Simulation-based training and assessment of non-technical skills in the Norwegian Helicopter Emergency Medical Services: a cross-sectional survey

Abstract

BackgroundHuman error and deficient non-technical skills (NTSs) among providers of ALS in helicopter emergency medical services (HEMS) is a threat to patient and operational safety. Skills can be improved through simulation-based training and assessment.ObjectiveTo document the current level of simulation-based training and assessment of seven generic NTSs in crew members in the Norwegian HEMS.MethodsA cross-sectional survey, either electronic or paper-based, of all 207 physicians, HEMS crew members (HCMs) and pilots working in the civilian Norwegian HEMS (11 bases), between 8 May and 25 July 2012.ResultsThe response rate was 82% (n=193). A large proportion of each of the professional groups lacked simulation-based training and assessment of their NTSs. Compared with pilots and HCMs, physicians undergo statistically significantly less frequent simulation-based training and assessment of their NTSs. Fifty out of 82 (61%) physicians were on call for more than 72 consecutive hours on a regular basis. Of these, 79% did not have any training in coping with fatigue. In contrast, 72 out of 73 (99%) pilots and HCMs were on call for more than 3 days in a row. Of these, 54% did not have any training in coping with fatigue.ConclusionsOur study indicates a lack of simulation-based training and assessment. Pilots and HCMs train and are assessed more frequently than physicians. All professional groups are on call for extended hours, but receive limited training in how to cope with fatigue.

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

“…The frequency of simulation-based training in and assessment of NTSs observed in the HEMS during 2011 [ 34 ] is statistically insignificantly different from the frequency observed in the GEMS during 2015 (Fig. 4 and Table 4 ), except for communication and coping with fatigue.…”

“…In Norway, the physician-manned HEMS supports the GEMS in emergency missions for patient care and retrieval, in addition to inter-hospital transportation of patients [ 34 ], especially when the time dimension is critical. A HEMS crew consists of three members, each of whom belongs to a different profession.…”

“…To the extent of our knowledge, the level of training in and assessment of NTSs in the Norwegian GEMS has not been reported in the literature. The level of simulation-based training in and assessment of NTSs in the Norwegian HEMS during 2011 has been documented in the literature [ 34 ]. The results indicated a significant difference in the frequency of training in and assessment of NTSs between employees working for the flight operator and those in the health trust.…”

Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument - an observational study

“…Air ambulance transport teams tend to be small and comprise different professional categories such as nurses, emergency medical technicians, and physicians. Challenges for maintaining patient safety in an aviation environment include managing sometimes acutely life-threatening and rapidly evolving medical issues without the support and facilities available in a hospital environment [ 13 , 14 ]. High noise levels in the cabin may preclude traditional options for clinical surveillance such as auscultation or audible alarms, and make communication challenging.…”

Dynamic nurse leadership in high-pressure situations

“…Practitioners in some specialties, including anaesthesia and surgery, have developed a vocabulary for the skills they require, such as situation awareness, teamwork and task management (Flin et al 2008). Emergency care practitioners have been slower to engage with NTS, however, and NTS for paramedics (Shields and Flin 2013), emergency helicopter services (Abrahamsen et al 2014) and emergency physicians (Flowerdew et al 2013) were explored only recently. Yet, these studies suggest that core NTS are necessary across healthcare professions.…”