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Sound Engineering: Making aeromedical flights safer

Industrial and systems engineering postdoc research fellow Chris Johnson talks about his research into integrated simulation training for aeromedical teams, and the challenges he faces trying to change the training culture. Johnson says that by training aeromedical pilots and medical staff together, we can better prepare them to make decisions under pressure—and save lives.

John Steeno: Chris Johnson thinks the aeromedical evacuation industry does heroic work, but says it has a fatal weakness.

Chris Johnson: The safety record in aeromedical evacuation is… it’s dismal.

John Steeno: Johnson is currently a postdoc research fellow under Professor Doug Wiegmann in the UW-Madison College of Engineering Department of Industrial and Systems Engineering. He’s also a certified flight instructor and commercial pilot, so he recognizes the dangers associated with aeromedical flights. While inclement weather contributes to a lot of aeromedical crashes, it may be just as important to study the decision-making and communication of the aviation and medical crews. His current research will target a crucial gap in the training of the aeromedical pilots and medical staff.

Chris Johnson: Right now, pilots get trained in flight simulators, medics get trained in medical simulators, and the first time these teams ever come together is in a real operational mission, which is dangerous. I’ve talked to many medevac physicians saying, “The first time I’ve ever been in the heat of the moment is when my life was really on the line.” So that is the technology that we’re trying to build. It’s going to bring these people together in the same virtual world. The grant that we won recently is just to build a proof of concept. Say, three years from now, that’s our goal is to be able to have a capsule for the helicopter, and actually have these guys training in the same scenario, OK? Whereas right now it’s just pilots in flight simulators and medics in an equivalent to what would be an operating room, training on just a part task of whatever medical procedure they have to learn.

John Steeno: In addition to improving aeromedical training, Johnson wants to look at the conflicts and difficult choices that arise when a crew has to balance its own safety with the best interests of a patient.

Chris Johnson: We want to build scenarios where we put the safety of the patient, that goal, at odds with the safety of the crew in general, to test the hypothesis that there’s social influence. The medics are going to try to get the pilot to fly into bad weather to save a patient, but that may compromise all their lives. And vice versa, if it’s communicated to the medical crew, “hey, we can’t get to a level one facility right now because it’s socked in by weather,” that’s a safe decision on behalf of the entire safety of the crew, but it may require the medics to get inventive, make use of the resources they have at hand, which may be lower-quality patient care, but again, at the safety of the crew. And so we plan to use these types of technologies not only to train team-based decision-making, but also to look at, OK, well, there are circumstances where we couldn’t get to these resources, so maybe we need to outfit the helicopter with better on-board equipment. We’re going to drive standardization and all kinds of training guidelines.

John Steeno: One of the biggest obstacles, Johnson says, is the culture of the industry.

Chris Johnson: We’re starting to realize as we do our initial research on this that our bigger challenges are political. Pilots learn how to fly multimillion-dollar simulators, and the only things they’re really trained on is engine failures and procedures and things that are applicable only to flying an aircraft. They don’t get credit for training with medical people in the cabin, and the simulators aren’t built like that. The training in these two industries have been disparate forever. We’re trying to merge these two industries and say, “Hey, FAA, give these medevac pilots extra credit for training with medical people on board, and vice versa.” The political challenges therein are really challenging, because nobody wants to pay for more training. The only thing you can really do is get insurance companies involved and say, “Hey, if you do go through this training, your premiums are going to go down because we know that you’ve trained in a more high-fidelity simulation environment.” These are some of the basic ideas we have. It all starts with a seed grant, which we have, and we have a stellar team. We have the director of Med Flight, we have the director of the Clinical Simulation laboratory, which is a multimillion-dollar sim lab over at the hospital. We have the director of the flight-sim lab, myself, also an instructor pilot. We have Abe Megahed, developed Hypercosm 3-D simulation software, he’s developed simulations for the Navy, NASA, DOD. We also have involved one of NASA’s advisors for medical informatics. Our team is amazing, but at the same time, we need to take baby steps. This project won’t be anything that’s super rapidly, we’re going to develop things and start generating data, because of all the hurdles that we need to overcome, so that’s why I say in about two or three years’ time we’ll have a full simulator.

John Steeno: For more information about Johnson and his research, visit the Naturalistic Decision Making and Simulation Lab website at

Scott Gordon