Analyzing Communication Errors in an Air Medical Transport Service



      Poor communication can result in adverse events. Presently, no standards exist for classifying and analyzing air medical communication errors. This study sought to determine the frequency and types of communication errors reported within an air medical quality and safety assurance reporting system.


      Of 825 quality assurance reports submitted in 2009, 278 were randomly selected and analyzed for communication errors. Each communication error was classified and mapped to Clark's communication level hierarchy (ie, levels 1–4). Descriptive statistics were performed, and comparisons were evaluated using chi-square analysis.


      Sixty-four communication errors were identified in 58 reports (21% of 278). Of the 64 identified communication errors, only 18 (28%) were classified by the staff to be communication errors. Communication errors occurred most often at level 1 (n = 42/64, 66%) followed by level 4 (21/64, 33%). Level 2 and 3 communication failures were rare (, 1%).


      Communication errors were found in a fifth of quality and safety assurance reports. The reporting staff identified less than a third of these errors. Nearly all communication errors (99%) occurred at either the lowest level of communication (level 1, 66%) or the highest level (level 4, 33%). An air medical communication ontology is necessary to improve the recognition and analysis of communication errors.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Air Medical Journal
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Orasanu J
        • Fischer U
        Cross-cultural barriers to effective communication in aviation.
        in: Granrose CS Oskamp S Cross-cultural workgroups. Sage Publications, Thousand Oaks, CA1997: 134-162
        • Tajima A
        Fatal miscommunication: English in aviation safety.
        World Englishes. 2004; 23: 451-470
        • JCAHO
        Sentinel event statistics. 2011 statistics on sentinel events including root causes.
        (Accessed January 23, 2012.)
        • Kohn LT
        • Corrigan J
        • Donaldson MS
        • Institute of Medicine
        Committee on Quality of Health Care in America. To err is human: building a safer health system. National Academy Press, Washington, DC2000: 287
        • MacDonald RD
        • Banks BA
        • Morrison M
        Epidemiology of adverse events in air medical transport.
        Acad Emerg Med. 2008; 15: 923-931
        • Clark HH
        Grounding in communication.
        in: Resnick L Levine R Teasley S Perspectives on socially shared cognition. APA Press, Washington, DC1991: 127-149
        • Clark HH
        Using language. Cambridge University Press, New York1996: 146-154
        • Shannon CE
        The mathematical theory of communication. 1963.
        MD Comput. 1997; 14: 306-317
        • Littlejohn SW
        Information theory. Theories of human communication. Merrill, Columbus, OH1978: 147-157
        • Paek T
        Toward a taxonomy of communication errors. Microsoft Research, Redmond, WA2003
        • Levinson S
        Activity types and language.
        in: Drew P Heritage J Talk at work: Interaction in institutional settings. Cambridge University Press, Cambridge, UK1992: 66-100
        • Fleiss JL
        Measuring nominal scale agreement among many raters.
        Psychol Bull. 1971; 76: 378-382
      1. NTSB. DEN08MA116B. 2009 Accident report for Nonscheduled 14 CFR Part 135: Air Taxi & Commuter. Accessed January 23, 2012.

        • Thomas F
        • Allen C
        • Butts W
        • Rhoades C
        • Brandon C
        • Handrahan DL
        Does wearing a surgical facemask or N95-respirator impair radio communication?.
        Air Med J. 2011; 30: 97-102
        • Gruber TR
        A translation approach to portable ontologies.
        Knowledge Acquisition. 1993; 5: 199-220
        • Horan T
        • Kaplancali U
        • Burkhard R
        • Schooley B
        Inductive design and testing of a performance ontology for mobile emergency medical services.
        in: Sharman R Kishore R Ramesh R Ontology handbook. Springer, Heidelberg2007: 823-839