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Former employees say that many of the air ambulance companies under the Air Medical Resource Group (AMRG), headquartered in South Jordan, shirk safety to save money by requiring medical crews to work shifts lasting seven days or longer.

Limiting shifts to 24 hours or less promotes safety and patient care, but it requires employing more people, according to Dave Cavins, who worked for two AMRG providers. The nurse and former firefighter supervised an Eagle Air Med base in Alamosa, Colo., and later helped Guardian establish a base in Williston, N.D.

He called shifts more than a few days a "recipe for disaster."

"No one should work seven days straight," he says. "If you are on call 24-7, even after the third day, your mind won't be fully functional."

Those on a medical flight crew, he points out, "are not only saving patients, you are working around a dangerous piece of equipment."

Yet Guardian insisted medics work back-to-back days, Cavins says.

"You have to go, you can't turn it down. If you do, you paint a target on your back for termination," says Cavins, who retired three years ago.

"AMRG is the reason I got out. I do not want to die on the job," he says.

The Commission on Accreditation of Medical Transport Systems — known as CAMTS, formerly the only accreditation firm recognized in Utah or Colorado — limits medical shifts to 24 hours, which can be extended only in limited circumstances. The new, American Fork-based National Accreditation Alliance of Medical Transport Applications doesn't have a similar restriction.

Guardian also provided little medical oversight and pressured crews to fly in bad weather, said Jeremiah Sappington, a medic who quit two years ago out of concern for his personal safety while working at Guardian's Williston, N.D., base. The company designated a medical director, but the person was almost never available.

"He was a local attending physician, who would just be in Williston for a few shifts a month," Sappington says. "If you had a problem that was outside of your scope of practice, you were just out there on your own. There was nobody to call."

In 2010, AMRG subsidiary Hawaii Air Ambulance terminated pilot James Stone after he raised concerns about violations of safety standards, according to the Hawaii Labor Relations Board, which recently ruled that the company violated whistleblower protection laws.

Stone was awarded a $761,000 judgment. That ruling is under appeal, and Hawaii Air Ambulance has filed for bankruptcy protection.