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Appropriate Application of the Aviation - Medicine Analogy 


JN Armstrong MD FRCPC

Consultant anesthesiologist, Department of Anesthesia, Calgary Health Region.
Associate Professor of Anesthesia,  Cumming School of Medicine, University of Calgary, Alberta, Canada.
Chief Medical Officer, Shock Trauma Air Rescue Society (STARS)




Dr. JN Armstrong received a BSc in Physiology from the University of Calgary in 1980, and an MD from the same institution in 1981. He completed an internship at Dalhousie University in Halifax, Nova Scotia in 1981-82 and attained his CCFP (Canadian College of Family Practitioners) in 1983. Following this, with training in General Practice Anesthesia from the University of Alberta in Edmonton, Alberta, he practiced as a GP Anesthetist and Family Practitioner in Yellowknife Northwest Territories until 1988. He then returned to an anesthesia residency at the University of Calgary and earned his FRCP (Fellow of the Royal College of Canada, Anesthesiology) in 1991. He has since been on staff at the Calgary General Hospital in the Calgary Health Zone.
He assumed the role of Clinical and Academic Department Head in Anesthesia for the Calgary Health Region and the Faculty of Medicine, University of Calgary in 2004.
In 2013, after finishing his second term as Anesthesia Department Head he took on his current role as Chief Medical Officer for the Shock Trauma Air rescue Society (STARS). As the Chief Medical Officer he is responsible for the medical care delivered by the organization for the transport of the critically ill and injured across six bases and three provinces.
JN also has a strong interest in aviation and has been flying since 1973. He is a licensed commercial helicopter and fixed wing pilot. He currently holds active Airline Transport Licenses for both Fixed Wing and Helicopters. He presently flies as a Captain for STARS flying twin engine BK117 and AW 139 helicopters and also flies his own Cessna T210 privately.



Although patient safety has been an integral part of anaesthesia since its inception in 1846, widespread safety activities in healthcare in general were infrequent until the 21st century. The release of the Institute of Medicine’s report on patient safety (IOM 2000) appeared to give impetus to a number of initiatives to improve patient safety. Many of these initiatives, such as Crew Resource Management (CRM), were drawn from aviation, where considerable success has been made in managing threats to safety and minimizing the consequences of human error (Helmreich et al, 2001). Indeed, application of the aviation analogy to medicine, especially anaesthesia, was proposed several decades ago (Lee, 1983) and then adopted (Davies & Eagle, 1992).

Since then, one of the lessons learned from applying the aviation analogy to medicine is that examples and illustrative materials are best found within one’s own industry: specific behaviors and practices must come from medical experiences.

Without an evidence based approach to medical human factors there is the potential for a subsequent backlash, when such programs are shown to be minimally effective, and a real risk of doing harm (Hunt & Callaghan, 2008). However, the practice of applying specific concepts from aviation to medicine can provide significant benefits if carried out appropriately.



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