Category: SAFETY MATTERS: An Online Magazine

“Safety Matters” is an online magazine created and authored by both MedFlight and HealthNet Aeromedical Services.

Transporting Infectious Patients

by Karen Swecker, RN, Infectious Control Liaison at MedFlight.

Would you be able to recognize an infectious patient?  At this time outbreaks of vaccine preventable diseases such as chickenpox, measles, diptheria, and polio are occurring in several countries in Europe, Asia, the Middle East and the African continent.  In the U.S. the evening news has been reporting an ongoing outbreak of measles – more than 465 cases as of April 4, 2019.  A health threat anywhere is a health threat everywhere” is the statement from a 2018 conference of infectious disease physicians from across the world.  In today’s world of frequent international travel previously eliminated disease outbreaks in the U.S. are increasing.  Your chance of seeing a case of the measles, diptheria, chickenpox or even polio are increasing.  Would you be able to identify and protect yourself and others from one of these diseases during a patient transport?


Measles is a very contagious, acute viral respiratory illness that was eliminated in the U.S. from 2000 to 2008.  Before vaccine availability, the U.S. averaged 549,000 cases of measles with approximately 500 related deaths annually.  (The CDC states due to unreported cases the count of measles cases was in actuality closer to 3 to 4 million.)  Of the reported cases, 48,000 were hospitalized and 1000 people developed chronic disabilities due to acute encephalitis.  Signs and symptoms of the measles include:

  • Fever – may be up to 105oF
  • Malaise
  • “3 C’s” – cough, coryza (runny nose) and conjunctivitis (pink eye)
  • Koplik spots – white spots inside the mouth that look like tiny grains of sand surrounded by a red ring.
  • Maculopapular rash that appears about 14 days after exposure. Spreads from the head to the trunk to the extremities.  The immunocompromised typically do not develop the rash.


measles 1

Chickenpox is a very contagious, vaccine preventable disease.  Before the vaccine approximately 4 million people in the U.S. got chickenpox each year, more than 10,500 of those were hospitalized and 100-150 died each year.  Side effects of the disease include skin infections (may have more than 500 blisters), dehydration, pneumonia and encephalitis.  Symptoms last 7 to 10 days and include:

  • Infectious 1 to 2 days before rash begins
  • May start as “cold” symptoms – runny nose, sneezing, cough before rash begins
  • Itchy rash of blisters, appears as very small red pimples that rapidly spread
  • Fever
  • Headache
  • Malaise

Diptheria is very infectious bacteria whose toxin causes tissue death which creates a thick grey membrane.  This membrane may cover the back of the throat, tonsils, or larynx which leads to difficulty breathing, swallowing and speaking.  The bacterial toxin may also go systemic and cause damage to the heart, nerves and kidneys.  Before the vaccine (tetanus/diptheria/pertussis) there were more than 200,000 cases in the U.S. annually with more than 15,000 deaths.  Although still rare in the U.S., many countries continue with cases – more than 7,000 cases occur worldwide annually.  The overall death rate from diptheria is 5%-10%, with a fatality rate of 20% for those under 5 and over 40.  Diptheria is transmitted person to person via respiratory droplets from coughing or sneezing and via contact with contaminated surfaces or objects.  Symptoms begin 2 to 10 days after exposure, can involve any mucus membrane including the tonsils and include:

  • Weakness
  • Sore throat
  • Fever
  • Swollen glands in the neck
diptheria 1

Polio is an infectious disease that is crippling and potentially deadly.  It is caused by a virus that easily spreads from person to person mainly via fecal/oral route, although it is also transmitted through contaminated food or water.  Polio multiplies in the intestinal track then invades the nervous system where it can cause permanent paralysis within a few hours.  In the pre-vaccine years of the 1950s, polio outbreaks caused more than 15,000 cases of paralysis each year.  Due to vaccination there have been no polio cases originating in the U.S. since 1979.  In 1993 there was one case imported into the U.S. via an unvaccinated person who traveled to a country with wide spread polio.  Due to vaccine, the number of cases worldwide has dramatically decreased (33 reported in 2018).  However, as long as there is one case the unvaccinated are at risk.  There is no cure for polio and 1 in 200 infections will result in permanent paralysis.  Symptoms include:

·                     Fever ·                     Fatigue
·                     Headache ·                     Vomiting
·                     Stiff neck ·                     Pain in the limbs


What you can do to protect yourself and others from these diseases. 

  • Make sure you and your family’s vaccines are up to date.
  • Familiarize yourself with signs/symptoms of rarely seen communicable diseases.
  • Use airborne precautions If a patient has any of these signs/symptoms – wear a fit tested N95 mask, place a surgical mask on the patient if tolerated.
  • Use contact precautions which include gowns and gloves. Remember not to touch surfaces with contaminated gloves.
  • Thoroughly disinfect surfaces and equipment. Use EPA approved disinfectant wipes or sprays to clean surfaces.  Change wipes frequently as the wipes quickly become contaminated and will spread the germs instead of removing them.




A Lynyrd Skynyrd Case Study in Safety

by Amanda Ball, MedFlight Safety Officer


What can we learn from this rock band’s fatal plane crash?

While on their way to a show in 1977, the band’s chartered private plan ran out of fuel, and both engines failed… Causing a freefall from 4,500 ft cruising altitude.  Several on-board were killed on impact, including the band’s lead singer, shocking their friends, family, and fans… as well as the aviation industry.  What happened?  Why?  How?

The band’s management had advised that the plane they normally chartered was being replaced with a newer, more “trustworthy” aircraft after this concert.  But this concert was going to be a big one, and the pressure was on to be there.


“The flames shooting out of the engine 2 days earlier didn’t make me very confident.”
“We were afraid to get on the plane, but didn’t know any better.”
“Something’s not right.”
“Aerosmith previously used this plane, and the pilots had questioned its flight worthiness.”
“I didn’t see the pilots check it out before they climbed in.”
“Let’s go anyway, man.  We’ve got a gig to do.”


Inadequate fuel planning.
Aircraft was last checked 2 days prior to flight.
High, and unnoticed, fuel consumption by one of the engines during the flight.
Poor flight path planning prior to takeoff.
Continued flight with minimal fuel, overflying several airports with fuel resources.
Negligence or ignorance in regards to engine instruments.
Passengers entering and exiting cockpit.


“There were a lot of people on the plane that knew something was wrong, but we all kind of followed each other, and that’s where we made our mistake.”


There have been many speculations on what led to this incident… Pressure on the pilots to get the band to their destination, a rowdy culture that quite possibly caused distraction in the cockpit, lack of accountability in maintaining the plane’s airworthiness, and more.


Discuss with your transport team:  Do you see similarities to the pressures and challenges in our industry?  What factors may have played into this incident?  What measures does your organization have in place to enhance safe operations, reduce distraction, maintain vehicle quality and remove customer and financial pressure when reviewing transport requests?



ECHO Safety Team

By Jeff White, M.S., MTSP-C, FP-C.  Director of Safety, HealthNet Aeromedical Services

Every Coast Helicopter Operations (ECHO) has evolved into a driving force for our industry.  The organization was created by flight crews as an opportunity to collaborate on safety, training, and come together to share ideas to become better clinicians and patient care providers.  ECHO encompasses all public safety aviation, which includes law enforcement, search and rescue, and military members and provides free to low-cost education, high quality training programs, crew member and program support, and networking opportunities to public safety aviation members around the world.

As an added service for the industry, ECHO has developed a safety team to travel the country to assist agencies with an unbiased mindset to build internal safety management systems, complete safety and crew resource management training for agencies, etc.

Driven by CAMTS and the FAA, companies are now required to have their own safety programs that integrate into their operator’s safety program. This will create a more controllable safety program for a company’s specific area and hazards encountered.

This team will continue to grow and drive safety bringing it to the forefront of the industry and is another service for the aeromedical industry provided by the aeromedical industry.

The ECHO Safety Team is comprised of members from across

the country and includes:

Veronica Marzonie, Team Director: RN, LifeFlight of Maine

Ron Folse: Pilot, Orange County Florida Sheriff’s Office

Rachel Tester: Pilot/Paramedic, Tennessee

Brian Ceraolo: Business Development Manager for LifeForce, Tennessee

Justin Koper: Flight Paramedic and Safety Officer for HealthNet Aeromedical Services, West Virginia

Joey Loehner: EMS Planning Officer and Flight Paramedic for Humboldt General Hospital EMS, Nevada

Jeffrey White: Flight Paramedic and Director of Safety for HealthNet Aeromedical Services, West Virginia

Rhett Draehn: Safety Director of Air Division for CareFlite, Texas

ECHO Safety Team


Crew Resource Management in IIMC

by Dave Corbi, MedFlight 4 Pilot

Inadvertent Instrument Meteorological Condition (IIMC) is a potentially deadly situation that flight teams may encounter while operating in marginal weather conditions.  According to a recent FAA study: “Tests conducted with qualified instrument pilots indicated that it can take as long as 35 seconds to establish full control via instruments once visual reference to the horizon is lost.”  While MedFlight operates under visual flight rules (VFR), each pilot is instrument-rated and trained to fly in IIMC conditions.

The pilot is always in command of the aircraft.  However, safe operations is everyone’s responsibility, and everyone on-board the helicopter should have a vested interest in the safe completion of every flight. These crew resource management (CRM) actions during an IIMC event may assist the pilot and ultimately the safe completion of the flight:

  1.  A clinical team member’s actions should always support the pilot’s actions.  Keep the pilot situationally aware of deteriorating weather conditions. An example could be telling the pilot, “I can’t see the horizon any longer from the 2 o’clock to 5 o’clock position”.
  2. If the pilot is task-saturated, they may need you to make radio calls for them or perform other duties as requested. You may be asked to select and program frequencies or request assistance with air traffic control. Calls to your program’s communication center or operational control center are secondary to this radio traffic and should be completed following primary calls to local ATC.
  3. Assist in setting the aircraft GPS or communication radios as requested.
  4. Access information from the aviation resource manual or tablet and provide the pilot with requested information, such as frequencies, instrument approach plates and sectional charts.
  5. Ensure there is clear and concise communication between all team members on-board, and remain situationally-aware of the conditions you find yourself operating in.

It is important for crewmembers to understand IIMC avoidance and recovery procedures. Every crew member’s experience and knowledge can be helpful in the successful outcome of any in-flight emergency..  Take time regularly to train as a team, know where to locate and how to operate the above resources on your aircraft, and ask your pilot questions during your shift about these procedures.

Good crew resource management REQUIRES that you speak up when you have a concern.  Do not let lack of experience, or pressure to accept a flight in less-than-ideal weather, influence your decision-making.  Always trust your gut.  Remember: “Three to go, one to say no.”

Author Note:  Dave Corbi has worked as a helicopter pilot for MedFlight since 2001.  He also currently serves as the Battalion Standardization Pilot and Instrument Examiner with the Ohio Army National Guard.




Bird Strike Mitigation

Bird Strike Mitigation

By Jeff White, M.S., MTSP-C, FP-C, Director of Safety, HealthNet Aeromedical Services

Spring is here, and warmer temperatures means the risk of migratory birds is on the rise.

Along with an increased chance of bird strikes comes maintenance issues with birds nesting in open areas of aircraft.

The FAA has worked with many agencies to create risk mitigation and data collection techniques to prepare crews when flying this time of year. Date shows 66%-68% of bird strikes occur during the enroute portion of a flight, 8%-9% on approach phase and 9%-10% during climb phase. Elevations of 500’ and below is known as the bird rich zone while 93% of bird strikes occur below 3500’. To date, there has only been one known fatal HEMS accident due to a bird strike.

Here are tools available to you to assist with live tracking of birds:


Avian Hazard Advisory System

Please remember this time of year, visors and sleeves down and eyes out and always scanning. Bird strikes can occur at any time, so diligence is key.



Winter Helipad Safety Tips

Here are 10 quick tips on how to keep your helipad in SAFE shape this winter:

1.  Use only UREA or a chemical product that claims no corrosive properties or hazards to the environment, such as the ice-melting agents Sodium Acetate or Potassium Acetate.

2.  DO NOT USE ROCK SALT.  Rock salt is corrosive to the aircraft.

3.  Do not use sand as an anti-skid agent.  It will not stay in place, and creates a projectile hazard during rotor wash.

4.  Helipad warning/safety signs should be cleared of snow and remain visible.

5.  Do not bury perimeter lighting in snow piles.

6.  Do not pile snow in front of gates or routes of ingress/egress from the helipad.

7.  Snow piles immediately adjacent to the helipad greater than 2 ft high could cause damage to the helicopter tail rotor.

8.  Position snow piles so that melting snow and ice will drain from the helipad and not refreeze, creating a fall/slip hazard.

9.  Helicopters develop rotor was that typically exceeds 75-100 mph.  Dangers include serious wind chill and projectiles created by any loose snow or ice.

10.  Whiteout conditions can occur during takeoff and landings.  These can affect pedestrian and motor vehicle traffic.


**Consider helipad painting schemes that help melt ice and snow.  A red background is recommended.  See FAA Advisory Circular (AC) 150-5390-2BPara 409b. (2) and fig 4-10b**




For more info, visit

or contact:

Amanda Ball, Safety Officer at MedFlight.


Shorelines: More than Just Extension Cords

By Mark A. Farley, CFRN
Flight Nurse
HealthNet Aeromedical Services Base 9


When unplugging your ambulance or aircraft, have you ever noticed the shoreline connection felt a little warm? If so, do you realize this can potentially be a serious problem?

Even if the connection does not feel warm, an inspection of the cord and its connections
still needs to be done. This cord is essential to the Mission.Ready. philosophy we live by each day.

Ambulance manufacturers began using products for shoreline connections in the early 1970s. This equipment was equivalent to standard RV hardware that would accommodate the load of a tricklecharging for system batteries, a suction device and a hand-held radio.  This work load would pull less than 500 watts and a 15-amp residential cord could handle the demand easily. Shorelines are connected to many things today that are considered “parasitic loads.”

Some examples at minimum are a 10-amp charger for the chassis batteries, chargers for cot batteries, cardiac monitor, ventilator, suction, thermal angel/buddy lite, refrigerator and possibly a block heater.  All of this adds up!  The next time you remove the shoreline
cord and it feels warm, it is a safe bet it is delivering current more than its recommended capacity.
Always examine shoreline cords at both ends and the shoreline receptacles on both ambulances and aircraft. A safe cord should be firmly attached to its plugs on both ends. If you find cutting of the outer and inner jackets exposing bare copper, remove the cords from service immediately and notify the base lead.  Crews must be familiar with the breaker panel in their ambulance and should know where it is located and how to reset the panel. It should contain at least a 110-volt circuit breaker, which looks like a
toggle switch. There should be a number, either 15 or 20, on the visible part of the breaker which indicates the maximum amount of a 110-volt current the breaker will handle before it trips. The constant load rating for shoreline should amount to less than half of the breaker’s trip limit.
Cords should also be permanently labeled every three to four feet with the kind of wire it contains. For example, a cord that handles a max of 15 amps should be labeled 14-3 AWG. This indicates three 14-gauge wires. A cord that handles a max of 20 amps should say 12-3 AWG.  This means three 12-gauge wires.  A 12-gauge cord protected by a 20-amp breaker in the station or hangar and a 20-amp breaker in your ambulance or aircraft would be optimal.
It is recommended that ambulance and aircraft shoreline cords be replaced once each year. Each time the cord is plugged and unplugged the ends arc slightly. This arc causes some wear on the metal and creates some minor damage.  The amount of times the cords arc when plugged in wears the contacts, thus making the contacts less and less reliable when the cord is utilized over time. Cords do get wet and are run over from time to time by vehicles more than five tons.  Make it a habit to pull cords out of the drive path of
vehicles.  Habits are reliable, even when we are tired.


National EMS Health & Safety Officer Update

By Jeff White, M.S., MTSP-C, FP-C
Director of Safety
HealthNet Aeromedical Services

The National EMS Health and Safety Officer committee has been diligently
working for the past year in conjunction with the National EMS Management
Association (NEMSMA) to create a model for EMS agencies to use in selecting
a dedicated safety representative. NEMSMA already has certified and tested
positions for an EMS Director, EMS Manager, EMS Supervisor and has almost
completed the EMS QA/QI position. Now they are moving onto safety. Our
committee currently has the position description and position personal attributes
completed. We are currently in the process of creating the test model and
discussing what materials one might study or learn to achieve this position
We have based our test model on the Board of Certified Safety Professional’s
(BCSP) Associate Safety Professional (ASP) model. We have begun the process
of incorporating EMS specific modalities into this general safety model to make it
relevant for an EMS individual. Many agencies will most likely choose someone
with EMS experience, but others across the country have already begun to
incorporate general industry safety professionals into their system for a broader
look at safety processes. We hope the final model will increase the professionalism
of the position along with the industry.


MedComm: Columbus’ Air Medical “Air Traffic Control”

medcomm-retro (1)
Learn more about MedComm at

MedComm:  Columbus’ Air Medical “Air Traffic Control”

Amanda Ball, Safety Officer


Columbus, Ohio, is home to several trauma centers, burn centers, hyperbaric chambers, and hospitals offering the best in specialized care.  Because of this, air medical traffic in central Ohio is often congested.  With 9 helicopter teams positioned throughout Ohio, MedFlight is often in the air across the state and potentially crossing paths with other air medical programs in the area.

Since its inception, MedFlight’s communication center, MedComm, has been proudly located in Columbus.  These local and highly-trained experts are available 24/7 for your safety needs and have impressive experience in aviation, 911 dispatching, EMS, military service, nursing, and air medicine.

For decades, MedComm has provided flight-following and flight monitoring services for not only our teams, but for other air medical programs visiting central Ohio hospitals as well.  With safety as our top priority, MedComm acts as “air traffic control” for all inbound and outbound aircraft in the greater Columbus region.  This initiative began as part of a partnership with the Central Ohio Trauma System to help prevent “traffic jams” over hospital helipads, flight paths crossing, and potential near-misses in an already congested urban airspace.

If you work at an agency that transports into the Columbus area, we ask that you contact MedFlight MedComm so we can not only alert other flight teams and hospital security teams of your intended flight path, but we can keep an eye on YOUR safety as well.   This needed communication process is broken down into a few simple steps:

  1.  Have your dispatch center call MedComm with your flight path and an ETA. MedComm can be reached 24/7 at 1-800-222-5433.
  2. Once you are 15 minutes away from your Columbus destination, contact MedComm on the radio. Most visiting flight programs contact MedComm on 155.400 PL 141.3, but you are welcome to contact us on MedFlight’s MARCS channel, labeled as MEDFLT.  They will relay any air medical traffic you need to look out for in the area during your mission.
  3. Columbus is also home to several touring, media, and law enforcement helicopters, 3 major airports, and visiting air traffic (banner planes, blimps, etc) during special events. Please announce your intended flight path and altitude to air traffic on Unicom 123.025 when you are entering Columbus airspace.

Along with overseeing air medical traffic, MedComm is more than happy to assist your teams with their operational needs, like arranging for extra personnel to be waiting on your arrival for patient unloading, contacting your dispatch center if you are out of range, etc.

With your help, we can maintain a safe flying culture in the Greater Columbus area and around Ohio.  #PartnersForLife


Safer Operations: The MedFlight Risk Assessment Experience

Schano, Greg
Written by Greg Schano, RN, MSN, MBA, CCRN, CMTE, CNML, EMTP.  Flight Nurse, MedFlight.

Healthcare is an industry associated with high risk1 and while critical care transport (CCT) contributes to this, certain risks attendant to ground critical care transportation are not described well2, 3 and may be appreciated less completely than their rotor-wing counterparts.  Yet understanding and inculcating safety in CCT is important and urgent.4

During the period 1992-2011, there were 4,500 crashes involving an ambulance5 in the US (average 225 per year) and while 58% of these crashes occurred during emergency operations, 1% involved at least one fatality.5  It is not clear if these data includes ground critical care transport vehicles.  Blumen notes between 1972-2016, emergency medical service helicopters experienced 342 accidents (nearly 8 per year) with 36% involving at least one fatality.6  Many CCT agencies, including MedFlight, have adopted a variety of safety strategies including a philosophy of “three-to-go; one-to-say-no,” fatigue assessments, departure and arrival checklists, written time-out guidelines, and risk assessment (RA) matrices.7

Most often human error emerges from systems with flawed designs.8  Safe patient care, therefore, depends on systems designed around practices that aim to prevent, recognize, and mitigate harm.  Building safety into operations is an effective approach to reducing error8 and is achieved, in part, by indoctrinating a just culture,9 incorporating human factors awareness into organizational procedures and individual practices,8 and striving for high reliability.  Organizations of high reliability share five characteristics including sensitivity to operations, reluctance to simplify, preoccupation with failure, deference to expertise, and resilience.9, 10  Checklists and risk assessments are tools caregivers can use to help prevent, recognize, and mitigate harm.

In its enduring quest for safer operations, MedFlight began conducting risk assessments at the employee (partner) level in 2008 and includes a requirement for partners to conduct a shift risk assessment and ground transport risk assessment (sensitivity to operations, preoccupation with failure).  For rotor-wing helicopter operations, a pilot risk assessment is performed following Metro Aviation, Inc. standards.  Metro Aviation is contracted by MedFlight to provide aviation services including operational control (sensitivity to operations, preoccupation with failure, deference to expertise).  During the summer of 2017, MedFlight began a process of evaluating and updating its risk assessment matrices for medical crew (sensitivity to operations, reluctance to simplify, preoccupation with failure) with a task force of safety committee representatives including nurses, paramedics, and a safety officer.  The task force chose to evaluate MedFlight’s Shift Risk Assessment tool first (Figure 1).  Brainstorming followed with sessions on purpose, criteria, language, and weighted values.  Risk assessment tools from other CCT programs were reviewed (deference to expertise, reluctance to simplify) and a new tool was developed.  MedFlight’s safety committee, risk manager and leadership team approved the deliverable (deference to expertise, sensitivity to operations, reluctance to simplify).

Each MedFlight clinical partner for all modes of transport initiates an electronic risk assessment at the beginning of each 12-hour shift and following each transport throughout the shift (preoccupation with failure, sensitivity to operations, reluctance to simplify, resilience).  A new version of this risk assessment tool went into effect November, 2017.  The new Personal Risk Assessment tool (Figure 2), replaces the Shift Risk Assessment tool.  The task force believes this personal assessment with face validity represents a partner’s own analysis of their own risk based on their own unique features (deference to expertise, sensitivity to operations, reluctance to simplify).  Following are changes:

  • Criteria captures qualities which contribute to fatigue
  • Language written in first-person makes the tool more personal
  • New weighted values
  • Weighted values calculate in the background by the computer information system
  • Asks the partner to rate their activity level during the preceding 10 hours instead of the day before (MedFlight requires a partner to be off at least 10 hours between any and all employment)
  • Asks the partner if they feel rested rather than assessing rest in units of time
  • Modifies risk associated with number of days in a row the partner has worked to align more closely with the schedule a 12-hour shift worker may experience
  • Colorizes gradation of risk. Output of this assessment to the MedFlight partner is a color (green, yellow, red), which corresponds to increasingly more risk.  When a partner’s risk is red the partner takes crew rest (crew rest is consistent with long-standing MedFlight policy)

The Personal Risk Assessment tool is integrated into a computerized crew briefing form wherein the partner responds to each of the tool’s four questions.  Responses can be amended until the data is saved.  Once saved, the partner receives their risk color, their responses are fixed, and no further modifications are possible.  While the output to the partner is a color (green, yellow, red), MedFlight’s computer information system captures data in the background so the organization can trend in the aggregate.  By comparing risk colors with feelings of tiredness or fatigue, a partner can develop a sense of personal wisdom over time about how to best prepare for a work shift and manage their physical needs during a shift.

Next, MedFlight will revise its ground transport risk assessment matrix (Figure 3) for use by its mobile intensive care unit (MICU) and FlyCar teams and we look forward to sharing this process and tool.  MedFlight FlyCars are sport utility vehicles located strategically throughout the state of Ohio and are activated as needed to ensure availability of quality critical care transportation and a timely response.  Please look for future installments here…because…Safety Matters.


Figure 1.

Shift Risk Assessment used by MedFlight partners prior to 11.2017


Figure 2.

Personal Risk Assessment tool used by MedFlight partners beginning 11.2017


Figure 3:


Risk assessment matrix for ground transports currently in use by MedFlight partners.


  1. Saysana M, McCaskey M, Cox E, Thompson R, Tuttle L, Haut P. A Step Toward High Reliability: Implementation of a Daily Safety Brief in a Children’s Hospital. Journal Of Patient Safety. September 2017;13(3), 149-152.
  2. Singh J, MacDonald R, Ahghari M. Critical events during land-based interfacility transport. Annals Of Emergency Medicine. July 2014;64(1), 9-15.
  3. Spradlin W, Kalmar T, McLaughlin D, Bigham M, Volsko T. Use of Ground Risk Assessment to Identify and Mitigate Risks Associated With Ground Critical Care Transport. Air Medical Journal. September 2016;35(5), 287.
  4. Jaynes C, Werman H, White L. A Blueprint for Critical Care Transport Research. Air Medical Journal. January 2013;32(1), 30-35.
  5. The national highway traffic safety administration and ground ambulance crashes. National Highway Traffic Safety Administration. April, 2014. GroundAmbulanceCrashesPresentation.pdf. Accessed November 17, 2017.
  6. Huber M. HEMS industry getting safer. AINonline. 2016. aviation-news/business-aviation/2016-12-22/hems-industry-getting-safer. Accessed November 18, 2017.
  7. Greene M. 2012 Critical Care Transport Workplace and Salary Survey. Air Medical Journal. November 2012;31(6), 276-280.
  8. Kohn L, Corrigan J, Donaldson M, eds. To err is human: Building a safer health system.  Washington, DC: Institute of Medicine; 1999
  9. Advice for Hospital Leaders. AHRQ Publication No. 08-0022. Rockville, MD: Agency for Healthcare Research and Quality; 2008.
  10. Innovation in pursuit of high-reliability culture. Patient Safety Monitor Journal. May 2017;18(5),1-4.