Flight Physician Training and Workforce Sustainability Within an Integrated Emergency Department-Intensive Care Unit-Helicopter Emergency Medical Services Staffing Model: A Rural Helicopter Emergency Medical Services Experience in Japan.
Air Medical Journal · 2026-01-01 · Observational study
Abstract
OBJECTIVE: Maintaining physician-staffed helicopter emergency medical services (HEMS) in rural regions is increasingly challenging because of physician shortages, workforce sustainability concerns, and limited opportunities for dedicated flight physician staffing. We developed an integrated staffing and training model in which emergency physicians collectively provide emergency department (ED), intensive care unit (ICU), pediatric emergency, and HEMS care while participating in a regional physician-sharing collaboration. METHODS: This single-center retrospective study evaluated all consecutive HEMS missions conducted between April 2021 and March 2026 at a rural tertiary emergency and critical care center in Japan. Flight physician training was conducted through on-the-job training (OJT) embedded within routine ED, ICU, pediatric emergency, and HEMS practices. Missions performed during supervised OJT were compared with those performed after independent certification. Operational performance was assessed using on-scene time, scene intervention rates, intubation rates, cardiopulmonary resuscitation rates, and hospital mortality. RESULTS: Six physicians completed training; 4 achieved independent practice within 6 months and 2 within 12 months. The average annual flight volume was approximately 30 missions per physician. A total of 189 missions were analyzed. Patient characteristics were comparable between 98 OJT and 91 independent missions. No differences were observed across operational performance measures; no procedural, medication, or operational incidents occurred. CONCLUSIONS: Despite relatively limited individual flight exposure, most trainees achieved independent practice within 6 months, and operational performance following certification was not inferior to that of supervised training. Integrated acute care practice may support the development and maintenance of flight physician competency in resource-limited rural environments.
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Tags
Helicopter & air ambulance · Children · Endotracheal intubation · Medical direction & oversight · Prehospital physicians · Rural & remote
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