Overcommitment: Management in Helicopter Emergency Medical Services in Norway.

OBJECTIVE: Overcommitment in demanding rescue situations may put both rescuers and patients in danger. This study aimed at identifying individual approaches and organizational strategies that counteract instances in which rescuers commit more than is feasible, desirable, expected, recommended, or compellingly necessary. How is overcommitment managed by professional frontline rescuers during hazardous medical evacuation and rescue situations? METHODS: In a qualitative, exploratory study, 9 focus group interviews were conducted with a total of 30 crewmembers from the Norwegian Helicopter Emergency Medical Service. RESULTS: In this second article in a series of 2 articles on overcommitment, 12 commitment-moderating factors are presented. Air ambulance personnel pointed at sociological, cognitive, and organizational elements that may influence their degree of commitment in challenging and hazardous rescue situations. CONCLUSION: Air ambulance personnel describe a team-based approach to adjust their level of commitment in medical evacuation and rescue missions. They rely on known, however important, nontechnical skills and organizational measures to combat overcommitment in demanding rescue situations. Some of their approaches to safe performance should be adoptable by other rescue units and less experienced voluntary, not-for-profit, rescue organizations.

The Concept of Overcommitment in Rescue Operations: Some Theoretical Aspects Based on Empirical Data.

OBJECTIVE: Studies on Norwegian avalanche rescue operations have indicated high-stake searching of avalanches during elevated risk conditions. We perceive these characteristics as a sign of overcommitment. The purpose of this study is to explore the concept of overcommitment in Norwegian medical evacuation and rescue operations. How can overcommitment be described and understood as a uniform concept in rescue operations based on empirical data? METHODS: In a qualitative, exploratory study, 9 focus group interviews were conducted with a total of 30 crewmembers from the Norwegian air ambulance service. RESULTS: In this first in a series of 2 articles, crewmembers' reflections on the concept of overcommitment, important factors to consider when balancing risk and benefit in every mission, and a number of causal factors are presented. A definition of overcommitment in the context of rescue activities is presented. CONCLUSION: Air ambulance personnel recognize overcommitment in a variety of situations. They broaden the concept to include both regular, everyday actions and hazardous rescue attempts in extraordinary incidents. The causal factors form recognizable constellations that may offer useful starting points for systems-based counteracting measures. The definition of overcommitment could provide a background for evaluation and learning in the rescue service.

Patient and rescuer safety: recommendations for dispatch and prioritization of rescue resources based on a retrospective study of Norwegian avalanche incidents 1996-2017.

BACKGROUND: Avalanche emergency response should address current accident scenarios to optimize survival chances of victims and to keep rescuers safe. The purpose of this article is to present a basis for evaluation and necessary adjustments in dispatch, prioritization, and management of Norwegian avalanche rescue operations. METHODS: This is the first peer-reviewed retrospective study of all Norwegian avalanche incidents registered by the two Joint Rescue Co-ordination Centers (JRCCs) in the period 1996-2017 that describes the characteristics and trends of rescue missions and victims. RESULTS: The Norwegian JRCCs have registered 720 snow avalanche events, with a total of 568 avalanche victims, of which 120 (21%) died. Including those fatally injured, a total of 313 avalanche victims in 209 accidents were treated as patients (55%), and we saw > 1 patient in 24% of these operations. Norwegian avalanche victims were partially or completely recovered prior to the arrival of rescuers in 75% (n = 117) of all rescue operations. In the remaining 25% of cases, the rescue service located 62% (n = 55) of the avalanche victims visually or electronically. In 50% of the 720 incidents, rescuers spent time searching in avalanches with no victims. CONCLUSIONS: This survey indicates that we have experienced a shift in Norwegian avalanche rescue: from search for missing persons in the avalanche debris to immediate medical care of already-located patients. The findings suggest that a stronger focus on both patient and rescuer safety is necessary. The patients must be ensured the right treatment at the right place at the right time and the allocation of rescue resources must reflect a need to reduce exposure in avalanche terrain, especially in cases with no affirmed victims. We present a flowchart with a recommended rescue response to avalanche accidents in Norway.