Evaluation of a Team-Based Flight Risk Assessment Tool in Air Medical Transport

Fatigue is common in emergency medical services (EMS) and is exacerbated in air medical transport. There is no gold standard for recognizing high-risk factors contributing to fatigue. Current survey instruments designed to assess fatigue in EMS have limited evidence supporting their reliability and validity. The purpose of this study was to investigate the use of a team-based flight risk assessment tool (FRAT) as an instrument to improve safety and patient care for air medical transport.

The FRAT factors professional experience, stressors, sleepiness, and work conditions at the beginning of each shift and generates a team-based score. The 1,919 FRAT scores from a single air/ground critical care transport program during 2021 were retrospectively analyzed against measurable operational outcomes and indicators of error, including first-pass intubation success, the presence of quality assurance flags on documentation, and the time spent on scene.

There were 281 occurrences of a FRAT score that warranted mitigation, and 259 reported mitigation strategies. There were no associations between FRAT score and intubation success, quality assurance flags, and scene time.

The team-based FRAT score triggered a mitigation activity on 281 occasions in 2021. There were no associations between the FRAT score and specific quality measures examined.