Medical training facility available to air ambulance crews

The doctors and nurses who fly air ambulance missions must be prepared for any medical situation involving any patient – whether ill or injured, needing basic or intensive care, whether adult, child or new-born baby.

Training is vital for our lifesaving aeromedical teams, and Luxembourg Air Ambulance (LAA), the mother company of European Air Ambulance (EAA), is committed to providing the very best ongoing training for all our medical staff.

At the heart of our headquarters is a new state-of-the-art SimCenter training facility, equipped with the latest medical simulation devices – an investment by LAA that ensures the teams flying our air ambulance missions are some of the best prepared anywhere in the world.

The facility currently provides medical simulation training in-house for EAA crews – but in the course of 2018 it will gradually be opened up to other, external companies who want their own medical teams to go through the same rigorous training programmes.

At the core of the SimCenter is the Simulator Room, where multiple different scenarios can be recreated thanks to 3D projectors, lighting and smoke effects – including road accidents, landscapes, or even a medical emergency in a hospital room.

Medical simulator mannequins are used within the scenarios, including the Sim Man 3G ® (Laerdal) – a high-end, full-scale adult patient simulator, which displays a whole range of symptoms and reactions and provides an extremely realistic training tool. Because the Sim Man is completely wireless, it can also be integrated into other training situations – including on our aircraft, helicopters, or at the onsite medical facility.

An infant version of the mannequin - a Sim Baby^® (Laerdal) - is also used, and provides incredibly realistic training in emergency paediatric treatment and care.

As well as the patient simulators, LAA has invested in an Airway Trainer with a Video Laryngoscope (C-Mac ®) permanently available within the SimCenter, which can be connected via HDMI to a video screen ensuring all those involved in the training session get a clear view and can learn - whether or not they are actually performing the procedure themselves.

There is also a Basic Life Support trainer; a difficult airway trainer; and an EZ-IO ® drill along with artificial bones for practising intraosseous access, which can be a life-saving route to administer medicine.

Next to the simulator room is a debriefing room, with video capability.

Video debriefings focus on CRM (Crew Resource Management) aspects, and LAA sent a team of four doctors and four nurses to ‘train the trainer’ courses (EuroSim ® for the French speakers and InFact ® for the German-speakers).

This eight-strong team is now responsible for training, and for maintaining the exceptionally high standards expected at the SimCenter. External specialists are also invited to lead sessions according to their particular areas of expertise.

The LAA system follows the “train as you fight” principle, which is a common medical training method, and we work with different modules:

• Theoretical: Lectures on particular themes, for example paediatric themes presented by our neonatologist. We also use lecture-based education principles to introduce modifications/changes in guidelines. As LAA is an international air ambulance service, based in the heart of Europe in Luxembourg, we operate strictly according to European guidelines including those of the European Resuscitation Council (ERC ®) and the European Society of Cardiology (ESC ®) and in line with the European Trauma Guideline. If European guidelines are not available, we operate in line with recommendations of the French, German or English medical authorities.
• Practical: We train in mixed teams of doctors and nurses, using the mannequins for repetitive training to ensure medical staff react automatically and instinctively in critical situations.
• Skill training: We train in multiple skills, including airways, life support and defibrillation.
• Full-scale simulator: This is a tool to debrief on interactions within the team – to deal with human factors, which can have a big effect on the progress of a mission.
• Realistic environment training: We have a hangar directly beside the facility, which allows us to put the training equipment into our aircraft to practise in a real environment. This is a very important tool, allowing us to properly assess whether our emergency concept works in the aircraft/helicopter, or needs to be adapted.

LAA provides some of the very best aeromedical training available, and as well as standard in-house training, all staff must take part in sessions in the SimCenter. Staff are ERC ALS ®, PHTLS ® or TraumaManagement ® certified.

Doctors must complete a minimum of 25 endotracheal intubations per year and be certified as such; and thanks to close working relationships with nearby hospitals, our doctors can maintain their skills by working in local operating theatres.

All the evidence shows that regular training improves the performance of a team, and contributes to a lower rate of medical complications.

It’s also clear that by standardising training and introducing an enjoyable and low-stress atmosphere for all our teams, we see not only better behaviour and performance, but also a greater understanding and application of guidelines; improved efficiency; and ultimately better outcomes for our patients and cost savings for our clients.

Recommended reading:

• Jha AK, Duncan BW, Bates DW. Simulator based training and patient safety in: Making health care safer: a critical analysis of patient safety practices. Agency for Health care, Research and Quality, US dept of Health and Human Services. 2001:511–8.
• Gaba D. Human work environment and simulators. In: Miller RD, editor. In Anaesthesia. 5th Edition. Churchill Livingstone: 1999. pp. 18–26.
• Gaba D. The future of simulation in health care. Qual Saf Health Care. 2004;13:2–10. [PMC free article] [PubMed]
• Lateef F. What’s new in emergencies, trauma, and shock? Role of simulation and ultrasound in acute care. J Emerg Trauma Shock . 2008;1:3–5. [PMC free article] [PubMed]
• Shapiro MJ, Morey JC, Small SD, Langford V, Kaylor CJ, Jagminas L, et al. Simulation based teamwork training for emergency department staff: does it improve clinical team performance when added to an existing didactic teamwork curriculum? Qual Saf Health Care. 2004;13:417–21. [PMC free article] [PubMed]
• Gaba D, Howard SK, Fish K. Simulation based training in anaesthesia crisis resource management: a decade of experience. Simulation and Gaming. 2001;32:175–93.
• Boeing Commercial Aircraft group. Statistical study of commercial jet aircraft incidents in worldwide operations. 1994
• Olympio MA. Simulation saves lives. Am Soc Anaesth News. 2001;65:15–9.
• Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J, Funch-Jensen P. Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg. 2004;91:146–50. [PubMed]
• Gaba DM, Howard SK, Flanagan B, Smith BE, Fish KJ, Botney R. Assessment of clinical performance during simulated crises using both technical and behavioral ratings. Anesthesiology. 1998;89:8–18. [PubMed]
• Gupta A, Peckler B, Schoken D. Introduction of hi-fidelity simulation techniques as an ideal teaching tool for upcoming emergency medicine and trauma residency programs in India. J Emerg Trauma Shock. 2008;1:15–8. [PMC free article] [PubMed]
• Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ. 2000;320:754–9. [PMC free article] [PubMed]
• Risser DT, Rice MM, Salisbury ML, Simon R, Jay GD, Berns SD. The potential for improved teamwork to reduce medical errors in the emergency department. The MedTeams Research Consortium. Ann Emerg Med. 1999;34:373–83. [PubMed]
• Beaubien JM, Baker DP. The use of simulation for training teamwork skills in health care: how low can you go? Qual Saf Health Care. 2004;13:151–6. [PMC free article] [PubMed]
• Rosen MA, Salas E, Wu TS, Silvestri S, Lazzara EH, Lyons R, et al. Promoting teamwork: an event-based approach to simulation-based teamwork training for emergency medicine residents. Acad Emerg Med. 2008;15:1190–8. [PubMed]
• Hammick M, Freeth D, Koppel I, Reeves S, Barr H. A best evidence systematic review of interprofessional education: BEME Guide no. 9. Med Teach. 2007;29:735–51. [PubMed]
• Oandasan I, Reeves S. Key elements of interprofessional education. Part 2: factors, processes and outcomes. J Interprof Care. 2005;19:39–48. [PubMed]
• McPherson K, Headrick L, Moss F. Working and learning together: good quality care depends on it, but how can we achieve it? Qual Health Care. 2001;10:46–53. [PMC free article] [PubMed]
• Reznek M, Harter P, Krummel T. Virtual reality and simulation: training the future emergency physician. Acad Emerg Med. 2002;9:78–87. [PubMed]
• Henriksen K, Dayton E. Issues in the design of training for quality and safety. Qual Saf Health Care. 2006;15:17–24. [PMC free article] [PubMed]
• Farrow D. Reducing the risk of military aircrew training through simulation technology. Performance and Instruction. 1982;21:3–8.
• Helmreich RL, Merritt AC, Wilhelm JA. The evolution of Crew Resource Management training in commercial aviation. Int J Aviat Psychol. 1999;9:19–32. [PubMed]
• Morey JC, Simon R, Jay GD, Wears RL, Salisbury M, Dukes KA, et al. Error reduction and performance improvement in the emergency department through formal teamwork training: evaluation results of the MedTeams project. Health Serv Res. 2003;37:1553–81. [PMC free article] [PubMed]
• Woolliscroft JO, Calhoun JG, Tenhaken JD, Judge RD. Harvey: the impact of a cardiovascular teaching simulator on student skill acquisition. Med Teach. 1987;9:53–7. [PubMed]
• DeVita MA, Schaefer J, Lutz J, Wang H, Dongilli T. Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator. Qual Saf Health Care. 2005;14:326–31. [PMC free article] [PubMed]
• Bradley P. The history of simulation in medical education and possible future directions. Med Educ. 2006;40:254–62. [PubMed]