Objective: Shared decision-making (SDM) has been promoted as a method to increase the patient-centeredness of medical decision-making and decrease low-yield testing, but little is known about its medico-legal ramifications in the setting of an adverse outcome. We sought to determine if the use of SDM changes perceptions of fault and liability in the case of an adverse outcome. Methods: Randomized controlled simulation experiment conducted via survey, utilizing clinical vignettes featuring either 1) No SDM, 2) Brief SDM, or 3) Thorough SDM. Participants were adult US citizens recruited via an online crowdsourcing platform. Participants were randomized to vignettes portraying one of three levels of SDM. All other information given was identical, including the final clinical decision and the adverse outcome. The primary outcome was reported likelihood of pursuing legal action. Secondary outcomes included perceptions of fault, quality of care, and trust in physician. Results: We recruited 804 participants. Participants exposed to SDM ("Brief" and "Thorough") were 80% less likely to report a plan to contact a lawyer than those participants not exposed to SDM (12% and 11% versus 41%; OR 0.2; 95%CI: 0.12-0.31). Participants exposed to either level of SDM reported higher trust, rated their physicians more highly, and were less likely to fault their physicians for the adverse outcome as compared to those exposed to the "No SDM" vignette. Conclusion and Relevance: In the setting of an adverse outcome from a missed diagnosis, use of SDM may affect patients' perceptions of fault and liability.

There is limited guidance on the use of helicopter medical personnel to facilitate care of critically ill COVID‐19 patients. This manuscript describes the emergence of this novel virus, its mode of transmission, and the potential impacts on patient care in the unique environment of rotor wing aircraft. It details the development of clinical and operational guidelines for flight crew members. This allows other out‐of‐hospital clinicians to utilize our framework to augment or supplement their own for the current response effort to COVID‐19. It further serves as a road map for future response to the care of high consequence infectious disease patients.

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