Air Ambulance Aviation Safety

The research paper mainly focuses on the safety of air ambulances looking at some of the challenges the industry faces which make safety a major concern. At first the essay explores the history of the service, which is traced way back in the nineteenth century within the military. The research paper acknowledges that even though several measures have been taken by various stakeholders in curbing the menace of aircraft crashes, the problem has not yet been alleviated. Huge costs required in providing this particular service have also been noted as one of the major factors contributing to lack of safety in air ambulances.

Air ambulance refers to an aircraft that is primarily used for the medical assistance in emergency situations. These aircrafts are used in situations when the traditional ambulances cannot be used since they cannot reach scene of accident quickly or easily enough. Air ambulance is also used in circumstances when the needy patients require urgent transportation over a terrain or distance where air transport is the only mode of transport that can be practically applied. The crews of air ambulance are supplied with all necessary equipments to enable them to adequately offer the required and most suitable medical assistance and treatment to critically ill or injured patients. The most common equipments that are used for air ambulance operations include medication, ventilators, CPR equipment, stretchers a monitoring unit and an ECG. All these equipments together with the air ambulance personnel are always ready to respond to any emergency situation in which their assistance is required in saving the life of a patient (Levin, 2008).

Air Ambulance Aviation Safety

The concept of Emergency medical Services commonly abbreviated as EMS, which involves transporting injured and critically ill people by air crafts, traces its origins from the military. The concept of applying aircrafts as emergency ambulances is as old as the powered flights themselves. This type of medical services started way back in the nineteenth century during the Paris Siege when one hundred and sixty wounded French military personnel were transported to France through the use of hot air balloons. Again in the twentieth century, during the first global conflict, testing of air ambulances took place by several military organizations that were taking part in the global conflict. However, the aircrafts which existed during this time period were quite primitive and could therefore not respond efficiently to patients requiring their assistance. But in the mid 1930s, following years of continued and persistent exploration of this great and noble idea, great successes were achieved. Well organized air ambulances belonging to military were used to evacuate seriously wounded soldiers from the civil war that was taking place in Spain. The evacuated soldiers could receive medical treatment and other forms of assistance from Nazi Germany (Campbell, 1993 Dillingham, 2009).

The idea of air ambulances achieved great success in the military and was thus extended to the civilians. The original applications of aircrafts as emergency ambulances were perhaps incidental. This mode of medical services was practiced in countries such as Australia, Canada and Scandinavian nations. Air ambulances in these nations could be used in remote areas, settlements that were sparsely populated and regions which could not be easily accessed through road or other forms of transport. The introduction of air ambulance services in such nations covering certain marginalized areas was therefore a great relief for the people living in such regions who could not access medical facilities through other modes of transportation (Pasztor, 2009).

At times, services of air ambulance are known as Medevac or Aeromedical Evacuation. These services are offered by several organizations in different parts of the world. There are several methods that are quite reasonable used in differentiating various forms of services offered by air ambulances. These include civilian or military air ambulance services and models that are funded by governments, charges the patients some fee, donated by the private sector especially large business enterprises, or financed through public donations. It is also quite reasonable to distinguish between aircrafts that are dedicated as air ambulances and the ones that are used for several roles and purposes including operating as air ambulances. It is also quite reasonable to make a distinction using the types of aircrafts that are used, these include fixed-wing, rotary wing, or huge aircrafts (Lewis, 2010).

In virtually all jurisdictions pilots of air ambulance are required to have a lot of experience in the piloting industry since the flights of air ambulance conditions are usually much more challenging compared to the regular flight services in which pilots are not responding to any emergencies. Following an increase in the number of crashes of air ambulance related aircrafts in the 1990s, the government of the United States together with the commission of concerned with air systems of medical transportation increased accreditation and requirements air ambulances. The increased requirements were mainly meant to ensure that all air ambulance air crafts, personnel and pilots met higher requirements. The increased requirements were essential in maintaining high safety standards in these services and at the same time reduce the number of accidents (National Academy of Sciences, 2010).

The requirements for medical staffing for air ambulances vary depending on the service provider, area the service is being offered and country. Ambulance services operating under the service delivery model of Anglo-American, helicopters are used for transporting patients. Under this particular system, the air ambulance crew mainly consists of Paramedics, emergency medical technicians, a respiratory therapist, flight nurses, and a physician. Air ambulance services whose main focus is providing critical health care to patients, such crews are likely to be staffed with more nurses and physicians. Under the model of Franco-German, aircrafts are likely to be applied as the method of transporting support of very high level to an EMS that is based on the ground. In such cases, the air ambulance crew may basically consist of a surgeon, physician, trauma specialist and anesthetist. They work together with nurses and paramedics who are specially trained in coping with emergency situations. In such cases, the main objective of the crew is saving the life of the patient and transporting him or her as fast as possible to an EMS that is based on the ground. However, depending on the prevailing situation, they may be required to perform some emergent surgical procedures before reaching the EMS base. Depending on the facilities available patients may be delivered up to the hospitals by aircrafts which evacuated them, or they may have to be transported through ground ambulances if the hospitals are located in areas where it is not possible to transport them by air (Maag, 2010, March 25).

The nature of services offered by a particular air ambulance service provider is in most cases used in determining the types of medical controls that are required. In virtually all cases the skill that is available for the staffer of an air ambulance is usually much greater compared to the one required for a paramedic. Hence, all operators within the field of air ambulances are in most cases allowed to by the medical agencies to exercise prudence when making various medical decisions. Assessment skills have the propensity of being relatively high, especially on inter facility transfers. The air ambulance service providers are normally allowed and in fact required to have such facilities as X-rays as well as facilities allowing them to interpret various laboratory results. Such requirements permit them to enhance their advance planning processes, consult well with the supervising physicians and also be in a good position of issuing the required contingency orders, should they be needed while transporting a patient. Air ambulances are required to operate some systems completely off line. In such instances, they have to use the necessary protocols for each and every procedure that is required to be performed. The crew members applying off line protocol procedures are only required to resort to the medial controls available online, only after completely exhausting the off-line protocols. There are some operations of air ambulance which have on-site medical doctors operating on full time basis. Others receive services of medical directors via pagers (Negroni, 2010).

The health of human beings is paramount and the air ambulances should not jeopardize in any way the lives of the patients they are evacuating. As a result, all air crafts used as ambulances are required to have special interiors and equipments which enhance the chances of survival of the patient. All aircrafts which are used by medical providers as air ambulances, apart from some aircrafts belonging to the military and the charter aircrafts are required to be well equipped with various equipments that can support lives of patients in critical conditions. The interiors of such aircrafts must reflect their ability to assist in saving a patients life. The challenges that are encountered in most operations of air ambulance especially those involving the use of helicopters are the high noise levels as well as limited amounts of available working space within the aircraft. These two challenges are responsible for the creation of significant issues when the patient is receiving care while inside such aircrafts (Meier, 2009).

Pilots and other crew members are very essential in assisting patients as well as ensuring that all the safety standards are maintained at all times when flying. However, despite the fact that the pilots together with the crew members are usually willing to meet the high safety standards required, at times they are unable to do so. This is because the nature of their work requires them to work for long hours in unfavorable conditions. The pilots thus get fatigued while carrying on their normal duties. The speed and the level of accuracy that is usually required for pilots flying patients in rugged terrains and in areas with poor visibility, can be achieved if the pilot is not fatigued at all. This is because a lot of concentration is required for pilots to fly safely under such circumstances. However, due to the fact that pilots working with air ambulances are fatigued most of the time by the nature of work they go through, they are usually at a higher risk of causing accidents (Brooks  Marron, 1991).

Safety of air ambulances is greatly affected by the nature of terrain that pilots have to fly through in order to rescue victims and patients requiring their assistance. Most of the regions where air ambulance services are required are usually less developed with poor infrastructure and highly rugged terrains. These factors pose a major challenge to the pilots who have to fly through them in order to rescue patients in dire need. The situation is even worse when the pilots have to fly through such terrains at night or under unfavorable weather conditions. The possibility of even a highly experienced pilot causing an accident in such circumstances is very high. Air ambulances are thus highly susceptible to suffering major accidents emanating from poor terrain (Zhiwei, Mark  Jim, 1992)

While equipments available for assisting patients tend to be grouped very conveniently and are of a very high level, at times it is not possible to carryout some procedures of assessment, like chest auscultation, which is very essential while in flight. There are other aircrafts that are designed in such a way that the patient cannot be accessed physically during the period of flight. This means that a patient being transported by the use of such aircraft cannot be attended to during the flight. This might increase the risk of a patient losing his or her life since the medical team that is supposed to assist them cannot access them physically. There are also issues regarding aircraft pressurization. It is not each and every aircraft that is utilized as an ambulance in various jurisdictions are equipped with cabins that are pressurized. The aircrafts operating as ambulances but have no pressurized cabins are only allowed to fly up to ten thousand feet above the sea level. Changes in pressure need advanced knowledge and skills by the flight crew, especially the medical team. They need to have sound knowledge including various changes taking place within their immediate physical environment such as gases behaviors and physiological changes (United States Government Accountability Office, 2009).

Service providers of air ambulances have faced several challenges they deal with very challenging tasks of saving lives of people who are located in areas far from medical facilities. They have to arrive in such areas in good time such places are in most cases remote and are not easily accessible. Starting in the early 1990s, the frequency of aircraft crashes involving air ambulances increased dramatically. Most of the reported crashes involved helicopters which were the main mode of air transport that was used in evacuating patients due to their flexibility. Most of these crashes were as a result of pilots and other crew members operating at a fast speed in order to save the lives of the patients being evacuated. Pilots flying such aircrafts are at times forced to fly in very challenging air space and thus increase their chance of causing an accident (Adams McConkey  Systems Control Technology, Inc, 19990).

In fact, the high rates of crashes involving air ambulances were at some point deemed acceptable bearing in mind the nature of operations they have to go through while attempting to save the life of a patient. These aircrafts in most cases find themselves operating on safety edges, pursuing missions through conditions that are not possible for other civilian pilots and generally overlooking some of the crucial safety procedures. Despite the fact that the requirements of the crew members especially those of pilots in terms of both experience and expertise were raised, air ambulance accidents continued to increase. But this does not mean that the increased requirements were not effective or were not necessary. It is only that the nature of operations involved in saving the lives of patients in distress conditions and in certain areas is so challenging that the pilots are compelled to take higher levels of risk. However, the high numbers of air ambulance crashes does not auger well for these service providers since it is not rational to risk lives of all the crew members on board in order to save the life of one patient. But in evacuation operations, most pilots tend to forget the lives of the crew members and concentrate on saving the life of the patients. As a result, if any misfortune takes place, it becomes quite difficult for the pilot to control the aircraft and ends up crashing killing all people on board including themselves (MacLeod, 1958).

The organization of air ambulance operations is arranged in a manner that ensures that they remain safe. Governments are highly involved in most operations of the air ambulances in order to ensure that all the necessary precautions are taken. In some cases, the air ambulance services are directly provided by the government. In such cases, the government either provides these services directly or they provide them through negotiated means such as contracts with various service providers. These services mainly focus on transferring critically ill patients, supporting the EMS operations based on the ground or may carryout several roles all of which must be aimed at increasing the survival chances of the patient. In order to ensure that all safety standards are well observed, governments usually provide certain guidelines to be applied for both EMS systems and hospitals providing medical services in conjunction with the air ambulance medical providers. Moreover, in order to ensure that costs of operation are under control, governments provide various specific procedures. The main objective of controls on costs by the governments is to limit the levels of liability a patient may incur as a result of receiving air ambulance services. At times a patient is required to pay for the air ambulance services, but in most cases, patients are only required to pay a lesser some of money that was actually incurred while the rest is paid by the government or charitable organizations (Hough, 1999).

In various jurisdictions, costs of operating air ambulances is a major concern and in fact dedicated air ambulances presence is practically not possible. This is usually the case in developing nations where societies and countries economies are not in a position to fully finance such high costly operations. Since the safety of people is very important and the air ambulance services are very crucial, various means have to be devised in order to ensure that people can receive these services when they are in need of them. One of the methods commonly used in such cases is using a government agency or a quasi government agency. Such agencies are made available to the EMS ground operations working together with the air ambulances. But even if these services are offered by quasi government agencies, they must meet all the necessary safety requirements in order to ensure that the lives of the patients who are being evacuated as well as those of the crew members are not risked in any way (Dillingham, 2009). 

Although in several jurisdictions patients are not charged for the medical services they receive from the air ambulances, there are some jurisdictions in which patients are charged some fee for the services they receive. However, one of the major requirements virtually all jurisdictions is that patients should first receive medical assistance and any charges accruing should come after. The air ambulance service providers should therefore not ask for money before they assist the patient. Their primary objective is saving the lives of critically ill patients who cannot access medical facilities fast enough (United States Government Accountability Office, 2009 Stundzia Lumsden, 1994). 

The costs that is involved in the provision services of air ambulance is considerably high and several service providers are forced to charge their patients some money since the amount they receive as donations and government funding is usually not enough to cater for the huge expenses that are incurred in saving the lives of patients and ensuring that the service providers continue operating. This has become a great challenge in several jurisdictions since lack of sufficient funding may have a great negative impact on the lives of several patients requiring the services of these providers on a daily basis. At times, it may not be possible to evacuate critically ill patients even in regions where it is normally possible to do so. Certain natural calamities such as tornadoes and flooding may take place making it impossible for such regions to be accessed through other means apart from aircrafts. Therefore, if the air ambulance medical providers are not well financed it will not be possible to evacuate thousands of people who are trapped in various places and urgently requiring medication in order to survive. Lack of finances in several jurisdictions has therefore greatly contributed negatively to the safety of air ambulances (Lewis, 2010). 

Due to the great importance of air ambulance services and the enormous challenge of high costs, several business multinationals around the world have developed programs for financing these all important services. Very high standards and equipments are required for aircrafts that are used as ambulances. A lot of financial resources are required in order to acquire them and also maintain them in good working conditions. Most of the safety requirements that are needed for the air ambulances are mandatory. If a service provider cannot meet the high standards that are required, they are not allowed to operate since they may jeopardize the lives of patients instead of saving them. Furthermore, if several air ambulance medical providers exit the industry due to the high costs involved, the remaining ones might be overstretched since they will be required to cover greater jurisdictions with limited resources. Such may in turn risk not only the lives of patients being evacuated from the remote areas, but it has the potential of also risking the lives of the crew members (United States Government Accountability Office, 2007).

The major concern and challenge that have been faced by air ambulance medial services providers is the high number of accidents. At times as discussed earlier, some of the accidents are unavoidable. However, various jurisdiction in conjunction with all the stakeholders within the aviation industry have developed various procedures and protocols which are supposed to be followed by all air ambulance service providers irrespective of whether they are privately or publicly owned. Such protocols and procedures are very essential in reducing the number of air ambulance crashes. They also ensure that the lives of all people on board including the pilot, crew members and the patients are well protected. Most of the accidents involving air ambulances involve helicopters. As a result, the protocols and procedures for these aircrafts are more compared to the ones required for the other air crafts operating in the same industry (Levin  Davis, 2005 Wears  Winton, 1993).

Air ambulance medical services can be traced from the military where they were first used in the nineteenth century to evacuate soldiers who had been wounded in war. Over the years, these particular modes of assisting patients who are in remote and sparsely populated regions where other modes of transport cannot be used have gained considerable popularity. However, despite the fact that air ambulances provide very essential services, these service providers are faced with the challenge of safety. The pilots usually find themselves flying in very challenging environments, which at times makes them to cause accidents. The safety of air ambulances have been a major concern for several jurisdictions since the early 1990s when the number of aircraft crashes involving air ambulances increased dramatically. Requirements and standards were raised for pilots and crew members in order to curb the increasing trend of air ambulance accidents. Even though the higher requirements were quite effective in increasing the safety of these aircrafts, the problem was never eliminated completely. Safety of the air ambulances still remains one of the single greatest challenges facing the service providers attending patients in critical conditions and located in remote regions.