Medicolegal Aspects of Aeromedical Evacuation
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Medicolegal Aspects of Aeromedical Evacuation
A light hearted and totally unofficial view of the complexities of the aeromedical industry both civilian and military. This view is through a legal and regulatory lens and seeks to inform and educate others involved through identification of best and worst practices giving my own personal opinions about both!
Curated by Dale Daborn
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Crossing the county line | AirMed and Rescue Magazine

Crossing the county line | AirMed and Rescue Magazine | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
Dale Daborn's insight:
Well - there's a lot in there to chew on from the Medicolegal Aspects of Aeromedical Evacuation. I would say that 'first do not harm' wouldn't have been my lead for the Beauchamp Childress Philosophies of Healthcare - I prefer Autonomy. Very interesting to see the huge areas where med legal can play a part in this area of medicine, but still don't see a vast amount of litigation through the courts. Perhaps the aeroplane chasers are not as fast as the ambulance chasers yet - but I'm sure this will follow. Also - there is perhaps a good reason for not seeing this in the fact that it would be commercially extremely damaging and settling pre-court would be far better for future business. The references to me throughout come from the dissertation submitted within my Masters in Medical Law which seems to be holding it's own despite 2-years passing since publication. For anyone involved in this emerging 'speciality' - a thought provoking article. 
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Unmanned K-MAX performs first casevac | Waypoint AirMed and Rescue Magazine

Unmanned K-MAX performs first casevac | Waypoint AirMed and Rescue Magazine | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
Dale Daborn's insight:

The judicious use of unmanned AE capability will significantly improve the options available to commanders / civilian disaster responders for specific patient groups within specific and known parameters of use. For more information on this through open source material: https://www.cso.nato.int/pubs/rdp.asp?RDP=RTO-TR-HFM-184 is an award winning piece of work which is of interest. Ultimately, the duty of care owed to the patient cannot be abrogated and medical assessment and oversight will still be required with the mission chain. Looking wider, this capability will provide significant utility where 'dangerous' retrieval of non-casualties is required.

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Final destination | Waypoint AirMed and Rescue Magazine

Final destination | Waypoint AirMed and Rescue Magazine | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
Dale Daborn's insight:

This article represents an extremely important and long overdue consideration of the fundamental principles of healthcare in the aeromedical environment concentrating on end-of-life transfer missions.

 

Throughout this article, the author touches on important ethical considerations and considers their relative merits such as fitness to fly, liability, waivers, autonomy, beneficence (or lack of it) and mental capacity, futility and, of course, finances factors.

While there appears to be an almost universal understanding and acceptance of the Childress and Beauchamp principles underpinning the philosophy of healthcare their application continues to be patchy reflecting the ongoing tensions between risk ownership and risk tolerance. Ultimately, the true ‘ownership’ of risk belongs to the patient (where capacity is not compromised) whose autonomy must always be respected (despite the fact that these choices may sometimes result in harm or death).

 

Dr Lelo of AMREF Flying Doctors aligns his/her practice with this right stating; ‘we do find, in most cases, that the decision to transfer these patients has already been made by the patient themselves, relatives or by the medical insurer’, recognizing the primary role of the patient’s autonomy.

 

However, comment by Dr Duchateau of Allianz Global reports that his/her company declines those patients for missions ‘if I think there is the possibility of the patient dying in the next hour’. Clearly logistics have a place, but the ability to predict life and death on a minute by minute basis is not scientific and declining the mission would not demonstrate to the patient or the relatives that the most effort had been applied. This position presumably reflecting futility in terms of meeting the objective (of transfer), ie ‘mission futility’.

 

Another company, East West Rescue, however, are reported in the article to decline ‘high risk’ patients where routing involved travel over international waters on the basis that ‘mission failure’ (ie death of the patient) would lead to ‘cumbersome paperwork’.

So, while Dr Warwick of Air Med Ltd describes the requirement for a ‘moral compass’ by aeromedical transportation companies, it would seem that ‘true North’ (and autonomy) still remains an infrequently visited destination for many companies who continue to steer away from autonomy and towards persistent paternalism and ‘loss of chance’ as Air Med Ltd themselves are reported to have done in declining a patient move for treatment (the company judging the treatment sought to present an unrealistic expectation of survival for the patient).

 

Beauchmp and Childress, Principles of Biomedical Ethics (OU Press, 2003)

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Underhand tactics on top of the world | Waypoint AirMed and Rescue Magazine

Underhand tactics on top of the world | Waypoint AirMed and Rescue Magazine | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
Dale Daborn's insight:

Another excellent article by James Paul Wallis who once again has identified another tension within the aeromedical chain of care. This time through the identification of unnecessary transfers, but unlike previous examples, these have been instigated (reportedly) by either the medical authority (on the ground - on Mt Everest) and even in collusion with a fake patient in order to gain a percentage of the call-out fee. Clearly all those involved in aeromedical evacuation are exposed to the ethical tensions between profit and good / best practice and sometimes the former wins out. Unlike previous posts, the provider company in this scenario is unaware of the spurious nature of the tasking and as CAPT Harman states (US Coast Guard colleague) - an unused aeromedical evacuation helicopter makes for an expensive paperweight!

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New accredited provider | European Aero-Medical Institute (EURAMI ...

Our congratulations go out to Medway Air Ambulance based in Lawrenceville USA for attaining Special Care accreditation! ‹ New accredited Provider: Malteser Service Center Medical Assistance & Air Ambulance.
Dale Daborn's insight:

And now accredited, presumably found to have reached a quality standard relating to the DRAFT standard 4.0 document which are yet to be completed or finalised. In other words, this accreditation provides little assurance to customers of any 'quality' in the absence of accountability. 

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understanding terminology: aeromedical evacuation, medevac, and repatriation

understanding terminology: aeromedical evacuation, medevac, and repatriation | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
Aeromedical evacuation (AE) is the long-distance, usually greater than 300miles, air transportation of patients after medical treatment that is adequate to assure a successful movement. It is most ...
Dale Daborn's insight:

Well, aside from the whole new set of terminology presented here, this article does once again bring up the issue of 'why' a patient is aeromedically evacuated / repatriated - opting for careful selection of patients and that there is nothing 'therapeutic' about aeromedical evacuation. However, there is certainly merit in undertaking an aeromedical evacuation which represents a 'last chance' of health. When does a breach of duty to undertake AE represent denial of service and 'loss of chance'?  While the ‘but for’ test creates a simple test for causation, the issue becomes more complicated when the breach may have prevented the possibility of avoiding the damage rather than causing it directly. Per Lord Guthrie in Kenyon v. Bell [1953] SC 125: “It is better to pursue damages from loss following negligence from poor treatment … than to pursue damages from negligence from poor treatment leading to the loss of chance of a better outcome than the loss”. 

 

So - not always as simple as it may seem !

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Air Reservists get worse-than-real training in C-17 packed with teams | Military | The Olympian

Air Reservists get worse-than-real training in C-17 packed with teams | Military | The Olympian | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
The Joint Base Lewis-McChord flight nurses in the air over the Northwest on Sunday had unbelievably bad luck during their training scenario inside a C-17 Globemaster III jet.
Dale Daborn's insight:

'Worse than real training' which actually exercises the competences of professional aviation trained healthcare providers in the most demanding circumstances.... is actually the best training possible. Aeromedical risk assessments commonly focus on the patient's needs and the possible eventualities surrounding the patient, however, the aviation environment is frequently unforgiving for those that underestimate the problems encountered managing patients during times of crisis... fires for example. While these may be considered unlikely, they are not impossible and rudimentary aircraft familiarisation (here are the fire exits - there is the fire axe) is no substitute for placing the healthcare providers in the scenario and demonstrating the competences required. Simulation and synthetic training is clearly becoming more prominent within the Aeromedical world and this is another welcome addition. 

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Air ambulance owner sues Tweed over deer strike

Air ambulance owner sues Tweed over deer strike | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
NEW HAVEN >> The Canadian owner of an air ambulance that was seriously damaged when it struck a deer on the main runway of Tweed New Haven Regional Airport on Sept.
Dale Daborn's insight:

Well, no-one ever said aeromedical evacuation was easy, however, the risks to successful mission completion of deer strike would not always be at the top of the risk list! That said, this is all about Duty... previous discussions relating to professional duty and to the duty of the flight crew aside, this is now the duty of the airport authorities to provide a 'safe runway'... but how far does that extend? How would Bolam deal with this? For me, the risk of 'wildlife' encroaching the runway was clearly a known risk - why else would the airport have a contract out for tender for a fence to mitigate this risk? Other airports already recognise this particular risk but even a 9 foot fence at RAF Leuchars was not enough to prevent the most agile deer from bouncing into harms way! However, whatever the known risk, those responsible for the runway have the duty, be it deer, or the broken shells of muscles dropped from a great height by seagulls to break them open (again RAF Leuchars)... creating a FOD hazard. Here however, the authority is mitigating the risk... at least in the process of doing so, but if the operator was not warned of that risk then the analogy with medicine continues.... perhaps (stretching it slightly now) with 'loss of chance' cases... had the operator known, then perhaps they would have been able to choose alternative airports etc... at least the damages sought do not include loss of life! My money is on breach of duty (to warn) here and causation is fairly simple! Oh Dear... (couldn't resist) !!

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STARS faces tough questions after Manitoba flights grounded

STARS faces tough questions after Manitoba flights grounded | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
The Manitoba government's suspension of STARS air ambulance flights in the province, in light of a recent patient death, has prompted tough questions about the service.
Dale Daborn's insight:

As usual in these cases, the negative outcome is a long long way from proving causation. An MI is always a bad situation, let alone one where the provision of secondary care is so far that a rotary wing transfer is required in the acute situation. Whether or not the O2 ?concentration / source was at fault would be difficult to prove that, but for this negligence, the outcome would not otherwise have occurred, on the balance of probabilities - certainly one to watch. However, the other incident referred to and previously reported within this curation is more clear cut (at least to my eyes) - the failure to consider the requirements for a ventilated patients airway to be managed and to know where the equipment was to acquit this duty would not (I would advance) be such a difficult prospect. Certainly one to watch - although dissappointing that it required a 'cluster' of such events to prompt action. Also - the language surrounding the monitoring of the safety measures put in place is significantly 'woolly' !

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Reassurances from Cornwall air ambulance operator over aircraft model ‘link’ to Glasgow pub crash tragedy

Reassurances from Cornwall air ambulance operator over aircraft model ‘link’ to Glasgow pub crash tragedy | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
The operator of Cornwall's air ambulance has reassured people the service will be unaffected after a similar model of helicopter crashed into a Glasgow pub.
Bond Air Services has confirmed it is...
Dale Daborn's insight:

Just the situation where the Memorandum of Understanding between CAA and CQC would (if needed - which it isn't in this case) be used to ensure the various regulatory bodies act in consert to ensure the 'wellbeing of people using the services' (para 4).  

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simulator - RP Defense

simulator - RP Defense | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
Web review defence industry - Revue du web industrie de défense
- company information
- news
in France, Europe and elsewhere ...
Dale Daborn's insight:

Aeromedical training placed high on the agenda by the RAAF - considering a legal expert to be one having knowledge, skill,

experience, training, or education. Ideally all the above are required for the individual to be competent, remembering that experience alone does not make an expert: R v. Dallagher [2003] 1 Cr. App. R. 12)

Court of Appeal (UK) - in which experience of 'reading' ear-prints was not considered to qualify the witness as an expert. This new simulator will go a long way to providing the necessary training. 

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Flying medics get high-tech new helicopter

Flying medics get high-tech new helicopter | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
THE county's air ambulance has received a new helicopter. Paramedics from the Derbyshire, Leicestershire and Rutland Air Ambulance will be able to travel at speeds of up to 185mph in the...
Dale Daborn's insight:

I don't think 'best care' if purely a function of the vehicle in which that care is provided.... a contributor certainly, but there's a lot more to the equation of best practice than the speed of moving from A to B. 

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Air Methods 3Q profit jumps 28 percent

Air Methods 3Q profit jumps 28 percent | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
NEWS: Air Methods Corp. reported Thursday that its third-quarter net income jumped 28 percent, exceeding market expectations. Shares of the air medical transportation company rose in extended trading.
Dale Daborn's insight:

Aeromedical transportation companies thriving is not a surprise with over 1 billion tourists travelling the globe each year, a figure which, according to Risi is increasing at a rate of 5.3% per year. [Risi, M, ‘International tourism hits one billion’, 2012, World Tourism Organization UNWTO , available from http://media.unwto.org/en/pressrelease/

2012-12-12/international-tourism-hits-one-billion  accessed 31 July 2013]

That said, an increase in revenue per patient of 18% is reported here this year. The reason for this is unclear, but given that revenue is separated from overheads, this may either indicate a more medically demanding type of patient or transportation from different regions or simply an increase in the profit margin of the company. While the latter may sound the ethical alarm bells ringing - it should be remembered that this is a competitive market place and the revenue would not have been earnt if patients and insurance companies were not willing to pay it. 

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Court rules flight nurse’s PTSD had ‘physical cause’ | AirMed and Rescue Magazine

Court rules flight nurse’s PTSD had ‘physical cause’ | AirMed and Rescue Magazine | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
Dale Daborn's insight:

This centres around the interpretation of 'bodily injury' used within the Act - however, I note the use of 'injury' during future references. The link (causation) between the crash and the subsequent mental and physical ill health can't be disputed, but for the judge (without medical background - assumption) to describe the PTSD as 'an injury to [the] brain and other parts of her body' is probably something that psychiatric colleagues would keenly debate. I remain unconvinced and it will be interesting to see if this creates an effective precedent for future cases, particularly those where no physical (in the traditional use of the word) injuries also occur. Will we next see claimants who develop PTSD from severe turbulence for example? Compare and contrast with the fierce debate surrounding claims for DVT and the aviation environment is certainly proving to be a controversial area.

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Scott Airmen train on Transport Isolation System

Scott Airmen train on Transport Isolation System | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
Members of the 375th and 932nd Aeromedical Evacuation Squadrons here began familiarization training on a Transport Isolation System Monday, which was unveiled to the world Jan. 23. 

The TIS, which was unveiled after 60 days of planning, developing and testing, provides the Depart
Dale Daborn's insight:

This article is interesting (as is the video to be found on this subject on Scott AFB's Facebook page) as it clearly identifies not only the developing capability, but that aeromedical transportation spans employment, contract and tort law. The Commander of US TRANSCOM very eloquently describes the non-delegable 'duty of care' that he owes not only to the patients, but to the staff undertaking this type of mission - a 'duty' per the Common Law of Obligations in both contract and tort within the jurisdiction of England and Wales. He recognizes that the duty requires a 'safe system of work', as in the UK but also that the participants (service members) are 'ordered' to undertake this mission. What is missing, however, is a pathway to remedy following a breach within the US due to the Doctrine of Feres prohibiting a serving member of the military suing the Federal Government. That said, it is refreshing to see a holistic understanding of this difficult process - especially regarding this type of mission. 

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Schumacher file leak suspect found dead | Waypoint AirMed and Rescue Magazine

Schumacher file leak suspect found dead | Waypoint AirMed and Rescue Magazine | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
Dale Daborn's insight:

A tragic outcome! What would have occurred within the English jurisdiction? Well - if Rega had been headquartered in England, then the Care Quality Commission - a product of the Health and Social Care Act 2008 - would regulate the activity of that company under Article 10 'transport services..'. Outcome 4 at para 9(1) details an essential standard that 'each service user is protected against the risks of receiving inappropriate or unsafe care....' and through the CQC's own mapping process against the Human Rights Act 1998, outcome 1A requires 'ensuring that the need to maintain confidentiality or disclose information is taken account of...'. Now, this was a very well publicised case and it was no secret that the patient was being treated and in many ways this harmonises with the 2004 case of Naomi Campbell v MDG Ltd UKHL 22 - where the Court found that the nature of Ms Campbell's treatment to be confidential although her addiction was considered to be of public interest (previously disclosed) and reporting permitted under Article 10 (Freedom of Speech) - Human Rights Act 1998. For Schumacher, however, the source of disclosure was not the press, but an employee within a company that had been contracted to provide a medical service. Therefore, like private practice in England, a head may be made against the individual under contract law as opposed to the usual NHS approach in tort law, where keeping a patient's affairs private is part of 'reasonable care'. Therefore, in England and Wales, the confidentiality of the patient (Schumacher) would have been protected based on GMC's persuasive (although not legally binding) standards of care, regulated through the CQC and defended at Court through breach of contract law (or tort law) for which precedent has already been set. This lapse in professional judgment was never going to end well unfortunately.

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English providers passed by CQC | Waypoint AirMed and Rescue Magazine

English providers passed by CQC | Waypoint AirMed and Rescue Magazine | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
Dale Daborn's insight:

While I completely understand that owners / directors of private medical companies are proud of their teams and outputs, I do find it strange that a straight forward pass / fail test applied by the Care Quality Commission can be interpreted and advertised as something completely different. In this article, Capital Air Ambulance consider their pass as 'glowing' while Air Med consider theirs as 'outstanding' (as presented on their website). This implies degrees of pass which do not exist and are misleading. So, why are we seeing this? Possibly due to the hard work and pride which individuals have invested in their companies, but surely in no small part as advertising for trade and bolstering reputation. Also - it is interesting to note that aeromedical companies passing the CQC 'standard' are not (to date) assessed on the process of delivering care. All Article 10 CQC inspections remain within the boundaries of England and Wales - on the ground, and to the medical standard of care reasonably expected in Bolam / Bolitho terms - on the ground. 

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Allways the patients in mind - the work of the AECC - Articles - EATC  |  European Air Transport Command

Allways the patients in mind - the work of the AECC - Articles - EATC  |  European Air Transport Command | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
EATC (European Air Transport Command) official website - Allways the patients in mind - the work of the AECC - Articles. The EATC exercises effective Operational Control over assigned air transport and air to air refueling assets and capabilities as well as a high level of authority over the force generation. EATC is located in Eindhoven.
Dale Daborn's insight:

Just when you think AE has 'enough' actors involved, we encounter interoperability issues. As mentioned in this article, international repatriation on occasion requires an international crew (French and German as stated within one part of this article). Clearly this now brings another dimension to the medicolegal aspects of AE - that of accountability and interoperability. While there are many circumstances in which Duty is transferred between teams (Operating Theatre to Ward etc), the shared Duty between professional of different nations presents a new dimension working to different (subtle or clear) standards and approaching missions from different cultural and ethical standpoints. Cultural relativism may play a part, as may altered Crew Resource Management issues. That said, the individual healthcare professional has a clear Duty and is proximate to the patient regardless of the other team members and as such may form or contribute to the 'chain of causation' should damage result. Clear and contemporaneous records remain best practice: the recommendation of Mancuso (with regard to handovers) remains salient; ‘detailed documentation of when the transport team assumed care and what did or did not transpire prior to the team’s arrival could help establish when the breach of duty, if any, occurred’.(Mancuso, C and Fallon, W Jr, ‘The Role of the Transport Nurse in Prehospital Trauma Care’ pp75-78 in Søreide, E and Grand, C, Prehospital Trauma Care (CRC Press, 2001)).

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EURAMI publishes standards for first time | Waypoint AirMed and Rescue Magazine

EURAMI publishes standards for first time | Waypoint AirMed and Rescue Magazine | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
Dale Daborn's insight:

A 'standard'... a parameter, a quantified position.... whatever your definition, a 'standard' would normally imply something which is both measurable and, in this context, indicated a degree of quality if that standard had been met. However,.... not entirely true where standards need to be 'substantially' met... and where the standards are still in development. All this seems to be a little premature and perhaps should have been staffed beyond 'draft' before release. So - what possible reasons could the organisation have for releasing in this form? The request for feedback - industry / member opinions prior to formalizing? The requirement to produce 'something'... ? Clearly this is all supposition, but for me - a standard should be a firm evidence-based requirement. Without robust standards, organisations cannot be held accountable to them, duty cannot be defined and breach will be impossible to prove. As a patient, I wouldn't feel at all comfortable that my provider was working to draft standards that should be substantially applied. 

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New Air Force concept for aeromedical evacuation to meet challenges in Africa

New Air Force concept for aeromedical evacuation to meet challenges in Africa | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
Air force aeromedical evacuation crews routinely move critically ill troops after they’ve been stabilized or received damage-control surgery.
Dale Daborn's insight:

This article moves from the aeromedical transportation of what used to be the stable patient, beyond the new US world order of the stabilized patient (ie stable for less time or of unproven stability) to the unstable patient who may require surgical intervention in-flight. While the concept remains to be proven, this will no doubt attract a new set of standards - for example - what is the reasonable standard of a surgeon undertaking work in-flight. As the article mentions, the trubulence and vibration may provide a particular challenge - as will the availabilility of blood and its products for those requiring massive or major haemodynamic support. This, of course, brings more sharply into focus the risk assessment and decision making process of 'when' to move a patient - whether the advantages of moving them from an unstable environment are worth the risks involved in the process - clearly if the originating area is 'hot' then scoop-and-run is the only option barring mission cancellation - but if not, perhaps surgical interventions on the ground (even in the back of the C130) would be a better alternative than tackling the procedures and the physiological stressors of flight together. The question will no doubt arise if something should go wrong (damages) - would the damages have occurred 'but for' the decision to underake the surgery in the air? If so, and if the option for ground-based intervention were available then we have an issue with 'duty'. Of course, the equation / decision making process will be complex with the requirement for asset availability elsewhere etc... but that's just part of the aeromedical problem. 

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State Tells Medevac Payment Program To Drop Alaska Members | Alaska Public Media

State Tells Medevac Payment Program To Drop Alaska Members | Alaska Public Media | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
The state has ordered a Seattle-based medevac insurance program to end coverage in Alaska. Airlift Northwest’s AirCare program fills the gap between air ambulance charges and what health insurance pays.
Dale Daborn's insight:

This probably centres more on the ethical 'smoke' relating to profit / non-profit rather than the legal 'fire' of insurance. It would have been useful to know in what respect the Alaskan authorities no longer considered AirCare (Northwest) to have breached the non-profit rules. Still, once again highlights the financial drives which lie overtly and covertly behind aeromedical transportation. 

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Air Evac Lifeteam Bases Reaccredited by CAMTS

Air Evac Lifeteam Bases Reaccredited by CAMTS | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
(UNDATED) - Air Evac Lifeteam, the largest independently owned and operated air ambulance company in the United States, has been reaccredited by the Commission on Accreditation of Medical Transport Se...
Dale Daborn's insight:

CAMTS - one of the more transparent organisations when it comes to the publication of aeromedical standards which are particularly robust. Meanwhile, the EURAMI standards remain strangely absent from the new Board!  (see http://www.camts.org/Downloads.html accessed 7 December 2013 for more information). 

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Female Doctor Beats Odds To Bring Air Ambulance To Nigeria

Female Doctor Beats Odds To Bring Air Ambulance To Nigeria | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
Experts said Dr. Ola Orekunrin's dream to create air ambulance service in Nigeria was impossible. But as a doctor and helicopter pilot, she had the skills and dedication to make it work.
Dale Daborn's insight:

So, this adds a new and interesting twist to aeromedical tranpsortation - the doctor is also the pilot, and the managing director of the company. While the entrepeneurial spirit is to be admired, the potential conflicts of interest between the company, the flight safety and the patient are taken to a whole new level within the Nigerian system which is described a 'bureaucratic'. There is no doubt regarding the need to address the 'silent epidemic' (trauma) and to ensure rapid transport to trauma centres - but how this works in practice in this particular company will be very interesting. 

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Should the NHS listen to clinical negligence lawyers?

Should the NHS listen to clinical negligence lawyers? | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
Clinical negligence lawyers are a necessary part of the process leading to improvement, argues Kate Rohde (Should the NHS listen to clinical negligence lawyers?
Dale Daborn's insight:

Will the new Duty of Candour extend to the aeromedical environment which is already still trailing behind ground-based practises? If so, will the Duty be fully embraced by both civilian and military organisations conducting this activity with significant events / near misses etc all being reported openly to the patient. To my mind, if this were to occur, then patients should be educated that the discharge of the Duty of Candour does not necessarily imply an opportunity for a head in negligence, in fact, it may not be long before any 'admittance' of error under Candour must be run past the Trust's solicitors before being released. The new Duty of Candour and its implications are certainly worth following over the next few months. 

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DOD Awards UTHSC Exclusive Contract To Train Medevac Paramedics

DOD Awards UTHSC Exclusive Contract To Train Medevac Paramedics | Medicolegal Aspects of Aeromedical Evacuation | Scoop.it
The University of Texas Health Science Center at San Antonio received a major contract to train military flight medics for more intensive paramedic
Dale Daborn's insight:

Clearly laudable, striving towards the higher professional standard within military crews which will not only benefit patients, but will enable a more level comparison between competences in allied settings. However, usually, a higher level of competence attracts a higher standard of care required of that professional, but in this case, for the US, the Doctrine of Feres [following Feres v. United States, 340 U.S. 135 (1950)] will prevent negligence cases being brought following the Supreme Court ruling that the United States is not liable under the United States Tort Act for injuries to members of the Armed Forces sustained while on active duty from the negligence of others in the Armed Forces. This has been tested and contested many times since !

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