An Evaluation of Navy En Route Care Training Using a High-Fidelity Medical Simulation Scenario of Interfacility Patient Transport

A Pilot Study Using a Standardized Trauma Assessment Tool After Tactical Combat Casualty Care Course: A Comparison of the United States and Ghana

INTRODUCTION

Assessment, monitoring, and evaluation have been a required part of Global Health Engagement but difficult to accomplish. The current assessment, monitoring, and evaluation frameworks require implementation at the start of the project and are not designed to use for already existing programs. Tactical Combat Casualty Care (TCCC) is a standardized course now offered in 89 countries, but there has not been a standardized method of evaluating the quality across programs. Ghana's TCCC program began in March 2022 and provides a platform for development of a new method of evaluation globally.

METHODS

In this study, a standardized trauma scenario was performed by two groups of students, one who completed a TCCC Medical Provider course in Fort Detrick, MD and one who completed the course in Accra, Ghana. The students were scored using a standardized Trauma Assessment Score Sheet and the scores compared across the two groups.

RESULTS

The mean Trauma Assessment Score was 58.5% in the United States and 58.3% in Ghana, with no statistically significant difference between the two groups (P-value of .97). When regressed for confounding variables such as years of experience and deployment, the two groups still had no statistically significant difference (P-value of .783).

DISCUSSION

The two groups achieved similar mean scores despite significantly different testing environments and experience levels. Written post-test scores did not correlate well due to multiple confounding factors and appear to be a less accurate representation of student understanding and application than the Trauma Assessment Score.

CONCLUSION

This study demonstrates use of a standardized scenario with graded checklist to compare between international programs. This can be used to and expanded to compare programs and support quality assurance and medical interoperability.

Experiences and perceptions of nurses and air ambulance service providers in carrying out aeromedical evacuations in Indonesia: A qualitative research

Background

Basic non-military flight nurse training is essential for enhancing nurses' competency in conducting aeromedical evacuations. Trained nurses possessing flight nurse proficiency are indispensable for ensuring stable patient conditions amidst the unique physical, physiological, and psychological challenges encountered during flights.

Objective

This study aimed to describe the experiences and perceptions of nurses and air ambulance service providers regarding aeromedical evacuations.

Methods

This study employed a qualitative descriptive design. Data were gathered from February to July 2023 through semi-structured online interviews with seven nurses and air ambulance service providers engaged in aeromedical evacuation. Content analysis was utilized to interpret the interview data.

Results

Seven themes were generated: 1) Experiences in aeromedical evacuation experiences, 2) Challenges faced by nurses and air ambulance service providers during aeromedical evacuations, 3) Essential knowledge for nurses involved in aeromedical evacuations, 4) Efforts to improve nurses' knowledge and skills, 5) Leveling of flight nurse training, 6) Flight nurse training methods, and 7) Flight nurse training evaluation strategies.

Conclusion

Nurses and air ambulance service providers acknowledge the significant influence of the flight environment on changes in patient conditions during aeromedical evacuations. To effectively manage alterations in patient conditions during flights, healthcare workers equipped with aviation health competency are imperative. One approach to enhancing the competency of healthcare workers is through flight nurse training. The findings from this study serve as a valuable resource for policymakers and health-related institutions endeavoring to formulate aeromedical evacuation strategies.

Please get me out of here: The difficult decision making in fit-to-fly assessments for international fixed-wing air ambulance operations

INTRODUCTION

With international travel for leisure and business almost back to pre-pandemic levels, demand for repatriation due to illness and injury abroad is increasing [1,2]. In any repatriation, there is considerable pressure on all involved to organize a rapid transport back home. Delay in such action may be perceived by the patient, relatives, and the public as an attempt by the underwriter to hold off on an expensive air ambulance mission [3-5].

METHODS

Review of the available literature and analysis of assistance and air ambulance Companies' infrastructure and processes to identify risk and benefit of executing or delaying aeromedical transport for international travellers.

KEY FINDINGS

While patients of almost any severity can be safely transported over great distances in modern air ambulance aircraft, immediate transport is not always in the patient's best interest. Each call for assistance requires a complex and dynamic risk-benefit analysis with multiple stakeholders involved to achieve an optimized outcome. Opportunities for risk mitigation within the assistance team include active case management with clearly assigned ownership, as well as medical and logistical experience with knowledge on local treatment opportunities and limitations. On the air ambulance side, modern equipment, experience, standards and procedures as well as accreditation can reduce risk.

CONCLUSIONS

Each patient evaluation remains a highly individual risk-benefit assessment. Optimal outcomes require a clear understanding of responsibilities, flawless communication and significant expertise among the key decision-makers. Negative outcomes are mostly associated with insufficient information, communication, inadequate experience or a lack of ownership/assigned responsibility.

U.S. Navy Aeromedical Missions from 20162019 with a Focus on En Route Care Provider Type

BACKGROUND: En route care (ERC) is a military aeromedical mission designed to transport a patient to a higher level of care. With the exception of one manual, there are no other formal Navy ERC guidelines, leaving the service to provide such missions ad hoc. Based on the authors review of available literature, it seems no prior research has been done on Navy rescue swimmers performing ERC, though many search and rescue (SAR) missions take place without designated medical personnel. This study specifically examines the type of provider involved in Navy ERC missions and the types of cases involved with the purpose of influencing Navy policy.METHODS: A cross-sectional study examining 829 air evacuations performed by Navy SAR flight crews from 2016 to 2019 was analyzed.RESULTS: Of 829 cases reviewed, patients were more likely to be active-duty personnel (51%) than civilian (47%), and there were 2.5 times more male than female patients. There were more trauma (54%) than medical (43%) patients, with Basic Life Support (BLS) level care (60%) delivered twice as often as Advanced Life Support (ALS) (28%). Search and Rescue Medical Technicians (SMTs) and rescue swimmers provided 83% of ERC, with rescue swimmers supporting 33% of all ERC missions alone.DISCUSSION: The results of this study are in contrast to previous ERC studies, in which rescue swimmer-only transports were excluded from the data. The results raise the question, do rescue swimmers need to be trained to a higher level of care?Henry SM, Stanfield MM. U.S. Navy aeromedical missions from 20162019 with a focus on en route care provider type. Aerosp Med Hum Perform. 2021; 92(11):873-879.