Storytelling as a Tool for Vicarious Learning among Air Medical Transport Crews

Learning vicariously from the experiences of others at work, such as those working on different teams or projects, has long been recognized as a driver of collective performance in organizations. Yet as work becomes more ambiguous and less observable in knowledge-intensive organizations, previously identified vicarious learning strategies, including direct observation and formal knowledge transfer, become less feasible. Drawing on ethnographic observations and interviews with flight nurse crews in an air medical transport program, I inductively build a model of how storytelling can serve as a valuable tool for vicarious learning. I explore a multistage process of triggering, telling, and transforming stories as a means by which flight nurses convert the raw experience of other crews’ patient transports into prospective knowledge and expanded repertoires of responses for potential future challenges. Further, I highlight how this storytelling process is situated within the transport program’s broader structures and practices, which serve to enable flight nurses’ storytelling and to scale the lessons of their stories throughout the entire program. I discuss the implications of these insights for the study of storytelling as a learning tool in organizations, as well as for revamping the field’s understanding of vicarious learning in knowledge-intensive work settings.

Availability of CT on island medical facilities: Association with mortality in patients evacuated via long-distance air medical transport

Background To examine the association between availability of computed tomography (CT) and severity-of-disease/mortality in patients evacuated via long-distance emergency air medical transport from island medical facilities. Methods We retrospectively and consecutively enrolled patients transferred via rotary- or fixed-wing aircraft from island medical facilities to a designated emergency medical center in Tokyo, Japan between 2010 and 2020. Airlifted patients were divided into two groups, depending on the availability of CTs on the island facilities in which they were transported from. The outcomes were severity-of-disease after air medical transport and in-hospital mortality. We examined the association between these outcomes and the availability of CTs on each island facility. Results Eligible patients (n=1,880) were categorized into the CT (n=1,744) or non-CT group (n=136). After adjusting for age, sex, diagnostic category and flight time, the CT group was significantly associated with greater severity of disease (coefficient, 1.30; 95% confidence interval, 0.13–2.47). In contrast, significant reductions in mortality were not documented in the CT group. Conclusion While the availability of CTs was significantly associated with greater severity of disease, CT availability did not significantly impact mortality in patients transferred from island medical facilities.

Risk of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) acquisition during ambulance transport: A retrospective propensity-score–matched cohort analysis

Objective: To estimate the relative risk (RR) of developing methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization or infection within 30 days of ambulance transport. Methods: We performed a retrospective cohort study of patients with a principal diagnosis of chest pain presenting to our emergency department (ED) over a 4-year period. Patients were included if they presented from and were discharged to nonhealthcare locations without being admitted. Encounters were stratified by arrival mechanism: ambulance versus private vehicle. We performed propensity score matching and multivariable logistic regression to estimate the RR for the primary outcome. Results: In total, 321,229 patients had ED encounters during the study period. After applying inclusion criteria and propensity score matching, there were 11,324 patients: 3,903 in the ambulance group and 7,421 in the unexposed group. Among them, 12 patients (0.11%) had the outcome of interest, including 9 (0.08%) with MRSA and 3 (0.03%) with VRE. The 30-day prevalence of MRSA or VRE was larger in the ambulance group than in the unexposed group: 8 (0.20%) and 4 (0.05%), respectively (P = .02). Patients who presented to the ED via ambulance were almost 4 times more likely to have MRSA or VRE within 30 days of their encounter (RR, 3.72; 95% CI, 1.09–12.71; P = .04). Conclusions: Our cohort study is the first to demonstrate an association between ambulance exposure and pathogen incidence, representing the first step in evaluating medical-transport–associated infection burden to eventually develop interventions to address it.

Risk of Methicillin-Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE) Acquisition in Ambulances: A Retrospective Propensity Score-Matched Cohort Analysis

Background: Infection following ambulance transport, or medical-transport–associated infection (MTAI), is understudied. Although medical-transport vehicles are routinely contaminated with methicillin-resistant Staphylococcus aureus (MRSA) and/or vancomycin-resistant Enterococcus (VRE), an association between vehicle exposure and disease development has not been identified. We estimated the relative risk (RR) of developing MRSA or VRE colonization or infection within 30 days of ambulance exposure. Methods: We performed a retrospective cohort study of patients with a principal diagnosis of chest pain presenting to our emergency department (ED) from January 1, 2016, through December 31, 2019. To control for confounding by healthcare exposure, patients were included if they presented from and were discharged to nonhealthcare locations without being admitted to the hospital. Encounters were stratified by whether the patient arrived at the ED via ambulance or private vehicle. Propensity scores were calculated using multivariable logistic regression with ambulance exposure as the dependent variable. Age, smoking status, history of myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, diabetes mellitus, and chronic kidney disease were included as covariates because their standard differences were >0.10. Propensity score matching was performed in a 2:1 ratio, but not all exposed patients received 2 matching unexposed patients due to a low sample size. A multivariable logistic regression was performed on the matched cohort to estimate the RR of newly diagnosed MRSA or VRE infection or colonization within 30 days following ambulance exposure. Results: In total, 321,229 patients had ED encounters during the study period. After applying inclusion criteria and propensity score-matching there were 11,324 patients: 3,903 in the ambulance group and 7,421 in the unexposed group. Moreover, 12 patients (0.11%) had the outcome of interest, including 9 (0.08%) with MRSA and 3 (0.03%) with VRE. The 30-day prevalences of MRSA and VRE were larger in the ambulance group than in the unexposed group: 8 (0.20%) and 4 (0.05%), respectively (P = .02). Patients who presented to the ED via ambulance were almost 4 times more likely to have MRSA or VRE within 30 days of their encounter (RR, 3.72; 95% CI, 1.09–12.71; P = .04). The RRs for MRSA and VRE alone were 3.33 (95% CI, 0.79–13.94; P = .10) and 4.14 (95% CI, 0.37–46; P = .25), respectively. Conclusions: To our knowledge, our cohort study is the first to demonstrate an association between ambulance exposure and the development of disease. These results represent the first step in evaluating MTAI burden to eventually develop targeted interventions with the purpose of reducing it.Funding: NoDisclosures: None