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In the aviation industry, safety is a priority. But it’s also a fundamental way of life, particularly in high-risk sectors like air medical services. Air Methods relies on its Safety Management System (SMS) program to establish a comprehensive systematic approach to safety, serving as the cornerstone of our company. It’s the backbone of our operations, ensuring that every flight is as safe as possible for patients and flight crew. With an unparalleled personal and financial commitment to our SMS, Air Methods has set the benchmark in air safety management.
What is a Safety Management System Program? A Safety Management System program is precisely what it sounds like — a method for proactively mitigating risk to operations. It involves structures, procedures, practices, and policies to handle safety risks. The Federal Aviation Administration (FAA) describes it as a “formal, top-down, organization-wide approach,” and having one ensures “the effectiveness of safety risk controls.”
Air Methods’ SMS program has several components, which include:
Until recently, the FAA did not require Part 135 operators (providing on-demand services like air ambulances) to have a safety program. Air Methods voluntarily implemented a safety management system to promote proactive safety practices. Following a federal ruling, most Part 135 operations will now adhere to the Department of Transportation and the FAA’s safety management system requirements, though not all. Operators impacted by the new rule are expected to comply by around May 2026, pending a final decision.
What the FAA’s New Requirement Means It is crucial that the FAA requires that most Part 135 operators follow safety procedures and have a formal Safety Management System program.
“Under the current voluntary program, it means that Air Methods has put into practice all relevant procedures required under the federal mandate,” says Caleb Luck, Safety Department. “To maintain acceptance, along with the active maintenance of our program and as part of the new standard, we must maintain a state of continuous improvement to our program.”
Part 135 operators rely on this program significantly. It allows us to maintain uniform standards while flexibly adapting to individual operational contexts. “This program also helps us navigate risks within our organization and foster collaboration using a shared approach,” explains Caleb.
The Key Components of an Effective Safety Management System To ensure a safe and secure working environment, organizations today need to have a robust SMS in place. An effective SMS program encompasses several key components that promote safety and minimize workplace risk.
These components include:
Safety Policy: Establishes senior management’s commitment to safety and defines methods and processes that will meet safety goals.
Safety Risk Management: Assessing acceptable risks helps determine the necessity and effectiveness of implementing new or updated risk management measures.
Safety Assurance: Assesses the ongoing efficiency of applied risk control tactics and aids in pinpointing fresh hazards.
Safety Promotion: Training, communication, and other efforts are essential for fostering a culture of safety across all levels of the workforce.
Specific Benefits of SMS-Certified Operations for Partners and Patients Our ongoing efforts to enhance our SMS program ensure the highest level of safety for all. We routinely monitor the program’s effectiveness and make sure it retains high standards for our employees, partners, and patients. This commitment is evident in our evolving platform, where employees can easily report concerns with the assurance that they will receive prompt action.
For Example, multiple reports were submitted by flight crews regarding the deficiency or absence of quality hazardous terrain and flight awareness systems across various aircraft within the fleet. These systems are essential for providing flight crews with information about nearby terrain and other aircraft. The safety management and aviation teams concluded that further discussion on this matter was necessary. As a result, immediate updates were implemented for aircraft with a critical need for these systems, accompanied by a phased-out plan to ensure the installation of new systems in other specified aircraft over time.
The Role of the SMS Program Within Air Methods The SMS program at Air Methods sets the stage for fostering a strong safety culture within the organization by setting clear expectations for all employees and outlining the two fundamental principles.
These are:
Upcoming Enhancements As we continue to evolve our safety culture, we are implementing new updates to our SMS program. In early June, we will see the release of a new tool for safety reporting that includes a Corrective/Preventative Action Plan (CAPA) tool. These tools will enable us to proactively identify hazards and unmanaged risk, respond more effectively, and ultimately decrease the risk of incidents and accidents from occurring.
We are confident that our SMS program will continue to evolve and adapt to meet the industry’s changing requirements. We will continue to work closely with the FAA to ensure we stay ahead of the curve and remain at the forefront of safety in the aviation industry. With the recent mandate for Part 135 operators, we have been working diligently to stay ahead of the changes that will impact the SMS landscape.
Learn more about safety practices at Air Methods.
Any pediatric case comes with a higher degree of tension due to a variety of factors, including compensatory efforts to distress leading to a precarious “cliff” when those efforts cease. When our team is called to assist a 5-year-old child struggling to breathe but still exhibiting strong vital signs, how will the AMPED team react? This episode emphasizes the importance of acknowledging that while we aim for perfection in our actions, sometimes achieving “good” outcomes is sufficient. Recovery is a journey, and there are skilled and compassionate teams ready to take over patient care as we transition. We’re joined by Robert Pringle, MD; Jamie Hogue, MSN, RN, TCRN, CEN, CFRN; and Greg Denz, NRP, FP-C, BS.
Interested in obtaining CE credit for this episode? Visit OnlineAscend.com to learn more. Listeners can purchase individual episode credits or subscribe to the Critical Care Review Bundle and gain access to all episode CE Credits.
AMPED is available on Apple Podcast, Spotify, Google Podcasts, Stitcher, and more. To listen to the episode or catch up on past discussions, visit https://ampedpodcast.libsyn.com/air-methods-prehospital-education-podcast-ep-40-macgyver-and-medicine. To join the conversation, use the hashtag #AMPEDpod on social media.
Improving patient outcomes by transfusing donated whole blood during transports
OMAHA, NE, May 01, 2024 – The LifeNet, TriCity LifeNet, and StarCare programs across Nebraska are proud to announce they now carry and can administer whole blood onboard every air medical transport. These programs are all part of Air Methods, the leading air medical service provider in the nation. Having whole blood aboard their helicopters allows their industry-leading trauma clinicians to provide additional life-saving care when every minute counts.
“Whole blood has been studied and proven to provide better outcomes of trauma patients versus administration of packed red blood cells (PRBCs),” said Base Outreach Coordinator and TriCity LifeNet Flight Nurse Luke Ballmer. “It is the best product for the human body, offering better and faster outcomes for the patient.”
Each unit of whole blood provides red blood cells, platelets, plasma, and clotting factors for superior outcomes for patients suffering from trauma or hemorrhagic shock. It is particularly valuable in rural areas where there may be limited access to donated blood. Since the Air Methods programs all carry their own blood supply, their clinicians can administer it in-flight while preserving hospital stock. The crews previously carried packed red blood cells and plasma and are excited to now carry whole blood which delivers oxygen around the body more effectively.
A recent study published in the Journal of the American College of Surgeons found that whole blood transfusions improve the 30-day survival rate of patients suffering from hemorrhagic shock by 60 percent. The earlier patients receive whole blood, the better their outcomes, showing the significance of pre-hospital transfusion. Moderately to severely injured patients, including those with head injuries, particularly benefit from whole blood transfusions.
“Having whole blood on board means Nebraskans have access to critical lifesaving interventions in trauma scenarios,” said Derek Strohman, account executive with Air Methods. “We can administer this resource immediately at the scene, then the patient can be flown directly to a higher-level trauma center for definitive surgery and further long-term care.”
The benefits of administering whole blood were accentuated during World War I and in the early stages of World War II. According to the National Institutes of Health, the ability to separate blood into its different components was developed in 1940, and it became more common to administer blood products due, in part, to the improved ability to store them. However, blood components don’t carry oxygen as well as whole blood, and during the wars in Afghanistan and Iraq the military brought whole blood transfusion back into favor. Doctors found that using warm whole blood allowed trauma patients to recover faster and live longer. Additionally, using universal, low-titer O blood is not only safe in both children and adults, but it also eliminates the time needed to test patients for blood type in an emergency.
All Air Methods clinicians have at least three years of experience in an emergency or intensive care setting before joining a flight crew. They receive ongoing advanced training, and every nurse and paramedic has access to Air Methods Ascend, an in-person and online training program that allows clinicians to perform at the top of their licensure. Air Methods Ascend is available to medical personnel across the country.
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About Air Methods:Air Methods (airmethods.com) is the nation’s leading air medical service, delivering lifesaving care to more than 100,000 people every year. With over 40 years of air medical experience, Air Methods is the preferred partner for hospitals and one of the largest community-based providers of air medical services. Air Methods’ fleet of owned, leased, or maintained aircraft features approximately 400 helicopters and fixed wing aircraft. Air Methods Ascend is the company’s clinical education program, allowing critical care nurses and paramedics best-in-class training opportunities using high-fidelity mannequins, virtual reality, and cadaver labs.
Contact:Denisse CoffmanAir Methods*protected email*720-666-8499
Any pediatric case comes with a higher degree of tension due to a variety of factors, including compensatory efforts to distress leading to a precarious “cliff” when those efforts cease. When our team is called to assist a 5-year-old child struggling to breathe but still exhibiting strong vital signs, how will the AMPED team react? This episode emphasizes the importance of acknowledging that while we aim for perfection in our actions, sometimes achieving “good” outcomes is sufficient. Recovery is a journey, and there are skilled and compassionate teams ready to take over patient care as we transition. We’re joined by Danica Mainridge RN, BSN, CEN, CPEN, CFRN and Kevin Dominic NRP, FP-C.
AMPED is available on Apple Podcast, Spotify, Google Podcasts, Stitcher, and more. To listen to the episode or catch up on past discussions, visit https://ampedpodcast.libsyn.com/air-methods-prehospital-education-podcast-ep-39-dont-let-the-perfect-be-the-enemy-of-the-good. To join the conversation, use the hashtag #AMPEDpod on social media.
Zachary T. Fica MD, MS; Amy Marquez MSN, CFRN; John Ehrhart FPC; Christian Sloane MD
We present the case of a 10-year-old previously healthy male who suffered an out-of-hospital cardiac arrest because of abdominal trauma and survived with excellent neurologic outcomes and near complete return to baseline functional status at hospital discharge. The rapid response and efficient mobilization of resources led to an excellent patient outcome despite the severity of injuries, including intra-abdominal injuries with expected mortality, out-of-hospital traumatic arrest, coagulopathy, and an extended pediatric intensive care unit stay. This case underscores the significance of timely advanced trauma life support interventions, especially early blood product administration, efficient transport, and airway management, while sharing a remarkable case of out-of-hospital pediatric traumatic arrest with near full recovery.
A 10-year-old previously healthy male called his mother on his smartwatch saying he had crashed his bicycle while riding in their neighborhood and felt unwell. His mother called 911 who activated emergency medical services, and the local advanced life support fire department arrived at the scene to find the patient pale and lethargic with right-sided abdominal pain. Recognizing the need for immediate transport to the nearest pediatric trauma facility approximately 35 miles away, helicopter emergency medical services (HEMS) was requested per county protocol because of a shorter transport time.
Click below to read the full case report and discussion published by ScienceDirect.
David J. Olvera MBA, NRP, FP-C, CMTE; Michael Lauria MD, NRP, FP-C; Jeremy Norman BAS, NRP, FP-C; David Gothard MS; Andrew D. Gothard BS; William Bradley Weir MD, FACEP, FAEMS, FAMPA
Rapid sequence intubation (RSI) is a critical skill commonly performed by air medical teams in the United States. To improve safety and reduce potential patient harm, checklists have been implemented by various institutions in intensive care units, emergency departments, and even prehospital air medical programs. However, the literature suggests that checklist use before RSI has not shown improvement in clinically important outcomes in the hospital. It is unclear if RSI checklist use by air medical crews in prehospital environments confers any clinically important benefit.
This institutional review board–approved project is a before-and-after observational study conducted within a large helicopter ambulance company. The RSI checklist was used by flight crewmembers (flight paramedic/nurse) for over 3 years. Data were evaluated for 8 quarters before and 8 quarters after checklist implementation, spanning December 2014 to March 2019. Data were collected, including the self-reported use of the checklist during intubation attempts, the reason for intubation, and correlation with difficult airway predictors (HEAVEN [Hypoxemia, Extremes of size, Anatomic disruption, Vomit, Exsanguination, Neck mobility/Neurologic injury] criteria), and compared with airway management before the implementation of the checklist. The primary outcome was improved first-pass success (FPS) when compared among those who received RSI before the checklist versus those who received RSI with the checklist. The secondary outcome was a definitive airway sans hypoxia improvement noted on the first pass among adult patients as measured before and after RSI checklist implementation. Post-RSI outcome scenarios were recorded to analyze and validate the effectiveness of the checklist.
Ten thousand four hundred five intubations were attempted during the study. FPS was achieved in 90.9% of patients before RSI checklist implementation, and 93.3% achieved FPS postimplementation of the RSI checklist (P ≤ .001). In the preimplementation epoch, 36.2% of patients had no HEAVEN predictors versus 31.5% after RSI checklist implementation. These data showed that before RSI checklist implementation, airways were defined as less difficult than after implementation.
The implementation of a standardized RSI checklist provided a better identification of deterring factors, affording efficient and accurate actions promoting FPS. Our data suggest that when a difficult airway is identified, using the RSI checklist improves FPS, thereby reducing adverse events.
Click below to read the full research paper published by ScienceDirect.
When an infant patient faces seemingly insurmountable odds over the course of several hours, one of our clinicians suffers a mental health breakdown over the ensuing shifts, days and weeks. Thankfully her team recognized changes in her behavior and mood and offered abundant help. This episode covers not only the case involving the infant patient, but the aftermath and care for our clinicians. If you, or someone you work with, is struggling with your mental health, please reach out to Shatterproof, part of FHE Health on the web or at (833) 591-1536.
AMPED is available on Apple Podcast, Spotify, Google Podcasts, Stitcher, and more. To listen to the episode or catch up on past discussions, visit https://ampedpodcast.libsyn.com/air-methods-prehospital-education-podcast-ep-37-asking-for-help-isnt-giving-up. To join the conversation, use the hashtag #AMPEDpod on social media.
Our profession requires extensive and exhaustive training. Much of it can seem esoteric and possibly unnecessary at the time, but we train on all of these things for a reason. When our team comes upon a severely burned patient, they extent of the burns causes a melange of difficulties. Could an obscure, and rarely used, procedure ultimately help and provide the patient more time? The AMPED team discusses this little-used technique and we discuss the importance of remaining familiar with the abundance of techniques and treatments we learn during our training.
AMPED is available on Apple Podcast, Spotify, Google Podcasts, Stitcher, and more. To listen to the episode or catch up on past discussions, visit https://ampedpodcast.libsyn.com/air-methods-prehospital-education-podcast-ep-36-sometimes-the-solution-is-obscure. To join the conversation, use the hashtag #AMPEDpod on social media.
As first responders, the odds of patient survival are not always in our favor. But that does not stop us from working quickly to provide the highest level of care for the chances of defying those odds. In this episode, a 10 year-old boy wrecks on his bicycle, a fairly common occurrence and one that rarely requires air transport, yet when our team arrives on scene, his vitals crash in front of their very eyes. What’s going on? And what actions do they take to save his life? An inspirational, harrowing and odds-defying episode of AMPED awaits you this holiday season.
AMPED is available on Apple Podcast, Spotify, Google Podcasts, Stitcher, and more. To listen to the episode or catch up on past discussions, visit https://ampedpodcast.libsyn.com/air-methods-prehospital-education-podcast-ep-35-hope-is-a-good-thing. To join the conversation, use the hashtag #AMPEDpod on social media.
February is American Heart Month, a month dedicated to promoting heart health and recommitting to our cardiovascular wellbeing. We also acknowledge pivotal programs like Mission: Lifeline®, a national American Heart Association initiative. Their goal is to revolutionize the system of care for patients facing critical heart-related emergencies. Mission: Lifeline® unites healthcare professionals and stakeholders to significantly raise survival rates and improve the quality of care for patients being treated for cardiac events. Their recognition system is well known throughout the country and celebrates hospitals and EMS agencies that consistently excel in timely, evidence-based care for acute heart conditions.
“Mission: Lifeline® gives us a roadmap best practices to deliver the best possible patient outcomes of STEMI and Stroke care. Air Methods provides our hospital and EMS partners a means to provide rapid and highly acute patient transport in order for them to obtain Bronze, Silver and even Gold recognition.” said Air Methods VP of Clinical Services, Kelly Miller.
At Air Methods, we are proud to play a key role in this life-saving initiative by providing indispensable support through:
“Time equals muscle for our STEMI patients and brain for our Stroke patients,” Kelly explains. “Air medical transport, when activated early, will improve patient outcomes and save lives.”Air Methods is dedicated to assisting EMS and hospital personnel in delivering the highest standard of patient care possible. Our air medical services directly impact the AHAEMS8, AHACAD9, and AHACAD23 recognition criteria across EMS, Receiving Center, and Referring Hospital programs. View the criteria here. If you are interested in partnering with Air Methods to increase quality of care and potentially receive Mission: Lifeline® recognition, click here and your local Air Methods representative will get in touch.
Concepts, research, and solutions pertaining to this article were contributed to by Aidan O’Connor, NR-P, FP-C, Regional Sales Director at Air Methods, and William Kelly Miller, Vice President of Clinical Services at Air Methods.
Air medical transport has been facing challenges in recent years, with a few emerging trends currently at the forefront. We are seeing changes in the industry emerge, from staffing shortages and increased specialty transports, to feeling the effects of the No Surprises Act. As we approach the end of 2023, we want to share the top three trends that we have observed here at Air Methods.
The industry, including medical transportation and healthcare facilities, is being heavily impacted by staff shortages affecting roles such as pilots, healthcare workers, and maintenance technicians. The presence of skilled personnel is crucial for providing high-quality care. However, it’s not just the medical transportation industry that’s grappling with these challenges. Hospitals and health centers are also struggling to maintain adequate staffing levels. Many rural communities are facing the decision of closing beds or units due to insufficient staffing. In some cases, specialty services like Labor and Delivery are being cut back. These shortages are placing enormous pressure on local ground transport and air services to ensure patients receive the necessary level of care.
Key insights into the reasons behind staff shortages:
A critical factor behind the shortage of medical professionals in the air medical industry is the high demand for their services. As the population grows older and medical emergencies become more frequent, the need for skilled practitioners and pilots in air transportation is rising. Becoming a qualified medical professional in this field requires rigorous training and extensive financial investment, which can put off some individuals from pursuing careers in healthcare. Furthermore, the competitive job market for healthcare and aviation sectors makes it challenging for the air medical industry to attract and retain top talent. Meeting strict safety and regulatory requirements also presents challenges for professionals working in air medical transport. The aviation and healthcare industries are both highly regulated to ensure the safety of patients and crew. This demonstrates the need for constant training and certification in addition to experience, which adds even more pressure to an already high-stress environment. Workload and stress are other significant factors associated with the air medical shortage crisis. Air medical professionals frequently face demanding work schedules and high-stress situations, which can lead to burnout and affect employee retention rates. Overall, these challenges contribute to a shortage of medical professionals in the air medical industry, a crucial component in transporting critically ill or injured patients quickly and efficiently. Read more about pilot staffing shortages here. Read more about clinical staff shortages here. Read more about AMT staff shortages here.
Specialized transport is on the rise, particularly in the fields of pediatrics and cardiovascular care. This includes transporting pediatric patients and newborns in the neonatal intensive care unit (NICU). We have also seen an increase in cardiovascular assist device transports for patients that require specialized interventions like IABP (intra-aortic balloon pump), Impella and ECMO (extracorporeal membrane oxygenation).
Key insights into reasons for increase in specialty transport:
The number of patients being transported by air has grown in recent years due to several factors. One of them is the regionalization of care as healthcare systems concentrate specialized services in specific hospitals. This often means that patients need to be transported from one facility to another, and air transport is crucial for ensuring they have access to these specialized centers. In addition, advances in neonatal and pediatric care have expanded the range of conditions that can be successfully treated in pediatric patients, making air transport an even more viable option for critically ill children.
Another factor driving the increase in air medical transport for patients is the growing awareness and utilization of this service. Healthcare providers, emergency medical services, and the public are becoming more aware of the benefits of air medical transport. Increased awareness and utilization of air transport services can provide a critical link in the chain of care, helping ensure that patients receive the specialized care they need in a timely manner.
Population growth is also contributing to the rise in air transport. With more and more people living in urban areas, traffic congestion on the ground is often a factor that can hinder the safe transport of critically ill patients. This increases the need for air transport, which can bypass ground traffic and quickly bring patients to the medical facility they need.
Read more about the increase in pediatric specialty transport here. Read more about the increase in cardiovascular specialty transports here.
The No Surprises Act went into effect in 2022 for the air medical industry. This is a law that Air Methods strongly supports as it removes patients from the middle of any billing dispute between medical providers and insurers, thereby protecting patients from “balance bills.” Now, when an out-of-network insurance company refuses to cover or under-reimburses for an emergency air transport of one of its customers, the air medical provider and insurer can enter an independent dispute resolution (IDR) process to resolve the billing dispute. This new system eliminates the possibility that a patient could receive a bill for unpaid transport. Unfortunately, the IDR process has been structured to favor insurance companies rather than air providers, particularly those in rural areas, and these remaining out of network health plans have pursued tactics of delaying payment or underpaying for critical services. While Air Methods has been a leader in the industry going in network and today is 76% percent in network with health plans, we have had to pursue the IDR process for the remaining out-of-network transports. We win these cases 87% of the time but it has delayed payments by months. States are looking at similar NSA-style initiatives for ground transportation, which may result in similar cost pressures for ground transport. We will have to wait and see if these changes result in loss of access to ground transport for patients leading to further demand on the air transport industry to fill the gap left by ground transportation, especially in rural America.
Read more about the No Surprises Act and its impacts here.
Things are not as they seem on this month’s episode of AMPED. Our team arrives on scene to find first responders dealing with a chemical burn and administering CPR. But something is amiss. This episode is a stark reminder that no matter the time of day, no matter the other circumstances, our role as clinicians is to stay vigilant in our analysis and always to assess every aspect of the situation thoroughly. We are joined by Amy Merritt, BSN RN CFRN, and Allen Walworth NREMT-P.
AMPED is available on Apple Podcast, Spotify, Google Podcasts, Stitcher, and more. To listen to the episode or catch up on past discussions, visit https://ampedpodcast.libsyn.com/air-methods-prehospital-education-podcast-ep-34-dont-be-a-canary. To join the conversation, use the hashtag #AMPEDpod on social media.