Medicine is a complex industry and requires highly skilled staff to operate within it. Working in the aeromedical field, however, adds an extra layer of complexity, with medical professionals needing to take to the skies for their work.
Simply being a doctor or nurse does not mean you can enter an aircraft and continue practising as normal – there are critical differences, for which additional training is required.
This training must be relevant, up to date, and of high quality for crew members – and their patients – to reap the benefits. In some cases, training is mandatory to meet regulatory standards, showing how fundamental recurring education is in the aeromedical environment.
The gravity of training
For all medical professionals, training is vitally important. They spend years studying and gaining experience by working in healthcare settings, constantly learning throughout. This is true too of air ambulance crews, as explained by Dr Ulrich Carshagen, Lead Flight Physician at Air Rescue Group. “There is an expectation on air ambulance crews to perform at the best possible and highest level – the importance of training throughout one’s career is emphasised even more,” he said. “The single most important reason for this is that, as a practitioner performing air ambulance transfers, you have the responsibility towards your sick patient to keep them safe in an isolated and often extremely challenging environment.”
Didier Dandrifosse, Head of Medical Department at European Air Ambulance (EAA), added: “Aviation and medicine are continuously evolving but at the same time heavily regulated fields. Hence, continuous training is vital for our EAA’s lifesaving aeromedical teams.” Therefore, being abreast of the latest developments and passing this knowledge on to medical staff involved in aviation is critical to maintaining and improving important practices.
It is not just the medical staff onboard who need to keep up to date, though. “Training and recurrent training is important for all disciplines involved in transport – medical crews, pilots, communicators, and ground ambulance operators,” explained Eileen Frazer, Executive Director of the Commission on Accreditation of Medical Transport Systems (CAMTS) and CAMTS Global. This view was echoed by Dr István Lunczer, Medical Director at TrustAir Aviation, who said that they ‘emphasise training for non-medical and non-technical skills’, in addition to other training courses.
However, Frazer also highlighted a current issue that the aeromedical training sphere is facing: the lack of people to fulfil roles onboard. “With staffing shortages still experienced as a result of the pandemic, there are concerns about training,” she said. “Orientations should not be shortened, and new medical personnel should be paired with more senior personnel to gain insight from their experience.”
Living up to expectations
As previously mentioned, medical professionals train for years to hone their lifesaving skills before they start on the job; the same is true of those in the aeromedical field. It is expected that those skills are learned and brought to any job in the aeromedical environment. “In our service, we have an expectation that all medical crew must meet our minimum requirements for formalised training, clinical experience, and continuous medical education prior to joining,” said Carshagen. Frazer confirmed this: “Both nurses and paramedics must have three years’ experience before they are hired as part of an air medical critical care team, according to the standards,” she said. But training doesn’t stop once they are in post. The European Aero-Medical Institute (EURAMI), which awards accreditation to aeromedical providers, stipulates that ‘training must be conducted at least annually’, according to its Managing Director, Claudia Schmiedhuber. She explained: “EURAMI-accredited providers must have an annual training schedule for their staff, as well as a comprehensive onboarding training course.
“This is the minimum requirement in order to successfully pass accreditation or re-accreditation; however, most of our providers exceed these requirements by offering a variety of clinical and non-clinical courses and sessions throughout the year.”
This is true of Air Rescue Group, for example. Carshagen explained that as part of its ‘continuous medical education programme’, Air Rescue Group has ‘skills-based sessions where crew members get to do training in a simulated environment’ each month, as well as ‘weekly academic meetings’, ‘monthly morbidity and mortality meetings’, and ‘provision – mostly outsourced to third-party institutions – for all crew members to complete the mandatory short courses’. TrustAir also organises training throughout the year, beyond the standards required by EURAMI. Lunczer explained: “We find it of utmost importance that our colleagues are kept up to date in the ever-changing field of medicine, and we regularly organise in-house recurrent training on the hot topics that have a relation to transport medicine, as was the case with Covid-19, for example.”
Training and recurrent training is important for all disciplines involved in transport – medical crews, pilots, communicators, and ground ambulance operators
Positive mental attitude
Given the significance of training to the industry and the frequency at which courses take place, how air ambulance crews and medical teams approach recurrent training can have a real impact. “It goes without saying that air ambulance crew should have a welcoming and enthusiastic attitude towards training,” emphasised Carshagen. “This forms the basis of a positive organisational culture that champions excellence in all aspects of medical care.”
Patrick Adamczuk, Chief Flight Nurse at EAA, concurred: “It is evident that air ambulance staff should have a positive attitude towards training. After all, training plays a major role in medicine and aviation.”
Frazer was also of the same view: “Air ambulance crews must be open and receptive to training, even if it is repetitive of former education due to the autonomous nature of transport.” She also explained why this particular personality trait is important in aeromedical staff: “In transport, medical teams must be creative and flexible since patient conditions may not be as reported from the hospital or emergency medical service (EMS) who request the aircraft,” she said.
It is not just about the air side, though; the medical side is just as important. Dr Lunczer explained why. “It is vital that crew members – and everyone in the field of medicine – realise that medical sciences and technologies are developing in leaps and bounds, and it should be their absolute priority to stay on top of those developments and not to stick with past knowledge and evidence,” he said. “Our profession is about constantly learning something new, and one of the best opportunities to do so is taking part in various training.”
It seems as if these expectations of positive attitudes from aeromedical crews are being met. Schmiedhuber reported: “From our experience, air ambulance staff are welcoming training opportunities within the companies.” This is encouraging to hear, particularly given the value put on and necessity of training in the aeromedical environment.
Training takes shape
With crews being receptive to attending training courses, it is important that the training then lives up to the expectations of the participants and offers them something beneficial; the positive mindset they have does not want to be lost. “For the crew to buy into the idea of investing time and effort into training, the value they get from training must be well appreciated,” said Carshagen. “Training days, courses or programmes must be well organised, interesting and relevant. Lunczer reiterated that point: “It is very important for training to be engaging, relevant, up to date and that the instructors are experienced and authentic.”
Authenticity within the training itself is also important to EAA, as Dandrifosse explained: “The provided training should reflect as much as possible the operational reality and be as realistic as possible to the actual circumstances that our medical crews are facing when operating air ambulance missions.”
Lunczer also noted that, though training has time value placed on it by air ambulances and their crews, it can be difficult to coordinate. “One key aspect of organising our training is the scheduling of the training dates,” he said. “Since most of our colleagues work not one but two or sometimes three jobs, we find it hard to pick a date that is suitable for everyone.” Therefore, the logistics can be one of the greatest challenges when arranging training courses.
Other key factors that have to be taken into account are quality and costs – how they can work in conjunction with and against one another. This can also be a challenge, as Lunczer explained: “I believe quality is more important than costs, but the former is not necessarily a direct function of the latter.” In other words, the higher cost of the course does not guarantee a higher-quality one.
However, it is critical to recognise, like Carshagen has, that ‘the air ambulance market is very competitive’, which can drive up prices. He affirmed: “It is thus critical that a training budget be established as a priority item. The value a well-constructed training programme offers is likely worth every little bit of investment.” Reserving finances shows that the service values training and wants to facilitate the learning of its crew members throughout their careers.
This investment in quality training is not just beneficial to the crews, but also to the patients they assist. Schmiedhuber explained: “For EURAMI, the quality of training is of great importance as it assures the highest quality of care during the missions.” And, as the key focus of any training for air ambulance staff will be to ultimately improve their abilities to help their patients, investing in quality training will then be reflected in the quality of care given.
The future of the field
As the medical field is constantly developing and technology is always evolving in the aviation industry, it is important that training standards, materials and provision are keeping up in the combined aeromedical environment. But, as the sector develops, it is key that the fundamentals are not neglected. “The first goal is, of course, to maintain the current skills,” affirmed Dandrifosse. “This is achieved by repeating the basics as often as possible.”
He does also recognise, though, that ‘the fields of medicine and aviation are evolving fast’ so it is important that training keeps up with this pace of change and that ‘programmes [are] adapted on a frequent basis’.
EURAMI is also regularly updating its standards. Schmiedhuber explained its latest updates: “We have updated our training requirements in the latest version of the EURAMI Fixed Wing Air Ambulance Standards V 6.0. and will do the same for the EURAMI Commercial Airline Medical Escort Standards 2.0. as well as the upcoming Rotary Wing Standards,” she said.
Predictions for upcoming training exercises show trends towards growing medical fields, as well as hopes for training in new technologies. “There has been a move towards defining retrieval medicine as a distinct subspeciality in medicine,” explained Carshagen. “It basically entails sending a skilled medical crew with specialised equipment to critically ill patients to assist local healthcare professionals with the resuscitation and stabilisation of a patient in order to facilitate a safe transfer.”
The value a well-constructed training programme offers is likely worth every little bit of investment
He added: “This field of retrieval medicine has expanded exponentially over the years and training needs to keep up with this. Courses focusing on retrieval medicine as an entity, also providing teaching on specialised transfers is currently lacking.”
In terms of technological improvements to be made in the training sector, Lunczer said that ‘what is generally missing – or simply adoption is lagging somewhat – is the use of the most current technologies, such as high fidelity simulators, virtual reality (VR) and artificial intelligence (AI)’.
High fidelity simulators were also highlighted by Carshagen: “High fidelity simulation training has been well established as an ideal training method and I expect to see many advancements in this field over the next couple of years,” he said.
Thanks to training
Aeromedical crews are specialists in their environment, thanks to the training they have participated in and continue to receive. Their educational journey never ends either, due to recurrent training to be completed as standard or additional courses that further support their education. But the learning doesn’t stop at the classroom door; it continues in the air on the job too.
As Frazer noted: “Didactic education is important but direct patient experience is also part of the education expected.” Thus, the learning never ends – benefiting patients who are treated in or transported by air ambulances.