title: Measuring adverse events in helicopter emergency medical services: establishing content validity.
abstract: BACKGROUND
  We sought to create a valid framework for detecting adverse events (AEs) in the high-risk setting of helicopter emergency medical services (HEMS).
  
  
  METHODS
  We assembled a panel of 10 expert clinicians (n = 6 emergency medicine physicians and n = 4 prehospital nurses and flight paramedics) affiliated with a large multistate HEMS organization in the Northeast US. We used a modified Delphi technique to develop a framework for detecting AEs associated with the treatment of critically ill or injured patients. We used a widely applied measure, the content validity index (CVI), to quantify the validity of the framework's content.
  
  
  RESULTS
  The expert panel of 10 clinicians reached consensus on a common AE definition and four-step protocol/process for AE detection in HEMS. The consensus-based framework is composed of three main components: (1) a trigger tool, (2) a method for rating proximal cause, and (3) a method for rating AE severity. The CVI findings isolate components of the framework considered content valid.
  
  
  CONCLUSIONS
  We demonstrate a standardized process for the development of a content-valid framework for AE detection. The framework is a model for the development of a method for AE identification in other settings, including ground-based EMS.
authors.affiliation: From the Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors.forename: P Daniel
authors.initials: PD
authors.lastname: Patterson
authors.forename: Judith R
authors.initials: JR
authors.lastname: Lave
authors.forename: Christian
authors.initials: C
authors.lastname: Martin-Gill
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Weaver
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wadas
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.forename: Ronald N
authors.initials: RN
authors.lastname: Roth
authors.forename: Vincent N
authors.initials: VN
authors.lastname: Mosesso
authors.forename: Francis X
authors.initials: FX
authors.lastname: Guyette
authors.forename: Jon C
authors.initials: JC
authors.lastname: Rittenberger
authors.forename: Donald M
authors.initials: DM
authors.lastname: Yealy
mesh_terms: D017732:Air Ambulances / Q000592:standards*; D003697:Delphi Technique; D006801:Humans; D008485:Medical Audit; D019300:Medical Errors / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care