Although every effort is made to minimise the risks, Perinatal/Neonatal transports may incur a significant risk to patients and staff determined by medical, equipment, weather, terrain and random factors. In January 1995 an aircraft carrying one of our perinatal transport teams crashed into the sea off the Queen Charlotte Islands with the loss of 1 doctor, 2 Infant Transport Paramedics and two pilots. This tragic accident gave us experience and insight into the issues arising after such an event and may be of help to others who have to cope with similar situations in the future. The rescue imperative(benificence) is a compelling force in the delivery of emergency and intensive care, and for staff who choose to work in such areas. Despite this there has to be careful balancing of potential risk to the staff involved against potential benefit for the patient in each case. The nature and magnitude of the risk being taken must be consented to in a valid way without coercion by those taking the risk in order to protect the autonomy of both staff and patients. There are extensive procedures for assuring informed consent for patients but not for health care staff when they themselves may be at risk. Occurence of a serious adverse event with near or actual loss of life precipitates a significant number of the unit staff into a simultaneous grief reaction, which may affect the abilility of the unit to cope effectively with the normal work load. Providing accurate up to date information about the incident to the staff is very important. Staff involved in, or closely associated with, the incident must be offered critical incident stress debriefing with release of those normally shouldering the risk until this is complete. Because of the closeness of the working relationship of intensive care staff within a large unit, those affected by the tragedy and in need of time off and debriefing extend far beyond those obviously directly or closely involved in the event. Those of us who organise and send others on transports need to reflect carefully on our expectations of others and provide appropriate support.
