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

BACKGROUND: In the isolated and dynamic health-care setting of critical care air ambulance transport, the quality of clinical care is strongly influenced by non-technical skills such as anticipating, recognising and understanding, decision making, and teamwork. However there are no published reports identifying or applying a non-technical skills framework specific to an intensive care air ambulance setting. The objective of this study was to adapt and evaluate a non-technical skills rating framework for the air ambulance clinical environment. METHODS: In the first phase of the project the anaesthetists' non-technical skills (ANTS) framework was adapted to the air ambulance setting, using data collected directly from clinician groups, published literature, and field observation. In the second phase experienced and inexperienced inter-hospital transport clinicians completed a simulated critical care air transport scenario, and their non-technical skills performance was independently rated by two blinded assessors. Observed and self-rated general clinical performance ratings were also collected. Rank-based statistical tests were used to examine differences in the performance of experienced and inexperienced clinicians, and relationships between different assessment approaches and assessors. RESULTS: The framework developed during phase one was referred to as an aeromedical non-technical skills framework, or AeroNOTS. During phase two 16 physicians from speciality training programmes in intensive care, emergency medicine and anaesthesia took part in the clinical simulation study. Clinicians with inter-hospital transport experience performed more highly than those without experience, according to both AeroNOTS non-technical skills ratings (p = 0.001) and general performance ratings (p = 0.003). Self-ratings did not distinguish experienced from inexperienced transport clinicians (p = 0.32) and were not strongly associated with either observed general performance (r(s) = 0.4, p = 0.11) or observed non-technical skills performance (r(s) = 0.4, p = 0.1). DISCUSSION: This study describes a framework which characterises the non-technical skills required by critical care air ambulance clinicians, and distinguishes higher and lower levels of performance. CONCLUSION: The AeroNOTS framework could be used to facilitate education and training in non-technical skills for air ambulance clinicians, and further evaluation of this rating system is merited.

Air transport by the Wellington Flight Service: a descriptive analysis of interhospital transfers over a 5-year period in the Wellington region of New Zealand.

AIM: To describe and characterise the interhospital transport workload of a New Zealand based flight service over a 5-year period. METHOD: Wellington Flight Service database records from 1 November 2005 to 31 October 2010 were reviewed. Details of mission purpose, timings, transport type, severity of illness, clinical service requesting the transfer, and medical crew in attendance, were examined. RESULTS: The Flight Service completed 4046 transport missions over 5 years. The median mission duration was 4.5 hours, but 9% of missions took 8 hours or more. Fixed wing aircraft were used for most transports (70%) with the trend for helicopter use decreasing steadily (from 23% down to 13%). High proportions of transfers were requested by cardiac services (25%), neurosurgery (14%) and ICU (9%), and 72% of those transported were critically (Category A) or seriously ill (Category B). A doctor accompanied a specialist flight nurse for Category A transports but for only 14% of Category B transports. 26% of missions began after 4pm and a further 6% began after midnight. Missions undertaken during the night were usually transfers of the critically or seriously ill (90%), with most (70%) being retrieved to Wellington Hospital for tertiary care. CONCLUSION: The Wellington Flight Service undertakes 2.2 interhospital transfers per day. Further examination of clinical outcomes in this cohort of patients transported to tertiary care is required to fully evaluate these services.