fortea, Chief Executive Officer and Medical Director of Aeromedical and Marine Training and Rescue International (TRI), training and the practice of clinical cases are essential to maintain quality and safety standards in the air medical domain. “To maintain the highest level of quality and safety, we analyze and study each mission individually, using the most suitable equipment and tools according to the specific needs,” she explained. “Safety protocols are one of the main pillars of the service, so by basing our quality policy on continuous improvement, we are constantly developing our practice and assistance service.”

In the specialties anesthesia and intensive care medicine, for example, it is necessary to meet specific annual training requirements, undergo an annual appraisal, and conform to a five-year revalidation program in the UK, explained Dr Martin, a consultant in anesthesia and intensive care medicine and creator and Director of CCAT Aeromedical Training. “Medical malpractice insurers also want to know about related areas of practice, such as emergency medicine and aviation medicine, and may impose other conditions in order to agree to providing insurance cover,” he said. “All these levels of authority have set their currency to practice criteria in order to ensure that air medical personnel remain ‘fit to practice’, up to date in modern ‘best-evidence’ practice, current in statutory training, and safe to operate and practice in the remote aircraft cabin environment with exposure to all the physical, physiological, and psychological stressors of flight.”

Significant variance

It should be noted that differences between assorted types of air medical transport and retrieval services, operating under different statutory and voluntary regulatory bodies – each using an assortment of healthcare professional groups – make generalization a difficult exercise, according to Dr Martin. “Even if discussing one country, one is faced with distinct rules for doctors (physicians), nurses, paramedics, and allied HCPs [healthcare professionals], such as respiratory therapists,” he said. “To make matters more complex, there may be statutory training criteria for an individual’s terrestrial role, as well as mandatory training for extended privileges, necessary for working in particular medical facilities, or for working with a specific air medical service provider.”

Unlike the aviation industry, which is well regulated, controlled and audited by both national and international statutory bodies, health and medical care around the world is less tightly disciplined, said Dr Martin. “Some countries have attempted to regulate air ambulance operations, but the truth is that most standards concern the physical attributes of the service, for example, aircraft–patient space and interface, air portable equipment, existence of clinical and logistic policies, presence of post-holders and staff, etc.,” he affirmed. “I have written training standards and guidance for many years, but, because of the wide disparity of aeromedical missions and services, and the fast-changing nature of medicine, there is no universal statutory agreement on what information must be provided in training.”

Because of the wide disparity of aeromedical missions and services, and the fast-changing nature of medicine, there is no universal statutory agreement on what information must be provided in training

With regard to the training and development of air medical crews, the European Aero-Medical Institute (EURAMI) accreditation program emphasizes a structured induction course during onboarding and CPD as part of the commitment to maintaining a high level of competency and adaptability among air medical crews, explained Claudia Schmiedhuber, Managing Director of EURAMI. “The induction course provides a comprehensive introduction to the company and air ambulance services, while CPD ensures ongoing training in evolving medical practices and company-specific procedures,” she said. “Maintaining detailed training records for each crewmember serves compliance and regulatory purposes, aiding in identifying areas for additional focus. The mapping of training against aeromedical competencies ensures alignment with the skills needed for safe and effective aeromedical transfers.”

Despite variations in training, lessons are always able to be learned, and can be learned from experience and taught based on these real-world circumstances. Dr Jeff Hooper, Director of Clinical Services and Governance for LifeFlight, explained how the air medical service transfers experience to training: “LifeFlight’s Clinical Governance Committee oversees our retrieval practitioners, ensuring the highest quality of patient care, thus improving patient outcomes. What we learn in the field one week, we teach the next.”

What training covers

EURAMI’s training curriculum covers a spectrum of non-clinical and clinical aspects that frame well-rounded professionals, added Schmiedhuber. “Non-clinical topics include communication skills, safety procedures, and an understanding of company policies; the clinical aspects equip the crews with medical knowledge essential for diverse patient conditions during air medical transfers,” she said. “The method in the training of air medical crews consists of a continuous review and refreshment of induction training topics during CPD to maintain currency in knowledge and skills, mission case discussions in CPD to foster a culture of shared learning and continuous improvement, enhancing problem-solving skills and critical thinking.”

Many air medical transport services provide in-house training, often created bespoke to match the needs of the individual service. Rotary-wing services, such as helicopter emergency medical services (HEMS) and search and rescue (SAR), tend to have more rigid training programs, affirmed Dr Martin. “Generic aeromedical transport education exists in two major formats: long part-time university-based courses, predominantly aimed at HCPs already working in the industry, and leading to formal diploma qualifications, or short intensive courses targeted mostly at HCPs wanting to work in the industry, or those who have recently started air medical transport work,” he explained. “The latter tend to be more practical and focus on essential knowledge and skills to safely join an air medical patient transport service. The types of training courses in the CCAT Aeromedical suite range from pure theory to full high-fidelity simulation. Most courses entail a mixture of both, alongside workshops, case studies, complex problem-solving and facilitated group discussions, explorations, and exercises. In effect, there is training to suit all needs, and for all roles in the aeromedical transport and retrieval industry.”

Acknowledging diverse learning preferences, a blend of face-to-face and online or distance learning is encouraged. This approach ensures accessibility and effectiveness in training for all crewmembers, regardless of individual circumstances

Dr Hooper said of LifeFlight’s training academy: “We are fortunate to train more than 1,500 aviation and medical professionals annually. LifeFlight employs more than 180 medical professionals, all of whom undergo rigorous pre-employment training specific to the air medical retrieval environment and regular training through our registered training organization. LifeFlight’s specialist retrieval practitioners are supported by LifeFlight’s clinical governance framework.” On induction and continued training, he added: “LifeFlight senior medical staff hold positions as specialists in emergency medicine, intensive care and anesthetics in the Queensland hospital system. Registrar doctors are employed from Australia and around the world. There is an intensive two-week orientation at the start of the term with both clinical and air medical training components. Weekly teaching based on aeromedical themes occurs each Thursday with invited experts from the LifeFlight team and specialty teams from the hospital.”

Requiring completion of training before undertaking unsupervised live missions is a fundamental safety measure that ensures air medical crewmembers possess the necessary skills and knowledge for successful air medical missions, according to Schmiedhuber. “Acknowledging diverse learning preferences, a blend of face-to-face and online or distance learning is encouraged. This approach ensures accessibility and effectiveness in training for all crewmembers, regardless of individual circumstances,” she said.

Training offer

During the Covid-19 pandemic, it was necessary to deliver a significant amount of training online instead of in the classical course format, observed Dr Matthias Ruppert, Chief Medical Officer at ADAC HEMS Academy. “After that period, there has been a transition to hybrid versions whereby a part of the training consists of online lectures and a part is face-to-face in the Academy,” he said. “There is sufficient supply in terms of opportunities for air medical crews, but the shortage of personnel in healthcare does make it difficult [to find] time to get them off-duty from work or out of their clinical obligations.”

The training provided by Aeromedical and Marine TRI covers fixed-wing and HEMS air medical transport, helicopter intensive care medical service (HICAMS), ICU air medical transport, pediatric air medical transport, and advanced life support (ALS) training, explained Dr Fortea. “The fixed-wing and HEMS training is taught every six months to the medical team. Other external educational companies specialized in EMS and HEMS are collaborating with us on some specific courses,” she said. “Furthermore, training is ongoing throughout the year; it is important for the team to receive both internal and external training to stay up to date. Our team undergoes internal training sessions established by the medical management, and, depending on the goal, we have annual, semi-annual, or quarterly training sessions.”

CCAT Aeromedical Training is a not-for-profit education provider delivering a suite of air medical transport short training courses from introductory basic sciences right through to advanced-level and specialist transport training, explained Dr Martin. “2024 is the 30th anniversary and we still run face-to-face courses in the UK, Thailand and, by arrangement, in other countries such as Kenya, UAE, Oman and Bahrain,” he said. “The UK and Thailand Basic and Foundation Level courses run once a year (twice if there is more demand) and the intermediate and advanced courses run once every 18 months in both centers.”

In addition, live webinar foundation, intermediate and advanced-level courses, together with bespoke hybrid arrangements, usually to match individuals’ requirements, are all part of CCAT Aeromedical Training’s catalogue, explained Dr Martin. “Participants on the courses are offered pre-course study materials and post-course mentorship. Certification is recognized and accredited around the world. The CCAT Foundation Level (FL) short course has recently been described as ‘the aeromedical transport equivalent of Advanced Trauma Life Support (ATLS)’, in that both have introduced innovative and learner-friendly methods to teach complex medicine in logical fundamental blocks,” he said. “These are the bricks that together build a structured framework designed to meet the needs of every patient. Ultimately, the CCAT FL course promotes novel and comprehensive risk management processes, targeted at improving patient safety and effective mission completion.”

Simulation plays a large role in the suite of tools to help train and educate air medical staff, providing a realistic simulacrum of what healthcare professionals may experience on the job

Simulation plays a large role in the suite of tools to help train and educate air medical staff, providing a realistic simulacrum of what healthcare professionals may experience on the job. Dr Hooper described the range of simulated environments that crew can experience and train in: “The training academy is located within a state-of-the-art, purpose-built training facility situated in the Brisbane International Airport precinct. It’s home to fully equipped medical training rooms, Thales’ AW139 high-fidelity full-flight simulator, a medical simulator, an aircrew simulator and a 20m indoor pool for all water-based training including helicopter underwater escape training (HUET).

“The LifeFlight ‘MediSim’ enables doctors and medical personnel to spend time in a lifelike helicopter environment, ensuring they are ready to face the real-life challenges of air medicine,” explained Dr Hooper. “The simulator is fitted with an intercom and communications systems along with electrical systems, fully functioning medical oxygen and aircraft lighting that can replicate the operational conditions doctors will encounter out in the field. It also generates the loud noise of the helicopter, which can pose a huge communication challenge in the cabin. Much of the medical simulation uses low-fidelity mannequins with a high-fidelity environmental pressure. We also utilize the Laerdal SimMan 3G and monitor for more intensive medical simulation.”

In general, even looking at different countries, the means of financing training is not a really big issue, according to Dr Ruppert. “HEMS in Germany is financed almost 100% by health insurance. In the UK, it is charity based, while other countries have different financing models. As an example, overall health insurance companies are pretty cooperative in terms of training needs, even if there is not a very strict legal obligation,” he concluded.

In the case of fixed-wing air ambulance and commercial airline transports, the final words from Dr Martin identified a key problem – “that there is no universal agreement on what information must be provided in aeromedical training. As always, content is more important than volume, and the devil is in the detail.” He added that a relatively new think tank called the International Community for Aeromedical Research and Universal Standards (ICARUS) has embraced the challenge and is forging ahead in the debate over international agreement on medical practice in the air transport of patients.