IAMTCS Position Statement
Recommended Standards for Safe Communications Staffing in Medical Transport Operations
Established by the IAMTCS Board of Directors
Effective Date: October 27, 2025
Purpose
The International Association of Medical Transport Communication Specialists (IAMTCS) establishes the following staffing standards to promote safety, operational efficiency, and workforce well-being in medical transport communications. These guidelines define the maximum safe workload for communications specialists responsible for both flight and ground operations, ensuring that staffing models protect personnel, patients, and mission outcomes.
Recommended Maximum Staffing Ratio
IAMTCS recommends a maximum ratio of three aircraft per one dedicated communications specialist (3:1) to maintain safe, effective, and sustainable operations.
This ratio assumes that the specialist’s primary duties are core dispatch and flight-following, with sufficient capacity to manage a single in-flight emergency without compromising oversight of other active assets.
Core Duties Supported by the 3:1 Ratio
The 3:1 ratio is based on the workload required to safely manage the following essential responsibilities:
- Basic intake and call processing
- Flight tracking and dispatch
- Notification management (hospitals, counties, and partner agencies)
- Ground transport coordination
- Flight-following inbound aircraft to receiving facilities
These represent the minimum essential functions necessary for safe oversight and coordination of medical transport operations.
Minimum Staffing Requirement — No Fewer Than Two
IAMTCS strongly recommends that no communications center operate with fewer than two communications specialists on duty at any time.
This is a non-negotiable baseline for safety and workforce protection.
Two-person coverage ensures the ability to:
- Maintain continuous oversight during breaks or temporary absences
- Support mental health and reduce fatigue
- Provide immediate assistance during emergent events
- Prevent cognitive overload and human error
If a program operates with only one specialist per shift, a formally documented contingency policy must exist. Such a policy must not rely on unsafe practices such as:
- Carrying radios or communication equipment into restrooms
- Expecting staff to forgo breaks or basic human needs
- Remaining “on duty” without relief options
Instead, programs must ensure that policies:
- Include clear, routinely drilled contingency protocols
- Define procedures for temporary coverage during brief absences
- Empower communications staff to initiate a Safety Stand Down when safe monitoring capacity is compromised
Failure to provide these safeguards constitutes a serious safety risk and is incompatible with IAMTCS best practices.
Impact of Fleet Size on Staffing Needs
Fleet size directly affects flight concurrency, communications workload, and redundancy. Therefore, the 3:1 ratio must be applied within the context of each program’s operational scale:
| Program Size | Flyable Assets | Operational Consideration |
|---|---|---|
| Small | 1–3 | High probability of full activation; limited redundancy |
| Medium | 4–9 | May require adjusted ratios aligned with OCC standards |
| Large | 10–24 | Supports layered staffing and role specialization |
| Supercenter | 25+ | High specialization; lower proportional activation rates |
Smaller programs experience greater workload intensity and higher strain when all aircraft are active, whereas larger programs benefit from overlapping shifts and peer redundancy.
Duties That Require Additional Staffing
If communications specialists perform duties beyond core dispatch and flight-following, staffing must be re-evaluated based on complexity and time demands. Examples include:
- Transfer center or patient logistics operations
- Non-flight asset coordination (security, truck, or ground dispatch)
- 911 or emergency call handling
- Administrative or support functions (documentation, administrative lines, pad management)
- Monitoring incoming patient or non-patient flight reports
- Managing specialty transports or interfacility coordination
Each added responsibility increases cognitive load and divides attention—particularly during high-tempo or emergent events. Staffing models must account for these additional duties to maintain safe decision-making and situational awareness.
Conclusion
The 3:1 ratio represents the maximum safe workload for a communications specialist under standard operating conditions.
Operating below this level—or without adequate relief and contingency coverage—introduces unacceptable risk to patients, flight crews, and communications staff.
As medical transport operations evolve in complexity and scope, staffing models must evolve accordingly. IAMTCS urges all organizations to uphold these standards as part of a safety-centered, sustainable communications model that protects the mission, the workforce, and those they serve.
For printed version: IAMTCS Position Statement –Recommended Standards for Safe Communications Staffing in Medical Transport Operations
