AAMS

As I write this I am just back from the European triennial Airmed2005 in Barcelona, and as you read this we will be in the final stages of production for this year's AMTC in Austin, which is on its way to being the largest gathering of the community yet.

As noted across the year, we are focusing this year's annual gathering on high performance in the high consequence environment. In the parlance of quality management, the term for success has become high reliability in describing organizations that consistently produce measured successful results with a minimal error rate.

In medicine today, the general thought is that most health care organizations operate at some-where between 90%-99% reliability. Even 99% reliability equates to a substantial number of errors. As measured in error rates, 100,000 errors per million is a 90% success and 10,000 errors per million equates to 99% reliability. Stated in six sigma terms, most health care organizations operate between 3 and 4 sigma, whereas the highest reliability organizations strive for 6 sigma measured reliability with an error rate of 3-4 occurrences per million actions.

In any complex operation it is not possible to reduce errors to zero. Successful organizations recognize, however, that while it is not possible to eliminate errors, through multiple error-trapping processes, it is possible to minimize and eliminate errors of consequence. In our arena this recognizes that, while it is not possible to achieve a zero accident/incident rate, it is indeed possible to achieve a zero fatality or serious injury rate similar to recent years' experience by the scheduled airlines.

Faced with continuing challenges in improving the safety of air medicine, AAMS has adopted an initiative entitled Vision Zero. The Foundation for Air Medical Research and Education (FARE), together with AAMS, are undertaking a series of strategies to deliver the Vision. A steering committee comprising leadership from the AAMS Safety, Standards, PR, and Communications committees, together with members representing FARE and CAMTS, has taken the task of fleshing out the conceptual framework.

The concept of Vision Zero was developed originally in Sweden to eliminate fatal motor vehicle accidents through a combination of education, engineering, and enforcement. Recognizing that the only guaranteed mechanism for eliminating crashes is to not drive, the concept was to develop cost/benefit analysis of potential public policy strategies to adopt the best investment for improvement. It is essential to recognize up front that while many strategies may have low costs, cost effectiveness is not the same as least cost, and all strategies require investment inputs.

It is our goal over the next several years to develop a “tool box” for our members composed of both action strategies and evaluation methods to improve safety and eliminate errors of consequence.

Already, AAMS has made the first investments in Vision Zero through initiating a new monthly electronic safety news capsule, “On the Fly;” producing a national conference for the community, vendors, the FAA, and NTSB on implementation of night vision goggles; and working with the FAA HEMS Task Force to produce a new AC—Air Medical Resource Management (AMRM) and a notice of best practice in risk reduction.

AAMS is a contributing sponsor to the International Helicopter Safety Symposium to be held in Montreal in September and hosted by the aviation and safety administrations of both the US and Canada.

At AMTC, in partnership with AMSAC, AAMS will continue the process of “train the trainer” for AMRM. Our stated goals are that every person in the community completes a formal AMRM program within the next 3 years and every medical transport organization adopts annual AMRM recurrency training.

The AAMS Core Industry Safety Committee, together with FARE and the FAA, is producing a special safety track at AMTC, and we will use one of the plenary sessions to look at lessons learned in other high consequence industries.

Next summer, AAMS will produce a second national conference on other new aviation safety technologies that our members are evaluating.

And most importantly, following from the mini safety summit at the spring meeting, AAMS has promised to present a report card next March at the our annual spring leadership conference.

It is interesting to note that our European colleagues are sharing many of the same challenges and ideas in improving systems—from ACRM (their version of AMRM) to introduction of night vision goggles to debates about the night operation requirements. Throughout the Spain gathering there was also a constant from around the world on the search for the value proposition in air medicine against a backdrop of cost containment in health care.

At the end of the day, however, all of these action steps will remain just that—energy without purpose—unless each and every member of the community shares the commitment to Vision Zero. We must get better at sharing information across and between our organizations. This must be simultaneously a bottom up and top down approach. Continually improving safety is at the very heart of effective patient care.

In an article some years back, Dr. Donald Berwick, a pediatrician from Cambridge who founded the Institute for Healthcare Quality Improvement, wrote an article about change and quality for the British Medical Journal (“Heal thyself or heal thy system: can doctors help to improve medical care?” Quality in Healthcare Series). In it he laid out eight action steps that each of us must take on board:

Said differently, each of the above can be stated as a question to us as individuals and to our organizations. Are we committed to the journey?

See you in Austin.