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Evaluation of retention of safety and survival training content versus industry standard for training
ORIGINAL
RESEARCH
Evaluation of Retention of Safety and Survival Training Content versus Industry Standard for Training Jane S. Wynn, RN, BSN,‘V’,~and Stephanie
1. Air Med Alliance, Dallas, Texas 2. Mobile Healthcare LLL, Dallas, 3. SB Air, Dallas, Texas
Abstract Introduction: Texas
Copyright Associates
industry
at the Air Medical Transport October 6, 1997, Cincinnati,
dustry
by the Air Medical
Journal
never
subject.
We
testing
of crews’
tain survival
Reprint
no. 74/l/93552
+ 0
training
solicited crews
survival
the
bers took
a sample and re-
the participa-
that
had received
and survival. training
to nurses
later
conon this
material.
in safety
and
after
The in-
at nor tested
to conduct
program
fore a refresher ately
is an-
ability to understand
Methods: This study
months
training
or retention
decided
administrated
in the
programs.
looked
training
on safety
1067-991)(/98/$5.00
and safety
comprehension
previous
standard
educational
has
tent
accepted
for survival
tion of four 0 1998
Introduction The
nual recurrent
Address for correspondence and reprints: Jane S. Wynn, RN, BSN, Air Med Alliance, 3860 W. Northwest Highway, Ste. 406, Dallas, TX 75220 Presented Conference, Ohio
Black1,2”
and
A test
content
was
paramedics
be-
course
(test I), then
immedi-
course
(test
again
2), and
(test 3). Ninety-six
tests
crew
6
mem-
1 and 2, and 79 (82%)
took
test 3.
Results: The average
time
member
in this
tended The
participating a survival
pretraining
course test
the posttraining
(92%);
and the 6-month
level
of survival
study
was
any
crew
had
at-
1 to 1.5 years.
mean
(60%);
(65%). Conclusion:
since
score
was
60
average
score
was 92
mean
score
was
65
Flight crews do not retain a safe skill knowledge with annual
recurrent training. needs to reevaluate
Therefore its position
the industry on this stan-
dard of annual recurrent training. Survival training is too important for flight crews to undertake
only once
as important
166
per year.
as patient
care!
Rescuer
care
is
Safety is always a high priority for any air medical program. Although quality and safety assurance programs have been implemented in air medical programs throughout the country, accidents still occur. As with any accident, the ability to respond quickly, efficiently, and effectively is paramount. A crew’s ability to respond appropriately depends on the members’ ability to recall learned and practiced skills. To be confident in their decision-making capabilities, they need to be able to retain knowledge they can use when necessary. Currently, the accepted industry standard for survival or safety training is annual recurrent educational programs. This training has been the norm for many years without question. This standard was first published in the American Society of Hospital Based Emergency Air Medical Services (ASHBEAMS) safety guidelines and again in the AAMS safety guidelines’ published in July 1991. The industry has neither thoroughly reviewed nor tested content comprehension or retention of this subject. Because we believed that annual recurrent training was not sufficient to ensure safety, we decided to conduct a study project on the retention rate of medical flight crews. A sample testing of several medical flight crews’ abilities to comprehend and retain survival and safety training material was developed specifically for this study project.
October-December
1998 17:4
Air Medical Journal
Setting
SB Air has provided fixed-wing air medical transport for more than 20 years. SB Air brought together several of its hospital-associated and independent provider programs to better evaluate the effects of its training programs and the overall retention rates of the crews. Several programs were selected for the study project because a prior rotorwing-based project2 conducted in 1993 studied only one program with a smaller sample group and showed higher levels of retention. By using a more diverse sample, SB Air wanted to gain a more accurate and comprehensive picture of actual retention rates. The participating fixed-wing programs, listed in Table 1, fly an average of 1200 flights per year and serve three states: Arkansas, New Mexico, and Texas. Two hospital-associated programs fly in a mountainous region with highaltitude conditions and cater predominately to rural and frontier populations. Another hospital-associated program conducts many interfacility transfers and flies under more adverse weather conditions. The other participants were nonhospital-associated, independent providers that cover a large geographic territory and fly under various conditions. Two programs serve large urban and suburban areas, whereas two others serve predominantly suburban areas. All programs care for diverse patient care needs and populations. Ninety-six nurses and paramedics participated in the project, all of whom had some preexisting knowledge and training in survival and safety. They volunteered for this study project as a means to complete their recurrent training obligations. Methods
This study solicited the participation of four air medical programs (one program has two separate crews and contracts for services but is considered one program, thus the reason five programs are listed as participants). All medical crew members had previous survival and safety training. The average time since any member had taken a similar training course was 1 to 1.5 years, the current industry norm. Air Medical Journal
17:4
October-December
A comprehensive safety and survival test was designed by a panel of pilots, nurses, and paramedics to evaluate the comprehension and retention of the candidates. A 25item questionnaire was developed from a pool of questions. Subject topics covered in the test are listed in Table 2. Each question was weighted on a scale of four with a total test score possibility of 100. One test was designed to be given at three intervals during the re search project and was called test 1, test 2, and test 3. The study project covered September 1996 to March 1997. Before beginning the refresher training course, an initial test-test l-on safety and survival training was adminis tered to the participating nurses and paramedics. Then an extensive survival and safety training course was conducted. The &hour training program covered all the federal aviation regulation 135.331 crew-member emergency training requirements listed in Table 2. Immediately after the course, test 2 was administered to the participants. Results from this second test indicated an increase in the level of learning comprehension from the initial test. Test 3 was administered to the same participants 6 months after the training course. This test was designed to show the actual amount of knowledge retention from test 2 to test 3 and the differences in all three tests. Results
Of the initial group of participants who took tests 1 and 2, 82% took test 3. Thus, of the original 96 participants, 79 actually completed all three tests. Crew members who initially participated in the study but left the program before completing all three tests were excluded from the final analysis. Also excluded were new crew members who joined the participating programs after the initiation date of the study. A comparison of the mean scores of all three tests is shown in Table 3. The mean test score for the pretraining examination (test 1) was 60%.After attending the training course, the group’s posttraining (test 2) average score was 92%.The study participants’ mean confidence scores increased from 60% before training to 90% afterward. Sii months later, 1998
Participating l
l
l
l
Lifeguard AES, University Mexico Health Sciences Albuquerque, N.M.
of New Center,
Lifeguard Neonate Transport, University of New Mexico Department of Pediatric Neonatology, Albuquerque, N.M. LifeNet, System,
l
Programs
Inc., Medical Transportation Texarkana, Texas
Children’s Transport
Medical Services,
SB Air, Inc.,
Center Pediatric Dallas, Texas
Dallas,
Texas
Topics Covered in the Training Test FAR 135.331
Content
Emergency assignments/procedures Crew member coordination Emergency equipment function/ operations First aid equipment Fire extinguisher use Rapid decompression Fire management in flight and on surface Smoke control Electrical/circuit breakers Ditching/evacuation Illness/injury/abnormal situations Hijacking/other unusual situations Review accidents/incidents Emergency dritls practice i Emergency exits/evacuation Deployment Evacuation chutes Crew/passenger oxygen Life vests/life rafts/life lines/boarding Crew member instruction above 25,000 feet Respiration Hypoxia Time useful consciousness Gas expansion/bubble formation Principles of decompression
Additional
Subjects
Aircraft structures Environmental conditions Insects Terrain Weather Physiological/psychologic issues Environmental stressors Survival/crash/disaster management
167
Survival Test
Test Mean
-7
Scores
1 -Pretraining
60%
Test 2-Posttraining
90%
Test 3-6
65%
months
crew members’ mean score on the posttraining test was 65%.
Conclusion
Under the current standards, medical flight crews are not retaining a safe level of survival skill knowledge with annual recurrent training. After only 6 months, the test groups’ retention rates decreased almost to the point of pretraining-65% and 60%,respectively. Based on this survey, the industry needs to reevaluate its position on standard annual recurrent training. Survival and safety train-
ing are too important for flight crews tc review only once a year. Rescuer care it as important as patient care. For crews tc respond appropriately in the event of a~ accident, more frequent training must bc implemented to ensure programs’ overal safety.
References 1. Association of Air Medical Services. Minimum quality standards and safety guidelines: rotorcraft/fixed-wing. Pasadena (CA): The Association; 1991.
2. Wright A. The effect of an in-flight emergency training program on crew confidence. Air Medical J 1994.
Bibliography Airman’s information manual/federal aviation regulation. Blue Ridge Summit (PA): TAB/AERO Books; 1997. Section 135.331. Blumen IJ, Rinnert KJ. Altitude physiology and the stresses of tliiht. Air Medical J 1995;14:87-100.
168
Hunt D. Survivak a primer, AirMed 1996;2(6):29-33. Lee G. Flight nursing principles and practice. Park Ridge (IL): National Flight Nurses Association; 1991.
National Highway Transportation Safety Administration. Air medical crew national standard curriculum instructor manual. Pasadena (CA): ASHBEAMS; 1983. p.15-43.
October-December
1998
17:4
Air
Medical
Journal
RESEARCH
Evaluation of Retention of Safety and Survival Training Content versus Industry Standard for Training Jane S. Wynn, RN, BSN,‘V’,~and Stephanie
1. Air Med Alliance, Dallas, Texas 2. Mobile Healthcare LLL, Dallas, 3. SB Air, Dallas, Texas
Abstract Introduction: Texas
Copyright Associates
industry
at the Air Medical Transport October 6, 1997, Cincinnati,
dustry
by the Air Medical
Journal
never
subject.
We
testing
of crews’
tain survival
Reprint
no. 74/l/93552
+ 0
training
solicited crews
survival
the
bers took
a sample and re-
the participa-
that
had received
and survival. training
to nurses
later
conon this
material.
in safety
and
after
The in-
at nor tested
to conduct
program
fore a refresher ately
is an-
ability to understand
Methods: This study
months
training
or retention
decided
administrated
in the
programs.
looked
training
on safety
1067-991)(/98/$5.00
and safety
comprehension
previous
standard
educational
has
tent
accepted
for survival
tion of four 0 1998
Introduction The
nual recurrent
Address for correspondence and reprints: Jane S. Wynn, RN, BSN, Air Med Alliance, 3860 W. Northwest Highway, Ste. 406, Dallas, TX 75220 Presented Conference, Ohio
Black1,2”
and
A test
content
was
paramedics
be-
course
(test I), then
immedi-
course
(test
again
2), and
(test 3). Ninety-six
tests
crew
6
mem-
1 and 2, and 79 (82%)
took
test 3.
Results: The average
time
member
in this
tended The
participating a survival
pretraining
course test
the posttraining
(92%);
and the 6-month
level
of survival
study
was
any
crew
had
at-
1 to 1.5 years.
mean
(60%);
(65%). Conclusion:
since
score
was
60
average
score
was 92
mean
score
was
65
Flight crews do not retain a safe skill knowledge with annual
recurrent training. needs to reevaluate
Therefore its position
the industry on this stan-
dard of annual recurrent training. Survival training is too important for flight crews to undertake
only once
as important
166
per year.
as patient
care!
Rescuer
care
is
Safety is always a high priority for any air medical program. Although quality and safety assurance programs have been implemented in air medical programs throughout the country, accidents still occur. As with any accident, the ability to respond quickly, efficiently, and effectively is paramount. A crew’s ability to respond appropriately depends on the members’ ability to recall learned and practiced skills. To be confident in their decision-making capabilities, they need to be able to retain knowledge they can use when necessary. Currently, the accepted industry standard for survival or safety training is annual recurrent educational programs. This training has been the norm for many years without question. This standard was first published in the American Society of Hospital Based Emergency Air Medical Services (ASHBEAMS) safety guidelines and again in the AAMS safety guidelines’ published in July 1991. The industry has neither thoroughly reviewed nor tested content comprehension or retention of this subject. Because we believed that annual recurrent training was not sufficient to ensure safety, we decided to conduct a study project on the retention rate of medical flight crews. A sample testing of several medical flight crews’ abilities to comprehend and retain survival and safety training material was developed specifically for this study project.
October-December
1998 17:4
Air Medical Journal
Setting
SB Air has provided fixed-wing air medical transport for more than 20 years. SB Air brought together several of its hospital-associated and independent provider programs to better evaluate the effects of its training programs and the overall retention rates of the crews. Several programs were selected for the study project because a prior rotorwing-based project2 conducted in 1993 studied only one program with a smaller sample group and showed higher levels of retention. By using a more diverse sample, SB Air wanted to gain a more accurate and comprehensive picture of actual retention rates. The participating fixed-wing programs, listed in Table 1, fly an average of 1200 flights per year and serve three states: Arkansas, New Mexico, and Texas. Two hospital-associated programs fly in a mountainous region with highaltitude conditions and cater predominately to rural and frontier populations. Another hospital-associated program conducts many interfacility transfers and flies under more adverse weather conditions. The other participants were nonhospital-associated, independent providers that cover a large geographic territory and fly under various conditions. Two programs serve large urban and suburban areas, whereas two others serve predominantly suburban areas. All programs care for diverse patient care needs and populations. Ninety-six nurses and paramedics participated in the project, all of whom had some preexisting knowledge and training in survival and safety. They volunteered for this study project as a means to complete their recurrent training obligations. Methods
This study solicited the participation of four air medical programs (one program has two separate crews and contracts for services but is considered one program, thus the reason five programs are listed as participants). All medical crew members had previous survival and safety training. The average time since any member had taken a similar training course was 1 to 1.5 years, the current industry norm. Air Medical Journal
17:4
October-December
A comprehensive safety and survival test was designed by a panel of pilots, nurses, and paramedics to evaluate the comprehension and retention of the candidates. A 25item questionnaire was developed from a pool of questions. Subject topics covered in the test are listed in Table 2. Each question was weighted on a scale of four with a total test score possibility of 100. One test was designed to be given at three intervals during the re search project and was called test 1, test 2, and test 3. The study project covered September 1996 to March 1997. Before beginning the refresher training course, an initial test-test l-on safety and survival training was adminis tered to the participating nurses and paramedics. Then an extensive survival and safety training course was conducted. The &hour training program covered all the federal aviation regulation 135.331 crew-member emergency training requirements listed in Table 2. Immediately after the course, test 2 was administered to the participants. Results from this second test indicated an increase in the level of learning comprehension from the initial test. Test 3 was administered to the same participants 6 months after the training course. This test was designed to show the actual amount of knowledge retention from test 2 to test 3 and the differences in all three tests. Results
Of the initial group of participants who took tests 1 and 2, 82% took test 3. Thus, of the original 96 participants, 79 actually completed all three tests. Crew members who initially participated in the study but left the program before completing all three tests were excluded from the final analysis. Also excluded were new crew members who joined the participating programs after the initiation date of the study. A comparison of the mean scores of all three tests is shown in Table 3. The mean test score for the pretraining examination (test 1) was 60%.After attending the training course, the group’s posttraining (test 2) average score was 92%.The study participants’ mean confidence scores increased from 60% before training to 90% afterward. Sii months later, 1998
Participating l
l
l
l
Lifeguard AES, University Mexico Health Sciences Albuquerque, N.M.
of New Center,
Lifeguard Neonate Transport, University of New Mexico Department of Pediatric Neonatology, Albuquerque, N.M. LifeNet, System,
l
Programs
Inc., Medical Transportation Texarkana, Texas
Children’s Transport
Medical Services,
SB Air, Inc.,
Center Pediatric Dallas, Texas
Dallas,
Texas
Topics Covered in the Training Test FAR 135.331
Content
Emergency assignments/procedures Crew member coordination Emergency equipment function/ operations First aid equipment Fire extinguisher use Rapid decompression Fire management in flight and on surface Smoke control Electrical/circuit breakers Ditching/evacuation Illness/injury/abnormal situations Hijacking/other unusual situations Review accidents/incidents Emergency dritls practice i Emergency exits/evacuation Deployment Evacuation chutes Crew/passenger oxygen Life vests/life rafts/life lines/boarding Crew member instruction above 25,000 feet Respiration Hypoxia Time useful consciousness Gas expansion/bubble formation Principles of decompression
Additional
Subjects
Aircraft structures Environmental conditions Insects Terrain Weather Physiological/psychologic issues Environmental stressors Survival/crash/disaster management
167
Survival Test
Test Mean
-7
Scores
1 -Pretraining
60%
Test 2-Posttraining
90%
Test 3-6
65%
months
crew members’ mean score on the posttraining test was 65%.
Conclusion
Under the current standards, medical flight crews are not retaining a safe level of survival skill knowledge with annual recurrent training. After only 6 months, the test groups’ retention rates decreased almost to the point of pretraining-65% and 60%,respectively. Based on this survey, the industry needs to reevaluate its position on standard annual recurrent training. Survival and safety train-
ing are too important for flight crews tc review only once a year. Rescuer care it as important as patient care. For crews tc respond appropriately in the event of a~ accident, more frequent training must bc implemented to ensure programs’ overal safety.
References 1. Association of Air Medical Services. Minimum quality standards and safety guidelines: rotorcraft/fixed-wing. Pasadena (CA): The Association; 1991.
2. Wright A. The effect of an in-flight emergency training program on crew confidence. Air Medical J 1994.
Bibliography Airman’s information manual/federal aviation regulation. Blue Ridge Summit (PA): TAB/AERO Books; 1997. Section 135.331. Blumen IJ, Rinnert KJ. Altitude physiology and the stresses of tliiht. Air Medical J 1995;14:87-100.
168
Hunt D. Survivak a primer, AirMed 1996;2(6):29-33. Lee G. Flight nursing principles and practice. Park Ridge (IL): National Flight Nurses Association; 1991.
National Highway Transportation Safety Administration. Air medical crew national standard curriculum instructor manual. Pasadena (CA): ASHBEAMS; 1983. p.15-43.
October-December
1998
17:4
Air
Medical
Journal