Medical direction may be even more important with rotor- and fixed-wing services than with ground services; it is certainly more complicated. Guidelines for the medical director of air medical transport programs has been developed by the National Association of EMS Physicians. 30 The medical director should be familiar with the physiology and stress of flight on the patient. A flight crew requires more initial training and more ongoing education than do ground EMS personnel because patients transported by air are generally sicker and require more advanced interventions than those transported by ground. Because flight crews are often far from their base of operations and out of voice contact, they must act independently. Standing orders or protocols for complex procedures such as chest tube insertion or cricothyrotomy are needed. More intense review of transport records is needed for quality control.
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