Evidence Library
Published research on air medical operational and clinical safety.
Air medical research is spread across many journals, agencies, and associations, and much of it is hard to find. This library brings it together in one place for clinicians, pilots, safety leaders, and researchers.
The collection includes peer-reviewed journal articles and FAA reports on air medical transport and helicopter air ambulance operations. It also includes selected government reports, association reports, theses, and letters, along with the CONCERN Network bulletins published in Air Medical Journal from 2001 to 2018. Each entry is labeled by type and links to the original publication.
The research covers two areas. Operational safety addresses the aircraft, the crew, and the flight. Clinical and patient safety addresses harm to patients during transport and the appropriate use of air medical transport. Other clinical research, such as a study of a drug or a procedure, is included only when it bears on patient safety in transport.
To see the ideas for future research these papers offer, see Research Opportunities. To suggest a publication for inclusion, use the suggestion form below.
Publications
Voice metrics and workload in helicopter rescue: insights from ninety-six cockpit recordings
Mattingsdal, Håvard; Søvik, Signe; Ottestad, William
Safety Science, 205, 107401, 2027
Research highlights
Highlights
- This study used cockpit voice data from standard rescue missions to compare hoist and rope methods in a three-person HEMS crew.
- It focused on rescuer insertion, the most demanding phase. Sixty-seven paired insertions were analyzed.
- Measures included the number of commands and corrections, departures from standard phraseology, and how long the insertion took.
- Pilots and physicians gave fewer commands with the hoist (29) than with rope (47). The hoist cut insertion time by about 55 seconds on average.
- Longer insertions and more commands and corrections were linked to higher workload scores. Links to heart rate measures varied by role and method.
Research into Practice takeaways
- Voice measures may offer a way to gauge task demand without placing sensors on the crew. The authors call them feasible and non-invasive.
- Programs that record cockpit audio for training can ask whether command counts and phraseology could support debriefs.
- The crew sample was small, with 4 pilots and 3 physicians.
Written by the Air Medical Safety Network from the publisher's abstract. It does not replace the full publication. Added November 2, 2026.
Enhancing High-Fidelity Simulation Flight–Based Training for Critical Care Paramedics in EMS Aviation: A Systematic Review
Hilditch, Matthew; Sharpe, Chris; Litwack, Kim; Widdowfield, Mark
Air Medical Journal, 45(6), 585-590, 2026
Research highlights
Highlights
- This systematic review looked at high-fidelity simulation (HFS) training for critical care paramedics in EMS aviation.
- The search turned up 7 articles. Each one was rated with the Critical Appraisal Skills Programme tool.
- Paramedics reported gains in expertise, engagement, motivation, responsiveness, and mood after HFS training.
- The review found too little evidence to say whether HFS builds self-awareness.
- Little evidence was found on how HFS-trained paramedics perform with real patients in the prehospital setting.
Research into Practice takeaways
- HFS appears workable as a way to train flight paramedics. Whether it changes performance on real missions is still an open question.
- Programs that use simulation can ask how they check whether skills carry over from the sim lab to the aircraft.
- The authors suggest standard methods for training and assessment. They tie this to skill building, team performance, and patient safety.
- Seven articles is a small base of evidence. The findings should be read with that limit in mind.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Fatigue Characteristics and Perceptions in US Helicopter Air Ambulance Pilots
Baumgartner, Hannah M. ; Durham, Justin; Sanders, Teena; Hilditch, Cassie J.
Air Medical Journal, 45(6), 535-542, 2026
Research highlights
Highlights
- A total of 120 helicopter air ambulance pilots from 21 U.S. operators completed a survey during a larger field study.
- The survey included the Morningness-Eveningness Questionnaire, the Epworth Sleepiness Scale, and the Pittsburgh Sleep Quality Index.
- More than half of the pilots (53%) reported poor sleep quality.
- Most pilots (71%) felt fatigue was worst on the leg back to base. Asked about schedules, 69% named the number of flight requests as the biggest schedule-related contributor to fatigue.
- A third of pilots (34%) said they had nodded off while flying. Most (87%) said sleep inertia had affected their work.
Research into Practice takeaways
- Pilots suggested limits on flight requests, maximum duty length, and protections for sleep inertia. These are pilot views, not tested measures.
- Pilots placed fatigue most on the leg home. Programs can look at risk checks for the return leg, not only the departure.
- Sleep inertia was common in this group. Teams may want to look at how soon crews fly after waking for a call.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter and Fixed-Wing Air Medical Transport in a Resource-Limited Region of Eastern Anatolia: Epidemiological Patterns and Operational Challenges in Van Province, Turkey (2022-2025)
Tatlı, Mehmet; Bilmez, Kerem Dost; Tosun, Muhammed
Air Medical Journal, 45(6), 550-558, 2026
Research highlights
Highlights
- The study looked back at all 940 air ambulance transports coordinated by Van Provincial Emergency Medical Services in eastern Turkey from 2022 to 2025. The region is mountainous, with hard winters and roads that often close.
- Helicopters carried 537 of the 940 patients (57.1%). Fixed-wing aircraft carried the other 403 (42.9%).
- Helicopter patients were older on average (38.4 years compared with 18.4), a statistically significant gap. Fixed-wing flights mostly carried neonates and children (71.0%), including 92.5% of the 147 patients with congenital heart disease.
- Helicopters flew all 295 patients (31.4%) from the remote Bahçesaray district. They also flew every one of the 52 scene responses.
- Preflight Glasgow Coma Scale scores differed slightly between groups. The authors judged the gap unlikely to matter clinically.
Research into Practice takeaways
- Helicopters and fixed-wing aircraft served different patients and roles. Programs in remote regions can review how they match aircraft to mission.
- Coma scale scores can mislead for sedated or intubated patients. The authors left 190 such patients out of that comparison.
- The study is descriptive and has no patient outcomes. The authors call for research linked to outcomes.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
REBOAHEMS: A Standardized, Competency-Based Operational Training Model for Air Medical REBOA Implementation
García, Antonio Martínez; Ortega-Deballon, Iván; Roldán, Juan Manuel López-Reina; Mínguez, Rubén Quintero; Melero, Martín Torralba; Hernández, Andreu Martínez
Air Medical Journal, 45(6), 565-572, 2026
Research highlights
Highlights
- REBOAHEMS is a training program to prepare HEMS crews for resuscitative endovascular balloon occlusion of the aorta (REBOA).
- It pairs 12 hours of online learning with 12 hours of in-person simulation in Bell 412 and AW109 cabin simulators.
- Fourteen HEMS clinicians, physicians and nurses, completed the program. Their knowledge scores rose, and the authors report the gain as significant.
- In simulation, crews performed consistently and took a mean of 9.0 minutes (plus or minus 3.6) to occlude the aorta. Satisfaction was high.
- No REBOA was done on patients after training because the device was not available.
Research into Practice takeaways
- The authors note that training alone did not lead to clinical use. Equipment, organizational readiness, and governance also mattered.
- This was a small group in simulation. The study does not show patient outcomes.
- Programs adding any new high-risk procedure can ask whether equipment, governance, and training will be ready at the same time.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Subjective and objective sleep in relation to the work context, profession, age, and workload among helicopter emergency medical service (HEMS) workers
Flaa, Tine Almenning; Zakariassen, Erik; Bjorvatn, Bjørn; Pallesen, Ståle; Harris, Anette; Waage, Siri
Chronobiology International, 43(11), 1827-1840, 2026
Research highlights
Highlights
- Researchers studied sleep in pilots and HEMS crew members over a 7-day duty period. They used sleep diaries and activity monitors.
- Diaries showed sleep timing moving later across the week. Sleep fell from 8 hours 22 minutes on the first duty day to 7 hours 48 minutes on the last, and sleep debt grew.
- Pilots went to bed later than HEMS crew members, at about 00:38 compared with 00:19.
- Night missions were linked to shorter sleep (6 hours 52 minutes compared with 7 hours 29 minutes) and lower sleep efficiency (80% compared with 92%). They were also linked to more time awake after falling asleep.
- Older workers at busy bases reported more sleep debt.
Research into Practice takeaways
- Sleep loss built up across the duty week. Programs can look at how fatigue is checked late in a duty period, not only at the start.
- Night missions and base workload were both linked to sleep. Teams may want to look at how call volume and crew factors such as age enter fatigue planning.
- The authors call for strategies to improve sleep. The abstract does not name specific strategies, the sample size, or the country.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The Operational Impact of a Tertiary Hospital Heliport in Lisbon: A One-Year Operational Review
Caldeira, Alexandre; Orfão, Filipe; Jorge, Nuno; Martins, Carlos N.
Air Medical Journal, 45(6), 573-578, 2026
Research highlights
Highlights
- Santa Maria Hospital Heliport in Lisbon, Portugal, was certified and reopened in March 2025. It runs 24 hours a day, 7 days a week.
- This study reviewed all helicopter movements in the heliport's operational registry from March 2025 to March 2026.
- There were 235 landings in the first year.
- About 60% were primary HEMS missions and 35% were transfers between hospitals. About 5% were extracorporeal membrane oxygenation (ECMO) or organ missions.
- Fewer than 10% of missions to the Lisbon area had to divert to another certified heliport.
Research into Practice takeaways
- This is a one-year description from one site. It does not measure transfer times or patient outcomes.
- The authors suggest the heliport may cut the need for follow-on ground transfers. Further study is needed to confirm this.
- Programs can track diversions to alternate heliports as one measure of hospital landing access.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Using Checklists to Improve Turnaround Times in Time-Critical Interhospital Transfers
Sheldrake, Ian; Cox, Stu
Air Medical Journal, 45(6), 527-529, 2026
Research highlights
Highlights
- A UK HEMS organization built two checklists for time-critical transfers between hospitals. One was for the referring team before the aircraft arrives, and one was for the transport team before it leaves.
- In 2022, before the checklists, the service met its goal of less than 45 minutes on the ground in 12 of 23 transfers (52%).
- Crews practiced with the checklists in high-fidelity simulation first. The 45-minute goal was met consistently in simulation.
- In 2024, after the checklists went into use, the goal was met in 7 of 11 air transfers (64%).
- The rise from 52% to 64% did not reach statistical significance. The number of transfers was small.
Research into Practice takeaways
- Time on the ground at the referring hospital depends on both teams. Work done before the aircraft lands is part of the transfer.
- The authors report that outlier delays affected performance in routine use. Programs can look at their own outliers and not just their averages.
- The authors note that with so few cases, a lack of statistical significance does not rule out a meaningful effect. It also does not prove one.
- This is a before-and-after evaluation at one service. Other changes over the same years could also play a part.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Hidden Hazards: Factors Influencing Near-Miss Reporting in Helicopter Emergency Medical Services
Griffin, Russell E. ; Greco, Lindsey M.
Air Medical Journal, 2026, Online ahead of print
Occupational Heat Stress in Helicopter Emergency Medical Services: A Narrative Review and Operational Framework
Stomeo, Niccolò; Leuci, Laura; Lombardo, Massimo; Colonetti, Efrem; Carenzo, Luca; Daminelli, Francesco
Air Medical Journal, 2026, Online ahead of print
Pressure to Fly and Phase of Flight Analysis in Helicopter Air Ambulance Accidents
Air Medical Journal, 2026, Online ahead of print
Burnout on Board: A Cross-Sectional Survey of Burnout and Safety Among Flight Medical Crews
Prochniak, John; Tschautscher, Craig; Mullan, Aidan F.; McGuire, Sarayna S.
Air Medical Journal, 45(5), 467-476, 2026
Research highlights
Highlights
- An anonymous survey went to flight medical clinicians through the Air Medical Physician Association and the Association of Air Medical Services from May to July 2025.
- In all, 450 people completed it, and most (408, or 90.7%) worked in the United States. Nurses made up half and paramedics one-third.
- The survey used a 2-item Maslach Burnout Inventory. High emotional exhaustion showed up in 98 respondents (22.7%), and high depersonalization in 90 (20.9%).
- Those with burnout at least weekly more often reported going along with a coworker's call to accept a flight they felt uneasy about.
- They also more often reported pressing on in worsening weather, taking flights in any weather out of trust in the crew, and departing from policy. They reported less seatbelt use.
Research into Practice takeaways
- These are associations from one survey. The study does not show that burnout causes these behaviors.
- Programs can treat crew well-being as part of how they support crewmembers who speak up about a flight.
- The behaviors are self-reported, and the abstract does not give a response rate.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
When tragedy strikes: from the rush matrix to the deliberate response framework – a narrative review of self-response decision-making in helicopter emergency medical services
Benton, Michael; Griffin, Russell E.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2026, Published online 21 September 2026
Research highlights
Highlights
- This narrative review looks at the choice to send a HEMS program's aircraft to the scene when one of the program's own aircraft has been in an accident.
- The authors found no primary research on this situation. They drew on five related fields, including casualties among firefighter rapid intervention teams, the second victim phenomenon, grief among professionals, police officer down responses, and decision science.
- Evidence from these fields pointed to four risks that act together. They were shared exposure to the same hazard, emotional and cognitive impairment in responders, chaotic convergence of responders, and the chance of more casualties.
- The authors use the name Rush Matrix for the pattern in which time pressure and a personal tie to the event push aside structured decisions.
- They propose a four-gate Deliberate Response Framework. The gates ask about system risk, other ways to respond, the likely effect on outcomes, and whether responders are fit from a human factors standpoint. Each gate must be cleared in order before a launch.
Research into Practice takeaways
- The authors offer the framework as a starting point for testing ideas. They say it is not a validated protocol.
- The authors suggest programs build the framework into their Safety Management System (SMS) and emergency response plan and then test it. Programs can ask whether their plan says who decides on a self-response and how.
- The evidence comes from other high-risk fields. How well each risk pattern carries over to HEMS is still an open question.
Written by the Air Medical Safety Network from the publisher's abstract. It does not replace the full publication. Added November 2, 2026.
Are All Helicopters Used for Neonatal Transport the Same? Balancing Safety, Crew Ergonomics, and Operational Readiness. What Is the Best Neonatal Chopper?
Bellini, Carlo
Air Medical Journal, 45(4), 354-362, 2026
Research highlights
Highlights
- The authors did a targeted review of sources from air medicine, aerospace engineering, and aircraft makers.
- They compared 10 helicopter models used in neonatal transport, including the UH-60, S-92, AW139, H145, and AW109.
- They compared cabin design, noise and vibration, and performance at high altitude. They also compared speed, range, backup power, and the ability to keep the cabin at a steady temperature.
- Models varied widely. Medium twin-engine helicopters with roomy cabins, such as the H145, S-76, AW139, and Bell 412, gave better access and working conditions.
- In every model, noise and vibration often went above recommended exposure limits for neonates.
Research into Practice takeaways
- This is a review of published and manufacturer sources. It is not a measured flight study.
- The authors suggest aircraft choice weigh neonatal stability and care needs, not only availability or logistics.
- Neonatal teams can ask what noise and vibration their patients meet in their current aircraft.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Safe Sleep, Safe Flight: A Fatigue-Readiness Framework for Air Medical Operations
Kubota, Kazumi
Air Medical Journal, 45(4), 332-335, 2026
Research highlights
Highlights
- The authors propose a fatigue-readiness framework for air medical programs that fly helicopters or airplanes.
- It has 2 checkpoints. A routine readiness check opens each shift, and the other is a "Safety Pause" before missions with higher risk.
- The framework can add brief objective alertness testing, such as psychomotor vigilance testing (PVT), to self-assessment.
- A green, amber, and red scale guides what to do and what to record. It is meant to be nonpunitive.
- The paper draws on PVT use in air medicine and on ways aviation counters fatigue. It also draws on health care studies of fatigue risk.
Research into Practice takeaways
- This is a proposed framework. The abstract reports no test of how well it works.
- The authors say it needs clear nonpunitive governance, protected reporting, and care with privacy. Without these, crews may hold back from reporting fatigue.
- Programs can ask whether fatigue is left to each person or handled as a team decision. The authors aim to move from endurance to readiness.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter Rescue at Very High Altitude: Recommendations of the International Commission for Mountain Emergency Medicine (ICAR MedCom) 2025
McLaughlin, Kyle; Shimanski, Charley; Zafren, Ken; Jackson, Ian; Biner, Gerold; Folini, Maurizio; et al.
High Altitude Medicine & Biology, 27(2), 107-116, 2026
Research highlights
Highlights
- This paper gives recommendations for helicopter rescue above 3500 m, which the authors call very high altitude.
- The authors note there were no established international guidelines for this work. Hazards include hard terrain, fast-changing weather, and thin air with less oxygen.
- The recommendations come from a narrative review of the literature plus expert opinion from pilots, physicians, and rescuers who do these rescues.
- The Medical Commission of the International Commission for Alpine Rescue (ICAR) approved the recommendations. The ICAR Air Rescue Commission endorsed them.
- The authors identified 19 key factors. These cover operations, ground site management, safety steps for pilots and rescuers, and psychological factors.
Research into Practice takeaways
- The factors are organized to support planning before, during, and after a mission. Programs that fly in high mountains can compare their own plans against them.
- Psychological factors sit on the list alongside operational ones. Mission planning and debriefs can cover both.
- These are expert consensus recommendations, not results of a trial. The abstract does not list the 19 factors.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Experience With Electrostatic Discharge During Hoist Operations in the Norwegian Search-and-Rescue Helicopter Service: A Nationwide Cross-Sectional Study
Brede, Jostein Rødseth; Storli, Arnfinn; Tangen-Jordan, Stein Bastian von; Coucheron, Lasse
Air Medical Journal, 45(3), 213-217, 2026
Research highlights
Highlights
- A nationwide survey went to all rescue paramedics and physicians in Norway's search and rescue helicopter service run by the 330 Squadron.
- The response rate was 91% (74 of 81). Mean experience was 13 years.
- All rescue paramedics and 73% of physicians had felt electrostatic discharge, or "static," during hoist work. The median was 10 episodes.
- Most had felt mild static (85%). Moderate static was reported by 61%, and 23% reported severe static.
- Rescue paramedics had more experience and more static, with higher severity, than physicians. Static was seen as a problem for the service by 30%, and 24% worried about long-term effects.
Research into Practice takeaways
- Static was common in this group even though discharge lines are meant to protect hoisted crew. Programs that hoist can ask crews how often they feel static.
- The survey relies on recall and self-rated severity. It did not measure health effects.
- The authors say more work is needed on how often static occurs and what it means for hoist operations.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
A Simulation-Based, Qualitative Assessment of Decision Making Among Critical Care Transport Crews
Johnson, Daniel; Costigan, Heather; Bordner, Candace; Flamm, Avram ; Van Scoy, Lauren
Air Medical Journal, 45(2), 117-120, 2026
Research highlights
Highlights
- Eight critical care transport clinicians (5 nurses and 3 paramedics) each cared for a simulated patient with airway concerns. Five scenarios were medical and 3 were trauma.
- A standard debrief on decision-making followed each session. It was recorded, transcribed, and analyzed for themes.
- Participants had a median of 15 years in critical care transport.
- Participants found the scenarios realistic and relevant to daily work. They said the scenarios made them think critically.
- They described making decisions with standing protocols combined with experience and basic knowledge.
Research into Practice takeaways
- This is a small study of experienced clinicians on one team. The findings may not apply to newer clinicians.
- Protocols and experience worked together in these decisions. Debriefs that ask how a decision was made can bring this mix to the surface.
- The study describes how clinicians reasoned. It does not judge whether their decisions were correct.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter Transport of Trauma Patients Continues to be Overutilized: A Call for Universal Transport Criterion
Srivatsa, Shachi; Chawla, Mehak; Hernandez, Marlene; Mallampalli, Grace; Duff, Angela; Lee, Ghee Rye; et al.
The American Surgeon, 92(2), 543-549, 2026
Research highlights
Highlights
- Researchers reviewed all 1,419 trauma patients flown to one Level I trauma center from January 2018 to December 2021.
- Of these, 536 (37.8%) had a procedure at some point during their stay. A procedure within one hour of arrival occurred for 21 of 1,419 (1.5%).
- When checked against current national field triage guidelines, fewer than 30% met criteria for helicopter transport.
- In all, 35% were admitted to the ICU and 8% went home within 24 hours. On arrival, 515 (36.3%) set off a Level I trauma alert.
Research into Practice takeaways
- The authors conclude that most flights were not clinically justified. They call for standard, evidence-based criteria for scene and interfacility flights. This is their position based on one center.
- Some measures of need, such as early procedures and going home within a day, were known only after arrival. Crews and requesters did not have that information when they decided. A procedure within one hour is one measure of urgency, not the only one.
- Programs can review how their own requests line up with national triage guidelines and how often their patients go home within a day.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Boosting Confidence Through Interagency Air Medical Simulation: A Quality Assurance Exercise of a Critical Care Helicopter Landing at a Tertiary Trauma Hospital
Iliff, John; Spring, Breeanna; Kumaradevan, San; Cosford, David; Vance, Jenny; Richardson, Alice; et al.
Air Medical Journal, 45(1), 45-51, 2026
Research highlights
Highlights
- The Royal Flying Doctor Service of Australia and Royal Perth Hospital ran their first joint simulation of a helicopter landing at the hospital.
- Data came from 21 participants and 8 facilitators by phone interview and survey from June to October 2023. Participants included clinicians, logisticians, and pilots.
- Facilitators said a good joint simulation took a large amount of planning and preparation.
- Participants reported more confidence in their own roles afterward. They wanted more varied simulation training.
- Debriefs helped clarify the overall process and gave feedback to the services involved.
Research into Practice takeaways
- This was a quality assurance exercise at one site. The findings describe staff views, not patient outcomes.
- Programs that land at hospitals can ask when they last practiced a landing together with hospital staff.
- Planning effort is a real cost. Teams may want to budget facilitator time when they plan joint drills.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Use of Health Care Simulation in Air Medical Settings: A Scoping Review
Belk, William B.; Wiedemann, Marybeth; O'Connor, Paul; O'Malley, Roisin
Air Medical Journal, 45(1), 69-76, 2026
Research highlights
Highlights
- This scoping review looked at how simulation has been used to train air medical professionals. It searched 5 databases plus gray literature and reference lists.
- A total of 21 studies met the criteria.
- Scenario-based simulation was the most common type (65.0%). Multimodal simulation made up 30.0%, and simulated participants 5.0%.
- Half of the programs trained intact (native) teams on team skills. Another 40.0% built clinical skills in context with partial teams.
- Most studies assessed how learners reacted (55.0%) or what they learned (45.0%). Few measured behavior change (5.0%) or effects on the organization (5.0%).
Research into Practice takeaways
- The authors call for research on the needs that set the air medical setting apart and on practical ways to reach learning outcomes.
- Programs can ask what their own simulation training measures. Reaction surveys alone do not show changes in practice.
- The authors suggest simulation be built into air medical training, with resources and space for educators.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Lifting the Silence: Psychological Stress in Air Medical Crew Members
Brooks, Justin
DNP final report, The University of Texas at Tyler, 2026
Speaking Up to Prevent Harm: An Events-Based Perspective on Anticipatory and Reflective Safety Voice in High-Risk Occupations
Doctoral dissertation, Oklahoma State University, 2025
The primary study is a vignette experiment with participants from the U.S. helicopter emergency medical services industry.
Workload in helicopter rescue operations – A comparison of two different rescue methods in a randomized cross-over design
Mattingsdal, Håvard; Dahle, Thomas Nordgaard; Abrahamsen, Eirik Bjorheim; Søvik, Signe; Ottestad, William
Safety Science, 192, 106996, 2025
Research highlights
Highlights
- Crews in a HEMS service that flies with three crew members did 55 standard rescue missions. Each mission was done with both rope and hoist, in random order.
- Missions covered alpine, gorge, forest, and vertical terrain. Workload was rated with the NASA Task Load Index, and heart measures tracked the body's stress response.
- Pilots (4), physicians (3), and rescuers (4) all reported lower workload with the hoist.
- Pilots showed the largest effect. Their mean workload score during the active mission was 35 with the hoist and 53 with rope.
- Pilots and rescuers also showed a lower body stress response with the hoist. Physicians, who ran the hoist, showed the reverse.
Research into Practice takeaways
- The authors suggest lower workload could help flight safety and favor the hoist. The study did not measure safety outcomes directly.
- Physicians running the hoist reported lower workload but showed a higher body stress response. Programs can look at how hoist tasks load each role.
- The sample was 11 crew members in one service. Results may differ with other crews or aircraft.
Written by the Air Medical Safety Network from the publisher's abstract. It does not replace the full publication. Added November 2, 2026.
Post-Pandemic Burnout and Staffing Shortages in Pediatric and Neonatal Transport Teams: A Multicenter Survey
Dahm, Paul; Kink, Rudy; Stroud, Michael; Dhar, Archana
Air Medical Journal, 44(6), 492-496, 2025
Research highlights
Highlights
- Members of the American Academy of Pediatrics Section on Transport Medicine received a survey on staffing in pediatric and neonatal interfacility transport teams.
- In all, 34 teams responded, a 30.9% response rate.
- Most teams (58.8%) had vacancies after the pandemic. Among them, 90% said a lack of qualified applicants kept the slots open.
- Half of the teams reported more turnover. This led to changes in onboarding for new hires.
- Burnout was identified by 26 teams (76.4%). Training to recognize burnout was reported by 25 (73.5%).
Research into Practice takeaways
- About 31% of those surveyed responded. The results may not reflect all pediatric and neonatal teams.
- The authors suggest shortages led to team makeups that differed from the ideal. Programs can watch how vacancies change who goes on each transport.
- The abstract does not report whether training or other resilience strategies lowered burnout.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Safety Listening in High-Risk Situations: A Qualitative Analysis of Responses to Safety Voice in Aviation
Pandolfo, Alyssa M.; Reader, Tom W.; Gillespie, Alex
Risk Analysis, 45(11), 3700-3723, 2025
Airline flight deck communication; included for its safety voice findings. Not air medical.
Research highlights
Highlights
- Researchers analyzed 45 flight deck transcripts recorded before crashes and near misses.
- They built a framework of how listeners respond when someone speaks up about safety in a risky moment.
- Responses that led to action and to shared sense making were described as effective listening.
- Dismissing a concern, or giving it only token attention, was described as ineffective listening.
- The authors propose that engaging with a raised concern helps a team build an accurate, shared picture of risk as it develops.
Research into Practice takeaways
- Speaking up is only half of the exchange. Programs can look at how pilots, crew leads, and team members respond when a concern is raised.
- The authors argue that observed listening behavior, rather than attitudes, gives a practical way to explain safety outcomes. Debriefs and line checks can note how a concern was received.
- The transcripts came from aviation flight decks, not medical crews. The framework is a proposal built from qualitative analysis.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Care of the Agitated Patient Who Presents a Threat to Safe Transport in Critical Care Transport Medicine: A Consensus Statement
DeMarco, Jennifer; Shields, Brian; Hinckley, William; Bates, Craig; Jasumback, Mike; Tschautscher, Craig; et al.
Air Medical Journal, 44(5), 360-364, 2025
Research highlights
Highlights
- The Air Medical Physicians Association brought experts together to build consensus on agitated patients who threaten safe transport.
- The meeting was the Air Medical Physician Symposium "Lite." It took place in Salt Lake City, Utah, on November 4, 2024, with participants from several countries.
- Attendees took a survey on in-flight sedation and agitation. The results shaped lectures and panels, and electronic audience voting then ranked the priority items.
- The group named five best practices. These were standard sedation protocols, a sedation checklist, training for staff who fly, tracking of sedation levels, and non-drug calming methods.
- The statement also lists knowledge gaps, barriers to putting practice in place, and research priorities.
Research into Practice takeaways
- This is expert consensus, not a trial. It reflects the views of those who attended and voted.
- Programs can review how their protocols, checklists, and training treat an agitated patient as a flight safety issue as well as a clinical one.
- The abstract does not list the knowledge gaps or research priorities. The full paper is needed for those.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Human Factors in Helicopter Air Ambulance Accidents, Incidents, and Safety Reports
Baumgartner, Hannah M. ; Durham, Justin; Hu, Peter T.
Air Medical Journal, 44(5), 347-353, 2025
Research highlights
Highlights
- Researchers at the Civil Aerospace Medical Institute looked at 158 helicopter air ambulance events in the United States from 2013 to 2023.
- The events came from 53 NTSB accident reports, 3 NTSB incident reports, and 102 reports to NASA's Aviation Safety Reporting System.
- Each event was coded for human factors and for risk factors in the organization.
- Risks for pilots were linked to situation awareness, decision-making and judgment, following procedures, and training and experience.
- Risks in the organization were linked to communication, safety culture, and operator policy and procedure.
Research into Practice takeaways
- Most events in this set came from voluntary safety reports, not accident reports. Programs can read their own safety reports for the same patterns.
- The findings go beyond the pilot. A review of an event can ask how policy, communication, and culture shaped what the crew did.
- The authors present these as possible areas for safety interventions. The abstract does not test any intervention.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The Potential of Flight Simulation to Support Pilot Training for Mountain Helicopter Emergency Medical Services
Watson, Neale A.; Fernandez, Nicholas; Owen, Ieuan; White, Mark D.
Air Medical Journal, 44(5), 386-389, 2025
Research highlights
Highlights
- Researchers built a flight simulation of rescue helicopter missions over mountain terrain in realistic turbulent air.
- The terrain model was a mountainous island 550 meters across. It included a bowl, a pinnacle, a ridge, a canyon, and a cliff.
- The team modeled air flow in a 20-knot wind. They paired it with a helicopter model like a UH-60 Black Hawk.
- Two test pilots flew the island in a full-motion simulator. They also held a hover while moving up the cliff face.
- The pilots found it hard to hold a steady hover in the rough air near the cliff top. They said this matched what they see in real flight.
Research into Practice takeaways
- This was an early test with 2 test pilots and one wind condition. It does not yet show a training benefit.
- The authors plan to add more wind conditions and to test the other terrain features.
- Programs that fly in mountains can ask how their pilots now train for turbulence near ridges and cliffs.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Recent Outcomes Research in Helicopter Emergency Medical Services: A Scoping Review of Publication-Year 2024 Additions to the Helicopter Outcomes Assessment Research Database
Fritz, Christie L.; Thomas, Caroline E.; Skaggs, Michael; Zernicke, Lincoln; McCartin, Michael Patrick; Blumen, Ira J.; et al.
Air Medical Journal, 44(4), 306-313, 2025
High-altitude HEMS missions—a retrospective analysis of 3,564 air rescue missions conducted between 2011 and 2021
Klocker, Eva; Wienandts, Lea; Josi, Dario; Rauch, Simon; Albrecht, Roland; Knapp, Jürgen; et al.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 33(1), 97, 2025
Research highlights
Highlights
- Researchers reviewed 3,564 Swiss Air Ambulance (Rega) missions flown above 2,500 meters between 2011 and 2021.
- Men made up 66.8% of patients. Adults made up 88.4%.
- Most patients (88.1%) were uninjured or had minor injuries, with a NACA (National Advisory Committee for Aeronautics) score of 0 to 3. Another 9.4% were seriously injured, and 2.5% died on scene.
- The number of trauma patients with minor injuries rose over the study period.
- Time on scene was linked to NACA score, hoist use, and trauma during summer.
Research into Practice takeaways
- The authors describe the many missions with uninjured patients as preventive. Programs can track how many of their mountain flights fit this pattern.
- Only about 9% of missions called for advanced medical care. Hoist use was one factor linked to time on scene, so teams may want to look at hoist missions when planning for time spent at altitude.
- This review covers one Swiss service. Patterns in other mountain regions may differ.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The First Fatal Helicopter Emergency Medical Services Crash in Turkey: Weather, Human Factors, and Lessons Learned
Golcuk, Yalcin; Güler, Lütfi Mert
Air Medical Journal, 44(3), 223-224, 2025
Factors Contributing to Fatalities in Helicopter Emergency Medical Service Accidents
Korentsides, Jenna; Keebler, Joseph R.; Berezovski, Mihhail; Chaparro, Alex
Aerospace Medicine and Human Performance, 96(2), 111-115, 2025
Research highlights
Highlights
- Researchers studied 267 U.S. HEMS accidents from 1991 to 2022 using the NTSB database.
- They calculated the odds of a fatal outcome for each condition and mapped where the accidents happened.
- They also used a machine learning method called XGBoost to rank which factors mattered most for a fatal outcome.
- Bad weather, having no copilot, and fire after the crash were linked to fatal outcomes.
- The authors say these results agree with earlier research on HEMS accident fatalities.
Research into Practice takeaways
- These factors are linked to whether a crash was fatal. They do not show why the crash happened in the first place.
- The authors see value in machine learning for finding patterns that older methods might miss. The abstract does not give effect sizes for each factor.
- Programs can compare these factors with their own risk assessment tools and see whether each one is addressed.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Longitudinal Assessment of a Single Referring-Receiving Hospital Pair to Assess Air Versus Ground Elapsed Time From Transport Request to Arrival at Cardiac Catheterization Laboratory: An Observational Cohort Study
Schoenfeld, David; Ho, Kalon K.L.; McCartin, Michael P.; Fritz, Christie; Petcu, Robert; Cohen, Jason ; et al.
Air Medical Journal, 44(1), 46-51, 2025
Helicopter hoist operations in German mid-range mountains retrospective analysis of incidence, medical characteristics, and mission tactics
Heinrich, Sebastian; Wielant, Christoph; Lerch, Frank; Friedrich, Mirko; Braun, Jörg; Reifferscheid, Florian; et al.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 32(1), 122, 2024
Research highlights
Highlights
- Researchers reviewed records of helicopter hoist rescues from three German air rescue bases (Freiburg, Nuremberg, and Bautzen) from January 2020 to July 2022.
- Of 410 hoist-related missions found, 304 had usable data. Freiburg flew 152 of these, Nuremberg 63, and Bautzen 89.
- Hoist missions were more common in summer and from Friday through Sunday.
- Trauma made up 75% of diagnoses, and 33% of patients had pelvic or lower limb injuries. Of all patients, 28% had a NACA score of 4 or higher, which marks a possible or actual threat to life.
- Patients got venous access in 79% of missions and intubation in 5%. Both rates were higher than in emergency missions overall.
Research into Practice takeaways
- The three bases used different tactics and worked with mountain rescue in different ways. These differences were linked to differences in who reached the patient first and in time spans.
- The authors suggest alerting the hoist helicopter at the same time as other services, with close coordination with mountain rescue and the rescue coordination center. They see this as a way to shorten the time before treatment and the total prehospital time.
- Programs can look at their own seasonal and weekend patterns for hoist calls when planning for this work.
- This is a descriptive review of records. It does not test which tactic works best.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
A comparison of historical versus proposed physical employment standards for flight paramedics performing helicopter winch rescue
Meadley, Benjamin N.; Caldwell-Odgers, Joanne
Work, 79(3), 1333-1341, 2024
Research highlights
Highlights
- This study compared older fitness selection tests for flight paramedics doing winch rescue with new tests built using physical employment standards methods.
- Fourteen candidates did the existing land and water tests. Fourteen experienced paramedics did the new tests.
- On land, the existing test took longer (17 compared with 7 minutes) and produced a higher peak heart rate and blood lactate than the new test.
- In water, the existing test took a little longer (12 compared with 10 minutes), but peak heart rate and lactate were about the same.
- Perceived exertion did not differ between groups on land or in water.
Research into Practice takeaways
- The authors warn that tests not built with established methods may screen out suitable candidates or let in unsuitable ones.
- Programs can ask how their own fitness tests were developed and whether they match the real demands of the role.
- The two groups were different people with different experience levels. That limits a direct comparison of the tests.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The effects of psychological safety and employee voice behavior on flight attendants’ mindful safety practices adoption
Hu, Shi; Nadeem, Muhammad Aamir; Luo, Ji; Yi, Xiaobo
Frontiers in Public Health, 12, 1398815, 2024
Airline flight attendants; included for its safety voice findings. Not air medical.
Research highlights
Highlights
- This survey study looked at 621 flight attendants at private commercial airlines in China.
- It tested whether psychological safety relates to mindful safety practices through flight attendants speaking up, known as voice.
- It also looked at ethical leadership and traditionality as factors that may change these links.
- The data were analyzed with partial least squares structural equation modeling (PLS-SEM).
- The authors report finding both a go-between (mediating) effect and moderating effects. The abstract does not give the size or direction of each effect.
Research into Practice takeaways
- The authors frame speaking up as one path from psychological safety to voluntary safety behavior beyond the formal job.
- This was a self-report survey in airline cabins, not air medical crews. The links are associations.
- Leaders can ask how their own behavior affects whether crew members raise concerns.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The creation, implementation, and harmonisation of medical standard operating procedures and checklists of Finnish Helicopter Emergency Medical Service units
Tukia, Simo; Pirnes, Jari; Nurmi, Jouni; Nordquist, Hilla
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 32(1), 66, 2024
Research highlights
Highlights
- Researchers interviewed 18 HEMS physicians in Finland, three from each of the country's six HEMS units.
- The interviews lasted 32 minutes on average. The authors sorted what physicians said into themes using qualitative content analysis.
- Views on creating and using medical standard operating procedures (SOPs) and checklists fell into three main groups. These covered the reasons for SOPs, how units write them, and how units put them into use.
- Views on making SOPs the same across units fell into four main groups. These were preconditions, changes at the system level, building shared SOPs into HEMS, and change in culture.
- Each unit writes its own SOPs and checklists. The authors describe how units develop, introduce, and follow up on them as fairly unstructured.
Research into Practice takeaways
- The authors suggest it would be possible to align the SOPs units already have. Writing new shared SOPs would need changes to how HEMS is structured, plus a stronger feeling of community among HEMS physicians.
- Programs can look at how their own procedures are written, introduced, and reviewed over time, not only at what the procedures say.
- This is an interview study of physicians in one country. It describes their views and experience, not effects on patient or crew safety.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Effect of oxygen supplementation on cognitive performance among HEMS providers after acute exposure to altitude: the HEMS II randomized clinical trial
Falla, Marika; van Veelen, Michiel J.; Falk, Markus; Weiss, Elisabeth M.; Roveri, Giulia; Masè, Michela; et al.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 32(1), 65, 2024
Research highlights
Highlights
- This randomized, double-blind crossover trial tested extra oxygen for HEMS providers during a climb at 4 meters per second to a simulated altitude of 4,000 meters.
- Thirty-six volunteers (30 men) took part in a low-pressure chamber in October 2021. Each person did one trial breathing oxygen and one breathing air.
- With oxygen, blood oxygen saturation averaged 97.9% compared with 86% on air. Brain oxygen levels were also higher (69.9% compared with 62.1%).
- Reaction time on a vigilance test was shorter with oxygen after 5 minutes (277.8 compared with 282.5 milliseconds, p = 0.006). The gap after 30 minutes was smaller (p = 0.054).
- With oxygen, people gave more correct answers on a digit and symbol test. Incorrect answers on that test and results on two other tests were similar in both conditions.
Research into Practice takeaways
- The reaction time gaps were a few milliseconds. The authors link oxygen to steadier attention and timing, but the abstract does not report effects on patient care or flight tasks.
- This was one chamber exposure in healthy volunteers. The authors suggest studying repeated climbs in one day, sleep loss, and other stressors.
- Programs that fly unpressurized aircraft into high terrain can ask how often their crews reach these altitudes and for how long.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Informal Peer Support and Intentional Acts of Kindness May Attenuate the Impact of Work-Related Stressors on Compassion Satisfaction, Secondary Traumatic Stress, and Burnout of Emergency Medical Services Clinicians
Maloney, Lauren M.; Hoffman, Jason; Peralta, Edder; Princi, Rudolph; Thode, Henry C.; DiDonato, Christopher; et al.
Air Medical Journal, 43(4), 333-339, 2024
Research highlights
Highlights
- EMS Code Lavender supports EMS clinicians after stressful events. It does this by recognizing those events every time, by peer support, and by planned acts of kindness.
- Anonymous surveys with 2 burnout screening tools were given in spring 2020, before the program began, and again 20 months later in fall 2021. The program started at the same time as COVID-19.
- There were 77 responses before the program (59% response rate) and 108 during it (88% response rate).
- Scores did not change between the two survey periods on any subscale.
- Scores differed by role and sex. For example, paramedics scored higher than emergency medical technicians on compassion satisfaction.
Research into Practice takeaways
- Scores held steady through the early pandemic. The authors suggest the program may have softened work stress, but the abstract describes no comparison group.
- Because the pandemic began at the same time, the study cannot separate program effects from pandemic effects.
- Differences by role suggest one approach may not fit everyone. Programs can look at how each role responds to support efforts.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Top 10 Tips on Safety From the Air Medical Transport Industry
Hough, Peter; Nawrocki, Philip; McCardell, Tyler; Parker, Gregory
Critical Care Nursing Quarterly, 47(2), 143-151, 2024
Evaluation of the offset static rope evacuation procedure: insights from a safe job analysis
Abrahamsen, Eirik Bjorheim; Mattingsdal, Håvard; Abrahamsen, Håkon Bjorheim
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 32(1), 21, 2024
Research highlights
Highlights
- The Norwegian HEMS developed a newer way to do static rope rescues, called the offset technique.
- In this method the helicopter holds a position away from the accident site. A technical crew member uses a throw line to reach the scene.
- The authors used a Safe Job Analysis. They broke the operation into tasks and smaller steps and listed possible hazards for each step.
- For each hazard, the authors suggested ways to prevent it. This review led to changes in the written procedure.
- Two changes the authors point to are having two throw lines and putting more focus on why each step is done.
Research into Practice takeaways
- The abstract notes that crews have little hands-on experience with this kind of rescue. A step-by-step hazard review is one way to look for risk before that experience builds up.
- Programs with rare or new procedures can ask whether each step explains the reason behind it, not only what to do.
- The abstract does not report results from real rescues. It shows a way to review a procedure, not proof that the revised procedure lowers risk.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Natural Experiment Outcomes Studies in Rotor Wing Air Medical Transport: Systematic Review and Meta-Analysis of Before-and-After and Helicopter-Unavailable Publications From 1970 to 2022
Schoenfeld, David; Thomas, Caroline E.; McCartin, Michael P.; Blumen, Ira J.; Galvagno, Samuel M.; Thomas, Stephen H.
Air Medical Journal, 43(2), 124-132, 2024
Simulated Acute Hypobaric Hypoxia Effects on Cognition in Helicopter Emergency Medical Service Personnel – A Randomized, Controlled, Single-Blind, Crossover Trial
Falla, Marika; Hüfner, Katharina; Falk, Markus; Weiss, Elisabeth M.; Vögele, Anna; Jan van Veelen, Michiel; et al.
Human Factors, 66(2), 404-423, 2024
Research highlights
Highlights
- Forty-eight HEMS personnel took part in a randomized, single-blind crossover trial in an environmental chamber. It simulated altitudes of 200, 3000, and 5000 m above sea level.
- Tests of attention, risky decision making, and processing speed were given before ascent, after 5 minutes at altitude, and after simulated CPR.
- Mean reaction time was slower at 5000 m (p = 0.002). Altitude had no separate effect on the other cognitive measures.
- The authors report that participants did not detect their slower reaction time in their own ratings.
- Scores on the processing speed test improved after the simulated CPR (p = 0.001).
Research into Practice takeaways
- Brief exposure to low oxygen at simulated altitude slowed reaction time without people sensing it. Self-checks alone may not catch this change.
- The slower reaction time was reported at 5000 m. Programs that operate at high altitude can ask how this finding applies to their missions.
- This was a chamber study with short exposures. Longer flights and real cockpit or patient care tasks were not tested.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Wellbeing of Helicopter Emergency Medical Services Personnel in a Challenging Work Context: A Qualitative Study
van Herpen, Merel M.; Nieuwe Weme, David; de Leeuw, Marcel A.; Colenbrander, Renske J.; Olff, Miranda; Te Brake, Hans
Prehospital Emergency Care, 28(2), 308-317, 2024
Research highlights
Highlights
- Researchers interviewed 16 HEMS staff from one Dutch university hospital.
- Interviews covered the work setting, coping, engagement with work, and emotional and social support. The analysis used coding methods drawn from grounded theory.
- Ten categories emerged. Examples include teamwork, coping, peer support outside formal channels, aftercare from the organization, and potentially traumatic events.
- Participants said the work can affect them emotionally. They described using several strategies to cope.
- Participants saw little need for formal support or aftercare from the organization.
Research into Practice takeaways
- Colleagues and social support mattered to wellbeing. Programs can look at how they make room for informal peer support.
- The authors say the findings describe HEMS work culture and how staff seek help. Leaders can ask how their own staff view formal support and whether they would use it.
- This was one program with 16 interviews. The findings describe themes, not how common each one is.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Sky-High Safety? A Qualitative Study of Physicians’ Experiences of Patient Safety in Norwegian Helicopter Emergency Services
Rasmussen, Kristen; Sollid, Stephen Jm; Kvangarsnes, Marit
Journal of Patient Safety, 20(1), 1-6, 2024
Research highlights
Highlights
- Researchers interviewed 8 experienced HEMS physicians from 4 Norwegian bases in 2020.
- The physicians said formal incident reports were few. They tied this to the nature of HEMS work and to reports mainly covering departures from procedures. HEMS has few written procedures.
- They preferred informal reporting, and reporting to a colleague over a superior. They said informal routes were easier, gave more feedback, and carried less fear of what might follow.
- Perceived risks spanned every phase of a mission. They included the physician's role as team leader, medication errors, handover, and the helicopter as a place to work.
Research into Practice takeaways
- The authors say sparse and informal reporting gives an incomplete picture of patient safety risk in HEMS.
- Programs can ask what makes their own reporting system easy to use and whether reporters get feedback.
- The authors call for more focus on the organization and on where system responsibility lies. They also call for research on the setting and context of the work.
- This was a small qualitative study of 8 physicians. It describes views and experiences, not how often incidents occur.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The Role of Paramedics in Disclosure of Patient Safety Incidents: A Mixed Methods Study
Krugliak, Netanel; Gagnon, Karla; Sawadsky, Bruce; Lewell, Michael; McGowan, Melissa; Nolan, Brodie
Air Medical Journal, 43(1), 66-68, 2024
Research highlights
Highlights
- Ornge provides critical care transport across the Canadian province of Ontario. It trained its paramedics on disclosure of patient safety incidents from 2020 to 2022.
- Disclosure means telling a patient or their substitute decision maker about a patient safety incident.
- Surveys before and after training drew 54 and 69 paramedics. That is about 25% to 30% of active paramedics.
- All paramedics who responded said they had a moral and professional duty to disclose. All rated the training as at least somewhat useful.
- After training, more paramedics felt at ease with disclosure. More also felt it could take place during the transport.
Research into Practice takeaways
- Only 25% to 30% of active paramedics responded, and the before and after groups differed in size. The results describe views, not actual disclosures.
- Programs can ask whether crews know how and when to disclose a safety incident, and who supports them when they do.
- The authors conclude that paramedics can take part in disclosure in a critical care transport setting.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
An Analysis of Helicopter Emergency Medical Services and Human Error Contributors to Accidents
Lawton, Paige M.
Doctoral dissertation, Embry-Riddle Aeronautical University, 2024
Analysis of Helicopter Air Ambulance Accidents in the United States From 2010 to 2021
Sanchez, Gustavo ; Gupta, Shantanu ; Johnson, Mary E.
Air Medical Journal, 43(6), 499-507, 2024
Research highlights
Highlights
- The authors reviewed NTSB final reports and data for 83 U.S. helicopter air ambulance accidents from 2010 to 2021.
- They compared the period 2010 to 2015 with the period 2016 to 2021.
- Fatal accidents fell from 21 of 47 (45%) to 6 of 36 (17%). This drop in the share of fatal accidents was statistically significant.
- Accidents where flight under visual flight rules (VFR) met instrument meteorological conditions (IMC) fell from 9 of 47 (19%) to 1 of 36 (3%). This drop was also statistically significant.
Research into Practice takeaways
- The authors suggest the drop may relate to changes in rules, training, safety awareness, and technology. The study did not test which of these mattered.
- The study compares shares of accidents, not accident rates per flight. Counts in each period are small, so a few events can move the percentages.
- Programs can track their own weather encounters and near misses, not only accidents, to see trends earlier.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Human Factors Analysis of Helicopter Air Ambulance Accidents, Incidents, and Events (2013-2023)
Baumgartner, Hannah M. ; Durham, Justin; DiDomenica, Rebecca; Hu, Peter T.
Federal Aviation Administration, Civil Aerospace Medical Institute. Report DOT/FAA/AM-24/22, 2024
Research highlights
Highlights
- FAA researchers looked at 158 air ambulance helicopter events in the United States from 2013 to 2023.
- The events came from 53 NTSB accident reports, 3 NTSB incident reports, and 102 reports to NASA's safety reporting system.
- Each event was coded for human factors and for factors in the organization.
- Risks for crews were linked to situation awareness, judgment and decision-making, following procedures, and training and experience.
- Risks in the organization were linked to communication, safety culture, and operator policy and procedure.
Research into Practice takeaways
- Voluntary safety reports showed events that accident data alone would miss. Programs can read their own safety reports the same way.
- The findings go beyond the crew. A review of an event can ask how policy, communication, and culture shaped what the crew did.
- The authors call for research on ways to support situation awareness, a new look at training needs, and more resources for crews.
Written by the Air Medical Safety Network from the report's public abstract. It does not replace the full report. Added November 2, 2026.
Read the abstract
Helicopter Air Ambulance (HAA) operations are subject to unique risks due to their time-sensitive and safety critical nature. The Civil Aerospace Medical Institute (CAMI) completed analyses of the National Transportation Safety Board’s (NTSB) Case Analysis and Reporting Online (CAROL) aviation accident and serious incident database and the National Aeronautics and Space Administration’s (NASA) Aviation Safety Reporting System (ASRS) data over a 10- year span. In total, 102 ASRS reports, 53 final NTSB accident reports, and 3 final NTSB incident reports involving HAA from 2013 to 2023 that occurred within the United States (U.S.) were coded for human factors and organizational risk factors. The analyses identified several human factors risks impacting HAA flight crew related to situation awareness (SA), judgment and decision-making (JDM), adherence to procedures, and experience and training. Further, organizational issues influencing HAA operations, such as communication, safety culture, and those involving operator policy and procedure, were identified. Research recommendations based on the findings broadly involve investigating techniques to improve SA, reevaluating or assessing training needs, and providing additional resources for pilots and flight crews in HAA operations.
Report documentation page. U.S. government work, not subject to copyright.
Using NEMSIS to report annual air medical transport statistics
Reimer, Andrew P. ; Shew, Joshua
Air Medical Journal, 43(3), 226-228, 2024
Research highlights
Highlights
- Researchers used the 2021 National Emergency Medical Services Information System (NEMSIS) dataset to count U.S. air medical transports.
- The count covered both fixed-wing and rotor-wing aircraft. It found 317,267 air medical transports in 2021.
- Location codes were missing for 19,421 transports (6%).
- Of 297,706 transports with valid codes, 70% (208,689) moved patients between facilities. The other 30% (89,016) went to the scene.
Research into Practice takeaways
- The authors say these early counts match other national estimates and include every state and territory.
- This is one year of data. The authors plan multi-year analysis and direct surveys of programs to check reliability.
- Programs can compare their own mix of interfacility and scene flights with these national figures.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Occupational Aspects of Alpine Helicopter Rescue Operations: Recommendation of the Medical Commission of the Union Internationale des Associations d’Alpinisme
Küpper, Thomas; Gieseler, Ulf; Morrison, Audry; Schöffl, Volker
Wilderness & Environmental Medicine, 34(4), 517-523, 2023
Research highlights
Highlights
- The Medical Commission of the International Climbing and Mountaineering Federation (UIAA MedCom) issued a recommendation on health checks for mountain helicopter rescue staff.
- The authors note there is no standard procedure for preventive checks of rescue personnel by occupational health professionals.
- The recommendation draws on more than 20 years of research by commission members and a broad literature search.
- The committee chose 248 references as relevant. The full list is in online supplemental material.
Research into Practice takeaways
- Mountain and high-altitude helicopter rescue is hard physical work with some risk. A standard screening approach gives programs a common starting point.
- The abstract does not describe the screening steps. Programs will need the full paper to see what is proposed.
- This is an expert recommendation, not a trial. It rests on research review and committee judgment.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The development of the helicopter non-technical skills (HeliNOTS) behavioural marker systems
Hamlet, Oliver E. D.; Irwin, Amy; Flin, Rhona; Sedlar, Nejc
Ergonomics, 66(12), 2232-2241, 2023
Search and rescue and offshore helicopter crews; not specific to air medical.
Research highlights
Highlights
- The authors report that no public behavioral marker system had been built from helicopter crew data before this study.
- Researchers held 9 discussion groups with 20 subject matter experts. The experts were pilots and technical crew who fly offshore transport or search and rescue missions.
- The academic team reviewed the systems in repeated rounds. Six more experts gave final reviews.
- Two systems were built. HeliNOTS (O) covers pilots in offshore transport, and HeliNOTS (SAR) covers search and rescue crews.
Research into Practice takeaways
- Behavioral markers give observers a shared way to rate nontechnical skills. Programs can look at how they now assess these skills in crew resource management (CRM) training.
- The systems were designed for offshore and search and rescue work, not HEMS. Air medical programs would need to test whether the markers fit their own missions.
- The authors describe both systems as prototypes. The abstract does not report testing in the field.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Evaluation of a Team-Based Flight Risk Assessment Tool in Air Medical Transport
Richardsen, Cecilia; Lubin, Jeffrey; Fadale, Michael; Flamm, Avram
Air Medical Journal, 42(6), 450-455, 2023
Research highlights
Highlights
- At the start of each shift, a team-based flight risk assessment tool (FRAT) rates the crew on experience, stress, sleepiness, and working conditions.
- The study looked back at one air and ground critical care transport program. It reviewed 1,919 of its FRAT scores from 2021.
- Scores reached the level that called for mitigation 281 times. Mitigation steps were reported for 259 of these.
- FRAT scores were not associated with first-pass intubation success, quality assurance flags on charts, or scene time.
Research into Practice takeaways
- Reaching the mitigation threshold is a process result. It is separate from the quality measures the study tested.
- The study cannot tell whether mitigation changed what happened on high-score shifts.
- This is one program's data. Programs using a FRAT can ask which outcomes they expect it to predict and track those.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Fatigue risk assessment of a Helicopter Emergency Medical Service crew working a 24/7 shift pattern: results of a prospective service evaluation
Rose, C.; Ter Avest, E.; Lyon, R. M.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 31(1), 72, 2023
Research highlights
Highlights
- HEMS medical crew working a forward-rotating 3-on, 3-off rota took psychomotor vigilance tests (PVT) at the start, middle, and end of each shift over a 5-week cycle.
- They also rated their tiredness on the Samn-Perelli Fatigue Scale and logged shift features that might relate to fatigue.
- PVT reaction times trended slower across a shift, from 447 ms at the start to 459 ms at the end. This trend was not statistically significant (p = 0.10).
- Over the 5-week cycle, average PVT and fatigue scores both trended up, with wide variation between people. Neither change was statistically significant.
- Moderate fatigue ratings (4 or higher) were mainly tied to workload and to car-based shifts.
Research into Practice takeaways
- The trends were not statistically significant and may reflect chance. The abstract does not give the number of crew members tested.
- Self-rated tiredness held steady within shifts while reaction times trended slower. Programs can pair self-report with other fatigue measures.
- The authors suggest a predictive fatigue tool used day to day could raise fatigue awareness and guide mitigation.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter Emergency Medical Services Outcomes Research 1983 to 2022: Evidence Overview and Longitudinal Trends
Rudman, Jordan S.; Fritz, Christie L.; Thomas, Sarah A.; McCartin, Michael; Price, James; Blumen, Ira J.; et al.
Air Medical Journal, 42(6), 429-435, 2023
An Examination of Human Factors in Australian Helicopter Emergency Medical Services (HEMS)
Gillott, Shaun; Ryley, Tim; Pingali, Sravan
The International Journal of Aerospace Psychology, 33(4), 270-287, 2023
Research highlights
Highlights
- This study looked at human factors in Australian HEMS. It used a survey of HEMS staff and past accident reports from the Australian Transport Safety Bureau (ATSB).
- The three leading human factor issues were weather, fatigue, and a sense of pressure.
- Weather was the issue most surveyed crews reported running into.
- The study linked feeling pressure to finish a task with a higher chance of an error or rule departure. The patient's condition was the most common cause of that pressure.
- Pressure came equally from crew members themselves and from others. More years in HEMS was linked to less exposure to some hazards.
Research into Practice takeaways
- The authors describe this pressure as unique to HEMS, because it comes from the patient. Programs can ask how their mission processes help crews manage that pressure.
- Half of the pressure came from other people. Leaders can look at where outside pressure on crews comes from in their own program.
- The authors say Australian results match global HEMS trends. The abstract does not give the survey sample size.
Written by the Air Medical Safety Network from the publisher's abstract. It does not replace the full publication. Added November 2, 2026.
Contributions and limitations of relational governance towards the reliability of publicly procured air ambulance services
Slotsvik, Tone Njølstad; Gould, Kenneth Arne Pettersen; Stene, Lillian Katarina
Safety Science, 164, 106167, 2023
Research highlights
Highlights
- This case study looked at Norway's last two rounds of buying air ambulance services.
- The shift from one contract period to the next can put stress on organizations and affect reliability.
- The authors used relational exchange theory to study governance built on relationships, alongside contracts.
- The buyer used relational governance, and the authors found it helped keep the service reliable.
- Balancing flexibility and stability was hard. When conflict between buyer and supplier ran deep, neither contracts nor relationships fully solved it.
Research into Practice takeaways
- The authors note that contracts cannot plan for every event in a long, complex service. They see joint problem solving as a way to fill some of the gaps.
- Contract changeovers are a risk period. Programs going through one can watch for strain on staff and operations.
- The authors argue that buyers and policy makers should expect possible periods of lower reliability when critical services are procured.
Written by the Air Medical Safety Network from the publisher's abstract. It does not replace the full publication. Added November 2, 2026.
Neonatal Transport Safety Metrics and Adverse Event Reporting: A Systematic Review
Gray, Megan M.; Riley, Taylor; Greene, Nancy D.; Mastroianni, Rossella; McLean, Courtney; Umoren, Rachel A.; et al.
Air Medical Journal, 42(4), 283-295, 2023
Research highlights
Highlights
- This systematic review found 38 studies on adverse events during neonatal transport from 2000 to 2019.
- Most studies (28 of 38) looked at abnormal vital signs. Low body temperature (hypothermia) was the abnormal vital sign reported most often.
- Fourteen studies covered abnormal lab values, 12 covered equipment issues, and 4 covered system issues.
- Twelve studies reported deaths related to transport. Four reported CPR during transport.
- Studies differed widely in their samples, in how they defined adverse events, and in quality.
Research into Practice takeaways
- Because studies defined events in different ways, the review could not say how often each type of event happens.
- The authors suggest shared definitions of adverse events, prospective data collection, and pooling data across larger systems.
- Neonatal teams can check how their own reports define and track events such as hypothermia and equipment problems.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Tracking the right path: Safety performance indicators as boundary objects in air ambulance services
Hayes, Jan; Slotsvik, Tone Njølstad; Macrae, Carl; Gould, Kenneth Arne Pettersen
Safety Science, 163, 106139, 2023
Research highlights
Highlights
- This study looked at how a safety performance indicator was read and debated by different groups in fixed-wing air ambulance services.
- The setting was public purchase of critical services. The groups were the public buyer and the service providers.
- The authors treat the indicator as a boundary object. That is something shared across groups that each understand it in their own way.
- The buyer and the providers used performance data for different purposes.
- In some cases, safety served as a stand-in for other risks, such as harm to reputation or finances.
Research into Practice takeaways
- A safety number can mean different things to a buyer and a provider. Programs can ask what each party thinks a given number shows.
- The authors warn that forcing indicators that are too simple can get in the way of key work. They say this could harm safety.
- The study looks at meaning and use. It does not test which indicator works best.
Written by the Air Medical Safety Network from the publisher's abstract. It does not replace the full publication. Added November 2, 2026.
Piloting Peer Support to Decrease Secondary Traumatic Stress, Compassion Fatigue, and Burnout Among Air Medical Crewmembers
McCall, W. Travis
Air Medical Journal, 42(3), 157-162, 2023
Research highlights
Highlights
- Flight nurses and paramedics completed the Professional Quality of Life Scale. The scale covers burnout, compassion satisfaction, and secondary traumatic stress.
- Scores were compared before a pilot peer support program and 16 months after it began.
- The authors found the highest risk among crewmembers with less time in their program and among those without a support system.
- Clinical role, marital status, and years in the profession showed no statistically significant differences.
- The authors read the score changes as a sign that peer support may help air medical crews.
Research into Practice takeaways
- The abstract does not give a sample size or say whether the before and after change was statistically significant. The result is a promising sign, not proof.
- Programs can look at who on the team is newest or has the least support outside work. The authors suggest these crewmembers may gain the most.
- Peer support after hard transports is one option programs can review. This was a single pilot program.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The Royal Flying Doctor Service Initiation of Helicopter Video Simulation Orientation Training for Air Medical Crews in Western Australia: A Pilot Study
Iliff, John; Spring, Breeanna; Powell, Glenn; Hendry, Miranda; Richardson, Alice; Gardiner, Fergus W.
Air Medical Journal, 42(3), 163-168, 2023
Research highlights
Highlights
- Royal Flying Doctor Service Western Operations began its first helicopter service in Western Australia in May 2022. It used 2 Eurocopter EC145 aircraft.
- This pilot study added video simulation to standard clinical training. Crews rated their confidence on a 5-point scale, and a control group was compared with a video group.
- Clinical staff, many with long experience, were not automatically confident doing critical care procedures in an aircraft type new to them.
- Confidence rose after the classroom session and rose again after the practical session. The rise from pretraining to post-classroom was statistically significant.
- The group that saw the videos showed a small added rise in confidence.
Research into Practice takeaways
- Programs adding a new airframe can plan orientation for experienced staff too, not only for new hires.
- The study measured confidence, not skill or patient outcomes. The added effect of the videos was small and was not reported as statistically significant.
- The authors suggest prerecorded procedure videos are a useful add-on to classroom and hands-on training.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Individual and Work-Related Psychological Characteristics Contributing to Subjective Well-Being in Air Rescue Employees
Mikutta, Christian A.; Sommer, Isabella; Ehlert, Ulrike
Air Medical Journal, 42(2), 99-104, 2023
Research highlights
Highlights
- Researchers sent a set of questionnaires to all 142 staff of Swiss Air-Rescue. Of these, 48 gave complete data.
- The questionnaires covered chronic stress, coping, sense of coherence, self-esteem, self-efficacy, mental health, and posttraumatic stress.
- A discriminant analysis looked at which factors set apart staff with higher and lower subjective well-being.
- The analysis was statistically significant. It placed 89.4% of cases in the right group.
- Self-esteem and sense of coherence were the strongest factors linked to well-being.
Research into Practice takeaways
- About one in three staff gave complete data. The results may not reflect the whole workforce.
- The study shows links, not causes. It does not test whether building these traits improves well-being.
- The authors suggest that prevention programs for rescue staff include work on self-esteem and sense of coherence.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Stress of emergency physicians during helicopter operations: impact of patients’ diagnoses, severity of diagnoses, and physicians’ work experience
Petrowski, Katja; Malkewitz, Camila Paola; Schöniger, Christian; Frank, Mark; Theiler, Lorenz
BMC Emergency Medicine, 23(1), 20, 2023
Research highlights
Highlights
- Researchers measured heart rate variability in 59 HEMS emergency physicians across two full air rescue days.
- They focused on the alarm and landing phases. They linked heart rate variability to the patient's diagnosis and to the National Advisory Committee for Aeronautics (NACA) severity score.
- Both heart rate variability measures showed lower parasympathetic activity depending on the diagnosis.
- High severity scores (NACA V or above) predicted lower heart rate variability.
- More work experience was linked to lower heart rate variability and to higher sympathetic activation.
Research into Practice takeaways
- The authors found pediatric and time-critical cases to be the most stressful. They suggest this knowledge can guide targeted stress training.
- Experience did not appear to buffer stress responses in this sample. Leaders may not want to assume senior clinicians are less affected.
- Heart rate variability measures a body response. It does not measure performance or well-being directly.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The bookmark method to establish minimum performance standards for intensive care flight paramedics performing helicopter winch rescue
Meadley, Ben; Rogers, Matthew; Bowles, Kelly-Ann; Caldwell, Joanne
Applied Ergonomics, 107, 103934, 2023
Research highlights
Highlights
- Researchers used the bookmark method to set minimum performance standards for intensive care flight paramedics doing winch rescue.
- Two expert groups watched nine videos of land and water rescue tasks. Each video showed the task done in a shorter time than the one before.
- One group of 10 watched on their own off site. The other group of 9 met in person.
- Each expert picked the video with the right pace and then saw feedback. This repeated until 80% agreed or three rounds were done.
- Both groups agreed on the land task in two rounds, and the task times chosen were similar. Only the in-person group reached agreement on the water task.
Research into Practice takeaways
- The method turned expert judgment into a time standard for winch tasks.
- The authors conclude that experts agree more readily when they meet face to face. That rests on one comparison of two small groups.
- The groups were small, with 19 experts in all. Standards set this way may need review before use in another service.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Correlation of Preflight Risk Assessment Scores With First-Pass Intubation Success in a Critical Care Transport Environment
Kothari, Arpan R.; Werman, Howard A.
Air Medical Journal, 42(1), 69-72, 2023
Research highlights
Highlights
- This study looked back at first-pass intubation success among critical care providers in a transport setting.
- It compared providers who reported they were fatigued with providers who did not.
- The study found no statistical difference in first-pass success between the two groups.
Research into Practice takeaways
- Fatigue here was self-reported. The abstract does not give the sample size or how fatigue was rated.
- No difference in one skill does not mean fatigue has no effect. Other skills and decisions were not measured.
- The authors suggest future studies measure fatigue with validated tools at the moment the skill is done.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Fatal Air Medical Accidents in the United States (2000-2020)
Shekhar, Aditya C. ; Blumen, Ira J.
Prehospital and Disaster Medicine, 38(2), 259-263, 2023
Research highlights
Highlights
- This study reviewed NTSB reports of fatal air medical accidents in the United States from 2000 through 2020. It included both helicopters and airplanes.
- There were 87 accidents with 239 deaths. Helicopters accounted for 72.4% of deaths and airplanes for 27.6%.
- Based on their reading of NTSB findings, the authors judged that human factors likely played a part in 87.4% of deaths. These included disorientation, fatigue, impairment, maintenance, and judging the weather.
- The authors judged that night-related factors likely played a part in 38.9% of deaths. The figures were 35.6% for weather factors and 17.2% for mechanical failures.
- Fatal accidents were fewer in recent years of the study.
Research into Practice takeaways
- A human factors finding shows where investigators placed probable cause. It does not show why choices made sense to the people involved.
- The authors call for a safety-first culture with human factors training. They point to gains from such training in other medical fields.
- Counts of deaths are not rates. Without flight hours, the study cannot show whether risk per flight changed.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Ground Versus Air: Which Mode of Emergency Medical Service Transportation Is More Likely to Crash?
Hartmann, Krista ; Lubin, Jeffrey; Boehmer, Sue; Amin, Sibgha; Flamm, Avram
Air Medical Journal, 42(1), 28-35, 2023
Research highlights
Highlights
- The authors compared crash data for HEMS and ground EMS in the United States. HEMS data ran from 1983 to 2020 and ground data from 1988 to 2020.
- Crash data came from the NTSB and the National Highway Traffic Safety Administration. Rates also drew on FAA data, the National Emergency Medical Services Information System, and earlier studies.
- HEMS crash rates went down over the period. Total ground EMS crashes went up.
- A third of HEMS crashes (33%) were fatal, compared with 1% of ground crashes. Injuries occurred in 20% of HEMS crashes and 31% of ground crashes.
- From 2016 to 2020, the ground EMS crash rate was 11.0 times the HEMS rate (95% confidence interval 5.2 to 23.3).
Research into Practice takeaways
- Ground crashes had the higher rate in 2016 to 2020, but HEMS crashes were more often fatal. A look at transport risk can weigh both how often crashes happen and how severe they are.
- The authors name limited data as a weakness. Rate comparisons depend on the exposure data behind them.
- The authors suggest national ground EMS transport data would help study this question further.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Human Factors in Helicopter Air Ambulance Operations Annotated Bibliography (2014 – 2022)
Baumgartner, Hannah M. ; DiDomenica, Rebecca; Durham, Justin; Hu, Peter T.
Federal Aviation Administration, Civil Aerospace Medical Institute. Report DOT/FAA/AM-23/08, 2023
Research highlights
Highlights
- This FAA report is an annotated bibliography of human factors research on helicopter air ambulance operations from 2014 to 2022.
- It describes the setting as demanding. Crews often land at unfamiliar, remote, or unprepared sites with terrain and obstacles, under time pressure.
- Human factors concerns in the report include fatigue, stress, human error, and a felt pressure to fly.
- The review centers on crew fatigue, environmental conditions, training needs, and other operational risk factors.
Research into Practice takeaways
- The report gathers recent research in one place. It can serve as a starting point for programs and researchers looking into these topics.
- The abstract does not report specific findings. Readers need the full report for what the studies found.
- Programs can ask how a felt pressure to fly shows up in their own launch decisions.
Written by the Air Medical Safety Network from the report's public abstract. It does not replace the full report. Added November 2, 2026.
Read the abstract
Helicopter air ambulance (HAA) operations involve particularly challenging conditions, including landing at unfamiliar, remote, or unimproved sites with terrain and obstacle hazards, and involve urgent or time-sensitive situations. Associated human factors (HF) issues including fatigue, stress, human error, and perceived pressure to fly compound the challenging nature of HAA operations. This report aims to inform the current understanding of HF risks and considerations within HAA operations spanning 2014 – 2022 through a focused review of flight crew fatigue considerations, environmental conditions, areas for increased training opportunities, and other operational risk factors.
Report documentation page. U.S. government work, not subject to copyright.
Profiling helicopter emergency medical service winch operations involving physicians in Queensland, Australia
Thorley, Liam; Shepherd, Ben; Donohue, Andrew; MacKillop, Allan
Emergency Medicine Australasia, 34(3), 355-360, 2022
Research highlights
Highlights
- Researchers reviewed all 2019 helicopter winch missions in Queensland, Australia, that involved physicians from LifeFlight Retrieval Medicine.
- Of 4,356 HEMS missions with physicians, 100 (2.3%) used the winch. Of these, 31 were over water and 12 were at night.
- The missions involved 106 patients and eight deaths. Most patients were injured (66%) and male (66%), with a median age of 43.5 years.
- Drowning victims were the focus of 13 missions. These patients had more severe injuries overall, and they made up half of the patients who were intubated.
- Median scene time was 30 minutes. Physicians were winched on 63 missions, and this was linked to longer scene times and more use of the winch stretcher.
Research into Practice takeaways
- Programs can ask how they keep winch and water rescue skills current when these missions are uncommon.
- The authors suggest that patient severity may explain part of the link between physician winching and longer scene times. The data cannot separate these factors.
- This was one service over one year. Mission mix may differ elsewhere.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Static Rope Rescue Operations in Western Norway: A Retrospective Analysis of 141 Missions
Mattingsdal, Håvard; Abrahamsen, Håkon B.; Fevang, Espen; Sollid, Stephen J. M.
Wilderness & Environmental Medicine, 33(2), 162-168, 2022
Research highlights
Highlights
- This study reviewed static rope missions flown in daylight from 2015 to 2019 at three HEMS bases in Western Norway.
- Static rope was used on 141 missions. That was 2% of the 8,352 primary missions these bases flew, counting HEMS and search and rescue together.
- Most missions used a triangle harness (62%) and a 30 m rope (81%).
- Most were in simple terrain (92, or 65%). Challenging terrain made up 38 missions (27%), and complex terrain made up 11 (8%).
- No accidents were reported, though a few adverse events were logged. Pain management was the most common treatment on site, followed by spinal immobilization.
Research into Practice takeaways
- About a third of missions needed extra safety steps at the scene. The ability to work in mountain or alpine settings was the measure needed most often.
- The authors say the results support the safety value of Norway's national standard for rescuers.
- Adverse events were few but present. Programs can review how they record and learn from events that do not become accidents.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The physiological demands of helicopter winch rescue in water and over land
Meadley, Ben; Horton, Ella; Perraton, Luke; Smith, Karen; Bowles, Kelly-Ann; Caldwell, Joanne
Ergonomics, 65(6), 828-841, 2022
Research highlights
Highlights
- Fourteen intensive care flight paramedics did simulated winch rescues on land and in water. The group had 12 men and 2 women with a mean age of 44.3 years.
- On the land task, oxygen uptake averaged 41.7 mL/kg/min, or 86% of each person's peak. The task lasted about 7.0 minutes.
- On the water task, oxygen uptake averaged 36.7 mL/kg/min, or 81% of peak. The task lasted about 10.2 minutes.
- The land task used about 53% of the maximal acceptable work duration. The water task used about 47.6%.
Research into Practice takeaways
- The authors describe the workload as high and the task durations as moderate. Programs can ask whether crew fitness is checked against these demands.
- The authors suggest using these demands when building selection tests and credentialing, and when deciding who deploys on a rescue.
- The data came from simulations with 14 paramedics. Results from actual rescues were not reported.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Integrative Review of Non-Technical Skills Frameworks to Apply for Air Medical Transfer of Pregnant Women
Perera, Anuradha; Griffiths, Robin; Myers, Julia A.
Journal of Obstetric, Gynecologic & Neonatal Nursing, 51(3), 257-277, 2022
Research highlights
Highlights
- This integrative review searched eight databases for non-technical skills frameworks for health care teams.
- The searches found 569 articles. The authors kept 71 full-text articles for review.
- They identified 42 frameworks from many care settings.
- For air transfer of pregnant women, team skills and routine performance mattered more than skills for crises alone.
- For this setting, the authors picked the Global Assessment of Obstetric Team Performance to adapt.
Research into Practice takeaways
- The authors name situation awareness and clear talk with the team, the patient, and her partner as key skills at every stage of transfer.
- Programs that move pregnant patients can ask whether crew training and review tools cover routine teamwork, not only emergencies.
- The review picked a framework but did not test it in air transport. It still needs adapting and testing there.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Posttraumatic Stress Responses and Psychological Well-being in Norwegian Medical Helicopter Personnel
Reid, Bjørn Ole; Næss-Pleym, Lars Eide; Haugland, Helge; Dale, Jostein; Uleberg, Oddvar; Nordstrand, Andreas Espetvedt
Air Medical Journal, 41(3), 292-297, 2022
Research highlights
Highlights
- Researchers ran a web survey of rescue paramedics and physicians on Norwegian HEMS and search and rescue helicopters from May to July 2021.
- Of 245 eligible staff, 161 took part (66%). Physicians made up 89 of the group and rescue paramedics 72.
- The survey used standard scales for anxiety, depression, posttraumatic stress symptoms, and posttraumatic change.
- Manifest symptoms of posttraumatic stress disorder were reported by 3.9%. Depression and anxiety at a moderate to severe level were reported by 1.9%.
- Most respondents (76%) said their work had led to emotional growth. Symptom rates were lower than in the Norwegian adult population.
Research into Practice takeaways
- About one in three eligible staff did not take part. The results may not describe everyone in the service.
- Programs can measure growth as well as harm when they look at crew well-being. Both showed up in this group.
- The study does not explain why distress was low. It does not show which supports or program features made a difference.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Work schedule and seasonal influences on sleep and fatigue in helicopter and fixed-wing aircraft operations in extreme environments
Fletcher, Adam; Stewart, Simon; Heathcote, Karen; Page, Peter; Dorrian, Jillian
Scientific Reports, 12(1), 8263, 2022
Research highlights
Highlights
- Researchers tracked sleep and fatigue in 210 aviation workers for 21 days each. The data came from 17 datasets in seven countries.
- The work covered search and rescue, firefighting, EMS, and offshore transfer flights in helicopters and fixed-wing aircraft.
- Sleep was measured with wrist-worn activity monitors and sleep diaries. Alertness was tested with a 5-minute Psychomotor Vigilance Task.
- Even with round-the-clock operations, most work took place in the day and most sleep took place at night. Work and sleep shifted with the seasons, and naps added to total sleep.
- The share of sleep taken while on duty ranged from zero to 30%. Changes in vigilance test results were described as trivial to small.
Research into Practice takeaways
- Duty and rest rules often assume crews do not sleep on duty. The authors note this may not hold for services that wait for calls, such as EMS and search and rescue.
- The authors suggest that fatigue risk management systems make room for safe sleep on duty where it fits the work.
- Programs that use on-duty rest can look at how much sleep crews actually get on shift and how that sleep is counted.
- The study pooled several mission types across seven countries. Results for any one EMS program may differ.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Sleep and Sleepiness Measured by Diaries and Actigraphy among Norwegian and Austrian Helicopter Emergency Medical Service (HEMS) Pilots
Flaa, Tine Almenning; Bjorvatn, Bjørn; Pallesen, Ståle; Zakariassen, Erik; Harris, Anette; Gatterbauer-Trischler, Pia; et al.
International Journal of Environmental Research and Public Health, 19(7), 4311, 2022
Research highlights
Highlights
- This study tracked sleep and sleepiness in 47 HEMS pilots from Norway and Austria.
- The pilots worked seven 24-hour shifts in a row. Sleep was measured with diaries and wrist activity monitors, and sleepiness with the Karolinska Sleepiness Scale.
- Across the week, pilots went to bed and woke up later. Total sleep and sleep efficiency did not change.
- Norwegian pilots slept longer and spent more time in bed than Austrian pilots, but woke more during the night and had lower sleep efficiency.
- Sleepiness was slightly higher on the first workday and lower on the days after.
Research into Practice takeaways
- The abstract does not report how often pilots flew at night during the shifts. That limits what the results say about busier bases.
- The study does not explain why the two services slept differently. Programs comparing bases can look at local routines and setting.
- Programs can watch the first shift of a rotation, when sleepiness was highest in this sample.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Operational Policies and Procedures for Critical Care Transport During a Respiratory Pandemic
Frakes, Michael A.; Denison, Todd; Leisten, David C.; Wheeler, Jennifer; Boomhower, James; Cohen, Jason E. ; et al.
Air Medical Journal, 41(2), 252-256, 2022
Research highlights
Highlights
- This report describes how critical care transport services changed operations during the 2020 to 2021 SARS-CoV-2 pandemic.
- The patient mix shifted. Trauma and pediatric transports dropped, and most patients became adults with acute hypoxemic respiratory failure.
- Early in 2020, teams moved these patients before anyone knew how well personal protective equipment worked.
- Even the definition of a person under investigation for COVID-19 differed between institutions. That left transport programs caught between conflicting rules.
- The authors point to being adaptable, communicating efficiently, reassessing often, and trying new approaches as the key changes.
Research into Practice takeaways
- This is an experience report with best practices, not a study with outcome data.
- The authors expect many of these processes to carry over to later respiratory epidemics and to everyday operations.
- Programs can review what they learned from the pandemic and decide which changes to keep in written procedures.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Risk Analysis by Failure Modes, Effects and Criticality Analysis and Biosafety Management During Collective Air Medical Evacuation of Critically Ill Coronavirus Disease 2019 Patients
Koch, Lionel; Nespoulous, Olivier; Turc, Jean; Linard, Cyril; Martigne, Patrick; Beaussac, Madeleine; et al.
Air Medical Journal, 41(1), 88-95, 2022
Research highlights
Highlights
- After COVID-19 spread in March 2020, the French Ministry of Defence used an Airbus A330 Multi Role Tanker Transport to move groups of critically ill patients. The aim was to ease the load on intensive care units that were over capacity.
- Before this, biosafety evacuations had carried one symptomatic patient at a time, such as patients with Ebola virus disease.
- The team mapped the process and used Failure Modes, Effects and Criticality Analysis (FMECA) to find risks.
- They put steps in place to reduce risk to medical staff, the aircrew, and the surroundings.
- Six flights moved 36 patients with COVID-19 who were critically ill. The authors report no casualties and say staff and aircraft were protected.
Research into Practice takeaways
- This is a report of one military operation over 6 flights. It describes a method and its outcome, not a comparison.
- FMECA is a structured way to look at what could go wrong before it does. Programs can apply it to new or unusual missions.
- The abstract does not list the specific risks or mitigations. Readers would need the full paper for those details.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Safety Competency, Certification, and Practical Drift
York, Donna; Xu, Jiayun; Foli, Karen; Potetz, Janelle
Air Medical Journal, 41(1), 78-81, 2022
Research highlights
Highlights
- A total of 432 transport nurses answered a cross-sectional survey on safety competency.
- The survey used an adapted version of the Critical Care Nursing Competence Questionnaire for Patient Safety (C3Q-safety), matched to Air and Surface Transport Nurses Association safety standards.
- Five transport nursing experts reviewed the items for fit with those standards.
- Certification status was not linked to self-rated safety competency.
- Nurses with more transport experience scored lower on safety competency (β = -0.150, P = .037).
Research into Practice takeaways
- The authors suggest practical drift may explain the experience finding. Drift is the move of daily practice away from written policy and procedure.
- The study did not measure drift directly. Scores were self-ratings at one point in time.
- The authors suggest a safety culture built on nonpunitive reporting, plus simulation, to limit drift.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
American Helicopter Emergency Medical Service Pilots Report to Work Despite High Rates of Sleepiness
Kamine, Tovy Haber ; Dhanani, Hiba; Wilcox, Susan ; Kelly, Edward; Alouidor, Reginald; Kramer, Kristina ; et al.
Air Medical Journal, 41(5), 432-434, 2022
Research highlights
Highlights
- An anonymous survey reached HEMS pilots through the National EMS Pilots Association email list. It used the Epworth Sleepiness Scale (ESS).
- Of 31 pilots who responded, 21 scored above 10 on the ESS. That score points to excessive daytime sleepiness.
- Twelve of 31 pilots (39%) said they had nodded off during a flight.
- Twenty pilots (65%) said fatigue was a reason they should have declined a flight. Fourteen (45%) said they had actually declined one.
- Pilots felt fatigue most often affected the en route phase (23 of 31). Takeoff and landing were each named by 2 pilots.
Research into Practice takeaways
- The sample is small, and pilots chose whether to answer. The rates may not reflect all HEMS pilots.
- There was a gap between pilots who felt they should decline and those who did. Programs can ask what makes a fatigue call easy or hard to make.
- Teams may want to think about alertness during the en route phase, not only at the start of a flight.
- The authors call for more research to measure how much fatigue HEMS pilots carry.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter versus ground ambulance transport for interfacility transfer of critically ill children
Joseph, Allan M.; Horvat, Christopher M.; Evans, Idris V.; Kuch, Bradley A.; Kahn, Jeremy M.
The American Journal of Emergency Medicine, 61, 44-51, 2022
Research highlights
Highlights
- This study looked at critically ill children moved to one pediatric hospital by a specialized pediatric transport team.
- Every patient in the study had a helicopter requested at first. Some went by ground ambulance for reasons that were not clinical.
- Median transport time was 143 minutes by helicopter and 289 minutes by ground.
- In-hospital death was 6.0% in the helicopter group and 7.0% in the ground group. This difference was not statistically significant.
- Before adjustment, helicopter patients had a shorter median hospital stay, 4 days compared with 5, and this difference was statistically significant. After adjustment, no differences were statistically significant.
Research into Practice takeaways
- The study only included children for whom a helicopter was requested. This design helps reduce bias in who ends up flown, and other researchers can use the same approach.
- Children who went by ground reached definitive care about 2.5 hours later. Teams can weigh time saved alongside other outcomes.
- The children studied did not have traumatic injuries, and all went to one hospital. The results may not apply to trauma patients or other systems.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Out-of-pocket payments made by patients transported by Helicopter Emergency Medical Services (HEMS)
Gooley, Brian; Sherr, Sela; Lenz, Timothy J.
The American Journal of Emergency Medicine, 58, 192-196, 2022
Research highlights
Highlights
- This study described billing at one non-profit HEMS program in the Midwest.
- It covered two periods. The first ran from January 2017 to June 2018 and the second from July 2018 to December 2019.
- The base charge per flight rose from $19,158 in the first period to $33,023 in the second.
- On average, patients paid $158.09 out of pocket in the first period and $178.99 in the second.
- How insurers paid varied widely across the two periods and from one insurer to another.
Research into Practice takeaways
- In this program, what patients paid on average was far below the base charge. The authors note it was also lower than amounts often reported in the news.
- These results come from a single non-profit program. They may not reflect other programs or other business models.
- The abstract reports averages only. It does not show the range of what individual patients paid.
- The authors call for more open reporting of costs and payments across HEMS programs, both non-profit and for-profit.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Overutilization of Helicopter Emergency Medical Services in Central Gulf Coast Region Results in Unnecessary Expenditure
Miles, M. Victoria P. ; Beasley, Justin R.; Reed, Haylie E.; Miles, Daniel T. ; Haiflich, Andrew; Beckett, Allison R.; et al.
Journal of Surgical Research, 273, 211-217, 2022
Research highlights
Highlights
- This study looked at 381 adult trauma patients flown from the scene to one level I trauma center over 28 months. The center serves the central Gulf Coast region.
- The authors judged 34% of the flights as possibly not warranted.
- Age, more than one long bone fracture, penetrating injury, and ejection from a vehicle were linked to warranted flights. Insurance status was not linked to transport mode.
- Many patients came from the same or a neighboring county. For patients moved by ground and by air from the same scene, the authors found no time savings by air.
- The authors estimated the cost of unwarranted flights at over $3 million in health care spending.
Research into Practice takeaways
- Triage happens with limited information at the scene. A review with full hospital records sees more than the crew or the requester could.
- The authors call for more joint work to set helicopter triage criteria.
- Programs can track how often scene flights come from nearby areas where ground transport may take about as long.
- This is one center, and the study team set the test for a warranted flight.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Combining in-situ simulation and live HEMS mission facilitator observation: a flexible learning concept
Bredmose, Per P.; Hagemo, Jostein; Østergaard, Doris; Sollid, Stephen
BMC Medical Education, 21(1), 579, 2021
Research highlights
Highlights
- Over one year at three HEMS bases, a facilitator could observe and debrief a live mission when that mission interrupted planned simulation training.
- Of 78 attempted sessions, 46 (59%) ran as planned. Another 23 (29%) never started because crews were tied up with other duties, and 9 (12%) became observed live missions.
- Facilitators found observing live missions harder than running a simulation.
- Interviews pointed to clinical skill, strong communication, and knowledge of the local base as needs for facilitators.
- Crews first found being observed uncomfortable. Later they saw it as a helpful way to learn.
Research into Practice takeaways
- Live missions often interrupt base training. Observation and debrief offer a way to keep some learning from a lost session.
- Fatigue and other duties stopped close to a third of sessions. Programs can track how often training is cancelled and why.
- The authors suggest more training for facilitators who observe live missions. This was a small study at three bases.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Incidence and challenges of helicopter emergency medical service (HEMS) rescue missions with helicopter hoist operations: analysis of 11,228 daytime and nighttime missions in Switzerland
Pietsch, Urs; Knapp, Jürgen; Mann, Michael; Meuli, Lorenz; Lischke, Volker; Tissi, Mario; et al.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1), 92, 2021
Research highlights
Highlights
- Researchers reviewed all 11,228 hoist and other human external cargo missions flown by Swiss Air-Rescue (Rega) from 2010 to 2019.
- Of these, 9,963 (88.7%) were flown by day and 1,265 (11.3%) at night.
- Among patients with time-critical injuries (NACA score of 4 or above), 21.1% reached a hospital within 60 minutes by day. At night the figure was 9.1%.
- Night missions, a trauma diagnosis, on-scene intubation, and a NACA severity score of 4 or above were each independently linked to longer mission times.
- By day, the largest group had moderate injuries (37.5%), and 55.1% were hurt during recreation. The most common interventions were intravenous access (38.7%) and pain relief (31.3%).
Research into Practice takeaways
- The authors report that nearly one in five hoisted patients was severely injured, and that complex lifesaving care was needed before some hoists. They conclude that only trained, experienced medical crew should go on these missions.
- Programs can compare their own day and night hoist timelines for time-critical patients against the gap seen here.
- This is one national service in Switzerland. Terrain, staffing, and patient mix may differ elsewhere.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Physiological Response in a Specialist Paramedic During Helicopter Winch Rescue in Remote Wilderness and Extreme Heat
Meadley, Benjamin N.; Horton, Ella; Perraton, Luke; Smith, Karen; Bowles, Kellly-Ann
Journal of Special Operations Medicine, 21(3), 41-44, 2021
Research highlights
Highlights
- This report describes one flight paramedic during a helicopter winch rescue in remote wilderness in extreme heat.
- The temperature was 37.1 degrees Celsius.
- The paramedic worked at about 81% of maximum heart rate for about 10 minutes and rated the effort 19 out of 20.
- The authors estimated that a person could keep up this task for at most about 38 minutes.
- The data collection methods proved workable in the field.
Research into Practice takeaways
- The authors present the case as an example of the strain HEMS search and rescue crews may face in hot, remote settings.
- This is a single case. It shows what is possible to measure, not what is typical.
- The authors suggest that search and rescue teams use a scientific approach to select, train, and equip personnel for heavy tasks in harsh settings.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Quantitative assessment of pilot-endured workloads during helicopter flying emergencies: an analysis of physiological parameters during an autorotation
Scarpari, José Ricardo Silva; Ribeiro, Mauricio Watanabe; Deolindo, Camila Sardeto; Aratanha, Maria Adelia Albano; de Andrade, Donizeti; Forster, Carlos Henrique Quartucci; et al.
Scientific Reports, 11(1), 17734, 2021
Single-engine helicopter flight testing; not specific to air medical operations.
Research highlights
Highlights
- Eleven pilots wore sensors during autorotation maneuvers in a flight test campaign. Autorotation is the maneuver used to land a single-engine helicopter after engine failure.
- Heart rate and electrodermal activity were recorded, along with movements of the flight controls.
- Pilots also rated each maneuver with the Handling Qualities Rate scale.
- Physiological data could be recorded and captured the most demanding parts of the maneuvers.
- Workload was linked to where the flight profile sat on the height-speed diagram. Strain levels correlated with physiological responses.
Research into Practice takeaways
- Test pilots often rely on subjective ratings near the height-speed limits. Physiological measures could add an objective view.
- These were planned maneuvers in a flight test campaign. Responses in an actual engine failure may differ.
- Programs that train autorotation can ask how they gauge pilot workload during that training.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Safety Matters: A Meta-analysis of Interhospital Transport Adverse Events in Critically Ill Patients
Jeyaraju, Maniraj; Andhavarapu, Sanketh; Palmer, Jamie; Bzhilyanskaya, Vera; Friedman, Eric; Lurie, Tucker; et al.
Air Medical Journal, 40(5), 350-358, 2021
Research highlights
Highlights
- This meta-analysis pooled studies of adverse events during interhospital transport of critically ill adult medical patients.
- It searched PubMed, Embase, and Scopus through February 12, 2021. It included 19 of 554 studies found, covering 14,969 patients.
- Pooled adverse events numbered 1,059, about 11% (95% confidence interval, 7.5% to 16%). Low blood pressure was the most common, at 424 events (2.8%).
- Higher event rates were linked to coronavirus-related respiratory failure (88%), to stroke (19%), and to patients who needed extracorporeal membrane oxygenation (40%).
- Transport by nurses (31%) and by physicians (11%) was linked to higher event rates. Type of transport was not.
Research into Practice takeaways
- The authors think the events mostly reflect how sick patients were. Links with crew type may reflect which patients each crew carries, so they need care in reading.
- Programs can review their own adverse events by patient condition to see where risk is concentrated.
- The authors call for studies of ways to reduce adverse events in transport.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The interdisciplinary team experiences of managing patient safety during a fixed-wing inter-hospital aeromedical transport: A qualitative study
Dias, Carla Pena; Chrispim Silva, Marina Aparecida; Santos, Moema Souza; Lopes Ferreira, Flávio; Carvalho, Vânia de Paula; Alves, Marilia
International Emergency Nursing, 58, 101052, 2021
Fatality and Operational Specificity of Helicopter Accidents on the Ground
de Voogt, Alexander J.; Hummel Hohl, Caio; Kalagher, Hilary
Aerospace Medicine and Human Performance, 92(7), 593-596, 2021
Research highlights
Highlights
- The authors reviewed 115 NTSB helicopter accidents from 1998 to 2018 that happened while the aircraft was on the ground and standing.
- About 57% of these accidents came after landings away from an airport. Off-airport cases were reported more often in Alaska, with 15 cases.
- All 10 fatal accidents involved a person struck by the main rotor. In 8 of those, the cause was attributed to the person who was struck.
- Accidents with fatal or serious injuries were less likely when the aircraft itself was substantially damaged or destroyed.
- No accident happened in instrument weather. High winds and gusts were a main cause in about 18% of cases.
Research into Practice takeaways
- These cases cover helicopter operations in general, not only air medical work. Programs can still look at how people approach and leave the aircraft while the rotors turn.
- A cause placed on the person struck shows where the cause was assigned. It does not explain why being near the rotor made sense to that person at the time.
- The authors suggest that operating manuals address wind and gust limits while the aircraft is standing, not only in takeoff and flight. Programs can look at how their own ground and scene procedures treat wind.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter Hoist Operations in Difficult Nonalpine Terrain
Wilhelm, Andreas; Lefering, Rolf
Air Medical Journal, 40(4), 242-250, 2021
Research highlights
Highlights
- The study looked at 251 rescue missions in difficult terrain in one German city borough near the Rhine valley and the Black Forest. Missions ran from the start of 2007 through July 2018.
- Patients were mostly male (66.7%), adult (57.5%), and injured (75.0%). Most were rescued by ground methods.
- Actual prehospital time was longer for hoist missions than for ground rescues (104 vs. 72 minutes).
- A simulation of all missions found hoist rescue would have been shorter overall (80 vs. 91 minutes).
- Longer prehospital times were linked to vague location descriptions, hard terrain, a site far from a road, steep slopes, and life-threatening conditions not caused by injury.
Research into Practice takeaways
- The real hoist missions took longer, while the simulation favored hoists. The simulation used expert estimates and training data, so it is a model and not observed results.
- Vague descriptions of the accident site were linked to delays. Programs and dispatch centers can review how they gather location details.
- The authors suggest consistent dispatch rules for hoist missions and adding hoist capability to some HEMS helicopters. The findings come from one German region.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
National Implementation of In Situ Simulation-Based Training in Helicopter Emergency Medical Services: A Multicenter Study
Bredmose, Per P.; Røislien, Jo; Østergaard, Doris; Sollid, Stephen
Air Medical Journal, 40(4), 205-210, 2021
Research highlights
Highlights
- Over 1 year, researchers studied in situ simulation at every Norwegian HEMS base (14 in all) plus one rescue base.
- Local facilitators were trained and ran simulations when they chose.
- All bases agreed to take part, but 1 dropped out because of technical problems.
- Each base attempted between 1 and 46 simulations, with a median of 17. Crews rated their satisfaction with the training highly at every base.
- Bases with 2 local facilitators attempted more simulations. Facilitators' travel distance to work did not seem to matter.
Research into Practice takeaways
- Bases had the same setup but ran widely different amounts of training. The authors point to conditions around the local facilitator as a key factor.
- Bases with the most missions finished fewer simulations. Programs can ask whether call volume leaves room for training at each base.
- Satisfaction was self-rated. The study tracked how often training happened, not whether it changed performance.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Pretransport Risk Assessment of Agitated Patients in Air Medical Transport
MacDonald, Russell D.; Leong, Yuen Chin
Air Medical Journal, 40(4), 274-277, 2021
Research highlights
Highlights
- The study used records from Ornge, which provides critical care transport by air and by land across the province of Ontario, Canada. It covered April 2019 through March 2020 and included 498 cases.
- Before transport, physicians rated patients who were agitated or had an acute psychiatric illness as low, moderate, or high risk.
- Of the cases, 207 were rated low risk, 198 moderate, and 93 high.
- The tool had 70% sensitivity and 87.1% specificity for disruptive behavior that needed more care.
- The negative predictive value was 96.3%, and the positive predictive value was 37.6%.
Research into Practice takeaways
- The tool was best at ruling out the need for escalation. Many patients the tool flagged did not go on to need it.
- The authors suggest the tool may help with resource use and safety without lowering quality of care.
- This was one system's records. Programs using a similar tool can track how its ratings match what happens in transit.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
A Survey the Critical Care Transport Industry Should Listen To
Miller, William Kelly
Air Medical Journal, 40(3), 146-148, 2021
Written on behalf of the Air and Surface Transport Nurses Association.
Defining the characteristics of physically demanding winch rescue in helicopter search and rescue operations
Meadley, Ben; Bowles, Kelly-Ann; Smith, Karen; Perraton, Luke; Caldwell, Joanne
Applied Ergonomics, 93, 103375, 2021
Research highlights
Highlights
- The authors report that no studies have described validated physical employment standards for HEMS search and rescue paramedics.
- Sixteen helicopter rescue paramedics took part in an expert focus group. Their mean age was 47 (range 36 to 52), and they had 8 years (range 2 to 20) of helicopter rescue experience.
- The group reviewed past case data to describe the tasks involved in winch rescue on land and over water.
- With case data in hand, the experts reached at least 80% agreement on the descriptions.
- The descriptions are meant as a base for task simulations that measure physical workload.
Research into Practice takeaways
- Physical standards that match real tasks help show whether crews are fit for the work. This study is an early step, not a finished standard.
- Basing task descriptions on past cases ties the standard to what crews have faced. Programs with hoist or winch work can ask what their own fitness checks are based on.
- The panel was small. Services with different terrain or equipment may need their own review.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
A Critical Care Transport Program's Innovative Approach to Safety During the Coronavirus Disease 2019 Pandemic
Garfinkel, Eric; Lopez, Sandra; Troncoso, Ruben; Leon, David; Hubble, Heidi; Bowman, Chad; et al.
Air Medical Journal, 40(2), 112-114, 2021
Research highlights
Highlights
- The Lifeline Critical Care Transport Program added new safety steps at the start of the COVID-19 pandemic to protect staff from exposure.
- The steps included a safety officer for transports, a clean team waiting at the receiving end of some transfers between hospitals, and changes to personal protective equipment.
- From February 29 to August 29, 2020, the program made 1,041 transports of patients under investigation for COVID-19. Of these, 660 (63.4%) later tested positive.
- About one third were ground transports and 11 (1.1%) were by air. The rest moved patients within a hospital.
- No staff exposures or illnesses were documented in that period.
Research into Practice takeaways
- This is one program's experience without a comparison group. The steps were linked to zero documented exposures, but the study cannot show they caused that result.
- The authors offer these steps as a model for other programs and future outbreaks.
- Few of these transports were by air. Programs can ask how each step would work in an aircraft cabin.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Subjective and objective sleep among air ambulance personnel
Flaa, Tine Almenning; Bjorvatn, Bjørn; Pallesen, Ståle; Røislien, Jo; Zakariassen, Erik; Harris, Anette; et al.
Chronobiology International, 38(1), 129-139, 2021
Research highlights
Highlights
- Researchers studied sleep in 50 pilots and HEMS crew members in the Norwegian Air Ambulance.
- Crews wore activity monitors and kept diaries during a 7-day, 24-hour duty week in winter and again in summer. Sleep was also compared with the weeks before and after work.
- Compared with the weeks off, sleep started later in the duty week. Crews also spent more time awake after falling asleep, and sleep efficiency was lower.
- Time in bed was longer in the duty week than in the weeks off. Diaries showed about 7 hours 17 minutes of sleep in the winter duty week and 7 hours 3 minutes in the summer one.
- In summer, bedtime was later and time in bed was shorter than in winter.
Research into Practice takeaways
- The authors conclude that crews slept well on duty, though the work week did affect sleep to some degree.
- Sleep efficiency dropped on duty even though total sleep stayed above 7 hours. Programs can look at both measures when they review fatigue.
- This was one national service with a specific 7-day on-call model. Programs with other shift patterns may see different results.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
A Bayesian Approach on Investigating Helicopter Emergency Medical Fatal Accidents
Simonson, Richard J.; Keebler, Joseph R.; Chaparro, Alex
Aerospace Medicine and Human Performance, 92(7), 563-569, 2021
Research highlights
Highlights
- This study used NTSB accident data from 2005 to 2018 to look at what was linked to death in HEMS accidents.
- The authors used a Bayesian method. It combined the new data with earlier findings by Baker and colleagues covering 1983 to 2005.
- Night flight was linked to about three times the odds of a fatal outcome (odds ratio 3.06).
- Flying under instrument flight rules was linked to about 7.5 times the odds (odds ratio 7.54).
- Fire after the crash was linked to about 19 times the odds (odds ratio 18.73).
Research into Practice takeaways
- The authors note that these same factors have stayed linked to fatal outcomes across about 35 years of data.
- These factors describe how severe an accident was. They do not explain why the accident happened.
- Post-crash fire had the strongest link. Programs can ask what their aircraft and training do to support survival after a crash.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Appropriate Air Medical Services Utilization and Recommendations for Integration of Air Medical Services Resources into the EMS System of Care: A Joint Position Statement and Resource Document of NAEMSP, ACEP, and AMPA
Lyng, John W. ; Braithwaite, Sabina ; Abraham, Heidi; Brent, Christine M.; Meurer, David A.; Torres, Alexander; et al.
Prehospital Emergency Care, 25(6), 854-873, 2021
Research highlights
Highlights
- This joint statement from the National Association of EMS Physicians (NAEMSP), the American College of Emergency Physicians (ACEP), and the Air Medical Physician Association (AMPA) updates a 2013 statement on HEMS use.
- It groups air medical use into three areas. These are clinical issues, safety issues, and system integration with quality assurance.
- It names three patient goals for air medical use. These are reaching advanced care not available locally, faster arrival for time-sensitive treatment, and access to patients in remote or hard-to-reach places.
- The statement favors ground EMS when ground crews can provide the care the patient needs and reach definitive care in time.
- It discourages helicopter shopping. It also discourages reverse helicopter shopping. It says auto-launch and auto-ready practices may improve access but risk overuse and need close review.
Research into Practice takeaways
- Programs can compare their own launch and cancel practices against the three patient goals in the statement.
- The statement supports ground clinicians canceling a flight that meets none of the goals. It also supports air medical clinicians moving a patient to ground transport.
- The authors favor sending requests through central coordination centers with EMS physician support. Programs can ask how requests in their region are routed today.
- This is a consensus statement based on current evidence. It offers guidance and is not itself a study of outcomes.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter Transport of Trauma Patients Improves Survival Irrespective of Transport Time
Schneider, Andrew M.; Ewing, Joseph A.; Cull, John D.
The American Surgeon, 87(4), 538-542, 2021
Research highlights
Highlights
- Researchers reviewed 3,967 trauma patients brought to one Level 1 trauma center from 2014 to 2017. Of these, 518 (13%) came by helicopter.
- Air patients were more badly hurt, with a median Injury Severity Score of 17 versus 9. They stayed longer (6 versus 3 days) and had a higher crude death rate (12.6% versus 6.5%).
- For the zip codes studied, air patients arrived 16.6 minutes sooner on average than ground patients.
- After adjusting for transport time, age, sex, injury type, severity, and intubation, arriving by air was linked to higher odds of survival (odds ratio 1.57, 95% CI 1.06 to 2.40).
Research into Practice takeaways
- The survival link remained after adjusting for transport time. The abstract does not report what else might explain it.
- This is a retrospective review at one trauma center. It shows an association, not proof that air transport caused better survival.
- Programs can track outcomes for their own patients by mode of transport, adjusted for injury severity, to see whether their results look similar.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Medical Helicopter Accident Review: Causes and Contributing Factors
Greenhaw, Richard; Jamali, Mehdi
Federal Aviation Administration, Civil Aerospace Medical Institute. Report DOT/FAA/AM-21/19, 2021
Research highlights
Highlights
- The study looked at more than 3,000 NTSB records of EMS and non-EMS helicopter accidents over 20 years, starting in 1999.
- Non-EMS helicopters had about twice the overall accident rate of EMS helicopters.
- More of the EMS accidents were fatal. The rate of fatal accidents was the same for EMS and non-EMS flying.
- Two factors were linked to whether an EMS accident was fatal. One was darkness or poor visibility. The other was pilot judgment and decision-making.
- Fatal EMS accidents were also linked to pilots with a second-class medical certificate instead of first-class, and to flights with no second pilot.
Research into Practice takeaways
- EMS helicopters did not crash more often than other helicopters. When they did crash, the crash was more often fatal. The authors say finding out why was outside this study.
- These are links found in accident records. They are not proven causes.
- A finding of pilot judgment shows where investigators placed the cause. It does not show why a choice made sense to the crew at the time.
- Darkness and poor visibility were linked to fatal outcomes. Programs can look at how night and weather decisions are supported before launch and in flight.
Written by the Air Medical Safety Network from the report's public abstract. It does not replace the full report. Added November 2, 2026.
Read the abstract
The purpose of this study was to determine the quantitative differences in Emergency Medical Service (EMS) and non-EMS helicopter accident rates and trends by examining accident reports of both fatal and non-fatal accidents. The study also aimed to identify contributing factors or conditions that result in either fatal or non-fatal helicopter accidents. This was a retrospective, longitudinal observational study that examined more than 3,000 EMS and non-EMS helicopter accident records covering 20 years beginning in 1999 provided by the National Transport Safety Board and analyzed their data using linear and multivariate logistic regression models along with statistical hypothesis tests to predict trends and associations. This study found that fatal accidents accounted for a much higher proportion of EMS helicopter accidents than non-EMS accidents (rates for non-EMS helicopter accidents were essentially twice that for EMS accidents), and the rates for fatal helicopter accidents did not differ between EMS and non-EMS. Additionally, the study found two prevalent factors that determined EMS accident fatality: visibility/darkness and pilot decision making/judgment. Additional factors highly associated with fatal EMS accidents were pilots with a second-class medical certificate rather than first-class and the lack of a second pilot. Exploring the reasons for the much higher proportion of fatal EMS vs. non-EMS accidents is outside the scope of this study. Such questions could be the subject of further research. Detailed analyses focusing on this research could lead to a reduction in fatal EMS accident rates.
Report documentation page. U.S. government work, not subject to copyright.
Predictors of Inappropriate Helicopter Transport
Brown, Christopher; Irfan, Wajeeh; Schoen, Jonathan E.; Marr, Alan B.; Stuke, Lance E.; Cavalea, Alexander C.; et al.
The American Surgeon, 87(2), 248-252, 2021
Research highlights
Highlights
- Researchers reviewed trauma registry records for all 713 helicopter transports to one urban Level I trauma center from 2016 to 2018.
- A transport was labeled inappropriate if the patient left the hospital alive, either released from the emergency department or after a hospital stay shorter than one day.
- By this definition, 148 of 713 transports (20.8%) were inappropriate.
- In unadjusted analysis, a Glasgow Coma Scale above 8, a shock index below 0.9, and a fall were linked to inappropriate transport. Age over 55 was linked to appropriate transport.
- Mean Injury Severity Score was 3.86 in the inappropriate group and 16.80 in the other group (P = .0001).
Research into Practice takeaways
- The 'inappropriate' label was based on what happened after arrival. Crews and those who requested the flight did not have that information when they decided.
- The authors suggest these predictors could guide helicopter triage and reduce unneeded flights and costs. The abstract does not report a test of such a triage tool.
- Programs can compare their own early-discharge rates with these figures and review what scene information drove each request.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Prehospital Blood Product and Crystalloid Resuscitation in the Severely Injured Patient: A Secondary Analysis of the Prehospital Air Medical Plasma Trial
Guyette, Francis X.; Sperry, Jason L.; Peitzman, Andrew B.; Billiar, Timothy R.; Daley, Brian J.; Miller, Richard S.; et al.
Annals of Surgery, 273(2), 358-364, 2021
Research highlights
Highlights
- This secondary analysis of the PAMPer trial included 407 injured patients with low blood pressure at the scene.
- In the parent trial, 27 helicopter bases were assigned at random to plasma or standard care. Standard care was split between crystalloid alone and crystalloid with packed red blood cells (PRBC).
- This created four groups. The groups were PRBC plus plasma, plasma alone, PRBC alone, and crystalloid alone.
- Compared with crystalloid only, risk-adjusted 30-day mortality was lowest with PRBC plus plasma (hazard ratio 0.38). Plasma alone (0.57) and PRBC alone (0.68) were also linked to lower mortality.
- Among patients who received blood products, more crystalloid volume was linked to higher mortality (hazard ratio 1.65).
Research into Practice takeaways
- Only plasma versus standard care was randomized. The four-group comparison is observational, so it shows links rather than proven effects.
- The authors suggest blood products for patients in hemorrhagic shock when available, with PRBC plus plasma preferred. They also raise whole blood as a possible option.
- Programs can look at whether their quality review tracks crystalloid volume along with blood product use.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Trends of Non-Fatal HEMS Accident-Related Injuries
Simonson, Richard J.; Keebler, Joseph R.; Chaparro, Alex
Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care, 10(1), 291-296, 2021
Research highlights
Highlights
- Researchers used the NTSB aviation accident database to study HEMS accidents from January 1991 to April 2018.
- Over this 28-year span, 247 accidents led to 251 deaths and 179 non-fatal injuries.
- More non-fatal injuries happened in September than in any other month.
- A regression analysis found no linear link between the database variables and the chance of non-fatal injury.
- The available variables also did not explain the September peak.
Research into Practice takeaways
- A null result can mean there is no relationship, or that the database lacks the right data. The authors say future work should sort out which one applies.
- Programs may need their own event and injury data to see patterns that national accident records do not show.
- The September finding is exploratory. It is a pattern to watch, not an explained cause.
Written by the Air Medical Safety Network from the publisher's abstract. It does not replace the full publication. Added November 2, 2026.
Comparison of the HRV of Emergency Physicians in the HEMS During Helicopter Operations: Analysis of Differences as a Function of Number of Operations and Workload
Schöniger, Christian; Braun, Desiree; Siepmann, Martin; Petrowski, Katja
Applied Psychophysiology and Biofeedback, 45(4), 249-257, 2020
Research highlights
Highlights
- Researchers recorded the heart rate variability of 20 HEMS emergency physicians across a full air rescue day.
- Heart rate climbed as each mission began and reached its peak after landing at the scene.
- One heart rate variability measure fell from the alarm phase to the end of the mission.
- Across three missions, the authors found no physical signs of fatigue.
- Self-rated stress was high and above a norm sample. Scores on the Symptom Checklist-90 were lower than the norm sample.
Research into Practice takeaways
- Heart rate variability was below standard values, which points to strong activation of the stress response. The authors suggest a heavy mental stress load may explain it.
- Heart rate peaked after landing at the scene. Teams can think about what demands pile up in that phase.
- This was a single day with 20 physicians. It shows patterns within a shift, not long-term health effects.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Efficacy and efficiency of indoor nighttime human external cargo mission simulation in a high-fidelity training Centre
Pietsch, Urs; Lischke, Volker; Sollid, Stephen J. M.; Prückner, Stephan; Theiler, Lorenz; Greif, Robert; et al.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 28(1), 61, 2020
Research highlights
Highlights
- This paper describes indoor simulation training for night human external cargo (HEC) operations, such as winch work, at a training center.
- Night HEC missions are rare in HEMS, so crews have few chances to build and keep these skills. Training requirements set by the European Union Aviation Safety Agency (EASA) could not be met.
- Trainees completed more cycles indoors than in outdoor training. The counts were 60 versus 20 for HEMS technical crew members and 20 versus 4 for medical crew members.
- Trainees reported that their technical and nontechnical skills improved.
- Outdoor night training cost about 138 euros per cycle, at least 6.5 times the roughly 21 euros for indoor simulation. Switching could cut carbon dioxide emissions by more than 35 tons.
Research into Practice takeaways
- Skill gains were self-reported. The study did not measure performance on real night missions.
- Programs that rarely fly night hoist missions can ask how crews keep those skills current between real events.
- The authors see indoor simulation as feasible and as a way to meet training intensity demands. Cost figures are estimates from one training center.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Evaluation of the Helicopter Emergency Breathing Apparatus on Egress Performance
King, Michael; Sanli, Elizabeth; Mugford, Kaitlin; Martina, Stefanie; Brown, Robert; Carnahan, Heather
Aerospace Medicine and Human Performance, 91(12), 962-965, 2020
Offshore helicopter underwater egress; not specific to air medical crews.
Research highlights
Highlights
- This study looked at whether an emergency breathing device changes how fast people complete the underwater escape sequence used in helicopter underwater escape training (HUET).
- Twelve people with no prior HUET experience each did 5 trials with the helicopter underwater egress breathing apparatus (HUEBA) and 5 trials without it.
- Video was used to time each step and to score errors against a checklist. The steps covered arm and head position, pushing the window, placing the mouthpiece, and undoing the seatbelt.
- With the device, the full sequence took 0.36 seconds longer. The seatbelt step alone took 0.39 seconds longer.
- The authors judged these differences to be small and unlikely to matter in a real escape.
Research into Practice takeaways
- Trainees say the device is easy to use. The authors note that learners often overrate their own learning, so they measured timing and errors directly.
- The abstract reports timing results but not error counts. Readers need the full paper for how often steps went wrong.
- This was a small study of new trainees in a training setting. It does not show performance in cold water, darkness, or a real ditching.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Prehospital Stressors: A Cross-sectional Study of Norwegian Helicopter Emergency Medical Physicians
Reid, Bjørn Ole; Haugland, Helge; Abrahamsen, Håkon Bjorheim; Bjørnsen, Lars Petter; Uleberg, Oddvar; Krüger, Andreas J.
Air Medical Journal, 39(5), 383-388, 2020
Research highlights
Highlights
- Norwegian HEMS and search and rescue (SAR) physicians took an anonymous online survey from December 2, 2019, to February 25, 2020. Of those invited, 119 (79.3%) responded.
- In helicopter operations, 40 of 119 (33.6%) reported being in a minor accident and 53 (44.5%) reported a near accident.
- Near accidents were also reported in the rapid response car by 31 (26.1%) and in an ambulance by 32 (26.9%).
- In the past 12 months, 24 (20.2%) had faced verbal abuse or threats.
- When on call, 60 (50.4%) said fatigue affected them sometimes or often.
Research into Practice takeaways
- Physicians face hazards on the ground as well as in the air. Safety programs can include car and ambulance travel, not only flight.
- Half of respondents reported fatigue on call at least sometimes. Fatigue programs can include medical crew as well as pilots.
- The authors report that the most serious incidents seemed rare and job satisfaction was high. These are self-reports from one country.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter Hoist Performance in Novice and Experienced Hoist Operators
King, Michael T.; Lenser, Stephen; Rogers, Derek; Carnahan, Heather
Aerospace Medicine and Human Performance, 91(6), 496-500, 2020
Research highlights
Highlights
- Researchers tested a helicopter hoist simulator with two groups of people.
- Nine experienced hoist operators took part. All had served as military hoist operators and now worked in commercial search and rescue.
- Seven novices from the general public had no hoisting experience and had never used the simulator.
- Experienced operators finished the simulated mission faster, kept lower cable tension, and had a steadier hand position. Both groups kept the cable about equally plumb.
- In wind, experienced operators pulled the cable inward. Novices pushed it away.
Research into Practice takeaways
- The authors see the results as an early step toward using this simulator to train hoist operators.
- The groups were small, and the novices had no hoisting experience. The study does not show how trainees progress over time.
- Measures such as cable tension and hand position could give hoist instructors something concrete to watch during training.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Age, aging and physiological dysregulation in safety–critical work: a retrospective longitudinal study of helicopter emergency medical services pilots
Bauer, Hans; Nowak, Dennis; Herbig, Britta
International Archives of Occupational and Environmental Health, 93(3), 301-314, 2020
Research highlights
Highlights
- This study used aeromedical exam records of healthy European HEMS pilots. It built indices of physiological dysregulation, the gradual loss of balance across body systems, from 18 biomarkers tied to health risk.
- The index of current state included 52 pilots. The index of change over time included 41 pilots followed for an average of 7.9 years.
- Dysregulation rose over the follow-up period. The rate of rise was not faster for pilots who were older at the start.
- Looking at one point in time, dysregulation was highest at about ages 45 to 50 and lower at older ages.
Research into Practice takeaways
- The authors point to a healthy worker survivor effect. Pilots who stay in the job may be those whose health holds up.
- Age alone may not track physical decline in this group. The authors suggest these indices could help balance safety concerns with fair treatment of older workers.
- The sample was small and came from one occupation. The abstract does not report how dysregulation relates to flight performance.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The Antecedents and Consequences of Psychological Safety in Airline Firms: Focusing on High-Quality Interpersonal Relationships
Lee, Kwang-Ho; Hyun, Sunghyup Sean; Park, Haeik; Kim, Kwangyong
International Journal of Environmental Research and Public Health, 17(7), 2187, 2020
Airline employees; included for its psychological safety findings. Not air medical.
Research highlights
Highlights
- This survey study included 341 airline employees in a convenience sample.
- It tested a model that links working relationships, psychological safety, learning from failures, and creativity at work.
- Good working relationships were linked to higher psychological safety.
- Psychological safety was linked to more learning from failures and more confidence in one's own creativity.
- Learning from failures was linked to creative confidence but not to creative work involvement.
Research into Practice takeaways
- The order of the model was set by the researchers. A single survey at one point in time cannot show which came first.
- The sample was airline employees, not air medical crews. It is one self-report survey.
- Programs can look at how relationships within teams shape whether people feel safe to discuss mistakes.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Statistical learning for turboshaft helicopter accidents using logistic regression
Subagia, Rachmat; Saleh, Joseph Homer; Churchwell, Jared S.; Zhang, Katherine S.
PLOS ONE, 15(1), e0227334, 2020
U.S. civil turboshaft helicopter fleet, all mission types.
Research highlights
Highlights
- The data covered 8,338 civil turboshaft helicopters in the United States. Between 2005 and 2015 these aircraft had 825 accidents.
- The authors built a logistic regression model to link design features to the chance of an accident. The features were main rotor blade count, engine count, rotor diameter, and takeoff weight.
- Whether twin-engine helicopters had a lower accident likelihood than single-engine ones depended on other factors. Past a certain rotor diameter, twin-engine aircraft had a higher accident likelihood than single-engine ones.
- Among single-engine turboshaft helicopters, four-bladed models had the lowest accident likelihood.
- Engine count and rotor diameter were tied together in how they related to accident likelihood.
Research into Practice takeaways
- The authors state that these are associations, not causes. Other factors not in the model may explain the links.
- The study covers the whole civil turboshaft fleet, not air medical aircraft alone. It does not show how mission type or operations shape the results.
- Programs comparing aircraft can treat these results as one input among many. They do not settle questions about engine count on their own.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Association of Prehospital Plasma Transfusion With Survival in Trauma Patients With Hemorrhagic Shock When Transport Times Are Longer Than 20 Minutes: A Post Hoc Analysis of the PAMPer and COMBAT Clinical Trials
Pusateri, Anthony E.; Moore, Ernest E.; Moore, Hunter B.; Le, Tuan D.; Guyette, Francis X.; Chapman, Michael P.; et al.
JAMA Surgery, 155(2), e195085, 2020
Pools the PAMPer (air medical) and COMBAT (ground) trials.
Research highlights
Highlights
- The authors pooled data from two randomized trials, PAMPer and COMBAT. The combined group was 626 trauma patients in shock from bleeding.
- Before reaching the hospital, patients were randomly assigned to standard care alone or to 2 units of thawed plasma plus standard care.
- Across both trials, plasma was linked to better 28-day survival (hazard ratio 0.65). The model accounted for injury severity, age, and which trial each patient was in.
- Transport time ran from the moment the team reached the scene until the patient reached the trauma center. When it ran past 20 minutes, patients on standard care had higher mortality (hazard ratio 2.12), but patients given plasma did not.
- The authors found no serious adverse events tied to plasma given before arrival at the hospital.
Research into Practice takeaways
- The two trials had seemed to reach different answers. The authors tested whether transport time could help explain the gap.
- This analysis was done after the trials ended and was not part of their original plan. Its results are best read as a signal for further study.
- Programs can track their own times from scene arrival to trauma center arrival. This study suggests that interval may matter for bleeding patients.
- The authors judged the balance of benefit and risk for plasma given before hospital arrival to be favorable. Any change in practice is a decision for each program's medical leadership.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter Air Ambulance Collision with Terrain, Survival Flight Inc., Bell 407 Helicopter, N191SF, near Zaleski, Ohio, January 29, 2019
National Transportation Safety Board. NTSB/AAR-20/01, 2020
Overutilization of Helicopter Transport in the Minimally Burned-A Healthcare System Problem That Should Be Corrected
Roman, Jordan; Shank, William; Demirjian, Joseph; Tang, Andrew; Vercruysse, Gary A.
Journal of Burn Care & Research, 41(1), 15-22, 2020
Research highlights
Highlights
- This 5-year review of one center's trauma registry looked at 616 burn patients and how they arrived.
- Of these patients, 13% came by helicopter. Of the helicopter patients, 38% had first been seen at another hospital.
- Compared with ground EMS patients, helicopter patients had larger and deeper burns, longer stays, and higher ICU admission and death rates. They also traveled farther, 88 miles on average compared with 16.
- Among helicopter patients, 53% had smaller burns, defined as under 20% total body surface area with no need for ICU care or surgery.
- In the smaller-burn group, about 1 in 4 helicopter patients were discharged from the emergency department. No one in either smaller-burn group died.
Research into Practice takeaways
- The authors suggest that careful triage, plus a call to the burn center ahead of transport, could identify patients who could go safely by ground or be seen later in clinic.
- The average helicopter transport cost about US$29,000. The authors estimate yearly savings near US$444,000 at their center if smaller burns went by ground.
- This was one center's registry. Programs can look at their own burn transfers to see how many patients went home soon after arrival.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Stop Flying the Patients! Evaluation of the Overutilization of Helicopter Transport of Trauma Patients
Horwood, Chelsea R.; Ricci, Kevin; Sobol, Carly G.; Evans, David; Eiferman, Daniel
Journal of Surgical Research, 256, 290-294, 2020
Research highlights
Highlights
- This study reviewed all trauma patients flown to a single level I trauma center in a city between 2015 and 2017. Patients came from scenes and from other hospitals.
- Of 1,590 patients, 612 (39%) went from the trauma bay to a regular floor. Another 249 (16%) needed only observation or went home.
- About a third (572) needed any procedure. The median time to a procedure was 31.5 hours.
- Only 74 patients (13% of those with a procedure) needed one within an hour of arrival.
- Estimated drive distances and times were similar for patients who needed an early procedure and for everyone else.
Research into Practice takeaways
- The study judged need by whether a procedure happened within one hour. Other measures of benefit could give a different answer.
- The decision to fly is made with the information at hand at the time. Programs can compare their triage criteria with what happened to patients later.
- This is one center over three years. Results may differ in other regions.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Prevalence and potential risk factors of flight-related neck, shoulder and low back pain among helicopter pilots and crewmembers: a questionnaire-based study
Posch, Markus; Schranz, Alois; Lener, Manfred; Senn, Werner; Äng, Björn O.; Burtscher, Martin; et al.
BMC Musculoskeletal Disorders, 20(1), 44, 2019
Research highlights
Highlights
- An online survey included 104 helicopter pilots and 117 crew members in Austria's armed forces, airborne police, and air rescue groups.
- Over 12 months, 67.3% of pilots reported neck pain, 48.1% low back pain, and 43.3% shoulder pain.
- Among crew members, 12-month rates were 45.3% for neck, 36.8% for low back, and 30.8% for shoulder pain.
- NVG use was linked to neck pain (odds ratio 1.9, 95% CI 1.06 to 3.50).
- Shoulder pain (odds ratio 4.9) and low back pain (odds ratio 2.3) were also linked to neck pain.
Research into Practice takeaways
- Neck, shoulder, and back pain were common in both pilots and crew members. Programs can ask crews about pain as part of health and fitness checks.
- The sample mixed military, police, and rescue crews. Programs that fly with NVG can ask crews about neck strain, keeping in mind that a survey link does not show cause.
- This was a one-time survey of self-reported pain. The authors call for long-term studies to follow these risk factors over time.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The reliability and accuracy of operational system data in a nationwide helicopter emergency medical services mission database
Heino, A.; Iirola, T.; Raatiniemi, L.; Nurmi, J.; Olkinuora, A.; Laukkanen-Nevala, P.; et al.
BMC Emergency Medicine, 19(1), 53, 2019
Research highlights
Highlights
- HEMS physicians and paramedics entered data from written fictional patient cases into the FinnHEMS database, a nationwide HEMS clinical quality registry.
- The study measured how often raters entered the same data, using percent agreement and kappa.
- Dispatch coding agreed 91% of the time (kappa 0.83). Coding for transport or mission cancellation agreed 84% of the time (kappa 0.68).
- Agreement on mission end, hospital arrival, and unit dispatch times ranged from 80% to 85%. The time from emergency call to dispatch center agreed only 71% of the time.
- Apart from pain, first vital sign entries agreed less than 70% of the time, with kappa values below 0.40.
Research into Practice takeaways
- The authors conclude that HEMS data can be collected reliably in a national registry, and that finding weak spots helps improve data quality. Programs can ask which fields in their own records are least consistent before drawing conclusions from them.
- Programs that use registry data for quality review can test charting consistency with shared practice cases, as this study did.
- These were fictional written cases. Real missions bring time pressure and interruptions that may change accuracy.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Time Course of Hoist Operations by the Search and Rescue Helicopter Service in Southeast Norway
Samdal, Martin; Eiding, Helge; Markengbakken, Lars; Røislien, Jo; Rehn, Marius; Sandberg, Mårten
Wilderness & Environmental Medicine, 30(4), 351-361, 2019
Research highlights
Highlights
- This study reviewed five years of hoist operations at one search and rescue helicopter base in southeast Norway. It also ran simulated hoist operations.
- There were 148 hoist operations with 180 patients. Hoist rescue made up 10% of the base's search and rescue operations.
- On average, the aircraft took off in 13 minutes. Of the patients, 49% were injured, 29% were ill, and 22% were evacuees.
- A quarter of patients (45) had a possible or actual threat to life. Medical care was given to 77 patients (43%), and 9 were intubated.
- In simulation, the rescuer reached the patient in about 4 minutes and the anesthesiologist in about 6. Hoist extrication took about 13 minutes.
Research into Practice takeaways
- Time estimates for each phase help dispatchers pick the right resource. The authors suggest these times can make dispatch more accurate.
- The extrication times come from simulation. Real missions may run longer or shorter.
- Programs with hoist capability can track their own phase times to build local estimates.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Training and assessment of non-technical skills in Norwegian helicopter emergency services: a cross-sectional and longitudinal study
Rasmussen, Kristen; Langdalen, Henrik; Sollid, Stephen J. M.; Abrahamsen, Eirik Bjorheim; Sørskår, Leif Inge K.; Bondevik, Gunnar Tschudi; et al.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 27(1), 1, 2019
Research highlights
Highlights
- A web survey in late 2016 asked physicians, HEMS crew members, and pilots at all civilian Norwegian HEMS bases about simulation training and assessment of nontechnical skills.
- Of 214 people invited, 109 responses could be analyzed.
- An earlier survey had found that physicians trained less than other crew and that all groups had little fatigue training. Since then, new training efforts and a project on managing fatigue risk had begun.
- Training and assessment frequency rose for all professional groups since 2011. The rise was statistically significant, and largest among physicians.
- For all groups, assessment generally happened less often than training.
Research into Practice takeaways
- The rise followed new training programs. The survey design cannot show that the programs caused the change.
- The authors suggest more systematic use of behavioral marker systems in HEMS.
- About half of those invited gave usable responses. Results may not reflect everyone at the bases.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Sleepiness among personnel in the Norwegian Air Ambulance Service
Flaa, Tine Almenning; Harris, Anette; Bjorvatn, Bjørn; Gundersen, Hilde; Zakariassen, Erik; Pallesen, Ståle; et al.
International Archives of Occupational and Environmental Health, 92(8), 1121-1130, 2019
Research highlights
Highlights
- Researchers followed 50 Norwegian Air Ambulance pilots and HEMS crew for three weeks. One week came before the duty period, one was the duty week, and one came after.
- Crew members kept a diary for all three weeks. In the duty week they also took reaction time tests.
- Sleepiness scores were low in all three weeks and lowest in the work week.
- Self-rated sleepiness was highest on the first duty day and at midnight. Reaction times did not change across the work week.
- Compared with a medium level, a heavier workload was linked to less sleepiness. Compared with a medium level, more total work time was linked to more sleepiness.
Research into Practice takeaways
- The authors conclude that this schedule and setting did not appear to raise sleepiness. Results may differ under other rosters or in other countries.
- The first duty day and the hours around midnight stood out. Programs can watch those periods in their own schedules.
- Busy shifts and long hours pulled in different directions. Teams can look at total work time, not only workload.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Cognitive Appraisal and Stress Performance: The Threat/Challenge Matrix and Its Implications on Performance
vonRosenberg, John
Air Medical Journal, 38(5), 331-333, 2019
Research highlights
Highlights
- This paper reviews published work on how stress affects performance in medical settings. It also covers how people assess threats and appraise stressful events.
- Cognitive appraisal is the way a person judges a stressful event, either as a challenge to meet or as a threat to back away from.
- Stress can help performance through focus and strength. It can also hurt performance through distraction and loss of fine motor control.
- According to the review, readiness for stress comes from skills practice and rehearsal, and also from mental readiness, mindfulness, and support from teammates.
- The authors report that challenge-focused appraisal can be practiced through simulation, case studies, and planned mental rehearsal.
Research into Practice takeaways
- This is a literature review. The abstract does not report how many studies were included or how they were judged.
- Programs can look at whether simulation and case reviews build how crews frame hard calls, not only their technical skills.
- Teammates can shape how a stressful call is framed. Crews can talk about how they encourage each other during high-stress moments.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Preflight Risk Assessment for Improved Safety in Helicopter Emergency Medical Service Operations
Aherne, Bryan B.; Zhang, Chrystal; Chen, Won Sun; Newman, David G.
Aerospace Medicine and Human Performance, 90(9), 792-799, 2019
Research highlights
Highlights
- Researchers analyzed 32 fatal night accidents under visual flight rules in single-pilot HEMS operations.
- They used logistic regression to build nomograms, which are charts that estimate risk. The three outcomes were entering non-visual weather conditions, accident cause, and a nonsurvivable accident.
- Factors in the models included temperature and dew point spread, elevation difference, years of HEMS experience, crew makeup, pilot task experience, instrument flight capability, and mission type.
- The nomograms correctly predicted entry into non-visual conditions in 75% of cases, accident cause in 55%, and a nonsurvivable accident in 94%.
- Applied to a recent fatal HEMS accident, the tool estimated a 92% chance of a nonsurvivable accident in the event that visual cues were lost.
Research into Practice takeaways
- The tool was built from 32 accidents. The authors say more development work is needed.
- The models draw only on accidents, not on flights that went well in similar conditions. That limits what they can say about risk on a typical night.
- Programs can compare the factors in these models with those in their own preflight risk tools.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Real-Time Fatigue Mitigation with Air-Medical Personnel: The SleepTrackTXT2 Randomized Trial
Patterson, P. Daniel; Moore, Charity G.; Guyette, Francis X.; Doman, Jack M.; Weaver, Matthew D.; Sequeira, Denisse J.; et al.
Prehospital Emergency Care, 23(4), 465-478, 2019
Research highlights
Highlights
- This multi-site randomized trial tested a text message program to reduce fatigue in air medical clinicians over 120 days.
- The trial enrolled 83 people, who logged 2,828 shifts. Participants answered 61,571 of 69,530 text messages (88.6%).
- The intervention group got texts with tips to reduce fatigue and weekly messages that promoted sleep.
- Fatigue rose over 12-hour shifts in both groups. By the close of these shifts, the intervention group reported less fatigue.
- Neither group showed a change in sleep quality by day 120. The two groups also ended up alike. Sleep before shifts was often under 7 hours.
Research into Practice takeaways
- Real-time text prompts were linked to less fatigue late in 12-hour shifts. They had no effect on longer shifts or on sleep quality over time.
- Text check-ins drew a high response rate over several months. Programs looking for a way to track fatigue during shifts can look at this method.
- Only 43 of 83 people completed the follow-up survey. This limits what the long-term results can show.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Impact of shift duration on alertness among air-medical emergency care clinician shift workers
Patterson, P. Daniel; Weaver, Matthew D.; Markosyan, Mark A.; Moore, Charity G.; Guyette, Frank X.; Doman, Jack M.; et al.
American Journal of Industrial Medicine, 62(4), 325-336, 2019
Research highlights
Highlights
- Researchers followed 112 clinicians for 14 days across four air medical EMS organizations.
- Alertness was measured with a psychomotor vigilance test (PVT) when each shift began and when it ended.
- Shifts shorter than 24 hours and 24-hour shifts showed no difference in test performance.
- Lapses and false starts were worse on night shifts than on day shifts.
- Scores were worse when the end-of-shift test came soon after waking from a nap on duty.
Research into Practice takeaways
- Finding no difference by shift length is not proof that 24-hour shifts carry no fatigue risk. Night work and time since waking may deserve as much attention as shift length.
- Crews may be less alert in the period just after waking on shift. Programs can look at what tasks tend to fall in that window.
- The study measured test scores, not errors in patient care or flight. The authors call for research on the timing and length of naps during shifts.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Occupational Stress in Helicopter Emergency Service Pilots From 4 European Countries
Bauer, Hans; Herbig, Britta
Air Medical Journal, 38(2), 82-94, 2019
Research highlights
Highlights
- Researchers collected questionnaires from 72 HEMS pilots in Europe, 24 from Western Europe and 48 from Eastern Europe. Mean age was 51.9 years.
- The study looked at stressors, resources, and signs of strain at work. It then checked how these related to engagement, well-being, and energy levels.
- Answers differed between Eastern and Western European pilots, but the overall picture was favorable.
- The stressors and resources pilots rated most favorably had the strongest links to lower well-being and energy.
- Pilots were highly engaged in their work.
Research into Practice takeaways
- The authors suggest that mental health support for pilots take into account how closely pilots identify with their work.
- Good overall ratings may hide strain. Programs can look past averages when they check on pilot well-being.
- This was a cross-sectional survey of 72 pilots. It shows links at one point in time, not causes.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter pilots’ views of air traffic controller responsibilities: a mismatch
Martin, Daniel; Nixon, Jim
Ergonomics, 62(2), 268-276, 2019
Helicopter pilots in the London control zone; not specific to air medical operations.
Research highlights
Highlights
- Thirty helicopter pilots rated how much responsibility they believed air traffic controllers held for five key flight tasks.
- The study looked at three types of airspace in the London control zone.
- Pilot views of controller responsibility varied. They did not always match the formal rules that define what controllers are responsible for.
- Differences were significant for separating aircraft, both in class D airspace and on helicopter routes.
- The type of task seemed to matter more than the type of airspace. The authors frame the results using the idea of a shared mental model between pilots and controllers.
Research into Practice takeaways
- Some pilots expected controllers to handle tasks that regulation does not assign to them. The authors say this mismatch could affect safety in the London zone.
- HEMS pilots who fly in busy controlled airspace can check their own understanding of who owns each task in each airspace type.
- The sample was 30 pilots in one complex airspace. Other regions may show different patterns.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Stress load of emergency service: effects on the CAR and HRV of HEMS emergency physicians on different working days (N = 20)
Petrowski, Katja; Herhaus, Benedict; Schöniger, Christian; Frank, Mark; Pyrc, Jaroslaw
International Archives of Occupational and Environmental Health, 92(2), 155-164, 2019
Research highlights
Highlights
- Researchers studied 20 HEMS emergency physicians on three kinds of days. These were an air ambulance duty day, a workday at an outpatient clinic, and a day of rest.
- Measures included the cortisol awakening response (CAR), a morning stress hormone pattern, and heart rate variability (HRV).
- The cortisol response was highest on the clinic workday. It was lower on the air ambulance day and the rest day.
- Two heart rate variability measures also showed more strain on the clinic day than on the other two days.
- Compared with standard values and earlier studies, the physicians showed higher morning hormone reactivity and signs of poor recovery.
Research into Practice takeaways
- By these measures, the flight day was not the most stressful day for this group. Strain may come from the full mix of jobs a clinician holds, not only from flying.
- The authors link their findings to long-term stress and too little recovery. Programs can ask how schedules across roles leave room to recover.
- With 20 physicians, this is a small sample. It may not apply to other crew roles or other settings.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Assessing aeromedical risk: a three-dimensional risk matrix approach
Gray, Gary; Bron, Dennis; Davenport, Eddie D.; d'Arcy, Joanna; Guettler, Norbert; Manen, Olivier; et al.
Heart, 105(Suppl 1), s9-s16, 2019
Aircrew medical certification; not air medical transport.
Research highlights
Highlights
- This paper describes a method for judging aeromedical risk, meaning the chance that a medical condition in aircrew could affect flight safety. It does not report new study data.
- Early medical standards tried to remove anyone with a known medical risk from flying. This led to many disqualifications.
- In the 1980s, medical risk began to be treated as one of many risks to flight, along with mechanical risks and human factors.
- That shift led to the 1% rule. It sets the highest acceptable chance of a medical event that causes incapacitation at 1% per year.
- The authors show how color-coded risk matrices can support aeromedical decisions. They also point out where these matrices fall short.
Research into Practice takeaways
- The 1% rule ties medical fitness to the level of risk aviation already accepts overall. Programs can treat crew medical risk as one part of their wider risk picture.
- The authors note that risk matrices have limits. Programs that use a matrix for any decision can ask what it may leave out.
- The abstract does not list the specific shortcomings. Readers will need the full paper for them.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Causes and Management of Sleepiness Among Pilots in a Norwegian and an Austrian Air Ambulance Service—A Comparative Study
Zakariassen, Erik; Waage, Siri; Harris, Anette; Gatterbauer-Trischler, Pia; Lang, Bernd; Voelckel, Wolfgang; et al.
Air Medical Journal, 38(1), 25-29, 2019
Research highlights
Highlights
- The study compared pilots at the Norwegian Air Ambulance and at Christophorus Flugrettungsverein in Austria.
- The Norwegian service flew around the clock. At the time, the Austrian bases in the study did not fly after sunset. Pilots in both services worked 1-week duty periods.
- Both groups used the same questionnaires. Pilots in both groups had normal scores on the Epworth and Karolinska sleepiness scales.
- Most pilots in both groups used naps and coffee to manage sleepiness. Austrian pilots kept busy, while Norwegian pilots slept and exercised.
- Austrian pilots more often named administrative duties and environmental factors as things that kept them from napping.
Research into Practice takeaways
- Even with normal sleepiness scores, pilots used several strategies to stay alert. Programs can ask crews what they do and what gets in the way.
- Duties outside flying were named as a barrier to napping. Programs can look at whether office tasks cut into rest time on duty.
- This compared two services with different shift systems. Differences may reflect the schedule, the culture, or other factors.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Force of Habit: Developing Situation Awareness in Critical Care Transport
Lauria, Michael J.; Ghobrial, Mina K.; Hicks, Christopher M.
Air Medical Journal, 38(1), 45-50, 2019
Research highlights
Highlights
- This article is a review, not a study with new data.
- It covers the main theory of situation awareness (SA) and the evidence on how to measure it in medicine.
- The authors note that SA can break down under stress and that little is known about how to train it.
- They draw on neuroscience, cognitive psychology, and research on human and organizational behavior to propose strategies.
- The strategies aim to build habits that run with little conscious effort, so SA holds up during high-stress events such as resuscitation.
Research into Practice takeaways
- The strategies are proposals drawn from other fields. The abstract does not report tests of them in transport medicine.
- Programs can look at whether training repeats SA behaviors often enough for them to become habits.
- Crews may want to talk about how stress affects their own awareness during high-stakes calls.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Establishing Transport Statistics: Results From the Medevac Transport Statistics Survey
Reimer, Andrew P. ; Hobensack, Mollie
Air Medical Journal, 38(3), 174-177, 2019
Research highlights
Highlights
- The study sent an online survey to medical transport programs listed in the Association of Air Medical Services Atlas and Database of Air Medical Services in 2015.
- About 20% of listed programs took part.
- The authors combined the survey with other data sources to estimate yearly transport volume.
- They estimate about 640,000 critical care transports a year nationwide, with a breakdown by mode of transport.
Research into Practice takeaways
- With only about 1 in 5 programs responding, the authors say the figures are not precise. The estimate is best read as a rough figure.
- Transport volume is the base for accident and event rates. Better counts would let programs and researchers compare rates with more confidence.
- The authors encourage more programs to take part in future surveys.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Evaluation of a New Helicopter Crew Transport Fatigue Assessment
Bushmaker, Ryan; Corey, Katherine; Dunn, Julie ; Lalonde, Trent; Estrada, Samantha
Air Medical Journal, 38(3), 198-201, 2019
Research highlights
Highlights
- Researchers tested a fatigue assessment built for air ambulance crews that includes factors specific to air transport.
- Flight crewmembers from several air ambulance programs completed the assessment.
- The assessment tracked fatigue as it built up and was correlated with the fatigue levels crews reported.
- The researchers also made a predicted fatigue scale to help crewmembers judge their own fatigue level.
- The authors note that no validated air ambulance fatigue tool with transport factors existed before this work.
Research into Practice takeaways
- The abstract does not report the number of participants or the statistics. The strength of the validation cannot be judged from the abstract alone.
- The authors suggest that regular use can raise awareness of building fatigue. Crews can then make a case for rest and other steps to reduce it.
- Programs using a fatigue tool can ask what happens after a crewmember reports high fatigue.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Responsible “Helicopter Shopping” Through Selective Resource Management
Good, Nikole Regina
Air Medical Journal, 38(3), 143-146, 2019
Systems Safety Risk Analysis of Fatal Night Helicopter Emergency Medical Service Accidents
Aherne, Bryan B.; Zhang, Chrystal; Chen, Won Sun; Newman, David G.
Aerospace Medicine and Human Performance, 90(4), 396-404, 2019
Research highlights
Highlights
- This study compared fatal accident rates by day and by night in U.S. HEMS. It also looked at what shaped the night accidents.
- It used data from 32 night fatal HEMS accidents under visual flight rules (VFR), along with industry flight hours.
- Pilots were grouped by HEMS experience, under 6 years or more. Missions were grouped by whether they could be flown under VFR only or under instrument flight rules (IFR).
- Night fatal accident rates differed from day rates in a statistically significant way.
- Pilots with less HEMS experience flying VFR-only missions had the highest likelihood of a nonsurvivable night accident.
Research into Practice takeaways
- The authors connect lower HEMS experience with less success avoiding hazardous conditions at night. They connect VFR-only capability with less success keeping spatial orientation.
- The authors say the analysis points to measures that could lower night fatal accidents. The abstract does not list those measures.
- Programs can ask how they pair newer pilots with night missions and what instrument capability those missions have.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
A comparative study on the frequency of simulation-based training and assessment of non-technical skills in the Norwegian ground ambulance services and helicopter emergency medical services
Langdalen, Henrik; Abrahamsen, Eirik B.; Sollid, Stephen J. M.; Sørskår, Leif Inge K.; Abrahamsen, Håkon B.
BMC Health Services Research, 18(1), 509, 2018
Research highlights
Highlights
- Researchers compared 2016 survey responses from Norwegian prehospital staff about simulation training and assessment of seven nontechnical skills during 2015.
- Staff in HEMS reported more frequent simulation training and assessment than staff in ground EMS. The difference was statistically significant.
- Pilots and HEMS crew members trained and were assessed more often than other health care providers in either service.
- HEMS physicians appeared to train and be assessed more often than other staff in their health trust.
- The study found a tendency for less focus on assessing nontechnical skills than on training them.
Research into Practice takeaways
- Programs can check whether they assess nontechnical skills as often as they train them.
- The authors suggest ground EMS could learn from HEMS training practice. They call for more assessment in both services.
- These are self-reported frequencies. They do not show whether skills or patient outcomes differed.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 37(6), e1-e2, 2018
CONCERN Network bulletin, November/December 2018 issue.
Helicopter Simulator Performance Prediction Using the Random Forest Method
Bauer, Hans; Nowak, Dennis; Herbig, Britta
Aerospace Medicine and Human Performance, 89(11), 967-975, 2018
Research highlights
Highlights
- Researchers studied 51 male European HEMS pilots flying two malfunction scenarios in a simulator.
- They tested 54 possible predictors of performance drawn from pilot questionnaires and aeromedical exam records.
- A machine learning method called Random Forests screened for the most informative predictors across 2,000 runs.
- Higher perceived rewards and predictability at work were linked to better simulator scores.
- Higher physiological dysregulation and higher alanine aminotransferase were linked to lower scores. Scores also varied by which training site's simulator was used.
Research into Practice takeaways
- Work conditions such as rewards and predictability were linked to performance, alongside pilot health measures. Programs can look at both when thinking about human factors.
- This was a cross-sectional, exploratory analysis. The predictors point to areas for more study, not proven causes.
- Performance differed by simulator site. Comparing simulator scores across sites may call for care.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 37(5), e1-e2, 2018
CONCERN Network bulletin, September/October 2018 issue.
Static Rope Evacuation by Helicopter Emergency Medical Services in Rescue Operations in Southeast Norway
Samdal, Martin; Haugland, Helge H.; Fjeldet, Cato; Rehn, Marius; Sandberg, Mårten
Wilderness & Environmental Medicine, 29(3), 315-324, 2018
Research highlights
Highlights
- This study reviewed three years of daylight static rope operations at 3 physician-staffed HEMS bases in southeast Norway.
- There were 59 operations involving 60 patients. The median age was 43 years, and the median time to take-off was 9 minutes.
- Most patients (48) had trauma, and lower limb injuries were the most common (32). Ten patients had medical conditions.
- Fifteen patients had a possible or actual life-threatening condition on the National Advisory Committee for Aeronautics (NACA) score.
- Common care included intravenous lines (19), pain medicine (17), and oxygen (14). Four patients were intubated.
Research into Practice takeaways
- Static rope work was rare in this region. Programs with rare high-risk tasks can ask how they keep skills current.
- By their quality indicators, the authors judged the service safe, available, and equitable.
- The authors see the main benefit as evacuation and keeping the aircraft ready to move the physician or the patient quickly.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Aging and Cardiometabolic Risk in European HEMS Pilots: An Assessment of Occupational Old-Age Limits as a Regulatory Risk Management Strategy
Bauer, Hans; Nowak, Dennis; Herbig, Britta
Risk Analysis, 38(7), 1332-1347, 2018
Research highlights
Highlights
- Researchers reviewed aeromedical exam records of 66 HEMS pilots from Germany, Austria, Poland, and the Czech Republic. Pilots were followed for an average of 8.52 years.
- They compared the rate of change in heart and metabolic risk markers between pilots close to 60 and younger pilots.
- Pilots near age 60 gained body mass index more slowly, and their blood lipid profile improved. Fasting glucose rose only in the younger group.
- An ECG marker of rhythm problem risk rose in younger pilots. The abstract says this rise persisted in the older pilots.
- The estimated six-month chance of a fatal cardiovascular event was between 0% and 0.3%. Stable differences between individuals explained 41% to 95% of the variation in markers.
Research into Practice takeaways
- The study compared how markers changed over time. It does not show that pilots near 60 carry lower risk at any given point.
- The authors recommend assessing each pilot near age 60 on an individual basis rather than grounding all pilots at a set age.
- The sample was 66 pilots in four European countries. The study looked at risk markers, not actual incapacitation events in flight.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
July/August 2018 Concern Network
Air Medical Journal, 37(4), e1-e2, 2018
CONCERN Network bulletin, July/August 2018 issue.
Patient Safety Events during Critical Care Transport
Swickard, Scott; Winkelman, Chris; Hustey, Fredric M.; Kerr, Mary; Reimer, Andrew P.
Air Medical Journal, 37(4), 253-258, 2018
Research highlights
Highlights
- The study reviewed charts at one large hospital-based health system in the Midwestern United States over 5 months.
- It compared 50 transports that had a patient safety event with randomly chosen control transports.
- Patient safety events occurred at a rate of 27.7 per 1,000 patient contacts.
- New or recurring low blood oxygen (hypoxia) was the most common of 9 event types.
- Hypoxia present when the transport team first reached the patient was linked to safety events (P = .046). Transport duration also predicted events (P = .025).
Research into Practice takeaways
- Programs can review whether they flag patients with low oxygen at first contact as higher risk for events in transit.
- The abstract names transport duration as a predictor but does not give the direction or size of the effect. Programs can look at how their own events vary with transport length.
- This was one site over 5 months. The findings are associations and may not apply to all programs.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 37(3), e1-e2, 2018
CONCERN Network bulletin, May/June 2018 issue.
Concern Network
Air Medical Journal, 37(2), e1-e2, 2018
CONCERN Network bulletin, March/April 2018 issue.
Helicopter Emergency Medical Services Literature 2014 to 2016: Lessons and Perspectives, Part 2-Nontrauma Transports and General Issues
Thomas, Stephen H.; Blumen, Ira
Air Medical Journal, 37(2), 126-130, 2018
Does Medical Staffing Influence Perceived Safety? An International Survey on Medical Crew Models in Helicopter Emergency Medical Services
Rasmussen, Kristen; Røislien, Jo; Sollid, Stephen J. M.
Air Medical Journal, 37(1), 29-36, 2018
International survey of HEMS medical directors, including comparison of crew models.
Research highlights
Highlights
- Researchers surveyed HEMS medical directors in several countries about the medical crew models their services use.
- Directors also rated patient safety and flight safety in their own services and gave reasons for their crew choice.
- Directors rated patient and flight safety higher when two medical crewmembers worked in the cabin.
- Directors most often cited tradition and scientific evidence as reasons for their crew model.
- Most directors would keep their current setup. Some would add a physician or add an assistant to work with the physician.
Research into Practice takeaways
- These are ratings of perceived safety by medical directors. They are not measured safety outcomes.
- The survey found a wide range of staffing models. Programs can ask how much evidence and how much tradition sit behind their own model.
- The abstract does not report how many directors responded or from which countries.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter Emergency Medical Services Literature 2014 to 2016: Lessons and Perspectives, Part 1-Helicopter Transport for Trauma
Thomas, Stephen H.; Blumen, Ira
Air Medical Journal, 37(1), 54-63, 2018
Human Error Analysis of Helicopter Emergency Medical Services (HEMS) Accidents Using the Human Factors Analysis and Classification System (HFACS)
Cline, Paul
Journal of Aviation/Aerospace Education & Research, 2018
Operational Impact of a Critical Care Transport Duty Time Tool Implementation: A Quality Improvement Project to Enhance Crew and Patient Safety
Sorensen, Megan; Chaplin, Robert
Air Medical Journal, 37(6), 352-356, 2018
Research highlights
Highlights
- Accreditation by the Commission on Accreditation of Medical Transport Systems calls for tools that assess operational risk, among them tools for crew fatigue and alertness.
- A hospital-based pediatric and neonatal transport team started a structured risk assessment process with a check on duty time.
- The team compared calls that led to long duty hours over 2 years before and 2 years after the tool started.
- Calls that kept crews more than 1 hour past the end of their shift fell by 48%.
- Transport requests did not decline after the tool started.
Research into Practice takeaways
- This is a before and after look at one program. Other changes over the same years could also have played a part.
- The authors report a lower risk of incidents linked to fatigue. The abstract does not give incident numbers to support this.
- The authors report no negative effect on referral patterns or volume. Programs adding a duty time tool can track their own request volume before and after.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Pilot Decision Making in Weather-Related Night Fatal Helicopter Emergency Medical Service Accidents
Aherne, Bryan B.; Zhang, Chrystal; Chen, Won Sun; Newman, David G.
Aerospace Medicine and Human Performance, 89(9), 830-836, 2018
Research highlights
Highlights
- This study looked at 32 fatal single-pilot night HEMS accidents under visual flight rules in the U.S. from 1995 to 2013.
- The authors used the gap between temperature and dew point, called the spread, as a sign of low clouds. A spread of 0 to 4 degrees Celsius followed FAA weather guidance.
- Of the 32 flights, 27 entered that range, and 20 of those 27 were linked to adverse weather.
- Pilots with fewer years in HEMS tended to crash at a wider spread, and pilots with more years at a narrower one (r = -0.423, P = 0.028).
- Pilots with under 6 years in HEMS were linked to fatal outcomes (P = 0.049). The authors put the figure for this group at more than nine times higher in these night conditions.
Research into Practice takeaways
- Temperature and dew point spread is a simple weather cue. Programs can ask how it shows up in their own preflight risk tools.
- The authors suggest added support for pilots in their first 6 years of HEMS work while they build experience.
- This is a small set of fatal accidents. It shows links with experience, not proof that experience alone changed the outcome.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock
Sperry, Jason L.; Guyette, Francis X.; Brown, Joshua B.; Yazer, Mark H.; Triulzi, Darrell J.; Early-Young, Barbara J.; et al.
The New England Journal of Medicine, 379(4), 315-326, 2018
Research highlights
Highlights
- This multicenter trial compared thawed plasma with standard care during air medical transport. Patients were injured and at risk for hemorrhagic shock, and randomization was by cluster rather than by patient.
- Of 501 patients, 230 got plasma. The other 271 got the usual resuscitation.
- Death at 30 days was 23.2% in the plasma group and 33.0% in the standard-care group. The difference was statistically significant.
- The survival curves began to separate about 3 hours after randomization. The gap lasted through 30 days.
- Rates of multiorgan failure, acute lung injury, hospital-acquired infection, and allergic or transfusion-related reactions did not differ significantly between groups.
Research into Practice takeaways
- This randomized trial was run during air medical transport at several centers. Air medical programs can take part in clinical trials.
- The trial measured both benefit and harm. Programs can look at whether their own quality review tracks both for interventions given in flight.
- The results apply to the injured patients studied in this trial. Teams may want to read the full paper to see which patients were included.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Fatigue mitigation with SleepTrackTXT2 in air medical emergency care systems: study protocol for a randomized controlled trial
Patterson, P. Daniel; Moore, Charity G.; Guyette, Frank X.; Doman, Jack M.; Sequeira, Denisse; Werman, Howard A.; et al.
Trials, 18(1), 254, 2017
Research highlights
Highlights
- This paper lays out the plan for a randomized trial called SleepTrackTXT2. It does not report results.
- Adult EMS clinicians from four air medical systems in the U.S. Midwest, Northeast, and South will take part for 120 days.
- The intervention group gets text check-ins on sleepiness, fatigue, and trouble concentrating at shift start, every 4 hours, and at shift end. Those who report high levels get a message with a tip to stay alert.
- The intervention group also gets a weekly text on sleep debt and a prompt to recover sleep. The control group gets only the check-in questions.
- The trial aims to measure short-term effects on fatigue during shifts and longer-term effects on sleep quality and recovery.
Research into Practice takeaways
- Because this is a protocol, it shows how the trial was designed, not whether the messages worked. Readers can look for the published results.
- The authors note that more than half of air medical EMS clinicians report poor sleep or poor recovery between shifts. They also note that an earlier pilot trial linked text messages to changes in self-reported fatigue and sleepiness.
- Programs can ask whether they have any real-time way to check crew fatigue during long shifts.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Noise exposure during prehospital emergency physicians work on Mobile Emergency Care Units and Helicopter Emergency Medical Services
Hansen, Mads Christian Tofte; Schmidt, Jesper Hvass; Brøchner, Anne C.; Johansen, Jakob Kjersgaard; Zwisler, Stine; Mikkelsen, Søren
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 25(1), 119, 2017
Research highlights
Highlights
- Researchers measured noise on emergency calls in HEMS and in mobile emergency care units (MECU). Tiny microphones sat beside the ear canal or inside the helmet earmuffs.
- Noise reached 80 dB(A) or more during siren use and HEMS operations, compared with 70 dB(A) for in-hospital controls.
- Under the helmet, HEMS crew were exposed to levels of 90 dB(A) or more.
- Hearing tests found no occupational hearing loss.
- After missions, HEMS crew showed a significant shift in inner ear hair cell function at 4 kHz compared with MECU physicians.
Research into Practice takeaways
- No hearing loss was found, but inner ear function changed after HEMS missions. Programs can track crew hearing over time, not only at hire.
- The authors found exposure above European noise recommendations. They suggest options like custom in-ear protection with built-in communication, or active noise reduction, for HEMS crews.
- The abstract names ten in-hospital controls but does not give the number of prehospital staff tested. The size of the sample is unclear.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 36(6), e1-e2, 2017
CONCERN Network bulletin, November/December 2017 issue.
The impact of fatigue on the non-technical skills performance of critical care air ambulance clinicians
Myers, J. A.; Powell, D. M. C.; Aldington, S.; Sim, D.; Psirides, A.; Hathaway, K.; et al.
Acta Anaesthesiologica Scandinavica, 61(10), 1305-1313, 2017
Research highlights
Highlights
- Nineteen physicians each completed two simulated air ambulance missions, once rested and once fatigued, in a randomized crossover design.
- Raters who did not know each physician's fatigue state scored four skill areas. These were teamwork, decision making, task management, and situation awareness.
- Overall nontechnical skill scores were higher when rested than when fatigued, with a mean difference of 2.8 (95% CI 2.2 to 3.4).
- The drop with fatigue held in each of the four skill areas. It also held after the authors adjusted for mission order and other factors.
- Physicians rated their own performance about the same whether rested or fatigued.
Research into Practice takeaways
- The authors suggest fatigued clinicians may not recognize how much their performance has slipped. Programs can ask whether fit-for-duty checks lean on self-report alone.
- Fatigue reviews can look at teamwork and decision making, not only hands-on tasks.
- This was a small simulation study of 19 physicians. Results in real missions and in other crew roles may differ.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 36(5), e1-e2, 2017
CONCERN Network bulletin, September/October 2017 issue.
Concern Network
Air Medical Journal, 36(4), e1-e4, 2017
CONCERN Network bulletin, July/August 2017 issue.
Helicopter Emergency Medical Service Simulation Training in the Extreme: Simulation-based Training in a Mountain Weather Chamber
Pietsch, Urs; Ney, Ludwig; Kreuzer, Oliver; Berner, Armin; Lischke, Volker
Air Medical Journal, 36(4), 193-194, 2017
Response of Flight Nurses in a Simulated Helicopter Environment
Kaniecki, David M.; Hickman, Ronald L.; Alfes, Celeste M.; Reimer, Andrew P.
Air Medical Journal, 36(3), 131-134, 2017
Research highlights
Highlights
- Flight nurses and people who were not flight nurses ran a simulated emergency in a helicopter flight simulator.
- Stress was measured with heart rate and with stress scores people rated from 0 to 100.
- Participants said the simulator felt close to a real helicopter, most of all in sound, communications, vibration, and motion.
- Perceived stress for all participants rose from 27 before the scenario to 51 at its peak, then fell to 28 (P < .001). Flight nurse heart rates rose from 77 to 100, then fell to 72.
- Perceived stress did not differ significantly between flight nurses and others before, during, or after the scenario.
Research into Practice takeaways
- The abstract does not report the sample size, so it is hard to judge how far the results extend.
- A simulator that raises stress lets crews practice in conditions closer to real flights. Programs can ask whether their own simulation creates that kind of stress.
- The study measured stress and realism, not learning or performance. It does not show whether training in the simulator changes care in flight.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Safety Considerations for Medical Staff and Patients Who Fly Over Water in a Helicopter for Work or Recreation
Brooks, Christopher J.; MacDonald, Conor V.
Aerospace Medicine and Human Performance, 88(4), 413-417, 2017
Research highlights
Highlights
- The authors reviewed 50 years of evidence on helicopter accidents in water. Sources included scientific papers, government reports, military safety center data, and offshore oil industry statistics.
- The authors cite a death rate of about 25% for people in helicopter accidents in water.
- Patients at most risk include those with heart or lung disease, physical disabilities, or large body size. People who cannot swim are also at higher risk.
- Risk for medical staff rises when they do not know how to get out of a flooded cabin that has turned upside down.
- Staff may also face problems after escape with life jackets and life rafts, and they may need to swim to shore.
Research into Practice takeaways
- The authors conclude that many past deaths could have been prevented. They point to simple mental and physical steps anyone boarding an overwater flight can take.
- Programs that fly over water can ask whether medical crew have had escape training and know the survival equipment on board.
- This is a review of past evidence, not a new study. The abstract does not list the specific steps.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Air Medical Services Cost Study Report
Association of Air Medical Services, 2017
Prepared by Xcenda, LLC for the Association of Air Medical Services, the industry trade association.
Concern Network
Air Medical Journal, 36(2), e1, 2017
CONCERN Network bulletin, March/April 2017 issue.
Weather Webcam System for the Safety of Helicopter Emergency Medical Services in Miyazaki, Japan
Kanemaru, Katsuhiro; Katzer, Robert; Hanato, Syu; Nakamura, Koji; Matsuoka, Hiroshi; Ochiai, Hidenobu
Air Medical Journal, 36(2), 71-76, 2017
Research highlights
Highlights
- Miyazaki Prefecture in Japan started HEMS in 2012. Mountains cover 88% of its land, and weather can affect flights.
- A weather webcam system was set up to show conditions at 29 locations.
- Researchers compared judgments about whether a flight could go using standard weather data alone and using standard data plus webcam views.
- Adding the webcams raised the chance that a flight could be accepted. That meant more patients in mountain areas could be reached.
- The results also suggest the webcams may help keep flights from launching into poor weather.
Research into Practice takeaways
- The abstract does not give numbers, so the size of the change is not known from this summary.
- Webcams added a live view between reporting stations. Programs in terrain with few weather stations can ask where their pilots lack current information.
- The authors say the webcams raised pilots' awareness of weather across the prefecture. The abstract does not report safety events.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 36(1), e1-e2, 2017
CONCERN Network bulletin, January/February 2017 issue.
Crew Resource Management in Helicopter Air Ambulance Operations: A Literature Review
Rowley, Crystal; Bryant, Michelle R.
Federal Aviation Administration, Civil Aerospace Medical Institute. Report DOT/FAA/AM-17/13, 2017
Research highlights
Highlights
- This FAA report reviews published research on crew resource management (CRM) in helicopter air ambulance operations.
- It notes that CRM began in aviation and has spread to other industries that depend on teams.
- Air ambulance work joins dispatch on the ground with the flight crew, and medical work with aviation work. This often happens in unplanned situations.
- The review found signs that some team members get less CRM training than others.
Research into Practice takeaways
- The authors point to gaps in both CRM theory and practice for air ambulance teams.
- Programs can ask whether pilots, medical crew, and communications staff all receive the same CRM training.
- This is a literature review. The abstract does not report new data or measure training outcomes.
Written by the Air Medical Safety Network from the report's public abstract. It does not replace the full report. Added November 2, 2026.
Read the abstract
Crew resource management (CRM) training has evolved from an aviation-specific practice to a much broader-scoped practice involving other industries with team oriented objectives. Combined objective industries such as helicopter air ambulance (HAA) operations have the unique requirement to combine ground (dispatch) and air (flight crew) with traditional medical and aviation operations in ad hoc situations adding another dimension to the CRM implementation process. Despite the requirements for such training in HAA operations, evidence suggests that CRM training does not reach all team members equally. Thus, there are gaps in the current research both in theory and practice
Report documentation page. U.S. government work, not subject to copyright.
The Effects of SMS Implementation on Safety Culture within Helicopter Emergency Medical Services
Gardner, Ray William
Master's thesis, University of North Dakota, 2017
Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument - an observational study
Myers, Julia A.; Powell, David M. C.; Psirides, Alex; Hathaway, Karyn; Aldington, Sarah; Haney, Michael F.
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 24(1), 24, 2016
Research highlights
Highlights
- Researchers adapted the anaesthetists' non-technical skills (ANTS) framework for critical care air ambulance work. They drew on clinician input, published literature, and field observation.
- The new framework is called AeroNOTS, short for aeromedical nontechnical skills.
- Sixteen trainee physicians from anesthesia, intensive care, and emergency medicine ran a simulated critical care air transfer. Two blinded assessors rated them.
- Physicians with inter-hospital transfer experience scored higher than those without on general performance (p = 0.003) and on AeroNOTS ratings (p = 0.001).
- Self-ratings did not separate experienced from inexperienced clinicians (p = 0.32). They were also not strongly tied to observed performance.
Research into Practice takeaways
- Self-ratings were a poor guide to observed performance in this study. Programs can use trained observers when they assess nontechnical skills.
- The authors suggest AeroNOTS could support education and training for air ambulance clinicians.
- The sample was 16 physicians in one simulation. The authors note the rating system needs further evaluation.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 35(6), e1-e2, 2016
CONCERN Network bulletin, November/December 2016 issue.
Perceptions and culture of safety among helicopter emergency medical service personnel in the UK
Chesters, Adam; Grieve, Philip H.; Hodgetts, Timothy J.
Emergency Medicine Journal, 33(11), 801-806, 2016
Research highlights
Highlights
- A survey asked 100 UK HEMS pilots, doctors, and paramedics how they viewed risk in their work. All 100 completed it.
- Respondents placed the most risk on flying at night without NVG, commercial pressure, and mechanical failure of the aircraft.
- Overall views of safety did not differ by profession (p=0.08) or by how many years people had worked (p=0.58).
- About two in three respondents saw HEMS work as safe by nature.
- Respondents who had lived through a crash more often said HEMS work is not safe by nature (p=0.05).
Research into Practice takeaways
- Commercial pressure was among the top risks crews named. Programs can ask how volume or business pressure shows up in go or no-go decisions.
- Views of safety were linked to personal experience of a crash. Leaders may find that views of risk vary within a team.
- The authors support more operational training for clinical crew, more incident reporting, and a close look at baseline training and equipment standards for every mission.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 35(5), e1-e2, 2016
CONCERN Network bulletin, September/October 2016 issue.
Simulation-Based Training in Mountain Helicopter Emergency Medical Service: A Multidisciplinary Team Training Concept
Pietsch, Urs; Knapp, Jürgen; Ney, Ludwig; Berner, Armin; Lischke, Volker
Air Medical Journal, 35(5), 301-304, 2016
Research highlights
Highlights
- Researchers built a simulation course for mountain HEMS rescue that trained crew from different professions together.
- Forty HEMS crewmembers rated their own skills before and after the training.
- Running this kind of team training in mountain HEMS proved feasible.
- Self-rated skill in safety-related human factors and team resource management went up, and the change was statistically significant.
- Structured decision-making showed the largest gain, but the abstract describes this only as a trend.
Research into Practice takeaways
- Results are self-ratings. They show crews felt more confident, not that performance or patient outcomes changed.
- The authors suggest team training across professions may help patient outcomes and rescuer safety. The study did not measure either.
- Programs with mountain or rescue missions can ask whether their crews train together for these settings, not only by role.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
State Model Rules for the Regulation of Air Medical Services
National Association of State EMS Officials, 2016
Developed with support from the NHTSA Office of EMS.
Concern Network
Air Medical Journal, 35(4), e11-e13, 2016
CONCERN Network bulletin, July/August 2016 issue.
Simulator-Based Air Medical Training Program Christoph Life: From Concept to Course
Winkelmann, Marcel; Friedrich, Lars; Schröter, Christian; Flemming, Andreas; Eismann, Hendrik; Sieg, Lion; et al.
Air Medical Journal, 35(4), 242-246, 2016
Research highlights
Highlights
- Christoph Life is a 2-day training program built around a full helicopter simulator that can move.
- The course covers crew resource management (CRM) basics and a series of emergency medical scenarios.
- Thirteen teams took part. The teams included emergency physicians and paramedics with special training.
- On an anonymous questionnaire, participants rated the course as helpful for daily work and for avoiding mistakes (5.7 on a 6-point scale for both).
- Self-rated CRM knowledge rose from 3.5 to 5.4. Self-rated communication skills rose from 4.2 to 4.8, and reflection on communication rose from 3.9 to 5.5.
Research into Practice takeaways
- All results are self-ratings from participants. The abstract does not report changes in performance on the job.
- The sample was 13 teams, and each team rated itself before and after with no comparison group.
- The authors report strong demand from users for more training of this kind. Programs weighing simulation can ask what measures beyond self-ratings they would use.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 35(3), e9, 2016
CONCERN Network bulletin, May/June 2016 issue.
Concern Network
Air Medical Journal, 35(2), e5-e8, 2016
CONCERN Network bulletin, March/April 2016 issue.
A Paramedic-staffed Helicopter Emergency Medical Service's Response to Winch Missions in Victoria, Australia
Meadley, Ben; Heschl, Stefan; Andrew, Emily; de Wit, Anthony; Bernard, Stephen A.; Smith, Karen
Prehospital Emergency Care, 20(1), 106-110, 2016
Research highlights
Highlights
- Researchers reviewed winch missions flown by Intensive Care Flight Paramedics in Victoria, Australia, from November 2010 to March 2014.
- Of 5,003 missions, 125 were winch operations. There were fewer winch missions in winter than in any other season.
- Most patients were male (78.4%), and the mean age was 38. Trauma accounted for 109 patients (87.2%). A single broken limb was the most common injury.
- Median time on scene was 49 minutes. Half of patients (50.4%) were lifted on a stretcher and 36.0% in a hypothermic strop.
- Pain relief (44.0%) and vascular access (38.4%) were the most frequent treatments. Forty-nine patients (39.2%) had no treatment before winch extraction.
Research into Practice takeaways
- Most winch patients had minor to moderate injuries, and advanced procedures before extraction were rare. Programs can review whether winch training matches this case mix.
- The abstract notes that winching carries risk. Knowing the usual patient type and scene time can help programs plan for that exposure.
- This is a review of records from one paramedic-staffed service. Services with other staffing models may see different patterns.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 35(1), e1-e3, 2016
CONCERN Network bulletin, January/February 2016 issue.
2015 Air Medical Safety Survey
Coons, Joe; Zalar, Christine
Air Medical Journal, 35(3), 120-125, 2016
Mechanical Ventilation in Critical Care Transport
Wilcox, Susan R. ; Saia, Mark S.; Waden, Heather; Frakes, Michael; Wedel, Suzanne K.; Richards, Jeremy B.
Air Medical Journal, 35(3), 161-165, 2016
Research highlights
Highlights
- The study reviewed records of critical care transports of patients with low blood oxygen from respiratory failure.
- Of 237 transports, 211 (89%) included ventilator changes by the transport team.
- Teams changed tidal volume, positive end-expiratory pressure (PEEP), and fraction of inspired oxygen (FiO2).
- Raising FiO2, raising FiO2 and PEEP together, and giving a neuromuscular blocking medication were each linked to higher arterial oxygen (PaO2) on arrival.
- The authors conclude that more complex ventilator care in transport was associated with higher oxygen levels at the receiving hospital.
Research into Practice takeaways
- This was a look back at records. It shows associations and does not test any ventilator approach.
- The abstract does not report how often patients lost oxygen saturation during transport. It reports oxygen levels at the sending and receiving hospitals.
- Programs can review how their teams record ventilator changes in transport, so they can study their own patterns.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Occupant Injury Severity and Accident Causes in Helicopter Emergency Medical Services (1983-2014)
Boyd, Douglas D.; Macchiarella, Nickolas D.
Aerospace Medicine and Human Performance, 87(1), 26-31, 2016
Research highlights
Highlights
- The authors used the NTSB database to study U.S. HEMS accidents from 1983 to 2014.
- The HEMS accident rate fell by 71% over the study period. The share of accidents that were fatal stayed between 36% and 50%, and injury patterns did not change.
- None of the aircraft in these accidents fully met current crashworthiness standards.
- The most common accident types were obstacle strikes, at 37%, and flight from visual into instrument conditions, at 26%. Both trended downward over time.
- Accidents attributed to aircraft malfunction trended upward over time.
Research into Practice takeaways
- Fewer accidents did not mean safer outcomes once an accident happened. Survivability is a separate question from accident rate.
- The authors suggest that operators consider aircraft built to current crashworthiness standards and equipped for instrument flight. These are the authors' views, not findings tested in the study.
- The rise in malfunction-related accidents is a trend programs can watch in their own maintenance and event data.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Pilot Domain Task Experience in Night Fatal Helicopter Emergency Medical Service Accidents
Aherne, Bryan B.; Zhang, Chrystal; Newman, David G.
Aerospace Medicine and Human Performance, 87(6), 550-556, 2016
Research highlights
Highlights
- This study looked at 32 fatal single-pilot HEMS accidents at night in the U.S. from 1995 to 2013. All involved controlled flight into terrain or loss of control from spatial disorientation.
- Pilot experience in HEMS work, called domain task experience, was compared with industry survey data.
- More than half of these pilots (56%) had 2 years or less in HEMS. Only 9% had more than 10 years.
- Accident rates were higher, to a statistically significant degree, for pilots with less than 2 or less than 4 years in HEMS. Rates were lower for pilots with more than 10 years.
- In 21 of the 32 accidents (66%), conditions were below visual flight rules, though all flights were required to fly under those rules.
Research into Practice takeaways
- Other studies cited by the authors found no link between total flight hours and HEMS accident outcomes. This study looked at years in HEMS work instead.
- The authors read the pattern as newer HEMS pilots having more trouble judging hazards at night. The study does not show what each pilot saw or why a choice made sense at the time.
- Programs can look at how newer HEMS pilots are supported on night flights, such as through mentoring, weather tools, or added review of go and no-go decisions.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Civilian Helicopter Search and Rescue Accidents in the United States: 1980 Through 2013
Worley, Gordon H.
Wilderness & Environmental Medicine, 26(4), 544-548, 2015
Civil helicopter search and rescue, not limited to air medical.
Research highlights
Highlights
- This study searched NTSB data, records kept by air medical and search and rescue organizations, and published reports for civilian helicopter search and rescue accidents in the United States.
- It found 47 accidents. Fatal injuries occurred in 43% of them.
- That compares with 19% for U.S. general aviation helicopter accidents and 40% for HEMS over the same years.
- The higher fatal share compared with general aviation helicopters was statistically significant.
- Accidents at night or in instrument weather did not show a statistically significant rise in fatal outcomes.
Research into Practice takeaways
- The number of missions flown each year was unknown, so no accident rate could be set. The study compares the share of fatal accidents, not risk per flight.
- The small count of 47 accidents limits what the study can show about causes or trends.
- Search and rescue flying and HEMS had similar fatal shares. Programs that do both kinds of work can share lessons across them.
- The authors suggest further study to improve the safety of these flights.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 34(6), e21-e22, 2015
CONCERN Network bulletin, November/December 2015 issue.
Concern Network
Air Medical Journal, 34(5), e17-e19, 2015
CONCERN Network bulletin, September/October 2015 issue.
The Evolution of a Safety Culture
Patton, Brian S.; Donovan, Kathy J.
Air Medical Journal, 34(5), 264-268, 2015
Simulation-based training and assessment of non-technical skills in the Norwegian Helicopter Emergency Medical Services: a cross-sectional survey
Abrahamsen, Håkon B.; Sollid, Stephen J. M.; Öhlund, Lennart S.; Røislien, Jo; Bondevik, Gunnar Tschudi
Emergency Medicine Journal, 32(8), 647-653, 2015
Research highlights
Highlights
- Researchers surveyed every physician, pilot, and HEMS crew member (207 in all) at 11 civilian Norwegian HEMS bases in 2012. Of these, 193 responded (82%).
- Many people in each professional group reported no simulation-based training or assessment of nontechnical skills.
- Physicians trained and were assessed in simulation less often than pilots and crew members. The difference was statistically significant.
- Among physicians, 50 of 82 (61%) regularly had on-call periods longer than 72 hours. Of these, 79% had no training in coping with fatigue.
- Among pilots and crew members, 72 of 73 (99%) worked on-call periods longer than three days straight. Of these, 54% had no fatigue training.
Research into Practice takeaways
- Long on-call periods were common across all roles, and fatigue training was often missing. Programs can check whether fatigue training matches their duty patterns.
- Training gaps differed by role. Since crews work as a team, leaders can ask whether every role takes part in team simulation.
- This is self-reported survey data from one country in 2012. It shows how often training happened, not how well crews performed.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 34(4), e16, 2015
CONCERN Network bulletin, July/August 2015 issue.
Should Charity Air Medical Organizations Require Commercial Certification of Their Pilots?
Boyd, Douglas D.; Peters, Charles
Air Medical Journal, 34(4), 188-194, 2015
Research highlights
Highlights
- The study used the NTSB accident database to look at fatal single-engine aircraft accidents from 2002 to 2012.
- It compared pilots who held a commercial certificate with pilots who held a private certificate.
- Commercial pilots had a lower fatality rate over the study period.
- In visual conditions, aerodynamic stall was a common cause recorded for fatal accidents in both groups.
- In instrument conditions, investigators most often cited problems on instrument approaches and spatial disorientation. At night, loss of clearance from obstacles or terrain was the cause cited most often.
Research into Practice takeaways
- The authors suggest that charity air medical groups encourage their pilots to earn commercial certification.
- These are links found in accident records across single-engine flights. They are not proven causes, and the abstract does not say how many were charity medical flights.
- The causes listed show where investigators placed cause. Charity programs can look at how their pilot training covers stall, instrument approaches, and terrain clearance at night.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
AAMS response to Habib et al, Probable cause in helicopter emergency medical services crashes
Sherlock, Richard
Journal of Trauma and Acute Care Surgery, 78(5), 1066, 2015
Response from the Association of Air Medical Services, the industry trade association, to Habib et al. (2014), which is also in this library.
Concern Network
Air Medical Journal, 34(3), e9-e11, 2015
CONCERN Network bulletin, May/June 2015 issue.
Guidelines for the Use and Availability of Helicopter Emergency Medical Transport (HEMS)
U.S. Department of Transportation, 2015
Concern Network
Air Medical Journal, 34(2), e5-e6, 2015
CONCERN Network bulletin, March/April 2015 issue.
Helicopter Air Ambulance Operations
Federal Aviation Administration, Flight Standards Service. Advisory Circular AC 135-14B, 2015
Advisory circular issued March 26, 2015. Guidance, not a research report.
Overuse of helicopter transport in the minimally injured: A health care system problem that should be corrected
Vercruysse, Gary A.; Friese, Randall S.; Khalil, Mazhar; Ibrahim-Zada, Irada; Zangbar, Bardiya; Hashmi, Ammar; et al.
Journal of Trauma and Acute Care Surgery, 78(3), 510-515, 2015
Research highlights
Highlights
- This review looked at trauma patients transferred to one center from 2007 to 2013.
- Of 5,202 transferred patients, 981 (18.9%) came by helicopter and 3,992 (76.7%) came by ground.
- Helicopter patients had longer hospital and ICU stays. Mortality did not differ between the groups.
- Minimally injured patients (Injury Severity Score under 5) were matched by propensity score. In this group, length of stay and early discharge did not differ by transport mode.
- The authors report that nearly a third of helicopter patients were minimally injured. Helicopter transfer cost $18,000 on average. For the 270 minimally injured helicopter patients, the total was $4,860,000.
Research into Practice takeaways
- The authors suggest policies to identify patients who may not benefit from flight, plus education for physicians who request transport.
- Programs can review how many of their transfers involve minimally injured patients and what drove those requests.
- This was one center's data. The authors rate the level of evidence as III for the epidemiologic findings and IV for the therapeutic findings.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 34(1), e1-e3, 2015
CONCERN Network bulletin, January/February 2015 issue.
Fatigue in Air Medical Clinicians Undertaking High-acuity Patient Transports
Myers, Julia A.; Haney, Michael F.; Griffiths, Robin F.; Pierse, Nevil F.; Powell, David M. C.
Prehospital Emergency Care, 19(1), 36-43, 2015
Research highlights
Highlights
- Over 4 months, physicians and flight nurses on two intensive care teams that move patients between hospitals rated their fatigue before and after missions.
- They returned 403 complete forms, an estimated return rate of 73%.
- Fatigue rose over the course of missions. One in 12 reports showed severe fatigue after the mission, meaning a Samn-Perelli score of 6 or 7.
- Fatigue after a mission was linked to fatigue before it, night work, mission length, and mission difficulty.
- Higher fatigue was linked to lower self-rated performance (r = -0.4). Clinicians reported 22 times in the prior 6 months when they should have turned down a mission because of fatigue.
Research into Practice takeaways
- The authors suggest that even moderate-length transports bring high fatigue fairly often. They see measures to prevent or resist fatigue as possibly helpful.
- Programs can ask whether clinicians have a clear and accepted way to decline a mission when they are fatigued.
- Fatigue and performance were both self-rated. The study did not measure performance directly.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Survivors Perceptions of Recovery following Air Medical Transport Accidents
Jaynes, Cathy L.; Valdez, Anna; Hamilton, Megan; Haugen, Krista; Henry, Colin; Jones, Pat; et al.
Prehospital Emergency Care, 19(1), 44-52, 2015
Research highlights
Highlights
- Researchers held a focus group with seven flight crew members who had survived an air medical transport accident.
- Accidents were defined using NTSB criteria.
- Survivors described effects in four areas. These were physical, psychological, relational, and financial.
- Responses from companies and the industry varied widely. Some survivors received generous support and saw safety changes, while others saw little response or attention to their needs.
Research into Practice takeaways
- The authors found post-accident planning lacking in scope and quality. They call for more focused support to help survivors return to personal and work life.
- The authors suggest planning should involve crew members, transport companies, and the wider industry. Programs can check whether their emergency response plan covers survivors' recovery, not only the first response.
- With seven participants, the findings show the range of experience. They cannot show how common each experience is.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter emergency medical services for adults with major trauma
Galvagno, Samuel M.; Sikorski, Robert; Hirshon, Jon M.; Floccare, Douglas; Stephens, Christopher; Beecher, Deirdre; et al.
Cochrane Database of Systematic Reviews, CD009228, 2015
Cochrane review pooling U.S. and international studies.
Research highlights
Highlights
- This Cochrane review searched the literature through April 2015. It looked for studies that compared helicopter and ground transport for adults with major trauma.
- It included 38 studies. None were randomized trials, and the evidence was rated very low quality under GRADE criteria.
- Unadjusted death data covered 282,258 people from 28 studies. The results varied too much to give one overall estimate.
- Among studies that adjusted for other factors, some found a survival benefit with helicopters and some did not. Six studies of traumatic brain injury showed no lower risk of death with helicopters in unadjusted data.
- Four studies of transfers to higher level trauma centers pointed to a benefit that ranged from small to moderate. None of the studies measured quality-adjusted or disability-adjusted life years.
Research into Practice takeaways
- The review could not estimate the overall effect of helicopter transport for adults with major trauma. Any single number drawn from this body of work deserves caution.
- The authors note that crashes are a possible harm of either ground or helicopter transport. None of the included studies reported safety data.
- Transfers between hospitals may be one area where the evidence leans toward benefit. Teams that review transfer criteria can watch for newer studies.
- The authors call for large studies across many centers that also look at cost and safety.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Prehospital Transfusion of Plasma and Red Blood Cells in Trauma Patients
Holcomb, John B.; Donathan, Daryn P.; Cotton, Bryan A.; Del Junco, Deborah J.; Brown, Georgian; Wenckstern, Toni von; et al.
Prehospital Emergency Care, 19(1), 1-9, 2015
Research highlights
Highlights
- Researchers reviewed records of 1,677 adult trauma patients who received blood products at one center between September 2011 and April 2013. These were the most severely injured patients, with 26% mortality.
- One helicopter service (LifeFlight) carried thawed plasma and red blood cells. Another air service and ground units used only crystalloid fluids.
- Of 716 LifeFlight patients, 137 (19%) received a transfusion before arrival. Wastage of the 942 units placed on the helicopters was 1.9%.
- Prehospital transfusion was linked to better acid-base status on arrival, less blood product use over 24 hours, and lower risk of death in the first 6 hours for the sickest patients.
- There was no statistically significant difference in 24-hour or 30-day mortality between the two helicopter services.
Research into Practice takeaways
- The authors call this a small single-center pilot study. Early benefits were linked to transfusion, but no overall survival advantage was found.
- Programs looking at a blood program can weigh storage and wastage data alongside clinical results.
- This was a review of past records across different services. Even with adjusted models, other differences between services may affect the results.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 33(6), e19-e21, 2014
CONCERN Network bulletin, November/December 2014 issue.
Helicopter Emergency Medical Service Patient Transport Safe at Night?
Peters, Joost H.; van Wageningen, Bas; Hoogerwerf, Nico; Biert, Jan
Air Medical Journal, 33(6), 296-298, 2014
Research highlights
Highlights
- A Dutch HEMS service looked back at its records of patients carried by helicopter at night.
- Of 513 patients carried by helicopter, 72 (14%) flew at night. Their median age was 25.3 years.
- The median flight to the hospital lasted 16 minutes. By road, the median for the same trips was estimated at about 44 minutes.
- Night helicopter transport was faster than the estimated road transport (P < .001).
- Three incidents were recorded. The abstract describes them as not specific to flight.
Research into Practice takeaways
- The study included 72 night patients from one service in the Netherlands. Results may differ in other terrain, weather, or operating models.
- Road times were estimates, not measured trips.
- The authors judged night flights safe in their Dutch setting. A sample this size can say little about rare events such as accidents.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Problems in analyzing helicopter emergency medical service accidents
Hinkelbein, Jochen; Neuhaus, Christopher; Braunecker, Stefan
Journal of Trauma and Acute Care Surgery, 77(5), 799-800, 2014
Work Stressors, Perseverative Cognition and Objective Sleep Quality: A Longitudinal Study among Dutch Helicopter Emergency Medical Service (HEMS) Pilots
Radstaak, Mirjam; Geurts, Sabine A. E.; Beckers, Debby G. J.; Brosschot, Jos F.; Kompier, Michiel A. J.
Journal of Occupational Health, 56(6), 469-477, 2014
Research highlights
Highlights
- Researchers followed 24 Dutch HEMS pilots across three day shifts in a row.
- Pilots filled out questionnaires after each shift and the next morning. They also wore actigraphs, which are wrist monitors that track sleep.
- Distressing shifts were linked to taking longer to fall asleep (r = 0.50). Higher workload was linked to worse self-rated sleep quality (r = -0.42).
- Distressing shifts were also linked to more perseverative cognition, or repeated thinking about stressors, during the evening (r = 0.62).
- This repeated thinking was linked to taking longer to fall asleep (r = 0.74). The analysis suggested it carried the link between distressing shifts and time to fall asleep.
Research into Practice takeaways
- The sample was small and the results are correlations. The authors suggest repeated thinking about work may be one path from work stress to poor sleep.
- Programs can look at how pilots wind down after distressing shifts, since this study linked those shifts to taking longer to fall asleep.
- The study paired self-reports with actigraph data. That gives an outside measure of sleep, not only the pilots' own ratings.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 33(5), e15, 2014
CONCERN Network bulletin, September/October 2014 issue.
Helicopter Emergency Medical Service Scene Communications Made Easy
Koval, Michael
Air Medical Journal, 33(5), 212-213, 2014
Sleep and Sleepiness of Pilots Operating Long-Range Airplane Emergency Medical Missions
Amann, Ulrike; Holmes, Alex; Caldwell, John; Hilditch, Cassie
Aviation, Space, and Environmental Medicine, 85(9), 954-959, 2014
Research highlights
Highlights
- This study followed pilots on nine long-range airplane emergency medical services (AEMS) missions. Pilots wore a wrist activity monitor and logged their sleep and how sleepy they felt.
- Missions lasted about 20 hours on average with two to four flight legs. Three or four pilots rotated between flying and sleeping in curtained bunks.
- Pilots slept about 3.5 hours on average during a mission, most often in two separate sleep periods on board.
- Sleepiness was rated on the Karolinska Sleepiness Scale at the start of cruise and at the start of descent. Scores were usually below the scale's midpoint.
- A few higher sleepiness scores came on the longest trips and on legs flown between 2 a.m. and 6 a.m.
Research into Practice takeaways
- The authors conclude that careful mission design and management can keep pilots alert on long, multileg flights.
- Programs planning crew rest can pay attention to legs flown between 2 a.m. and 6 a.m. and to the longest missions.
- This was a small sample of fixed-wing missions with extra pilots and bunks. The results may not apply to two-pilot or helicopter operations.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Injury Rate in a Helicopter Underwater Escape Trainer (HUET) from 2005–2012
Brooks, Christopher J.; MacDonald, Conor V.; Gibbs, Peter N. A.
Aviation, Space, and Environmental Medicine, 85(8), 857-862, 2014
Offshore helicopter underwater escape training; not specific to air medical crews.
Research highlights
Highlights
- This study counted injuries at one marine survival school that teaches helicopter underwater escape training (HUET).
- From 2005 to 2012, the school trained 8,902 students, who completed 59,245 underwater escapes in a simulator.
- There were 40 cases that needed only first aid and 3 serious injuries. The serious injuries were a cut that needed 5 stitches, a dislocated shoulder, and a case of water aspiration that led to a hospital stay.
- No one died. No problems were reported with the emergency breathing system or the air pocket.
- The overall injury rate was 0.74 per 1,000 ascents. Eleven injuries were linked to the escape technique the student used.
Research into Practice takeaways
- The authors say this injury rate was lower than in diving, parachute, and submarine escape training. The abstract does not give those comparison rates.
- The authors think medical screening and instructor attention to anxious students may explain the low rate. They note this was not tested.
- These data come from one school. Programs that send crews to HUET can ask their provider for its own injury records and screening steps.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 33(4), e11-e12, 2014
CONCERN Network bulletin, July/August 2014 issue.
Recovery and well-being among Helicopter Emergency Medical Service (HEMS) pilots
Radstaak, Mirjam; Geurts, Sabine A. E.; Beckers, Debby G. J.; Brosschot, Jos F.; Kompier, Michiel A. J.
Applied Ergonomics, 45(4), 986-993, 2014
Research highlights
Highlights
- This study followed Dutch HEMS pilots working a compressed week with high mental and emotional demands.
- Work stressors and well-being were measured before, during, and after runs of day shifts and night shifts.
- Starting a run of day shifts took a greater toll on well-being than starting a run of night shifts.
- Well-being dropped by a similar amount during day and night shifts. Distress during night shifts was more strongly tied to that drop.
- Recovery took longer after a run of night shifts than after a run of day shifts.
Research into Practice takeaways
- The authors suggest that day shifts should not start earlier and that runs of night shifts should not be longer.
- Recovery after night work is a scheduling question. Programs can look at how much time off follows a run of nights.
- The abstract does not give the number of pilots. The study covers pilots in one country.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 33(3), e7, 2014
CONCERN Network bulletin, May/June 2014 issue.
Pilots’ Age and Incidents in Helicopter Emergency Medical Services: A 5-Year Observational Study
Müller, Andreas; Prohn, Maria J.; Huster, Katharina M.; Nowak, Dennis; Angerer, Peter; Herbig, Britta
Aviation, Space, and Environmental Medicine, 85(5), 522-528, 2014
Research highlights
Highlights
- This study looked at whether pilot age was linked to incidents in HEMS.
- It covered 257 pilots who flew for three air rescue organizations, one in Austria and two in Germany, from 2007 to 2011.
- An incident was any mission with one or more liability damage events.
- There were 1,770 such events over 402,372 missions, about 4 per 1,000.
- Pilot age did not have a statistically significant effect on incidents. Older pilots showed a trend toward slightly fewer incidents over time than younger pilots.
Research into Practice takeaways
- A result that is not statistically significant does not prove age has no effect. It means this sample did not show one.
- Incidents here were measured by liability damage. That measure may not capture every kind of safety event.
- Programs can use their own event data to test age-related concerns rather than assume them.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
A 26-year comparative review of United Kingdom helicopter emergency medical services crashes and serious incidents
Chesters, Adam; Grieve, Phillip H.; Hodgetts, Timothy J.
Journal of Trauma and Acute Care Surgery, 76(4), 1055-1060, 2014
Research highlights
Highlights
- This study counted HEMS crashes and serious incidents in the United Kingdom from 1987 to 2013. Results were compared with rates published for the United States, Germany, and Australia.
- UK Civil Aviation Authority records showed 13 accidents or serious incidents. One was fatal.
- The authors estimated about 230,000 UK HEMS missions in that period.
- The UK accident rate was 0.57 per 10,000 missions, and the fatal accident rate was 0.04.
- Rates reported for the other three countries ranged from 0.57 to 0.75 accidents per 10,000 missions. Fatal rates ranged from 0.04 to 0.23.
Research into Practice takeaways
- The authors found data sources hard to locate and often unavailable. They call for standard data collection on HEMS safety.
- Mission counts were estimated. Rates per mission depend on that estimate.
- Programs can check whether their own records would let them count missions, accidents, and serious incidents in a consistent way.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter Crashes into Water: Warning Time, Final Position, and Other Factors Affecting Survival
Brooks, Christopher J.; MacDonald, Conor V.; Baker, Susan P.; Shanahan, Dennis F.; Haaland, Wren L.
Aviation, Space, and Environmental Medicine, 85(4), 440-444, 2014
U.S. civil helicopter accidents into water, all mission types.
Research highlights
Highlights
- This study used the NTSB database to review helicopter crashes into water in the Gulf of Mexico and Hawaii from 1981 to 2011.
- The 133 crashes carried 456 people. In all, 119 people (26%) died, and 38% of those who lived were hurt.
- Twelve people died after they had already escaped the helicopter.
- Fatality rates were 22% with less than 15 seconds of warning, 12% with 16 to 60 seconds, and 5% with more than 1 minute.
- For the crashes behind 57% of the deaths, no one could tell how much warning there was.
Research into Practice takeaways
- The crashes include helicopters of all kinds, not only air medical flights. The abstract does not break out mission type.
- The authors suggest that ditching and sea survival courses cover short warning times and survival in the water.
- The authors also suggest that investigators be trained to estimate warning time. Missing data limited what this study could show.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Are physicians required during winch rescue missions in an Australian helicopter emergency medical service?
Sherren, Peter Brendon; Hayes-Bradley, Clare; Reid, Cliff; Burns, Brian; Habig, Karel
Emergency Medicine Journal, 31(3), 229-232, 2014
Research highlights
Highlights
- Researchers reviewed missions in which a physician was winched, in the Greater Sydney Area HEMS in Australia, between August 2009 and January 2012.
- Of 130 such missions, 120 case sheets could be analyzed. Most patients were injured (90%) and male (85%), and the median age was 37.
- Physicians performed 63 interventions that only a physician could provide, on 48 of 120 patients (40%). Advanced pain relief made up 68.3% of these.
- Physician-only care went more often to patients whose trauma scores were abnormal (p=0.03).
- Giving a physician-only intervention did not lengthen median scene time (45 versus 43 minutes, p=0.51).
Research into Practice takeaways
- The authors argue for winching a physician. They point to long rescue times, occasional severe injuries, and the share of patients who received physician-only care.
- This is one service with one staffing model. Programs with a different crew mix or different terrain may see different needs.
- Teams that winch crew members can review which interventions are needed on scene and who on the crew is trained to provide them.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 33(2), e3-e4, 2014
CONCERN Network bulletin, March/April 2014 issue.
Concern Network
Air Medical Journal, 33(1), e1, 2014
CONCERN Network bulletin, January/February 2014 issue.
A Review of Risk Analysis and Helicopter Air Ambulance Accidents
Nix, Sam; Buckner, Steven; Cercone, Richard
Air Medical Journal, 33(5), 218-221, 2014
Research highlights
Highlights
- In February 2014, the FAA issued a final rule that requires helicopter air ambulance operators to have preflight risk analysis programs.
- It reviewed 22 NTSB reports on events involving air ambulance helicopters. The NTSB opened these reports from the start of 2011 through the end of 2013.
- The researchers checked the risk factors in these reports against FAA guidance on preflight risk analysis. Where it fit, they also coded human factors with the Human Factors Analysis and Classification System (HFACS).
- The authors report that their results suggest some weak points in the existing preflight risk analysis guidance that may affect safety.
- The authors report that human factors likely played a part in most of the events in the study period.
Research into Practice takeaways
- Programs can compare their own risk analysis tool with the risk factors that show up in recent accident reports.
- The authors suggest that risk tools give pilots support during flight as well as before it. A program can ask what its crews have to reassess risk once airborne.
- This was a qualitative review of 22 reports, and some were preliminary. The findings point to areas to examine, not measured effects.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
An Analysis of Helicopter EMS Accidents using HFACS: 2000-2012
Bryan, Christopher G.
Master's thesis, Embry-Riddle Aeronautical University, 2014
An Evidence-based Guideline for the air medical transportation of prehospital trauma patients
Thomas, Stephen H.; Brown, Kathleen M.; Oliver, Zoë J.; Spaite, Daniel W.; Lawner, Benjamin J.; Sahni, Ritu; et al.
Prehospital Emergency Care, 18 Suppl 1, 35-44, 2014
Research highlights
Highlights
- A panel of experts in trauma, guideline writing, and EMS outcomes research built a guideline on which injured patients in the field gain most from air transport.
- The panel used the GRADE method (Grading of Recommendations Assessment, Development and Evaluation) and worked through the steps of the National Evidence-Based Guideline Model Process.
- The process yielded five recommendations, two strong and three weak. The evidence behind all five was rated low or very low quality.
- The strong recommendations were to start triage with the 2011 CDC field triage guideline and to use ground EMS for patients who do not meet its high-acuity criteria. The panel also gave a strong recommendation that activating HEMS should not depend on online medical direction.
- A weak recommendation supported HEMS for higher-acuity patients when it saves time over ground EMS, or when ground EMS cannot reach a suitable hospital.
Research into Practice takeaways
- Every recommendation rested on low-quality evidence. The panel calls for more research on the data, on putting the guideline into practice, and on effects on safety, outcomes, and cost.
- The panel allowed for local adaptation. Programs can compare their own activation criteria with the guideline and note where local factors differ.
- This is a guideline built from existing evidence, not a new study of patient outcomes.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter Emergency Medical Services and Weather-Related Accidents
Butler, Bryan
Air Medical Journal, 33(3), 84-85, 2014
Probable cause in helicopter emergency medical services crashes
Habib, Fahim A.; Shatz, David; Habib, Aliya I.; Bukur, Marko; Puente, Ivan; Catino, Joe; et al.
Journal of Trauma and Acute Care Surgery, 77(6), 989-993, 2014
Research highlights
Highlights
- Researchers reviewed NTSB reports on HEMS crashes in the United States from 1998 to 2012. They grouped crashes by type of operator.
- HEMS was involved in 139 of the 2,040 crashes reviewed (6.8%). These crashes killed 120 people and seriously injured 146.
- Of the 139 crashes, 118 involved commercial operators, 14 not-for-profit operators, and 7 public safety operators. Crash counts did not decline across 5-year blocks.
- Using NTSB probable cause findings, the authors counted human error in 91 of 118 commercial crashes and 2 of 7 public safety crashes. Pilot error was counted in 75 of 116 and 1 of 7, and the authors report both gaps as statistically significant.
- The authors point to training gaps, limited resources and equipment, and flight selection as key factors. Of the crash flights, 34 (24.5%) carried trauma patients.
Research into Practice takeaways
- A finding of pilot error shows where investigators placed cause. It does not show why choices made sense to the crew at the time.
- The public safety group had only 7 crashes. Comparisons with that group rest on small numbers.
- The study counts crashes, not missions or flight hours. It cannot say whether crash rates differ between operator types.
- Programs can look at how training, equipment, and the way flights are accepted shape risk in their own operation.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Two decades' experience with interfacility transport on extracorporeal membrane oxygenation
Bryner, Benjamin; Cooley, Elaine; Copenhaver, William; Brierley, Kristin; Teman, Nicholas; Landis, Denise; et al.
The Annals of Thoracic Surgery, 98(4), 1363-1370, 2014
Research highlights
Highlights
- This study combined about 20 years of extracorporeal membrane oxygenation (ECMO) transport data from one institution with a systematic review of other published case series.
- From 1990 to 2012, 221 patients came to the institution on ECMO. Of these, 135 (62%) survived to discharge.
- Another 27 case series covered 643 transported patients. Overall survival in those series was 61%.
- After grouping by age and reason for ECMO, the authors found no significant difference in survival between transported patients and ECMO patients in the international Extracorporeal Life Support Organization registry.
- One group differed. Children transported for respiratory failure had higher survival than the registry.
Research into Practice takeaways
- The authors conclude that ECMO transport is feasible and can be done safely in critically ill patients.
- Survival was compared with a registry, not with similar patients who were not moved. The abstract does not report problems during transport.
- The authors note that only a few programs have done many ECMO transports. Programs starting or reviewing this service can ask how their team, volume, and support compare.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 32(6), e27-e28, 2013
CONCERN Network bulletin, November/December 2013 issue.
Safety in Alpine Helicopter Rescue Operations—Minimal Requirements of Alpine Skills for Rescue Personnel
Küpper, Thomas; Hillebrandt, David; Steffgen, Juergen; Schöffl, Volker
The Annals of Occupational Hygiene, 57(9), 1180-1188, 2013
Research highlights
Highlights
- Researchers graded the terrain in one year of Alpine helicopter rescues, 2,731 missions in all.
- Rock was graded on the Union Internationale des Associations d'Alpinisme (UIAA) scale, and ice by slope angle. Terrain could be graded for 99.7% of missions.
- At least 30.7% of missions required advanced climbing skills from rescue staff.
- In 6.0% of missions the rock was UIAA grade III, and in 2.4% it was grade IV or higher. About 1.5% of missions took place on ice steeper than 50 degrees.
Research into Practice takeaways
- The authors suggest that every crew member other than the pilot be able to climb UIAA grade IV rock and 50-degree ice with proper rope and belay methods. They estimate this would cover 90% of missions.
- The proposed standard builds in a margin for bad weather and other hard conditions.
- Programs that fly mountain rescue can compare their crews' skill standards with the terrain they actually face. Terrain varies by region, so local data may differ.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Injury severity and seating position in accidents with German EMS helicopters
Hinkelbein, Jochen; Spelten, Oliver; Neuhaus, Christopher; Hinkelbein, Mandy; Özgür, Enver; Wetsch, Wolfgang A.
Accident Analysis & Prevention, 59, 283-288, 2013
Research highlights
Highlights
- Researchers reviewed 99 HEMS accidents in Germany from 1970 to 2009. The data came from the German Federal Agency for Flight Accident Investigation.
- Of the 99 accidents, 61 caused no injuries and 15 caused fatal injuries. Seven caused minor injuries and six caused severe injuries.
- The person in the patient position had the highest rate of fatal injury, at 44.9%.
- The rear seat used by a HEMS crew member had the next highest rate of fatal injury, at 25.0%. Other seats ranged from 9.4% to 11.2%.
- The rear crew seat also had the highest share of severe and minor injuries, at 12.5% each.
Research into Practice takeaways
- Where a person sat was linked to how badly they were hurt. Programs can look at seating and restraints for patients and rear crew members.
- This descriptive study spans 40 years. Aircraft types may have changed over that span, which may affect how the results apply today.
- The authors call for a large international HEMS accident database to support further safety research.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
An Investigation of Pilot Fatigue in Helicopter Emergency Medical Services
Nix, Sam; Gossett, Kenneth; Shepherd, Andrew D.
Air Medical Journal, 32(5), 275-279, 2013
Research highlights
Highlights
- The study surveyed 395 HEMS pilots in the United States while they were on duty.
- Fatigue was measured with the Brief Fatigue Inventory.
- The researchers tested whether fatigue was related to back-to-back day shifts, back-to-back night shifts, age, and HEMS flying experience.
- On night shifts, pilots with more HEMS experience reported higher fatigue scores. This held after accounting for consecutive night shifts and age.
- The authors describe this as some evidence of a link and call for more research to confirm it.
Research into Practice takeaways
- This was a survey of self-reported fatigue. It shows a link with experience, not a cause.
- Programs may not want to assume that senior pilots are less affected by night fatigue. Fatigue checks can apply to every pilot on a night shift.
- The authors also call for interviews or other qualitative work to record the ways experienced pilots manage fatigue.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 32(5), e23-e24, 2013
CONCERN Network bulletin, September/October 2013 issue.
Concern Network
Air Medical Journal, 32(4), e19-e20, 2013
CONCERN Network bulletin, July/August 2013 issue.
Concern Network
Air Medical Journal, 32(3), e13-e16, 2013
CONCERN Network bulletin, May/June 2013 issue.
A 10-Year Analysis of 214 HEMS Backcountry Hoist Rescues
Carpenter, Judi; Thomas, Frank
Air Medical Journal, 32(2), 98-101, 2013
Research highlights
Highlights
- This study reviewed 10 years of hoist rescues, from 2001 to 2011, at one operator. The authors describe it as the sole U.S. civilian HEMS operator with FAA Part 135 approval for hoist work.
- Of 214 victims, 212 were hoisted. Falls (38%) and being stranded (21%) were the most common reasons.
- Victims averaged 35 years of age, 79% were male, and 66% had trauma.
- Most victims (68%) needed a hospital afterward, reached by ground ambulance (24%) or by the program's aircraft (44%).
- Hoists clustered in the afternoon, on weekends (53%), and from May through September (71%). The average altitude was close to 7,500 feet.
Research into Practice takeaways
- Demand was seasonal and peaked on weekends. Programs planning hoist work can use patterns like these for staffing and training.
- Most hoisted people still needed hospital care. Hoist programs can plan for handoffs to ground or air transport.
- This is one operator in one region. The study describes who was hoisted and when, not patient outcomes.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 32(2), e7-e10, 2013
CONCERN Network bulletin, March/April 2013 issue.
Prevalence of Disease Spectrum and Sick Leave Time Associated with Illness in Helicopter Pilots
Xiao, Dan; Li, Haitao; Wang, Xia; Wang, Bo; Yan, Yongping; Men, Ke
Aviation, Space, and Environmental Medicine, 84(3), 234-236, 2013
Helicopter pilots generally; not specific to air medical operations.
Research highlights
Highlights
- This study looked at illness and sick leave among 516 helicopter pilots in China.
- Researchers used yearly aviation medical exam records and hospital records from a random sample.
- The digestive system (32%), heart and blood vessels (19%), and muscles and bones (12%) had the most disease.
- The longest sick leave came from digestive, musculoskeletal, and nervous system conditions.
- Fainting on the ground was not common, but it had the longest sick leave of any single condition at 157 days.
Research into Practice takeaways
- The conditions that were most common were not always the ones that kept pilots off duty the longest.
- The authors point to digestive and musculoskeletal conditions as having the most effect on pilot health and work.
- This study comes from one country and pilot population. Programs can look at their own fitness for duty data to see which conditions cost the most time.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 32(1), e1-e3, 2013
CONCERN Network bulletin, January/February 2013 issue.
Does Modern Helicopter Construction Reduce Noise Exposure in Helicopter Rescue Operations?
Küpper, Thomas; Jansing, Paul; Schöffl, Volker; van Der Giet, Simone
The Annals of Occupational Hygiene, 57(1), 34-42, 2013
Research highlights
Highlights
- Researchers estimated noise exposure for medical crews on rescue helicopters in the Alps.
- They reviewed one year of operations at four bases in Switzerland and Austria, 2,731 missions in all.
- Noise was measured at set points inside and outside the aircraft. Exposure was converted to an 8-hour equivalent level.
- Models compared older types such as the Alouette with newer ones such as the Eurocopter EC135.
- The authors report that newer helicopter designs have reduced noise exposure for crews.
Research into Practice takeaways
- Newer aircraft lower the risk but do not remove it. The authors say crews still need breaks from noise in their time off.
- The authors point to work outside the aircraft, such as winch operations, as the loudest exposure. Programs can review hearing protection for these tasks.
- The authors note that occupational medical checks for crews are still required, using the German G20 exam as an example.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The Effect of Shift Length on Fatigue and Cognitive Performance in Air Medical Providers
Guyette, Francis Xavier; Morley, Julia L.; Weaver, Matthew D.; Patterson, P. Daniel; Hostler, David
Prehospital Emergency Care, 17(1), 23-28, 2013
Research highlights
Highlights
- Flight nurses and flight paramedics from one air medical service took part. The convenience sample of 34 worked either 12-hour or 24-hour shifts.
- Before and after shifts, they completed sleep and fatigue surveys and a set of memory and thinking tests.
- Half of both groups had poor sleep quality on the Pittsburgh Sleep Quality Index.
- Self-rated fatigue was low before shifts (median 2 of 10) and lower after shifts (median 1 of 10).
- On average, providers got 6.8 hours of sleep on a 24-hour shift and 1 hour on a 12-hour shift. Changes in test scores did not differ between the two groups.
Research into Practice takeaways
- The authors note this service had low to moderate call volume. Results may not hold for busier programs.
- Half the sample had poor sleep quality even though self-rated fatigue was low. Programs can ask whether self-ratings alone give a full picture.
- This was a small sample at one service. It does not show that 24-hour shifts carry no cognitive cost in every setting.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
A blueprint for critical care transport research
Jaynes, Cathy L.; Werman, Howard A.; White, Lynn J.
Air Medical Journal, 32(1), 30-35, 2013
Research highlights
Highlights
- About 500,000 critical care transports are thought to occur in the United States each year. The authors note that little research exists to guide practice.
- A modified Delphi method, a structured way to build expert agreement, guided the work. Experts came from all parts of critical care transport.
- Twenty-seven participants produced and ranked 101 research questions.
- The questions grouped into eight areas. These were safety, human factors, clinical care, patient outcomes, team configuration, utilization, finance, and education and training.
- Each area was plotted by how urgent and how feasible it was.
Research into Practice takeaways
- The authors suggest the map can guide research planning and help set funding priorities.
- Programs can use the eight areas to see where their own questions fit and where data are missing.
- The list reflects the views of 27 experts. It is a starting agenda, not a measure of what matters most to every program.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Analyzing Communication Errors in an Air Medical Transport Service
Dalto, Joseph D.; Weir, Charlene; Thomas, Frank
Air Medical Journal, 32(3), 129-137, 2013
Research highlights
Highlights
- Researchers randomly picked 278 of 825 quality assurance reports from 2009 at one air medical service.
- They found 64 communication errors in 58 reports, about 21% of those reviewed.
- Staff who filed the reports had named only 18 of the 64 (28%) as communication errors.
- Using Clark's levels of communication, 66% of errors fell at level 1 and 33% at level 4. Levels 2 and 3 were rare.
Research into Practice takeaways
- Many communication problems went unnamed in reports. Programs can reread their own reports with a closer eye on communication.
- Clark's levels offer one way to sort these events. The authors call for a shared air medical communication ontology, a common set of terms and categories.
- The word error here describes a breakdown in an exchange. It does not assign blame to the people involved.
- This is one service and one year of reports. Patterns may differ elsewhere.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Appropriate and safe utilization of helicopter emergency medical services: a joint position statement with resource document
Floccare, Douglas J.; Stuhlmiller, David F. E.; Braithwaite, Sabina A. ; Thomas, Stephen H.; Madden, John F.; Hankins, Daniel G.; et al.
Prehospital Emergency Care, 17(4), 521-525, 2013
Research highlights
Highlights
- This position statement came from a writing group of four physician organizations. They were the Air Medical Physician Association, the American College of Emergency Physicians, the National Association of EMS Physicians, and the American Academy of Emergency Medicine.
- It names three ways HEMS can help patients. These are cutting time to definitive care for time-sensitive conditions, bringing special expertise or equipment, and reaching patients that other transport cannot reach.
- It treats the medical decision to use HEMS as separate from the aviation decision on whether a flight can be done safely.
- It calls for physicians with EMS and air medical training to help decide when HEMS is used. It also calls for them to help write guidelines and lead quality improvement.
- It also calls for operators to use safety management systems when accepting and continuing each transport, and for HEMS to be part of regional health care systems.
Research into Practice takeaways
- This is a consensus statement, not a study. It gives expert positions rather than new data.
- The statement says too many HEMS resources may lead to competition that affects use and safety, and too few may delay care. Programs can ask how their region decides on coverage.
- The authors call for national guidelines on HEMS use and a national agenda that includes research to refine those guidelines.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Cost-effectiveness of helicopter versus ground emergency medical services for trauma scene transport in the United States
Delgado, M. Kit; Staudenmayer, Kristan L.; Wang, N. Ewen; Spain, David A.; Weir, Sharada; Owens, Douglas K.; et al.
Annals of Emergency Medicine, 62(4), 351-364.e19, 2013
Research highlights
Highlights
- Researchers built a decision model that weighed cost against patient outcomes for helicopter versus ground EMS in trauma scene transport. It took a societal view over a patient's lifetime.
- Model inputs came from national trauma data, Medicare payments, and published studies.
- Helicopter EMS would need a relative cut in deaths of at least 15% (1.3 lives saved per 100 patients) to cost under $100,000 for each quality-adjusted life-year gained.
- To cost under $50,000 for each quality-adjusted life-year gained, the relative cut in deaths would need to reach 30% or more (3.3 lives per 100 patients).
- Fewer flights for patients with minor injuries, or better long-term disability outcomes, made helicopter EMS more cost-effective in the model.
Research into Practice takeaways
- This is a model, not a study of patients. Its results depend on the inputs the authors chose.
- The authors say current evidence does not make clear whether helicopter EMS reaches these levels.
- Overtriage of minor injuries affects the cost picture. Programs can look at how often their scene patients turn out to have minor injuries.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Pediatric and neonatal interfacility transport: results from a national consensus conference
Stroud, Michael H.; Trautman, Michael S.; Meyer, Keith; Moss, M. Michele; Schwartz, Hamilton P.; Bigham, Michael T.; et al.
Pediatrics, 132(2), 359-366, 2013
Perceived patient safety culture in a critical care transport program
Erler, Cheryl; Edwards, Nancy E.; Ritchey, Steve; Pesut, Daniel J.; Sands, Laura; Wu, Jingwei
Air Medical Journal, 32(4), 208-215, 2013
Research highlights
Highlights
- Researchers surveyed 76 staff members in one large critical care transport program in the Midwest of the United States.
- They used the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture to measure how staff saw safety culture.
- Teamwork, manager actions that support safety, and open communication were each linked to how often staff reported errors. Open communication had the strongest link with reporting (r = .575).
- The same three culture areas were linked to staff's overall sense of safety and to the patient safety grade they gave. Manager actions had the strongest link with overall sense of safety (r = .779).
Research into Practice takeaways
- This was a survey at one program at one point in time. It shows links, not causes, and it cannot show which came first.
- Programs can look at how staff rate manager support and open communication next to their own reporting rates.
- The authors offer the study as a starting point for more research on safety culture in transport programs.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Application of the FIA Score to German Rescue Helicopter Accidents to Predict Fatalities in Helicopter Emergency Medical Systems (HEMS) Crashes
Hinkelbein, Jochen; Schwalbe, Mandy; Wetsch, Wolfgang A.; Neuhaus, Christopher; Spelten, Oliver
The Journal of Emergency Medicine, 43(6), 1014-1019, 2012
Research highlights
Highlights
- The FIA Score rates the risk of death in an aircraft crash on three factors. F is fire, I is instrument weather conditions, and A is a crash site away from an airport.
- Two emergency physician pilots scored German HEMS accidents from 1970 to 2009 using records from the federal accident investigation agency.
- Of 99 accidents, 19.2% had at least one death. In 63 (63.6%) no one was injured.
- Complete data were available for 72 accidents.
- Fatality rates rose with the score. They were 0% at a score of 0, 8.1% at 1, 53.3% at 2, and 100% at 3.
Research into Practice takeaways
- The score is simple to apply. The authors suggest it could help EMS call centers judge survival chances after a crash.
- The study looks at what makes a crash deadly, not why it happens.
- Programs can ask how their emergency response plans use early reports of fire, poor weather, or an off-airport site.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 31(6), e21-e22, 2012
CONCERN Network bulletin, November/December 2012 issue.
Air Medical Accident/Incident Preparation, Response, and Recovery: Lessons from Crash Survivors
Association of Air Medical Services, Survivors Network, 2012
Concern Network
Air Medical Journal, 31(5), e15-e16, 2012
CONCERN Network bulletin, September/October 2012 issue.
CT Examination of the Pericardium and Lungs in Helicopter Pilots Exposed to Vibration and Noise
Kåsin, Jan Ivar; Kjellevand, Tor Ole; Kjekshus, John; Nesheim, Geir B.; Wagstaff, Anthony
Aviation, Space, and Environmental Medicine, 83(9), 858-864, 2012
Helicopter pilots generally; not specific to air medical operations.
Research highlights
Highlights
- This study checked whether helicopter pilots show signs of vibroacoustic disease, a condition some researchers have tied to vibration and noise.
- Researchers compared 27 helicopter pilots with office workers of the same age.
- High resolution CT scans of the chest were read by two radiologists who did not know which group each person was in.
- Neither group showed thickening of the sac around the heart or meaningful lung scarring. Average thickness was about 1.38 mm for pilots and 1.37 mm for controls.
- Thickness showed no significant link with age or flight hours.
Research into Practice takeaways
- The authors conclude that the scans do not support vibroacoustic disease, whose main sign is a thicker sac around the heart.
- This was a small study that looked at one sign of the condition. It does not rule out other effects of vibration and noise on crews.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopter rescue operations involving winching of an emergency physician
Pasquier, M.; Geiser, V.; De Riedmatten, M.; Carron, P. N.
Injury, 43(9), 1377-1380, 2012
Research highlights
Highlights
- This study reviewed alpine rescue missions from 2003 to 2008 at one helicopter EMS service where an emergency physician was winched down to the patient.
- There were 921 patients. Men outnumbered women 2 to 1, and 56 (6%) were 15 or younger.
- Most patients (840, or 91%) had trauma, most often from falls during sports. Leg and head injuries were the most common.
- Take-off came a median of 7 minutes after the emergency call.
- About 27% (246) had a possible or actual threat to life. Medical cases were fewer (81, or 9%) but more severe than trauma cases on the National Advisory Committee for Aeronautics (NACA) severity score.
Research into Practice takeaways
- The authors say the findings support winching a physician for advanced care and pain relief on scene.
- Over half of patients (478) received strong pain medicine, and 39 (4%) needed major interventions. Teams with hoist work can look at what care their crews give on scene before pickup.
- This is one service in an alpine setting. Programs with other staffing or terrain can weigh how far it applies.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 31(4), e13, 2012
CONCERN Network bulletin, July/August 2012 issue.
Concern Network
Air Medical Journal, 31(3), e9-e11, 2012
CONCERN Network bulletin, May/June 2012 issue.
Simulator Training: Reducing Risk in Helicopter Rescue
Petri, Maximilian; Friedrich, Lars; Hildebrand, Frank; Mommsen, Philipp; Brand, Stephan; Hubrich, Volker; et al.
Air Medical Journal, 31(3), 117-123, 2012
Safety culture in the air ambulance services
Abrahamsen, Håkon Bjorheim; Abrahamsen, Eirik Bjorheim; Lossius, Hans Morten
Tidsskrift for Den norske legeforening, 132(7), 797-798, 2012
A systemic analysis of patterns of organizational breakdowns in accidents: A case from Helicopter Emergency Medical Service (HEMS) operations
Kontogiannis, Tom; Malakis, Stathis
Reliability Engineering & System Safety, 99, 193-208, 2012
Concern Network
Air Medical Journal, 31(2), e7, 2012
CONCERN Network bulletin, March/April 2012 issue.
Helicopter Rescue Involving the Winching of a Physician
Corniche, Jocelyn; Pasquier, Mathieu; Yersin, Bertrand; Kern, Christian; Schoettker, Patrick
Air Medical Journal, 31(2), 87-91, 2012
Research highlights
Highlights
- This prospective study covered 133 patients reached by a winched physician at one helicopter service in pre-alpine Switzerland, from 1998 to 2002.
- Most patients were male (74%), and most had traumatic injuries (77%).
- The nine most severely injured patients had longer scene times, a median of 54 minutes compared with 37 for others.
- The most common procedures were intubation (5 patients), fracture reduction (5), strong pain relief with sedation (4), and more than 1,500 mL of IV fluid (4).
- The physician judged that 14 patients (10%) with minor injuries did not need to be flown. No patient had died by the 48-hour mark.
Research into Practice takeaways
- In this service, the winched physician also made triage calls on scene. Some patients did not need a flight at all.
- Severe injuries were linked to longer scene times. Programs with hoist operations can plan for that extra time on scene.
- This is one service in one region. Results may differ with other terrain or staffing models.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Preliminary study of the pilot’s workload during emergency procedures in helicopters air operations
Bezerra, Flávio G. V.; Ribeiro, Selma L. O.
Work, 41(S1), 225-231, 2012
Military and law enforcement helicopter pilots; not specific to air medical operations.
Research highlights
Highlights
- This preliminary study tested tools and a protocol for measuring helicopter pilot workload during emergencies.
- Ten pilots volunteered. They had flown several helicopter types and took part during real flight training.
- The researchers set up four emergency procedure scenarios in the HB-350 Squirrel.
- Workload was rated with the NASA-TLX scale, and pilots were interviewed about their main tasks. This report used only the physical and mental demand ratings.
- Early results point to time pressure as a factor that raised mental demand. It showed up in tasks such as figuring out what had failed, paying attention, and monitoring parameters.
Research into Practice takeaways
- With 10 pilots and part of the data, these results are early. The authors plan a larger sample and physiological measures.
- Programs can ask where their emergency procedures and training ask pilots to diagnose a problem under time pressure.
- The abstract frames the work around military and law enforcement flying. Its fit with air medical operations was not tested.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 31(1), e1-e4, 2012
CONCERN Network bulletin, January/February 2012 issue.
Should helicopters have a hoist or ‘long-line’ capability to perform mountain rescue in the UK?
Ellerton, John; Gilbert, Hannah
Emergency Medicine Journal, 29(1), 56-59, 2012
Research highlights
Highlights
- Researchers reviewed stretcher evacuations by a mountain rescue team based in Patterdale, in the English Lake District, from 2006 to 2008.
- For 119 casualties, the median route from casualty to helicopter landing site was 250 m across, with a median vertical change of -30 m.
- Planned hand carries were 100 m or less for 33 casualties (28%), 101 to 400 m for 60 (50%), and over 400 m for 26 (22%).
- A technical rope evacuation was needed for 31 of 119 (26%). For 13 of 119 (11%), the site was out of reach even for a hoist or long-line helicopter.
- Counting casualties who needed a technical rescue or a carry over 400 m, the authors estimate 34% could have been rescued by hoist or long-line.
Research into Practice takeaways
- The authors expect hoist or long-line access would shorten prehospital time for about a third of these casualties. That time saving was estimated, not measured.
- The authors call for UK mountain rescue helicopters to be equipped to international standards. This is their view based on one rescue team's records.
- Programs weighing hoist capability can look at their own terrain, carry distances, and how often ropes are needed.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Aeronautical Decision Making in Helicopter Emergency Medical Systems (HEMS): The Effect of Mission Orientation and Local Base Finances on the Go/No Go Decision
Cline, Paul E.
Master's thesis, University of North Dakota, 2012
Association between helicopter vs ground emergency medical services and survival for adults with major trauma
Galvagno, Samuel M.; Haut, Elliott R.; Zafar, S. Nabeel; Millin, Michael G.; Efron, David T.; Koenig, George J.; et al.
JAMA, 307(15), 1602-1610, 2012
Research highlights
Highlights
- Researchers looked back at 223,475 patients over age 15 with serious blunt or penetrating injuries. All were taken to U.S. level I or II trauma centers.
- The data came from the 2007 to 2009 files of the American College of Surgeons National Trauma Data Bank.
- Of these patients, 61,909 went by helicopter and 161,566 went by ground. Before adjustment, 12.6% of helicopter patients died, compared with 11% of ground patients.
- Helicopter patients had more severe injuries at the outset. After the authors matched patients on known factors, helicopter transport was linked to better odds of surviving to discharge (odds ratio 1.16 at level I centers and 1.15 at level II centers).
- At level I centers, more helicopter patients went on to rehabilitation, 18.2% compared with 12.7% of ground patients.
Research into Practice takeaways
- The raw death rate was higher in the helicopter group, and the survival link appeared only after adjustment for injury severity and other known factors. How a study adjusts for differences shapes what it finds.
- The absolute gain was about 1.5 percentage points at level I centers and 1.4 at level II centers. Readers can look at absolute differences, not only odds ratios.
- This is an observational study of registry data. It shows an association, and factors the registry did not capture may still play a part.
- The abstract does not say which patients showed the strongest link. Teams that review triage criteria may want to watch for research on that question.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Strategies to Reduce US HEMS Accidents
Winn, William; Thomas, Frank; Johnson, Kent
Air Medical Journal, 31(2), 78-83, 2012
Helicopter Type and Accident Severity in Helicopter Emergency Medical Services Missions
Hinkelbein, Jochen; Schwalbe, Mandy; Wetsch, Wolfgang A.; Spelten, Oliver; Neuhaus, Christopher
Aviation, Space, and Environmental Medicine, 82(12), 1148-1152, 2011
Research highlights
Highlights
- This study looked at HEMS accidents in Germany from 1970 to 2009. Each accident was sorted by its worst injury, and only models with at least 5 accidents were included.
- Of 99 accidents, 63 had no injuries, 8 had minor injuries, 9 had major injuries, and 19 were fatal.
- The BO105 had the most accidents, with 38 of the 99. The BK117 and UH-1D came next.
- The EC135 and BK117 had the highest share of uninjured occupants and the lowest share of fatal accidents. These differences were not statistically significant.
- Most fatal accidents involved the UH-1D and other Bell models.
Research into Practice takeaways
- The authors suggest these data can help estimate how severe accidents may be by helicopter model.
- The abstract counts accidents, not accidents per flight hour. It does not report adjusting for when or how each model was flown.
- Programs can look at injury outcomes, not only accident counts, when they think about survivability.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 30(6), 299-300, 2011
CONCERN Network bulletin, November/December 2011 issue.
Incidents, accidents and fatalities in 40 years of German helicopter emergency medical system operations
Hinkelbein, Jochen; Schwalbe, Mandy; Neuhaus, Christopher; Wetsch, Wolfgang A.; Genzwürker, Harald V.
European Journal of Anaesthesiology, 28(11), 766-773, 2011
Research highlights
Highlights
- This retrospective study reviewed German HEMS accidents from 1970 to 2009. Sources were federal accident reports, operator interviews, publications, and internet searches.
- About 1.698 million missions were flown in that period, with 99 accidents. That is about 2.4 accidents a year on average.
- There were 0.57 accidents per 10,000 missions. Fatal accidents occurred at 0.11 per 10,000.
- Striking an obstacle while landing, taking off, or hovering made up 43.4% of accidents. Landing was the phase most often tied to accidents, at 44.4%.
- Accidents per 10,000 missions were significantly lower than in earlier data.
Research into Practice takeaways
- Programs can look at how crews spot and clear obstacles near the ground during landing, takeoff, and hover.
- The authors say HEMS risk has dropped since the early years but remains higher than commercial aviation.
- The authors note that data from the early years were hard to collect. They say more work is needed on fatality risk and injury patterns.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The effect of transportation suit induced heat stress on helicopter underwater escape preparation and task performance
Taber, Michael J.; Dies, Natalie F.; Cheung, Stephen S.
Applied Ergonomics, 42(6), 883-889, 2011
Offshore helicopter passengers; not specific to air medical crews.
Research highlights
Highlights
- Eleven people did underwater escape drills while wearing helicopter transport survival suits.
- Each person did the drill at two room temperatures, 21 °C and 34 °C. A recorded emergency message played at a random time between 50 and 90 minutes.
- By the end of each trial, skin and core body temperatures had risen, and the rise was statistically significant.
- Escape performance was not impaired in either condition.
- Participants rated situation awareness and thermal comfort after each trial. The authors note that offshore transport helicopter cabins are seen as hot and uncomfortable.
Research into Practice takeaways
- This was a small lab study of 11 people. The suits studied were for offshore transport, not air medical crews.
- The finding covers the first 90 minutes of flight. It does not show what happens on longer flights.
- Heat from required gear can affect comfort even when escape is not affected. Programs can ask how cabin heat affects crews across a full shift.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 30(5), 238, 2011
CONCERN Network bulletin, September/October 2011 issue.
Influence of Stressors on HEMS Crewmembers in Flight
Carchietti, Elio; Valent, Francesca; Cecchi, Adriana; Rammer, Raphael
Air Medical Journal, 30(5), 270-275, 2011
Research highlights
Highlights
- Researchers measured heart rate, blood pressure, and oxygen saturation before and after flights in a regional HEMS in Friuli Venezia Giulia, Italy.
- Data covered 95 shifts and 162 flights across 2009 and 2010.
- Only heart rate changed significantly after flight, with a median rise of 15 beats per minute.
- Heart rate rose more after flights in bad weather, in hostile settings, and at high altitude.
- After adjustment, technical crew had higher heart rates after flight than physicians and nurses.
Research into Practice takeaways
- Flight conditions, not only the patient, may add to crew stress. Programs can look at how they support crews after missions in hard weather or terrain.
- Stress support may need to reach every role on the aircraft, including technical crew, not only clinicians.
- The authors suggest tracking these measures to spot acute stress. Crew took part by choice, which may affect who was measured.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 30(4), 185-186, 2011
CONCERN Network bulletin, July/August 2011 issue.
Concern Network
Air Medical Journal, 30(3), 124, 2011
CONCERN Network bulletin, May/June 2011 issue.
Air Medical Providers' Physiological Response to a Simulated Trauma Scenario
Hinchey, Paul R.; De Maio, Valerie J.; Patel, Amar; Cabañas, Jose G.
Air Medical Journal, 30(2), 86-92, 2011
Research highlights
Highlights
- Nineteen providers from the air medical team of a level 1 trauma center took part in a high-fidelity trauma simulation in an ambulance.
- Providers were randomly assigned to an adult or a pediatric case. Heart rate was tracked by wireless monitor, along with video, from first patient contact until the patient was packaged.
- Heart rate rose from intake to the start of the scenario, leveled off, then jumped when the scenario ended.
- Less experienced providers had higher heart rates before the scenario, 106 compared with 92 beats per minute. Their peak was also higher, 132 compared with 123.
Research into Practice takeaways
- Heart rate, used here as a stand-in for stress, rose during the simulation. Simulation may offer practice under some stress, but the study did not compare it with live missions.
- Newer providers showed more stress before the case began. Educators can keep this in mind when planning practice for less experienced staff.
- The sample was small, and heart rate is only one stress marker. The authors suggest testing whether the response lasts and whether it matches live missions.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 30(2), 74-75, 2011
CONCERN Network bulletin, March/April 2011 issue.
Does Wearing a Surgical Facemask or N95-Respirator Impair Radio Communication?
Thomas, Frank; Allen, Craig; Butts, William; Rhoades, Carol; Brandon, Cynthia; Handrahan, Diana L.
Air Medical Journal, 30(2), 97-102, 2011
Research highlights
Highlights
- A HEMS pilot read 20 aviation terms over the radio while wearing a surgical facemask or one of six N95 respirators.
- A flight crew member and a layperson in a Bell 407 cabin wrote down what they heard. So did a dispatcher in a communication center.
- With the engine off, listeners got every term right with or without a mask.
- With the engine on, the surgical mask and two N95 models stayed at 100%. The other N95 models ranged from 93% to 98%.
Research into Practice takeaways
- Small losses in accuracy can matter on key radio calls. The authors advise HEMS pilots and crew to be aware of these effects when wearing an N95 in transport.
- Programs can check how the masks they stock affect radio clarity in their own aircraft.
- One pilot spoke single terms to three listeners in a test setting. The abstract does not report tests of full radio exchanges in flight.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Web-Based Media for Landing Zone Safety Instruction
Bellazzini, Marc A.; Repplinger, Michael D.; Gangnon, Ronald E.
Air Medical Journal, 30(2), 93-96, 2011
Research highlights
Highlights
- This randomized study tested a 5-minute online video on landing zone safety with 257 first responders.
- Participants included 114 firefighters, 62 EMTs, and 80 people who held both roles.
- Groups were assigned to post-video testing right away or at 2, 4, or 6 months. Of the 257, 184 (71.6%) finished.
- Scores rose 11.1% in the immediate group, 9.0% at 2 months, and 9.9% at 6 months. All three gains were statistically significant.
- The 4-month group rose 2.3%, which was not statistically significant.
Research into Practice takeaways
- Short online videos may be a practical way to reach the ground crews who set up landing zones.
- Fewer than two thirds finished in the 2, 4, and 6 month groups. Dropouts could affect how well the results hold up.
- The study tested knowledge, not how landing zones were run on real calls.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Communication Errors in Dispatch of Air Medical Transport
Vilensky, Daniel; MacDonald, Russell D.
Prehospital Emergency Care, 15(1), 39-43, 2011
Research highlights
Highlights
- Researchers examined requests for urgent interfacility air medical transport over two straight weeks.
- After each booking call, investigators called the sending facility to check the details and find errors.
- Of 98 calls that met criteria, 41 (42%) had at least one error, for 65 errors in total.
- Eleven errors were major, meaning they could affect care. The most common were a drug allergy listed as none when the patient had one, a wrong diagnosis, and a missing note that the patient was intubated or on a ventilator.
- The other 54 errors were minor, and most were omissions. No identified error led to patient harm.
Research into Practice takeaways
- Nearly half the errors were traced to procedures and software. Programs can look at their intake forms and systems, not only at the people on the call.
- The authors found that human and process factors contributed equally. A review of booking errors can look at both.
- This was a short sample at one communication center. Error rates in other centers may differ.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 30(1), 23-26, 2011
CONCERN Network bulletin, January/February 2011 issue.
Intermountain Life Flight Preflight Risk Assessment Score and Transport Outcomes
Thomas, Frank; Groke, Steve; Handrahan, Diana
Air Medical Journal, 30(1), 49-54, 2011
Research highlights
Highlights
- One program reviewed its preflight risk assessment scores (PRAS) from August 2005 to April 2008.
- Pilots filed a PRAS report when the score was 15 or higher, or when weather led to an aborted or turned-down flight.
- Of 4,986 transports, 4,844 (97%) had a score under 15.
- All 28 transports with a score of 15 or higher for reasons other than weather were completed.
- Weather-related scores looked alike for 20 aborted and 65 turned-down flights. Of the weather-related reports, 41% had scores under 15.
Research into Practice takeaways
- Many weather-related aborts and turndowns came with scores under 15. Programs can compare their own risk scores with what happens on weather flights.
- Reports were filed only in some cases, at one program. The data do not show how scores behaved on every flight.
- An aborted or turned-down flight reflects a safety decision. Studies like this can help programs see how scores relate to those choices.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Fixed-Wing Medical Transport Crashes: Characteristics Associated with Fatal Outcomes
Handel, Daniel A.; Yackel, Thomas R.
Air Medical Journal, 30(3), 149-152, 2011
Research highlights
Highlights
- Researchers used NTSB accident data from 1984 to 2009 to study crashes of fixed-wing medical flights.
- Fatal outcomes were more common in medical flights than in commercial flights, 35.6% compared with 19.7%.
- Medical flight crashes also had more aircraft fires (20.3% compared with 10.5%) and more collisions on the ground (5.1% compared with 2.0%).
- Fire occurred in 12 of 21 fatal crashes and in 2 of 38 nonfatal crashes.
- In a regression model, fire was the only factor linked to higher odds of a fatal outcome.
Research into Practice takeaways
- Fire after a crash was the factor most tied to death in these records. Programs that fly fixed-wing aircraft can review what they know about fire risk in their fleet.
- The odds ratio for fire had a wide confidence interval, from 4.28 to 808.23. The direction is clear, but the size of the effect is not.
- The crash count was small. These are links in accident records, not proven causes.
- The authors note that the fire finding matches earlier studies of helicopter medical transport.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopters improve survival in seriously injured patients requiring interfacility transfer for definitive care
Brown, Joshua B.; Stassen, Nicole A.; Bankey, Paul E.; Sangosanya, Ayodele T.; Cheng, Julius D.; Gestring, Mark L.
The Journal of Trauma, 70(2), 310-314, 2011
Research highlights
Highlights
- Researchers used the National Trauma Databank to study 74,779 trauma patients moved between hospitals in 2007. One in five went by helicopter.
- Helicopter patients were more severely injured (mean Injury Severity Score 17 compared with 12). They were also more often admitted to the ICU (54% compared with 29%).
- Helicopter transfers were faster. Transport took 61 minutes on average compared with 98, and total prehospital time was 135 minutes compared with 202.
- Helicopter transport did not predict survival overall or for patients with an Injury Severity Score of 15 or less. For scores above 15, it predicted survival (odds ratio 1.09).
Research into Practice takeaways
- The survival link appeared only in the most severely injured patients. Programs can review how injury severity enters their interfacility transfer decisions.
- The authors suggest these findings be weighed when setting transfer policies for severe injuries.
- This is registry data from one year. It shows associations, not proof of cause.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 29(6), 282-284, 2010
CONCERN Network bulletin, November/December 2010 issue.
HEMS Simulator Training for Safety and Clinical Proficiency
Winn, William T.
Air Medical Journal, 29(6), 300-303, 2010
Concern Network
Air Medical Journal, 29(5), 214-215, 2010
CONCERN Network bulletin, September/October 2010 issue.
Prevalence of Low Back Pain (LBP) in Rotary Wing Aviation Pilots
Cunningham, Laura K.; Docherty, Sharon; Tyler, Alan W.
Aviation, Space, and Environmental Medicine, 81(8), 774-778, 2010
Military and civilian helicopter pilots; not specific to air medical operations.
Research highlights
Highlights
- Researchers surveyed Royal Air Force (RAF) helicopter pilots and civilian helicopter pilots in the United Kingdom about low back pain.
- Civilian pilots included air ambulance and coastguard pilots. About 40% of them had flown in the military before.
- RAF pilots were younger on average (about 39 years) than civilian pilots (about 47 years).
- Low back pain was common in both groups, at 83% of RAF pilots and 81% of civilian pilots. The type of pain was similar.
- About 33% of RAF pilots and 55% of civilian pilots used a back support.
Research into Practice takeaways
- The survey does not show what causes the back pain. The authors say several factors may play a part.
- The authors call for a larger study of civilian pilots, including those without military flying.
- The authors suggest lumbar support may help in the meantime. The survey did not test this.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 29(4), 150-169, 2010
CONCERN Network bulletin, July/August 2010 issue.
Occupational Health and Safety Assessment of Exposure to Jet Fuel Combustion Products in Air Medical Transport
MacDonald, Russell D.; Thomas, Laura; Rusk, Frederick C.; Marques, Shauna D.; McGuire, Dan
Prehospital Emergency Care, 14(2), 202-208, 2010
Research highlights
Highlights
- Researchers sampled air in the paramedic breathing zone of a Beechcraft King Air B200 for about 60 minutes, from just before boarding through startup and flight.
- They compared three engine start setups. These were an internal start with the door closed, a ground power unit start with the door open, and a ground power unit start of the right engine only with the door open.
- Aldehydes, polycyclic aromatic hydrocarbons, aliphatic hydrocarbons, and volatile organic compounds were at very low levels or below detection limits.
- Carbon monoxide and total volatile organic compounds rose when a ground power unit started both engines. Particulate exposure also differed between that setup and the right-engine-only start.
- The other two setups showed no meaningful exposure. All levels stayed within U.S. and Canadian exposure limits.
Research into Practice takeaways
- The authors suggest avoiding ground power unit starts of both engines and closing the hangar door before start to cut exposure.
- Exposure depended on the start procedure, not only on the aircraft. Programs can look at ground procedures as part of crew health.
- The study used one aircraft type and one fuel. Programs with other aircraft or start methods can ask how their setup compares.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 29(3), 110-111, 2010
CONCERN Network bulletin, May/June 2010 issue.
Concern Network
Air Medical Journal, 29(2), 71-77, 2010
CONCERN Network bulletin, March/April 2010 issue.
A Literature Review of Air Medical Work Hazards and Pregnancy
Van Dyke, Patricia
Air Medical Journal, 29(1), 40-47, 2010
Concern Network
Air Medical Journal, 29(1), 20-22, 2010
CONCERN Network bulletin, January/February 2010 issue.
Noise exposure during ambulance flights and repatriation operations
Küpper, Thomas E.; Zimmer, Bernd; Conrad, Gerson; Jansing, Paul; Hardt, Aline
International Journal of Occupational Medicine and Environmental Health, 23(4), 323-329, 2010
Research highlights
Highlights
- Researchers measured noise inside a Learjet 35A, the aircraft type used most often for international patient repatriation.
- Readings came from spots where crews usually spend their time, during several real repatriation flights.
- The team combined noise readings with daily flight hours to estimate the crews' equivalent noise exposure at work.
- Measured cabin levels were just under the 85 dB(A) threshold.
- Engine noise outside the cabin exceeded the 85 dB(A) threshold.
Research into Practice takeaways
- The authors expect no permanent hearing loss at these cabin levels if crews avoid other loud noise outside work.
- The authors suggest keeping doors closed while engines run and using hearing protection for any task outside or with doors open.
- The study covers one aircraft type. Programs flying other aircraft can ask whether they have noise data for their own fleet.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Helicopters and the civilian trauma system: national utilization patterns demonstrate improved outcomes after traumatic injury
Brown, Joshua B.; Stassen, Nicole A.; Bankey, Paul E.; Sangosanya, Ayodele T.; Cheng, Julius D.; Gestring, Mark L.
The Journal of Trauma, 69(5), 1030-1034; discussion 1034-1036, 2010
Research highlights
Highlights
- Researchers used the National Trauma Databank to compare 258,387 patients taken from the scene in 2007. Of these, 16% went by helicopter and 84% by ground.
- Helicopter patients had a higher mean Injury Severity Score (15.9 compared with 10.2) and longer transport times.
- Helicopter patients were more often admitted to the ICU (43.5% compared with 22.9%) and placed on a ventilator (20.8% compared with 7.4%).
- After adjustment, helicopter transport was linked to higher odds of survival (odds ratio 1.22) and of discharge home (odds ratio 1.05).
Research into Practice takeaways
- These are adjusted links in registry data. They do not prove that the helicopter caused better outcomes.
- Helicopter patients were sicker yet more likely to survive after adjustment. Programs can compare their own patient mix and outcomes with ground transport.
- The data cover a single year, 2007.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Pilot Fatigue Survey: Exploring Fatigue Factors in Air Medical Operations
Gregory, Kevin B.; Winn, William; Johnson, Kent; Rosekind, Mark R.
Air Medical Journal, 29(6), 309-319, 2010
Research highlights
Highlights
- A national online survey of air medical pilots drew 697 responses.
- Most rotor-wing pilots worked 3/3/7 or 7/7 duty schedules.
- Over 84% said fatigue had affected how they flew. Less than 28% said they had nodded off in flight.
- More than 90% had a separate rest area with a bed at work. Over 90% said their company had no rules limiting sleep on duty.
- About half got 4 or more hours of sleep on a typical night shift. About half said sleep inertia, the grogginess after waking, had never put a flight at risk.
Research into Practice takeaways
- Most pilots in this survey said fatigue had touched their flying. This is self-report and does not show how often fatigue led to events.
- The authors see on-site sleep rooms as one practice that can reduce fatigue effects. Programs can look at how rest space and on-duty sleep policy support crews.
- Over 90% preferred to sleep at night and deal with grogginess if called. The authors call for more study of sleep inertia and for alertness management programs.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The emergency medical services safety attitudes questionnaire
Patterson, P. Daniel; Huang, David T.; Fairbanks, Rollin J.; Wang, Henry E.
American Journal of Medical Quality, 25(2), 109-115, 2010
EMS-wide U.S. instrument study; the sample includes air medical agencies.
Research highlights
Highlights
- The authors adapted the Safety Attitudes Questionnaire for EMS and tested it at 3 EMS agencies in one large metropolitan area.
- The tool covers six areas. These include safety climate, teamwork climate, stress recognition, job satisfaction, working conditions, and views of management.
- The response rate was high and internal consistency was acceptable. Model fit supported the tool's validity.
- Some agencies raised concerns about the time it took to complete and about the wording of some items.
- Safety culture scores varied between agencies in the same area and across types of respondents.
Research into Practice takeaways
- Safety culture differed between agencies in the same region. A single regional score may hide local differences.
- Agency leaders found some items unclear or burdensome. Programs that adapt a survey can pilot it with their own staff first.
- The abstract does not say whether air medical crews took part. The results speak to whether the tool works, not to how safe the agencies are.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 28(6), 276-277, 2009
CONCERN Network bulletin, November/December 2009 issue.
Concern Network
Air Medical Journal, 28(5), 218-221, 2009
CONCERN Network bulletin, September/October 2009 issue.
For Emergency Medical Service Helicopter Pilots, All Wind Is Local
Robinson, Bruce R.; Johnson, David
Air Medical Journal, 28(5), 232-256, 2009
Transport Nurse Safety Practices, Perceptions, and Experiences: The Air and Surface Transport Nurses Association Survey
Frakes, Michael A.; High, Kevin; Stocking, Jacqueline
Air Medical Journal, 28(5), 250-255, 2009
Concern Network
Air Medical Journal, 28(4), 179-182, 2009
CONCERN Network bulletin, July/August 2009 issue.
Safety Management as a Foundation for Evidence-Based Aeromedical Standards and Reporting of Medical Events
Evans, Anthony D.; Watson, Dougal B.; Evans, Sally A.; Hastings, John; Singh, Jarnail; Thibeault, Claude
Aviation, Space, and Environmental Medicine, 80(6), 511-515, 2009
Aircrew medical standards and certification; not air medical transport.
Research highlights
Highlights
- This paper looks at the aviation medical standards set by the International Civil Aviation Organization (ICAO).
- The author notes that countries read these standards in different ways. As a result, national policies are not well aligned.
- The paper proposes safety management systems as a way to use medical data to improve flight safety.
- It names four areas. These are matching the timing and content of routine medical exams to risk, better reporting of exam data, better reporting of medical events in flight, and a culture that supports reporting.
Research into Practice takeaways
- This is a discussion paper, not a study with new data.
- The paper treats medical reporting as part of safety management, not only as a pass or fail check.
- Here, medical events refers to aviation medicine and flight safety. The abstract does not address patient care in flight.
- Programs can ask whether aviation medical events reach their own safety reporting and review.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Stress during simulated emergency transportation in a rescue helicopter: Cross-correlation between stress hormones, vital functions and subjective well-being
Witzel, K.; Elzer, M.; Koch, Horst J.
Acta Physiologica Hungarica, 96(2), 221-230, 2009
Research highlights
Highlights
- Twenty-three healthy volunteers took part in a 15-minute simulated transport in a rescue helicopter.
- Researchers tracked heart rate and other body functions during the flight, along with the stress hormones ACTH, cortisol, and prolactin. Volunteers answered a standard questionnaire before and after.
- Heart rate and related measures rose during takeoff. Cortisol and ACTH were highest before takeoff and then fell over time.
- Volunteers reported fear and concern before takeoff. Afterward they said the flight was less stressful than they had expected.
- Diastolic blood pressure and prolactin were linked to questionnaire items such as staff behavior and nausea. Heart rate was linked to anxiety scores.
Research into Practice takeaways
- The authors read the stress response as a reason to favor smooth transports and attentive staff behavior toward patients.
- Cortisol and ACTH peaked before takeoff. Teams may want to look at what patients see and hear in the minutes before departure.
- These were healthy volunteers in a simulation. Patients who are ill or injured may respond differently.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 28(3), 120-122, 2009
CONCERN Network bulletin, May/June 2009 issue.
Aviation Safety: Potential Strategies to Address Air Ambulance Safety Concerns
Dillingham, Gerald L.
U.S. Government Accountability Office. GAO-09-627T, 2009
Testimony before the House Subcommittee on Aviation, April 22, 2009.
Concern Network
Air Medical Journal, 28(2), 68-70, 2009
CONCERN Network bulletin, March/April 2009 issue.
Federal Preemption of State Regulation Over Air Ambulances
Scarano, R. Michael; Bryant, Bill
Air Medical Journal, 28(2), 77-87, 2009
Helicopter Air Medical Transport Safety: What is the Role of the Emergency Nurse?
Worley, Gordon H.
Journal of Emergency Nursing, 35(2), 152-153, 2009
An Analysis of HEMS Accidents and Accident Rates
Blumen, Ira J.
National Transportation Safety Board public hearing on helicopter emergency medical services safety, 2009
Presentation slides from the February 2009 NTSB public hearing on helicopter emergency medical services safety.
Concern Network
Air Medical Journal, 28(1), 14-16, 2009
CONCERN Network bulletin, January/February 2009 issue.
The Changing Role of Air Medical Communication Specialists
Cockerill, Robin; Hickman, Garet; Thomas, Frank
Air Medical Journal, 28(1), 26-30, 2009
Incidence and predictors of critical events during urgent air-medical transport
Singh, Jeffrey M.; MacDonald, Russell D.; Bronskill, Susan E.; Schull, Michael J.
CMAJ, 181(9), 579-584, 2009
Canadian study (Ornge).
Research highlights
Highlights
- This retrospective cohort study covered all adults flown on urgent air medical transport in Ontario, Canada, from January 2004 to May 2006.
- The study covered 19,228 patients. A critical event occurred in 5.1% of transports, or about one event for every 12.6 hours of transport time.
- Critical events were death, a major resuscitation procedure, a drop in blood pressure or circulation, or unplanned extubation or respiratory arrest. Most were new low blood pressure or airway procedures.
- Events were linked to assisted breathing before transport, unstable circulation before transport, female sex, fixed-wing transport, longer transport time, and scene calls.
- Transports with advanced care paramedics had lower odds of an event than those with critical care paramedics (adjusted odds ratio 0.6).
Research into Practice takeaways
- Risk factors appeared in the patient, in the transport itself, and in the system. Programs can review each of these levels in their own event data.
- The abstract does not explain why crew type was linked to events. It is an association, not a measure of crew skill.
- The authors suggest the results can inform training for paramedic transport crews and the way patients are triaged and transported.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Pediatric specialized transport teams are associated with improved outcomes
Orr, Richard A.; Felmet, Kathryn A.; Han, Yong; McCloskey, Karin A.; Dragotta, Michelle A.; Bills, Debra M.; et al.
Pediatrics, 124(1), 40-48, 2009
Research highlights
Highlights
- This prospective cohort study at one center in Pittsburgh followed 1,085 infants and children moved between hospitals from January 2001 to September 2002.
- A specialized pediatric critical care team moved 1,021 patients (94%). Teams without that specialty moved 64 (6%).
- Unplanned events occurred in 55 patients (5%). They happened in 61% of transports by nonspecialized teams and 1.5% of transports by the specialized team.
- Airway events were the most common type. Next came cardiopulmonary arrest, sustained low blood pressure, and loss of key IV access.
- After adjusting for how sick patients were, the nonspecialized team was the only factor independently linked to an unplanned event. Death within 28 days was 23% with nonspecialized teams and 9% with the specialized team.
Research into Practice takeaways
- The comparison group was small, at 64 patients, and the study came from one center. Results may differ in other systems.
- The authors conclude that the specialized pediatric team was linked to safer transport. Programs that move critically ill children can review what pediatric training and experience their teams bring.
- This is an observational study. It shows associations, not that team type alone caused the difference.
- The abstract does not say whether these transports were by air or ground.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 27(6), 264-266, 2008
CONCERN Network bulletin, November/December 2008 issue.
Civilian Helicopter Accidents into Water: Analysis of 46 Cases, 1979-2006
Brooks, Christopher James; MacDonald, Conor Vaughan; Donati, Leo; Taber, Michael John
Aviation, Space, and Environmental Medicine, 79(10), 935-940, 2008
Canadian civil helicopter accidents into water, all mission types.
Research highlights
Highlights
- This study reviewed 46 Canadian civilian helicopter accidents into water from 1979 to 2006.
- Data came from the Transportation Safety Board of Canada.
- The accidents involved 124 crew and passengers, and 27 of them died.
- The most common problems were little or no warning (55%), fast sinking (72%), and the helicopter turning upside down (35%).
- The survival rate was about 78%, similar to earlier data from around the world.
Research into Practice takeaways
- The data cover Canadian civilian helicopters of all kinds, not only air medical flights.
- The authors suggest that people on planned flights over water wear all life support equipment from the time they strap in.
- Programs that fly over water can review where survival gear is kept and when it is put on.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 27(5), 212-215, 2008
CONCERN Network bulletin, September/October 2008 issue.
Concern Network
Air Medical Journal, 27(4), 170-172, 2008
CONCERN Network bulletin, July/August 2008 issue.
Ambulance and aeromedical accident rates during emergency retrieval in Great Britain
Lutman, D.; Montgomery, M.; Ramnarayan, P.; Petros, A.
Emergency Medicine Journal, 25(5), 301-302, 2008
Concern Network
Air Medical Journal, 27(3), 126-127, 2008
CONCERN Network bulletin, May/June 2008 issue.
Concern Network
Air Medical Journal, 27(2), 70-71, 2008
CONCERN Network bulletin, March/April 2008 issue.
A 6-Year Analysis of German Emergency Medical Services Helicopter Crashes
Hinkelbein, Jochen; Dambier, Michael; Viergutz, Tim; Genzwürker, Harald
The Journal of Trauma, 64(1), 204-210, 2008
Research highlights
Highlights
- Researchers reviewed HEMS helicopter crashes in Germany from 1999 to 2004. Germany has about 80,000 HEMS missions each year.
- Data came from federal accident reports, phone interviews with operators, and internet sources.
- There were 24 crashes, 22 by day and 2 at night. Three were fatal, with 7 people killed, and no patients were hurt.
- Compared with earlier data, crashes per 10,000 missions dropped significantly. The rate per 100,000 flight hours did not.
- Approach and landing accounted for 13 of 24 crashes. Four happened during ground run and seven during other phases such as takeoff and cruise.
Research into Practice takeaways
- Rates per mission and per flight hour gave different pictures. Programs can track safety with more than one measure.
- Programs can review how they manage risk on approach and at landing sites, the phase where these crashes clustered.
- Most crashes happened by day. The abstract does not report how many missions were flown at night, so day and night risk cannot be compared.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern network
Air Medical Journal, 27(1), 20-22, 2008
CONCERN Network bulletin, January/February 2008 issue.
Cricothyrotomy in air medical transport
McIntosh, Scott E.; Swanson, Eric R.; Barton, Erik D.
The Journal of Trauma, 64(6), 1543-1547, 2008
Research highlights
Highlights
- This review covered cricothyrotomy cases in the University of Utah AirMed program from 1995 to 2004.
- Of 14,994 transports, 17 involved a cricothyrotomy.
- The most common reason was an airway blocked by blood or vomit (47%). Next was airway swelling or distorted anatomy (24%).
- The procedure succeeded in all 17 cases. Seven patients (41%) survived and had a reasonable neurologic result.
- The number of cricothyrotomies fell over the study period.
Research into Practice takeaways
- The procedure is rare. Programs can look at how crews keep skills current for a rescue procedure they seldom perform.
- The authors report that this success rate matched or beat rates reported for other emergency personnel.
- This was one program with 17 cases. The success rate may not hold for other programs.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Formal testing and utilization of streaming media to improve flight crew safety knowledge
Bellazzini, Marc A.; Rankin, Peter M.; Quisling, Jason; Gangnon, Ronald; Kohrs, Mike
Air Medical Journal, 27(2), 84-98, 2008
Research highlights
Highlights
- One air medical program made a safety video for its own crews and offered it online.
- Of 40 crew members, 23 took a pretest, watched the video, and took tests right after and 6 months later.
- Mean scores were 84.9% before the video, 92.3% right after, and 88.4% at 6 months.
- The differences among all three scores were statistically significant.
Research into Practice takeaways
- Scores slipped by 6 months but stayed above the starting level. Programs can think about when to refresh online training.
- Only 23 of 40 crew members took part, at one program. Those who joined may differ from those who did not.
- The study measured knowledge on a test, not safety behavior on the job.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern network
Air Medical Journal, 26(6), 268-269, 2007
CONCERN Network bulletin, November/December 2007 issue.
Concern network
Air Medical Journal, 26(5), 214-216, 2007
CONCERN Network bulletin, September/October 2007 issue.
Effectiveness of a challenge-and-respond checklist in ensuring safety behavior compliance by medical team members at a rotor-wing Air Medical Program
Frakes, Michael A.; Van Voorhis, Samantha
Air Medical Journal, 26(5), 248-251, 2007
Research highlights
Highlights
- At one helicopter program, investigators planted a checklist problem before departure on 33 observed transports.
- The program's interactive checklist covers four safety items that medical crew confirm before takeoff.
- Transport teams caught 7 of the 33 planted problems (21.2%) while running the checklist.
- Crew with under 3 years in the program caught 10% of problems. Those with more than 3 years caught 38.5%.
- Investigators fixed any missed problem before the aircraft left.
Research into Practice takeaways
- Completing a checklist did not mean every item was verified. Programs can test whether their own checklists catch what they are meant to catch.
- Detection was higher with longer tenure in this small sample. The confidence intervals were wide, so the size of that gap is uncertain.
- A low catch rate says more about how the checklist works in practice than about individual crew members. Teams can look at how routine, timing, and workload shape the way a checklist is run.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern network
Air Medical Journal, 26(4), 170-171, 2007
CONCERN Network bulletin, July/August 2007 issue.
Concern network
Air Medical Journal, 26(3), 130-133, 2007
CONCERN Network bulletin, May/June 2007 issue.
A survey of adherence to community-generated safety guidelines in rotor-wing air medical programs
Frakes, Michael A.; Kelly, John G.
Air Medical Journal, 26(2), 100-103, 2007
Research highlights
Highlights
- An anonymous survey asked flight team members at 10 rotor-wing programs whether they followed 19 safety guidelines, 8 for individuals and 11 for programs. Data came from 126 of 200 surveys.
- Program adherence ran from 41.3% for running a checklist before departure up to 99.2% for holding an annual safety review.
- Individual adherence ranged from 15.1% for wearing fire-resistant gloves to 99.2% for using belts and harnesses during approach and departure.
- Every respondent whose program supplied a helmet at no cost reported wearing one.
- Programs run by hospitals less often held a daily briefing or had written policy letting crews turn down a flight when fatigued. Programs not run by hospitals less often supplied helmets or flew an aircraft with a clear head strike area, and their crews less often wore long-sleeved fire-resistant flight suits.
Research into Practice takeaways
- Helmet use was complete when helmets were free. Programs can ask whether cost or access shapes how often crews use protective gear.
- Gaps differed by operating model. Each type of program may have its own areas to review.
- The data are self-reported. They show patterns in what people said, not observed behavior.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern network
Air Medical Journal, 26(2), 81-82, 2007
CONCERN Network bulletin, March/April 2007 issue.
Use of the Lund University Cardiopulmonary Assist System in the MD902: a fire safety assessment
Farmery, J. S.; Carter, M.
Emergency Medicine Journal, 24(2), 110-111, 2007
Research highlights
Highlights
- The Lund University Cardiopulmonary Assist System (LUCAS) is a mechanical CPR device driven by gas. If oxygen drives it in a closed space, fire risk may rise.
- The authors used 24% oxygen as the level above which fire risk increases.
- Three trials measured cabin oxygen during device use in an MD902 helicopter under different ventilation settings.
- Oxygen rose quickly when the aircraft was at rest. In flight, with realistic ventilation and run times, oxygen stayed below 24%.
Research into Practice takeaways
- The authors judged the device safe for flights of normal length in the MD902. They found it may be unsafe in a parked aircraft.
- The authors extend the concern to other parked aircraft the same size or smaller, naming the EC135 and Bolkow 105. Those aircraft were not tested directly.
- Programs that carry oxygen-driven devices can review when and where those devices run, including time on the ground.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern network
Air Medical Journal, 26(1), 23-25, 2007
CONCERN Network bulletin, January/February 2007 issue.
Pilot safety survey 2005: What pilots are saying
Boschert, Greg; Dery, Markalain; Hustwit, Jack
Air Medical Journal, 26(1), 34-37, 2007
Results and recommendations from the helicopter EMS pilot safety survey 2005
Dery, MarkAlain; Hustuit, Jack; Boschert, Greg; Wish, John
Air Medical Journal, 26(1), 38-44, 2007
Research highlights
Highlights
- In 2005, a research group from the Association of Air Medical Services surveyed HEMS pilots about safety knowledge, attitudes, and views.
- The online survey went out through operator and program mailing lists, not by random sample. The average respondent had logged 6,625 flight hours.
- Most respondents named pushing weather minimums (92%) and pilot decision-making (82%) as main reasons for crashes.
- Pilots valued crew resource management (CRM). Programs that offered CRM appeared to be linked to more positive pilot views on safety.
- Of respondents, 74% said more realistic simulator training would improve safety. A total of 57% wanted night vision goggles and believed they would help.
Research into Practice takeaways
- Pilots' views on crash causes show what they believed at the time. They are not findings from accident investigations.
- The authors note that the survey does not give firm evidence that their recommendations reduce crashes.
- The authors recommend annual CRM training at all HEMS operators and annual realistic simulator training for all HEMS pilots. They also recommend NVG on all HEMS aircraft or, where that is not possible, regular night training.
- Program leaders can ask their own pilots how they see training and safety needs.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Sleep debt and outside employment patterns in helicopter air medical staff working 24-hour shifts
Frakes, Michael A.; Kelly, John G.
Air Medical Journal, 26(1), 45-49, 2007
Research highlights
Highlights
- An anonymous survey went to medical crew at 10 helicopter air medical programs picked by stratified random sample. Of 138 surveys returned, 133 were complete and analyzed.
- Crew on 24-hour shifts reported about 6.9 hours of sleep on duty days and 6.4 hours on days off. This difference was not statistically significant.
- On duty, crew slept an average of 1.1 hours in the first half of the shift and 5.3 hours overnight.
- In the past month, 3.8% had come to a 24-hour shift with no sleep beforehand.
- Outside jobs were reported by 81.1% of respondents. Of those, 16.3% had started a flight shift less than eight hours after finishing outside work in the past 30 days.
Research into Practice takeaways
- On average, crews in this sample did not build up much sleep debt. Averages can hide the short nights some crew members reported.
- Outside work was common. Sleep before duty was not significantly different for crew with and without outside jobs, so programs may want other ways to learn about and plan around second jobs.
- The data are self-reported. Actual sleep may differ from what people recall.
- The authors name shift length, rest on duty, and outside work as factors to weigh in fatigue planning.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern network
Air Medical Journal, 25(6), 248-251, 2006
CONCERN Network bulletin, November/December 2006 issue.
Sleep and cognitive performance of flight nurses after 12-hour evening versus 18-hour shifts
Thomas, Frank; Hopkins, Ramona O.; Handrahan, Diana L.; Walker, James; Carpenter, Judi
Air Medical Journal, 25(5), 216-225, 2006
Research highlights
Highlights
- Ten flight nurses each worked two 72-hour duty schedules. One had three 12-hour night shifts in a row, and the other had two 18-hour shifts with 24 hours off between them.
- Sleep was tracked with actigraphy, an activity monitor that estimates sleep. Nurses took mental performance tests before and after each schedule.
- Daily sleep fell from about 9 hours before duty to about 7 hours during duty on both schedules.
- The 12-hour schedule had less sleep before shifts and more sleep during shifts than the 18-hour schedule.
- Test scores did not decline significantly on either schedule. Nurses rated the 18-hour schedule as a better fit with life outside work.
Research into Practice takeaways
- The authors tie their result to crews getting at least 7 hours of sleep a day. The finding may not hold when crews sleep less.
- With 10 nurses, the sample is small. The results are a starting point, not proof that longer shifts carry no risk.
- The authors suggest actigraphy as a way for programs to check whether crews on long or unusual shifts are getting enough sleep.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 25(4), 150-151, 2006
CONCERN Network bulletin, July/August 2006 issue.
Neck pain and related disability in helicopter pilots: A survey of prevalence and risk factors
Ang, Björn; Harms-Ringdahl, Karin
Aviation, Space, and Environmental Medicine, 77(7), 713-719, 2006
Helicopter pilots across mission types; not specific to air medical operations.
Research highlights
Highlights
- Researchers surveyed 127 Swedish helicopter pilots about neck pain during routine medical checkups.
- Over 3 months, 57% reported neck pain, and 32% reported frequent pain.
- Earlier neck pain and recent shoulder pain were linked to higher risk of neck pain. Both links were statistically significant.
- Night vision goggle use showed a trend toward more risk, and strength training a trend toward less. Neither trend was statistically significant.
- Among pilots with neck pain, 58% said it affected flying and 55% said it affected leisure. Only 25% had ever taken sick leave for it.
Research into Practice takeaways
- Sick leave records may undercount neck pain, since only a quarter of pilots with pain had taken leave for it.
- The authors call for early prevention in pilot health care and for well-designed clinical trials.
- Programs can ask crews about neck and shoulder pain directly rather than rely on absence data.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern network
Air Medical Journal, 25(3), 112, 2006
CONCERN Network bulletin, May/June 2006 issue.
EMS Helicopter Crashes: What Influences Fatal Outcome?
Baker, Susan P.; Grabowski, Jurek G.; Dodd, Robert S.; Shanahan, Dennis F.; Lamb, Margaret W.; Li, Guohua H.
Annals of Emergency Medicine, 47(4), 351-356, 2006
Research highlights
Highlights
- Researchers reviewed NTSB records of 182 helicopter EMS crashes from January 1983 to April 2005. Of these, 39% were fatal.
- In all, 184 people died. Among those on board, 32% of 513 crew members died, and so did 45% of 44 patients.
- Crashes in darkness were fatal 56% of the time, against 24% for other crashes. Crashes in instrument weather were fatal 77% of the time, against 31% for crashes in good visibility.
- Crashes with fire after impact were fatal 76% of the time. Fire was the strongest factor in the adjusted model (odds ratio 16.1).
- Bad weather (odds ratio 8.0) and darkness (odds ratio 3.2) were also linked to higher odds of a fatal outcome after adjustment.
Research into Practice takeaways
- The study looks at what made a crash deadly once it happened. It does not tell us why the crashes occurred.
- The authors point to crashworthiness, including post-crash fire, and to fewer flights in hazardous conditions. Programs can ask how their aircraft and their launch decisions address each one.
- The authors call for further research to find out which changes would reduce fatal crashes and which would justify their cost.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern network
Air Medical Journal, 25(2), 66, 2006
CONCERN Network bulletin, March/April 2006 issue.
How safe are HEMS-programmes in Germany? A retrospective analysis
Thies, Karl-Christian; Sep, Daan; Derksen, Remon
Resuscitation, 68(3), 359-363, 2006
Research highlights
Highlights
- Researchers surveyed all German HEMS programs and reviewed accident data from the German Aviation Authority.
- On average, a program would see one accident with at least severe damage to the helicopter every 26 years of operation.
- An accident with casualties came about once in 65 operating years. A fatal accident came about once in 111 operating years.
- Striking obstacles while landing at the scene was the main cause the authors found.
- The authors also named flying in bad weather and a lack of discipline as factors.
Research into Practice takeaways
- Scene landings stand out as a risk point. Programs can review how crews choose and check landing sites.
- Terms like lack of discipline show where the authors placed cause. They do not explain why choices made sense to crews at the time.
- The authors suggest special training for pilots and crew members on these factors. They also recommend safety training for doctors.
- The authors did not find support for changing the doctor's legal status from passenger to crew member.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Case-control study of risk factors for fatal and non-fatal injury in crashes of rotary-wing aircraft
O'Hare, D.; Chalmers, D.; Scuffham, P.
Journal of Safety Research, 37(3), 293-298, 2006
Research highlights
Highlights
- This study looked at all reported civil helicopter crashes in New Zealand from 1988 to 1994.
- Crash data were linked with injury records and coroner files. Crashes were compared on 50 pilot, aircraft, environment, and operational variables.
- Not getting a weather briefing was linked to serious injury to the pilot in command.
- Off-airport crash sites, air transport flights, and flights with others on board were also linked to serious injury.
- Fire after the crash and the type of terrain were linked to fatal injury only.
Research into Practice takeaways
- These are links found in crash records. They are not proven causes.
- The authors placed some factors within the pilot's control. That shows where they placed cause, not why a choice made sense at the time.
- A weather briefing is part of preflight planning. Programs can review how weather information reaches crews before each flight.
- The data cover civil helicopter flying of all kinds, not air medical work alone.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 25(1), 10-11, 2006
CONCERN Network bulletin, January/February 2006 issue.
Helicopter scene transport of trauma patients with nonlife-threatening injuries: a meta-analysis
Bledsoe, Bryan E.; Wesley, A. Keith; Eckstein, Marc; Dunn, Thomas M.; O'Keefe, Michael F.
The Journal of Trauma, 60(6), 1257-1265; discussion 1265-1266, 2006
Research highlights
Highlights
- This meta-analysis pooled 22 studies with 37,350 trauma patients flown from the scene to a trauma center.
- Injury Severity Score put 60.0% of patients in the minor injury range. Trauma Score put 61.4% there.
- Using the Trauma Score-Injury Severity Score (TRISS) method, 69.3% of patients had a better than 90% chance of survival.
- About 25.8% of patients were discharged within 24 hours of arrival. The confidence interval for this figure was wide.
Research into Practice takeaways
- The authors call for better ways to identify which scene patients gain the most from helicopter transport.
- The study shows how many flown patients had minor injuries. It does not show whether flying helped or harmed those patients.
- Programs can review their own scene flights using injury scores to see how their patient mix compares.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Assessment of air medical coverage using the Atlas and database of air medical services and correlations with reduced highway fatality rates
Flanigan, Marie; Blatt, Alan; Lombardo, Louis; Mancuso, Dawn; Miller, Maile; Wiles, Dale; et al.
Air Medical Journal, 24(4), 151-163, 2005
Critical issues facing the air medical transport community the 2003 Air Medical Leadership Congress survey
Thomas, Frank; Romig, Laurie; Durand, John; Hutton, Kevin; Handrahan, Diana
Air Medical Journal, 24(3), 106-111, 2005
The impact of aeromedical response to patients with moderate to severe traumatic brain injury
Davis, Daniel P.; Peay, Jeremy; Serrano, Jennifer A.; Buono, Colleen; Vilke, Gary M.; Sise, Michael J.; et al.
Annals of Emergency Medicine, 46(2), 115-122, 2005
Research highlights
Highlights
- This study used a county trauma registry to compare air and ground transport for traumatic brain injury rated moderate to severe. Transfers between facilities were excluded.
- Of 10,314 patients, 3,017 were carried by air medical crews.
- Unadjusted death rates were 25% in both groups. After adjustment, air patients had better outcomes (adjusted odds ratio 1.90).
- Good discharge outcomes, such as going home or to rehabilitation, were also more common in the air group after adjustment.
- The gap was largest in the most severely injured patients. After adjustment, air patients intubated in the field also had higher survival than ground patients intubated in the emergency department.
Research into Practice takeaways
- This was a look back at registry data. The authors used propensity scores to account for how patients were chosen for air, but links are not proof of cause.
- The intubation comparison sets air crews in the field against ground patients treated in the emergency department. Crew skill and patient selection may both shape that result.
- Programs can ask whether their triage matches the patients who showed the largest difference in this study.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
The 2003 Air Medical Leadership Congress: findings and recommendations
Thomas, Frank; Robinson, Kenneth; Judge, Tom; Eastlee, Connie; Frazer, Eileen; Thomas, Stephen H; et al.
Air Medical Journal, 23(3), 20-36, 2004
Out-of-hospital endotracheal intubation and outcome after traumatic brain injury
Wang, Henry E.; Peitzman, Andrew B.; Cassidy, Laura D.; Adelson, P. David; Yealy, Donald M.
Annals of Emergency Medicine, 44(5), 439-450, 2004
Statewide EMS registry study that includes air medical crews.
Research highlights
Highlights
- This study used Pennsylvania trauma registry data from 2000 to 2002. It compared adults with severe traumatic brain injury who were intubated before reaching the hospital with those intubated in the emergency department.
- Of 4,098 patients, 1,797 (43.9%) were intubated out of hospital and 2,301 (56.1%) in the emergency department.
- After adjustment, intubation out of hospital was linked to higher odds of death (odds ratio 3.99).
- It was also linked to higher odds of a poor neurologic outcome and of moderate or severe loss of function.
- The models adjusted for injury severity, age, blood pressure, transport mode, and other factors. Patients transferred from other hospitals were left out.
Research into Practice takeaways
- This is an association in registry data. It does not show that intubation in the field caused the worse outcomes.
- The authors say the meaning for current clinical care is not defined. The study does not tell crews what to do.
- The data come from one state over 2000 to 2002. Programs can weigh how far the findings apply to their own setting and time.
- Teams may want to look at how their own airway records connect to patient outcomes over time.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Concern Network
Air Medical Journal, 22(4), 3, 2003
CONCERN Network bulletin, July/August 2003 issue.
Concern network
Air Medical Journal, 22(3), 4, 2003
CONCERN Network bulletin, May/June 2003 issue.
Concern network
Air Medical Journal, 22(2), 4, 2003
CONCERN Network bulletin, March/April 2003 issue.
Concern network
Air Medical Journal, 22(1), 4, 2003
CONCERN Network bulletin, January/February 2003 issue.
Use of a field-to-stroke center helicopter transport program to extend thrombolytic therapy to rural residents
Silliman, Scott L.; Quinn, Barbara; Huggett, Vicki; Merino, José G.
Stroke, 34(3), 729-733, 2003
Research highlights
Highlights
- Researchers reviewed 111 consecutive helicopter transports from the field to a stroke center in Jacksonville over three years.
- Patients came from an 11-county region served by the program in rural northeast Florida and southeast Georgia. Scene-to-hospital distance averaged 29.4 miles and ran from 11 to 90 miles.
- Of 111 patients, 85 (76%) had a cerebrovascular event. These included 47 ischemic strokes, 19 transient ischemic attacks, and 19 hemorrhagic strokes.
- Clot-dissolving therapy was given to 18 of 47 ischemic stroke patients (38%).
- Of 111 patients, 65 reached the hospital within 135 minutes of when symptoms began.
Research into Practice takeaways
- The authors conclude that helicopter transport can give rural communities a route to a stroke center and to time-sensitive stroke care.
- About one in four patients did not have a cerebrovascular event. Programs can review how field triage for suspected stroke performs over time.
- This was one program with 111 patients and no comparison group. It describes access to care, not patient outcomes.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
A Safety Review and Risk Assessment in Air Medical Transport
Blumen, Ira J.
Air Medical Physician Association, 2002
Supplement to the Air Medical Physician Handbook, November 2002. Prepared with the University of Chicago Aeromedical Network Safety Committee. No stable public link.
Concern network
Air Medical Journal, 21(6), 6, 2002
CONCERN Network bulletin, November/December 2002 issue.
Concern network
Air Medical Journal, 21(5), 6, 2002
CONCERN Network bulletin, September/October 2002 issue.
Concern network
Air Medical Journal, 21(4), 9, 2002
CONCERN Network bulletin, July/August 2002 issue.
Concern network
Air Medical Journal, 21(3), 5, 2002
CONCERN Network bulletin, May/June 2002 issue.
Concern network
Air Medical Journal, 21(2), 7, 2002
CONCERN Network bulletin, March/April 2002 issue.
Concern network
Air Medical Journal, 21(1), 6, 2002
CONCERN Network bulletin, January/February 2002 issue.
Helicopter transport and blunt trauma mortality: a multicenter trial
Thomas, Stephen H.; Harrison, Timothy H.; Buras, Wende Reenstra; Ahmed, Waleed; Cheema, Farah; Wedel, Suzanne K.
The Journal of Trauma, 52(1), 136-145, 2002
Research highlights
Highlights
- The authors pooled past registry records from five urban Level I trauma centers serving adults and children.
- The database held 16,699 patients with blunt trauma.
- Before adjustment, death rates were 9.4% for helicopter patients and 3.0% for ground patients.
- After adjusting for age, injury severity, level of prehospital care, mission type, and other factors, helicopter transport was linked to lower mortality. The odds ratio was 0.76.
Research into Practice takeaways
- Raw and adjusted results pointed in opposite directions. Air and ground comparisons depend on how well they account for differences between patients.
- The authors describe the result as an association. A registry review cannot prove that the helicopter caused better survival.
- The data came from urban Level I centers. Results may differ in rural systems.
Written by the Air Medical Safety Network from the PubMed abstract. It does not replace the full publication. Added November 2, 2026.
Trauma helicopter emergency medical services transport: annotated review of selected outcomes-related literature
Thomas, Stephen H.; Cheema, Farah; Wedel, Suzanne K.; Thomson, David
Prehospital Emergency Care, 6(3), 359-371, 2002
Concern network
Air Medical Journal, 20(6), 3, 2001
CONCERN Network bulletin, November/December 2001 issue.
Concern network
Air Medical Journal, 20(5), 8, 2001
CONCERN Network bulletin, September/October 2001 issue.
Concern Network
Air Medical Journal, 20(4), 4, 2001
CONCERN Network bulletin, July/August 2001 issue.
Concern Network
Air Medical Journal, 20(3), 20, 2001
CONCERN Network bulletin, May/June 2001 issue.
Concern Network
Air Medical Journal, 20(2), 5, 2001
CONCERN Network bulletin, March/April 2001 issue.
Concern Network
Air Medical Journal, 20(1), 7, 2001
CONCERN Network bulletin, January/February 2001 issue.
Factors associated with the safety of EMS helicopters
Low, Ronald B.; Dunne, Mary Jo; Blumen, Ira J.; Tagney, Gail
The American Journal of Emergency Medicine, 9(2), 103-106, 1991
Activity-sensing permanent internal pacemaker dysfunction during helicopter aeromedical transport
Gordon, Ronald S; O'Dell, Kevin B; Low, Ronald B; Blumen, Ira J
Annals of Emergency Medicine, 19(11), 1260-1263, 1990
No publications match these filters.
About this library. Entries are drawn from the working group's reference collection. Research entries are journal articles, FAA and government reports, association reports, theses, and letters. Each is tagged by region, United States or International, based on where the study was conducted. The CONCERN Network collection lists every bulletin indexed under that title in Air Medical Journal's publisher record, January 2001 to November 2018. The bulletins carry no named author in that record, and they are tagged at the series level, not bulletin by bulletin. The library lists bibliographic details only. Full text is available from each publisher.
The library opens to publications from the past six months. Date filters use the month of publication where it is known. An entry with only a year is counted as published within that year.
Inclusion is not endorsement of a study's methods or conclusions. Domain and topic tags are AMSN's, not the authors'.
Author profile links appear only where the publisher's record lists the author's ORCID iD and the public ORCID record matches the author's name, or where an author has provided the link.
Last updated November 2, 2026.