Organization and Mission

Intermountain Health Care (IHC) is an integrated health system that includes 20 hospitals, numerous clinics, and an insurance company. IHC serves Utah and southeastern Idaho. More information is available at www.ihc.com.

IHC Life Flight operates three rotor-wing aircraft 24 hours a day that provide scene and interfacility response within 150 miles of its bases in Salt Lake City and Provo, Utah. The RWA also supports search-and-rescue missions in the intermountain area. IHC operates three fixed-wing aircraft transporting patients throughout the west. A specially designed neonatal critical care ambulance is stationed at Primary Children’s Medical Center in Salt Lake City. Life Flight provides interfacility transfer services over a seven-State area. Life Flight is accredited by CAMTS.

Medical Direction
Life Flight’s approach to medical direction involves two intensivists and one emergency medicine physician. Life Flight perceived that interfacility transfer was being impaired by inconsistent understanding and expectations. In part this was due to the extreme variability in the size and nature of sending facilities and in the professional credentials and experience of clinicians, ranging from a physician’s assistant in a very remote setting to more sophisticated hospitals transferring patients to a tertiary facility. Also, because of the large and sometimes sparsely populated service area, bringing clinicians to a central location for training was difficult logistically.

In part the inconsistency followed from the different levels of knowledge on the part of medical directors. Several types of physicians are involved, representing emergency medicine and other forms of critical care. Without specific training in medical direction of interfacility transfer, the physicians might lack a full understanding of the established protocols, optimal preparation for transfer, the capabilities and limitations of the crew, and the capabilities and limitations of the equipment.

IHC addressed this problem by developing a training program for medical direction, the goal of which is to improve the both the results and the process of the transfer. One concern was that the referring facility not feel alienated or patronized. IHC treats the transfer as a teaching opportunity. The medical director stays in contact with the referring facility while the aircraft is en route, addressing clinical issues and assuring that appropriate preparations are made so that the patient is as ready for transport as possible.

Implementation Strategy
Recognizing that gathering a group of physicians for training programs can be difficult logistically, IHC has developed the program so it can be distributed on DVD. This technology makes the learning available at a convenient time and place for the learner. Once the master is prepared reproduction and distribution are very economical. One of the approaches IHC used to build confidence in its service was to emphasize timely response because IHC had found that physicians working in a tertiary hospital might not fully understand the sense of isolation and need for prompt assistance experienced by colleagues in remote areas.

Evaluation and Results
Life Flight has found that the program has been effective in achieving the desired consistency. The entire team has greater confidence in each other and in the system.

Education and Replication
Dr. Frank Thomas, the physician who developed the original training program, has presented all over the world. The DVD format has made it easy and cost-effective to share with other organizations. The DVD has been recognized by CAMTS as a best practice.