title: A survey of adherence to community-generated safety guidelines in rotor-wing air medical programs.
abstract: BACKGROUND
  Operational safety, both crash prevention and improved crash survival, is a central concern in the air medical community. Professional organizations have published operational safety guidelines, but the extent to which those guidelines are followed is unclear. We report the results of a survey of adherence with selected safe practice recommendations.
  
  
  METHODS
  An anonymous survey of adherence with 8 individual and 11 program safety guidelines was distributed to flight team members at 10 Association of Air Medical Services-member rotor-wing air medical programs selected by stratified random sample to ensure geographic diversity. Descriptive statistics are reported and relationships are evaluated with the chi-square test. The sample size provided 80% power at a .05 significance level for the comparisons.
  
  
  RESULTS
  Data were analyzed from 126 of the 200 surveys distributed. Adherence with program-wide safety behaviors ranged from 41.3% (complete a pre-departure checklist) to 99.2% (program has an annual safety review). Adherence to individual behaviors ranged from 15.1% (wear fire-resistant gloves) to 99.2% (wear seatbelts and shoulder harnesses on approach and departure). There was 100% adherence to wearing helmets by the respondents whose program provided a helmet at no cost to the staff member. There were no associations between job description and any individual behavior. Hospital-operated programs were less likely to have a daily briefing (P < .05), less likely to have a written policy allowing flight refusal for fatigue (P < .01), and tended toward lower rates of having a written policy allowing flight refusal for fatigue (P = .07). Non-hospital-operated programs were less likely to provide helmets (P < .001), to operate in an airframe with a clear headstrike area (P < .001), and to wear long-sleeved fire-resistant flight suits (P = .01).
  
  
  CONCLUSIONS
  Both organizational and individual adherence to community safety recommendations are variable and not universal. There is variability by operational models.
authors.affiliation: LIFE STAR/Hartford Hospital, Hartford, CT 06102-5037, USA. mfrakes@hartosp.org
authors.forename: Michael A
authors.initials: MA
authors.lastname: Frakes
authors.forename: John G
authors.initials: JG
authors.lastname: Kelly
mesh_terms: D017732:Air Ambulances; D003625:Data Collection; D004632:Emergency Medical Services; D019983:Guideline Adherence; D008404:Massachusetts; D017751:Safety Management / Q000592:standards*