Kenneth A. Williams

Teamwork in emergency medical services

Emergency medical care is delivered by highly trained and motivated individuals working in groups. In some cases, these groups function as teams, but their teamwork has been poorly studied and rarely is the result of focused training. Medical outcome traditionally is described using patient parameters and often is related to the economics of care delivery. Errors in medical care typically are blamed on individuals and occasionally on system problems. Teams and teamwork, although a major part of the medical delivery system, usually are not included in training, outcome measures, or rigorous quality improvement efforts. This article outlines issues involved in the analysis of medical errors as they relate to measures of individual and team performance and introduces concepts related to emergency care teamwork and team training. Through analogy with aviation analysis of errors and corrective training medical care similarly is being analyzed and error-reduction efforts studied and implemented. The potential benefit of teamwork training for EMS personnel, including air medical crews, is discussed.

Educational and Research Implications of Portable Human Patient Simulation in Acute Care Medicine

Advanced medical simulation has become widespread. One development, the adaptation of simulation techniques and manikin technologies for portable operation, is starting to impact the training of personnel in acute care fields such as emergency medicine (EM) and trauma surgery. Unencumbered by cables and wires, portable simulation programs mitigate several limitations of traditional (nonportable) simulation and introduce new approaches to acute care education and research. Portable simulation is already conducted across multiple specialties and disciplines. In situ medical simulations are those carried out within actual clinical environments, while off-site portable simulations take place outside of clinical practice settings. Mobile simulation systems feature functionality while moving between locations; progressive simulations are longer-duration events using mobile simulations that follow a simulated patient through sequential care environments. All of these variants have direct applications for acute care medicine. Unique training and investigative opportunities are created by portable simulation through four characteristics: 1) enhancement of experiential learning by reframing training inside clinical care environments, 2) improving simulation accessibility through delivery of training to learner locations, 3) capitalizing on existing care environments to maximize simulation realism, and 4) provision of improved training capabilities for providers in specialized fields. Research agendas in acute care medicine are expanded via portable simulations introduction of novel topics, new perspectives, and innovative methodologies. Presenting opportunities and challenges, portable simulation represents an evolutionary progression in medical simulation. The use of portable manikins and associated techniques may increasingly complement established instructional measures and research programs at acute care institutions and simulation centers.

True costs of air medical vs. ground ambulance systems

The economic model created in this paper replaces the existing University of Massachusetts Medical Centers New England Life Flight (NELF) helicopter ambulance service with a ground ambulance system to investigate comparative costs. The model is based on a less than 30-minute response time to the patient, similar medical team staffing and equal service area. The annual budgetary cost of the replacement ground network is

Medical director for air medical transport programs

3,804,000 while the helicopter ambulance costs are

Flight physician training program—core content*☆☆☆★

1,686,500 (based on 1991 dollars). The cost per patient transported is

Multipatient disaster scenario design using mixed modality medical simulation for the evaluation of civilian prehospital medical response: a "dirty bomb" case study.

4,475 for the ground system and

The 2003 Air Medical Leadership Congress: findings and recommendations.

2,811 for the helicopter system. The comparison finds that the commonly held notion that condemns helicopters as an excessively expensive technology for patient transport is incorrect. Future research to address intermediate alternatives using similar analytical technology assessment techniques is recommended.

Critical care transport.

The NAEMSP recognizes the multifaceted and integral position of a medical director for an air medical transport program and the EMS community at large.

Disaster Education and Research

The purpose of this core content is to provide physicians with a comprehensive education in all of the components of air medical transports, including fixedand rotarywing transport. It is designed specifically to provide a physician with the knowledge and skills necessary to function effectively during air medical transport of critically ill and injured persons. The intent of this document is to present an outline for the core content of a flight physician training program. It does not define the necessary or optimal level of staffing for air medical transports. This document, initially published in Prehospital and Disaster Medicine in April–June 1993 as a contribution of the 1992 Air Medical Services Task Force, has been updated in 2002 by the National Association of EMS Physicians (NAEMSP) Air Medical Services Task Force. The current Task Force members gratefully acknowledge the work of the previous document’s authors: Jon R. Krohmer, MD, Richard C. Hunt, MD, Nicholas Benson, MD, and Russell B. Bieniek, MD.