Module Eight

Question 1

What is the “product” in AMR?

Answer 1

Safe and effective transport of patients.

Question 2

What are the features of clinical effectiveness in AME?

Answer 2

Appropriate outcomes in the safest and most cost-effective way for every mission, in a timely manner, and without risk to crew or patient.

Question 3

What systems must be developed to ensure appropriate clinical governance in AME?

Answer 3

Accreditation standards, and operating procedures/protocols/guidelines.
In Australasia, lack KPIs and quality standards for AME. Orgs have tried but politics get in the way.

Question 4

How can databases be used in the AME context?

Answer 4

To file records, develop summary data, and identify trends.

Question 5

Name a common database format and collection process in AME.

Answer 5

Air Maestro.

Question 6

What is an important element to minimise a data set?

Answer 6

Use of common language with standard definitions.

Question 7

What is the GAMUT?

Answer 7

Ground Air Medical Quality Transport Improvement Collaborative.
Recent development in quality improvement. Orgs can compare their KPIs to benchmark themselves.

Question 8

Describe auditing.

Answer 8

Very important to improving continuous quality management of local and national priorities, published guidelines, and operational exposure.
Need to regularly review clinical cases.
Systematic review of care and change against explicit criteria.

Question 9

Why do AME services need a robust risk management system?

Answer 9

AME is a highly risky work environment.
Need to understand, monitor, and minimise risk in a strong governance system.
Standards have taken time to evolve and still in their infancy.

Question 10

What is the goal of AME?

Answer 10

That the right patient is transferred to the right place at the right time by the right transport and with the right level of care.

Question 11

What does implementation of evidence-based protocol achieve?

Answer 11

Facilitates performance review by reviewing adherence/deviation to these protocols.

Question 12

Name some standards set by AME orgs.

Answer 12

ACEM, ANZCA, and College of Intensive Care Medicine Aus and NZ Guidelines for Transport of Critically Ill Patients
Aeromedical Society of Australasia Standards for Aeromedical Services
American College of Emergency Physicians Inter Hospital Transfer
Association of Anaesthetists of Great Britain and Ireland Safety Guidelines on Inter Hospital Transfer
The UK Intensive Care Society Standards and Guidelines on the Transfer of the Critically Ill Adult

Question 13

Define clinical governance.

Answer 13

The system by which the governing body, managers, and clinicians share responsibility and are held accountable for patient care, minimising risks to the consumer, and for continuously monitoring and improving the quality of clinical care.

Question 14

What are the goals of clinical governance systems? (4)

Answer 14

Build a culture of trust and honesty
Foster organisational commitment to continuous improvement
Establish rigorous monitoring, reporting, and response systems
Evaluate and respond to key aspects of organisational performance

Question 15

Who do retrieval services report to in the context of clinical governance?

Answer 15

Depends on jurisdiction.

Question 16

What are the requirements for a clinical governance authority in the AME context?

Answer 16

Carry appropriate designated authority
Have direct board access
Be qualified to provide advice and support for service

Question 17

What is the role of a board/governance committee? (7)

Answer 17

Diverse.
Checkpoint to ensure all necessary structures and processes are in place and functioning well.
Monitor quality of outcomes.
Ensure culture and direction of service aligned with the org.
Ensure staff are credentialed, working within scope, and part of performance management/development program
Oversight for medication, clinical protocols and practices, research, and ethics
Not an operational entity
Role is to check, guide, align, and support management

Question 18

What are the responsibilities of the retrieval service director? (6)

Answer 18

Recruitment of staff and management of development
Coordination and responsibility of a teaching program
Ongoing review of medical guidelines and protocols
Quality management program
Choosing medical equipment
Licensing, storage, and written accountability of scheduled drugs
Documentation of standard procedures, protocols, etc.

Question 19

Where should retrieval sources get their guidelines from?

Answer 19

Standard and non-contentious sources (national, peak bodies).

Question 20

What are standard operating procedures in the AME context?

Answer 20

Documents that explain how the system works at a practical level.
Safe standards that reduce variability.

Question 21

What are clinical practice guidelines in the AME context?

Answer 21

Descriptions of how standard clinical practices should be applied in the specific clinical service and AME context.
Diagnostic/therapeutic/interventional.
Describe restrictions, methods for audit, and outcome measurement.

Question 22

Describe the use of checklists in the AME context. (4)

Answer 22

Routinely used.
Range of activities.
Can be useful for case coordinators when providing advice.
Ensures consistency.

Question 23

Describe policies in the AME context.

Answer 23

Set the agenda for operational staff by defining what the org expects to happen/not, in terms of an action occurring or not.
Org/system level.

Question 24

Describe procedures in the AME context.

Answer 24

Describe how things should happen.

Question 25

How should new equipment be introduced to a service?

Answer 25

After a defined process of assessment and evaluation, and after completing procurement and purchasing.

Question 26

List the forms of practical guidelines for retrieval staff and coordinators. (7)

Answer 26

SOPs
CPGs
Checklists
Electronic decision support
Policy
Support staff guidelines
Equipment management systems

Question 27

Describe the use of audio records in the AME context.

Answer 27

All phone consults and conversations regarding case management must be recorded

Question 28

What is the purpose of a minimum data set?

Answer 28

Provides basis for research, quality, improvement, and benchmarking.

Question 29

Describe the processes of auditing. (5)

Answer 29

Prepare for audit
Select criteria
Measure performance
Make improvements
Sustain improvements

Question 30

What are the features of effective audits?

Answer 30

Methodical
Look for system issues
Have an effective communication arm
Don’t spend too much time on auditing clinical cases - poor improvement tool

Question 31

What is risk management?

Answer 31

Coordinated activities to direct and control an org with regard to risk.

Question 32

What is the most pressing risk that a retrieval service faces?

Answer 32

Interruption to business continuity through disaster.

Question 33

What are the main reasons that the AME environment differs from the hospital? (3)

Answer 33

Prehospital vs hospital
In-flight vs in-hospital management
Different hospital vs usual workplace

Question 34

List specific aspects of the environmental differences between AME and the hospital. (5)

Answer 34

Physical environment
Altitude
Equipment limitations
Team support
Access to investigations

Question 35

Describe the debate over shifting education to a competence-based framework.

Answer 35

Pro shifting: Links competence with credentialing, accreditation programs, maintaining standards of care
Against shifting: reductionist, prevents use of clinical acumen as it deters variance from protocol

Question 36

What is the structured training pathway in the UK for retrieval practitioners?

Answer 36

Curriculum through the Intercollegiate Board for Training in Prehospital Emergency Medicine.

Question 37

Describe the educational requirements in retrieval med.

Answer 37

Knowledge, skills, culture.
Specific to service and its environment.

Question 38

Describe the knowledge requirements of retrieval practitioners.

Answer 38

How pt assessment and clinical management apply pre-hospital, in small facilities, and in transfer - extra challenges.

Question 39

Describe the skill requirements of retrieval practitioners.

Answer 39

Clinical - applying existing critical care skills in resource-poor, challenging environment.
Non-clinical - to keep themselves safe and access pts.

Question 40

List some non-clinical skills required of retrieval practitioners. (10)

Answer 40

Heli underwater escape training (HUET)
Winch rescue
Navigation
Vertical rescue
MVA extrication techniques
Rapid response driver training
Scene safety
Safety around aircraft
Radio operation and protocols
Mass casualty and disaster management, incl hazardous materials, and urban SAR response.

Question 41

Describe the culture and attitude requirements of retrieval practitioners.

Answer 41

Human factors training - maximise performance and optimise outcomes
Teamwork, leadership, communication

Question 42

What concepts should be included when developing human factor skills? (5)

Answer 42

Shared mental model
Situational monitoring and cross monitoring
Advocacy and assertion
Conflict resolution
Techniques for cognitive support in stressful times

Question 43

What values are particularly important to workplace culture?

Answer 43

Safety, caring, team support, attention to detail, excellence.

Question 44

Why is it important that AME develop their own body of research? (3)

Answer 44

To improve systems
To drive arguments based on cost, efficiency, and outcomes to health management and bureaucracy
Need to prove that what we are doing is making a difference

Question 45

What are the difficulties to conducting research in the retrieval environment? (6)

Answer 45

Patient numbers low
Case mix heterogenous
Difficult to isolate effects from prehospital management and hospital management
Limited time
Minimal manpower
Difficulties in patient consent