Oh, the Places They Will GoTo Safely Save Lives: Case Study of a HRO Medical Aviation Program

Historically, the Helicopter Emergency Medical Services (HEMS) has been considered one of the most hazardous professions in the United States [1]. While an essential part of healthcare, HEMS can expedite transport of critically ill patients to a higher level of care under the attention of in-flight skilled healthcare personnel. The goal is to limit the time a patient is outside of the acute care hospital setting where additional advanced resources to sustain and improve life are readily available. A highly reliable safety infrastructure is considered innate to the overall performance. There are three entity institutions that influence the foundational framework for HEMS operations: commercial, hospital-based not-for-profit, and public safety programs. Each one contributes to limiting operational variability to prevent errors. In addition to the ground and air safety processes, within the helicopter cabin, it takes a coordinated effort between crew members to mitigate safety issues from occurring. Paired with a helicopter pilot, the medical team consists of a flight registered nurse (RN) and a flight paramedic, typically referred to as an aeromedical crew. With the coordinated effort between the flight and medical crew members, risk mitigation is of primary concern to transport and deliver the patient safely to the identified destination. The coordinated education, training, and practice required of the medical crew and pilots in a large regional Level I Trauma Center to work in this type of environment is extensive. Outcomes of these efforts are calculated through threat and error management exercises to positively influence human factors on this patient transport choice. To be successful, the team employs high-reliability practices. There are five central principles that High-Reliability Organizations (HROs) follow to accomplish safety, quality, and efficiency operational results: sensitivity to operations, reluctance to simplify, preoccupation with failure, deference to expertise, and the practice of resilience [2]. With the application of these principles, choices are made for every mission to prevent human and machine error, regardless of the unpredictable circumstances the crew faces. Through clear lines of communication, workload management, situational awareness, and decision-making of all crew members, air medical transport safety risks are mitigated. As a result, patient transports between 2019 and 2022, totaling 2937 were successfully completed. This is defined as reaching the desired tertiary (hospital) level of care destination regardless of the circumstances. While there were often times transfer center calls that were declined due to weather, missions were not aborted because of mechanical or human error during this period of time.