AAMS

Raising the bar 

The days fly by, and snow has arrived in New England. AMTC has come and gone, and we are already hard at work on the community agenda. For the third year running, last year's AMTC was the largest ever—the most attendees, most vendors, and a huge list of classes and meetings. As with all AMTC host cities, Cincinnati provided the opportunity for the community to come together—celebrate another year, see old friends, make new friends, and recognize and celebrate the best of our efforts.

Unfortunately, once again we also gathered with shrouded wings. In the midst of celebration, we mourned lost colleagues, including a tribute to Michelle North, our most tireless advocate for safety. And once again we had another Tuesday morning of near unbearable sadness with tough lessons shared courageously by IHC LifeFlight of Salt Lake City. I haven't been doing this very long, but it seems every Tuesday at AMTC is one of tears.

More unfortunate, immediately before, then during, and then immediately after AMTC, we experienced three more crashes—two rotorcraft and a fixed-wing, two of the accidents with multiple fatalities. Somehow we are not getting it right.

While causes of accidents and incidents are multifactorial and there is great debate on accident numbers versus accident rates as measured by flight numbers and hours, a single unique element in air medicine frames the safety issue. Unlike any other arena of aviation, our passengers by and large do not get a choice—neither a choice of carrier or in many cases transportation itself. The lack of choice in turn increases our responsibility for our patients' welfare multiple-fold.

This unique characteristic of our mission—choice—must take center stage and guide every decision for ourselves, and more importantly, for those we serve. We are entrusted by patients and the public with medicine's first precept—first do no harm. While the benefits we bring to our patients are immeasurable, we must ensure that benefits we bring outweigh risks in every instance.

In 2005, AMTC's theme will be “Raise the Bar: High Performance in the High Consequence Environment.” This year we are making raise the bar our mantra. We are going to push, pull, and tug everyone in the community to raise the bar in the high performance/high consequence environment. We are forging a new partnership between our safety/CORE industry committee and the FAA and NTSB. We are going to work to ensure that every single person in the community completes AMRM by AMTC in 2008. We will challenge our collective performance at every step. We will choose safety.

As AAMS, we have agreed this will become the year of standards. We are hard at work to shape an educational track for AMTC that will bring other industries that share high consequence environments to look at lessons learned and process control. As a community, we must collectively raise the bar together. At the end of the day, however, a theme is just a theme, words awaiting action. No one profession or group can change the environment on its own. Improvements to safety must be top down, bottom up, and from every side.

As program directors, we must make sure that all our decisions are based on safety first. From hiring to purchasing to policy, we must choose safety. This is an active process—not one that just happens on its own—no matter how talented and skilled our staff. We must not let competition and the need for a bottom line contaminate our decisions or our culture. It is clear that pilots and flight medical crew, despite our words and policies, feel inordinate pressure to fly. We must find ways to fund safety equipment, training, policies, and a bottom line that is not solely driven by flight volume. While recognizing the importance of margin to keep our mission whole, we must acknowledge that, first and foremost, the business of medicine is not business.

As air operator/certificate holders, we must find new ways to measure and enhance safety performance. We must find ways to increase the safety margin while operating in a competitive marketplace. We must not let pressures on the bottom line eclipse our investment in safety, and we must find new ways to share safety as we operate. We must listen to and lead the employees of our organizations. The mechanisms are in place—AMSAC, safety roundtables, the CEO Operators Forum, and the HAI Root Cause Study. We must define business models that reward safety and penalize risk.

As pilots, we must look at our training, skills, and decision making. We must lead through our professional association, NEMSPA. At the end of the day, this industry is much more than a licensed pilot and certified aircraft; this is a unique mission with unique and vulnerable passengers. We must say no at appropriate moments and stick to the decision. We must ensure our skills are better than the best and define a new quality standard for EMS aviation. We must commit to finding new means to assess, measure, and manage risk. We must practice and lead AMRM at every turn with each and every colleague that shares our aircraft and the envelope of maintenance and communications that surrounds us.

As mechanics and flight engineers, we must insist on the time, resources, and environment necessary to take care of our aircraft. We must commit to excellence in every area of our practice. We cannot avoid the pressure to keep in the air, but we can work together with our program administration to create an environment that improves the margins of safety. We must insist on policies, equipment, an environment, and time to do our jobs and promise not to release an aircraft to service if we are not ready to climb aboard for every flight.

As communication specialists, we must commit to knowing our environment at all times, especially in jurisdictions with multiple programs. We must lead through our professional association, NAACS. We are the first point of contact—the entry of patients into the flight and critical care environment. We operate often alone at the heart of the command and control system. We must take on new roles; it is not just about passing information but more about searching out, assessing each aspect of the environment we call our colleagues to enter and proactively sharing information that can assist in better decision making.

As flight medical crew, we must lead through our professional associations—ASTNA and NFPA. Each has promulgated standards and safety practices. Are they part of our program's policies? We must insist on good equipment and decision making. We can no longer go along for the ride. We must become integrally involved in the management of our safety programs. We must insist on AMRM and become partners with our colleagues in aviation (pilots and mechanics) and our colleagues in our communication centers in creating an environment that our patients can truly trust. We must become more than acquaintances or friends with our colleagues in other programs that share our jurisdictions. We must ensure our collective efforts are based first and foremost as patient advocates.

As physicians, we must demand at every opportunity that each choice in the myriad of decisions and caregivers is always based on safety. This must become the first and foremost consideration of our practice. We are ultimately the gatekeepers of each aircraft and every ground vehicle, and our professional organization, AMPA, must insist that good and safe medicine is at the core of every care decision.

At the end of the day, this is not transport—this is medicine in a transport environment. We cannot allow a competitive marketplace to drive patient-care determinates. We must insist on adherence to the highest and most rigorous standards of safety and care from every colleague that delivers services to our patients—and we must call an immediate stop when care falls short of our individual practice.

NFPA has coined a new pledge for their members to take on board: “I will see you next year.” Let this be the year we finally come together at AMTC and not find a missing hole, a lost colleague, and another heart-wrenching story. Choose safety—it won't just happen on its own.