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AAMS
News and successes
There have been many things going on over the past few months at AAMS. Most recently we had another great Spring Conference from March 8–11. We had excellent feedback from the conference and had 147 attendees and 14 exhibitors. Our sponsors included AgustaWestland, Air Methods Corporation, American Eurocopter, Bell Helicopter, FARE, and Heli-Dyne Systems. I saw one of the written comments that I think sums up the spring conference: “The AAMS Spring Conference is a must attend for the leaders of our community.” We like to think so, too, as we strive to provide excellent management sessions and, through the Hill Day, positive impact on future public policy for our critical care transport community. Thanks to all who attended and to the AAMS Education Committee and staff for pulling it all together. Great work!
During the Spring Conference we heard the tragic news of the Hawaii Air Ambulance crash on March 8 in Maui. Andrew Kluger, AAMS Region I director, is the president of the company and was fortunately in Hawaii at the time of the crash to provide support for his team. Our thoughts and prayers go out to the families and friends of pilot Peter Miller, nurse Brien Eisaman, and paramedic Marlena Yomes. The crash is under investigation as of this writing.
We also received sad news from Eagle III in Bellevue, Wisconsin, with the crash of their BO105 helicopter while on a maintenance flight on April 13. Our thoughts and prayers go out to the family, friends, and colleagues of pilot James Vincent, who lost his life in the crash.
Tom Judge, Dustin Duncan, Tammy Chatman, Glenn Lyden, and I had the opportunity to spend an evening with Tracey Friedman, the sister of Erin Reed, one of the crew that perished in the Airlift Northwest crash last September off of Puget Sound, Washington. Tracey is both trying to understand our community and how she and other family members of staff lost in the line of duty can positively impact improving overall air medical safety. We of course embrace safety efforts so that we can truly see the day of Vision Zero.
The General Accounting Office (GAO) is conducting an investigation into air ambulance safety at the request of Congressman Jerry Costello (D-Illinois), a member of the U.S. House of Representatives Transportation and Infrastructure Committee. Senior investigators and analysts for the GAO requested input from AAMS on April 5, 2006. AAMS has supplied a number of key contacts in our community, and they have all been notified of possible contact by members of the GAO. The AAMS office will fully cooperate in providing information as needed. One of the areas that will be assessed is the need for regulatory or legislative action to address ambulance safety.
Johnny Delgado, our AAMS Region VI director, resigned from his position as he has accepted a job in Washington, DC, with the department of Homeland Security. We are sorry to see Johnny leave not only our board but also our community but wish him the best of luck in his exciting new position. It is also nice to know that the Department of Homeland Security now has a very knowledgeable person on critical care transport issues. We have had a number of individuals interested in filling the Region VI position, and like with past vacancies, we will ask for input from the members in Region VI. Director vacancies are appointments made by the president.
The AAMS board is conducting some focus groups with AAMS members over the next several months. The board thought that, since it had been over 3 years since our restructuring and the subsequent dues change, we want to check in with members to see how we are doing. Regional directors, as well as Dawn Mancuso and I, will be contacting programs in their areas. Of course we are always open to feedback, so please feel free to contact our office if you have something on your mind.
As I said in the last issue, I am a big proponent of the development of AAMS state and regional chapters. Tim Pickering has reported that there is AAMS chapter development going on in Iowa and Kansas. I am delighted to hear this because, as I said last time, we must think nationally and internationally but act locally. There is so much that can be accomplished at the state level by working together. There are draft articles of incorporation and bylaws available, so if you are interested in starting a state or regional chapter of AAMS, contact your regional director.
The Medical Transport Institute (MTLI) had another great year with a sold-out 1st year class and graduate school. I thank all the regents, especially Denise Landis, Dawn Mancuso, and Bill Koegler, for their hard work in making this such a wonderful program for our community. Next year will be the 10th anniversary, which is hard to believe. Being a regent I can honestly say, as I think my fellow regents and instructors would echo, this is the best work week of the year! It was also great to see Jackie Stocking, president of ASTNA and Gloria Dow, president of IAFP, in the first year class, along with Shelley Sholl, president of NAACS completing her second year and CMTE. Shelley had to suffer through a new project that Gina Blevins and I developed this year titled “Intense Competition,” but I am happy to report that she and her colleagues came through with flying colors. It was wonderful to have the leadership of our affiliated associations at MTLI!
I had the opportunity to attend the Critical Care Transport Medicine Conference in Las Vegas for a day on April 3. It was nice to see such a successful meeting with over 200 in attendance. Congratulations to AMPA, ASTNA, IAFP, and NAACS for a job well done!
The Vision Zero White Paper has now been published at visionszero.aams.org on the AAMS website. Please take the time to read this important work as it outlines are efforts to improve safety. Many thanks go to the Vision Zero Steering Committee with the development of this paper and in their continued efforts with Vision Zero. Wear that bracelet if you are not already doing so!
AAMS, in collaboration with all the associations in the critical care transport community, continues to add value to your individual programs. Be a part of things; we are always looking for volunteers for committees. Contact Dawn Mancuso at the AAMS office—we need your expertise and assistance.
AMPA
Elections, Kevin Hutton
It is that time of year again to begin thinking of nominations for the upcoming AMPA elections. The positions open for election are president-elect, secretary-treasurer, and three board-member-at-large positions. I would like to encourage nomination of those who have not participated on the AMPA board in the past. It is only through the continuous changing of the board and the new ideas and efforts that result from participation that AMPA continues to grow.
The recent Safety First preconference and the CCTMC in Las Vegas were both great successes. The reviews for the Safety First program were excellent. The attendees especially liked the multidisciplinary approach to safety and the varied topics. In addition, the feedback on CCTMC was strongly positive. This continues to be considered an outstanding educational opportunity for clinical topics. Thank you to all who made this year's conference a success.
The call for speaker submissions for the 2007 CCTMC has just gone out. I encourage participation by AMPA members. All topic submissions are due no later than July 10, 2006. Please submit your topic electronically to Pat at Ppeter1111@aol.com; she will confirm your submission. CCTMC offers the speaker a $200 honorarium and complimentary registration to the conference.
All members are reminded to visit our new website at www.AMPA.org.
Lastly, the Handbook is coming. The updated edition of the AMPA Handbook will be available at AMTC in Phoenix in September. Thanks to Ira Blumen and the other editors and contributors for their continued attention to this project.
The following is the next in a series highlighting AMPA members.
Kevin Hutton, MD, is a board-certified emergency physician practicing in San Diego, California. He attended USC as an undergraduate, then Georgetown University School of Medicine, and completed the University of Pittsburgh Affiliated Residency in Emergency Medicine.
Kevin began his career in EMS in 1980 as an EMT in Los Angeles. Since then he has worked as an emergency medical service command physician with the City of Pittsburgh Bureau of EMS, a flight physician with STAT Critical Care Transport Program at the University of Pittsburgh, the base hospital medical director at Scripps Memorial Hospital, and as the medical director of Life Flight-San Diego Air Medical Service at UCSD Medical Center. He has also served on the National Disaster Medical Assistance Team (DMAT) in Pittsburgh and was the assistant director of the department of emergency medicine at UCSD Medical Center from 1990 to 1995.
In addition, he has served multiple administrative roles in the local EMS system, including a member of the Medical Audit (QA) Committee for Trauma for the San Diego County Trauma System from 1990 to 1993, the Liaison to Medical Audit Committee from Prehospital Audit (QA) Committee for San Diego County from 1992 to 1993, and as the Chairman of the San Diego County EMS Prehospital Audit Committee from 1995 to 1999.
Kevin's involvement in the air medical transport industry is as extensive as anyone's. He is a founding member of AMPA and has been a member since 1993. He served three terms on the AMPA board, one term on the AAMS board, and 6 years as a board member for Foundation for Air Medical Research (combined into AAMS Foundation). He has been a reviewer for the Journal of Emergency Medicine since 1990, Air Medical Journal since 1994, and AirMed from 1994 until it was combined with Air Medical Journal in 2000. He is the president of the Foundation of Air Medical Research and Education and is or has served on numerous AAMS committees, including Research, Government Relations, Standards, Membership, Executive, and the Foundation of Air Medical Transport, Research Grant Review committees.
Kevin is a recognized educator. In 1991 he was awarded the Outstanding Teacher Award from the Family Medicine Residency Program at UCSD Medical Center. He has spoken widely, both nationally and internationally, on topics ranging from clinical care and administration of HEMS to compliance and financial issues related to air medical transport. He has published over 14 papers in the air medical transport, disaster medicine, and emergency medicine literature.
The most important contribution Kevin has made to the air medical transport industry is his prolific authoring of position papers. He is the principal or affiliate author of 7 position papers, including:
Although widely known for his participation in AMPA and AAMS, Kevin is also an entrepreneur. In 1997 he founded Golden Hour Data Systems Inc. EMS Information and Revenue Management and since then he has been the CEO. From 2000 to 2005 he served as the chief compliance and privacy officer for Golden Hour Data Systems, and he has been the chairman of the board for the last 4 years. Last year he became board certified in healthcare compliance from the Healthcare Compliance Association. Even before his board certification, his knowledge of compliance issues in air medical transport has been invaluable to many individuals, associations, and programs who have sought his guidance.
Kevin Hutton, MD, continues to be an important leader in the air medical transport industry. His efforts and contributions have enabled AMPA and AAMS to continue to grow and evolve. AMPA is proud to have him as a member and is grateful for his contributions to our association and industry.
ASTNA
Professional membership: “what's in it for me?”
I often hear colleagues ask some variation of this question. Honestly, I think it is a very fair question. After all, in today's busy world and in an era of shrinking educational budgets, it is important to know why you should take the time to become an ASTNA member and what value you will receive in return for your annual membership dues.
As you know, the mission of ASTNA is to “advance the practice of transport nursing and enhance the quality of patient care.” For a summary of the more obvious mission-aligned benefits ASTNA provides to its members, please visit the ASTNA website at www.astna.org. You will find that safety is woven throughout each and every product and member benefit. In this column you will find some additional, and perhaps less obvious, ways in which the ASTNA board of directors works on your behalf.
In transport nursing, safety must be a core value, and we must all do our part to promote a safety culture. The ASTNA board of directors has been hard at work raising awareness on safety issues and collaborating on transport community and nursing profession safety initiatives to lend the perspective of the specialty of transport nursing. While this important work is partially funded by membership dues, it would not be possible without the generous financial support and donation of time from the programs that employ our board members. A hearty thank you to all for supporting ASTNA!
Collaborative Venues
So far this year ASTNA board members have been hard at work representing the safety interests of members in many venues:
ASTNA board members will also represent ASTNA at the following venues later this year:
A Short Note on CONCERN and HARP
The ASTNA office recently received an email indicating that not all transport professionals are aware of these two reporting and information sharing venues. What follows is a brief excerpt, taken from the FAQ page, describing the purpose of CONCERN and HARP. For more information, please go to www.concern-network.org.
Safety Position Paper
Maximizing safety of transport crewmembers has always been a priority of ASTNA. In 1986 the National Flight Nurses Association (now ASTNA) published Practice Standards for Flight Nursing. Within that document the “Aircraft Standards for Flight Nursing” (Comprehensive Standard IV: Crew Safety) stated “the actions of each crew member may affect the safety of other crew members or the entire aircraft…the flight nurse shares the responsibility of assuring the safety of aircraft and crew.” By creating this standard, ASTNA was at the forefront of changing a long-standing myth that the safety of the aircraft and its occupants was the sole responsibility of the pilot(s). A copy of the current ASTNA Position Paper, “Flight Nurse Safety in the Air Medical Environment,” is available on the ASTNA website. This document is being revised to include Critical Care Ground Transport Safety. The revision will be available by AMTC and is expected to be endorsed by other professional nursing associations.
AMTC 2006
Please join us in Phoenix, Arizona, September 25–27 for AMTC. ASTNA will be celebrating its 25th anniversary, so don't miss out on the important milestone, which we will celebrate at the ASTNA Membership Luncheon!
As always, feel free to contact the ASTNA office or any ASTNA board member for additional information. We look forward to working with you on important association and community initiatives. Through your involvement, we can work together to shape the future of transport nursing safely!
“Leadership and learning are indispensable to each other.” John Fitzgerald Kennedy Be a leader—continue to learn all you can about safety and teach all you know to others so we may all enjoy a SAFE summer.
IAFP
Thanks, Chief Alan Brunacini!
I am here today to celebrate the accomplishments of an illustrious career that spanned decades and forever altered the way we approach EMS in this country and throughout the world. Far from mourning the passing, join me in celebrating the joy we've shared.
Sounds a like the beginning to a eulogy, but I'm not talking about a death. I'm talking about a life, a passion, and a commitment so profound it is contagious. In June of this year, Chief Alan Brunacini retires from the Phoenix Fire Department. Yes, I know I'm writing for AMJ. Yes, I know nothing in your hangar has burned since the Playstation and surround sound overloaded the extension cord. But Chief Brunacini most graciously asked that people thank him by passing on the universally applicable “A-Ha” moments he inspired. Thank you, Chief.
Do the right thing. In an era of lofty mission statements and protocol books encompassing volumes, Chief Brunacini made it simple. Except during the week of your CAMTS visit, can you recite your mission statement? Does it personally guide you through each conundrum you face? Keep it simple.
Take care of Mrs. Smith. Why do you come to work each day? Is it for the glory? To buzz your neighborhood? Because you look good in a flight suit? As you are toned out for each call, I hope you're here to take care of Mrs. Smith, Chief Brunacini's universal designator for customer. No matter the time of day or the nature of the call, Mrs. Smith needs help. There are a multitude of Mrs. Smiths:
They are all Mrs. Smiths. They may all need resources more difficult to muster than your considerable medical expertise. You have the trust, confidence, and responsibility to do the best you can for each of them. It's not about you; it's about Mrs. Smith.
Be nice. No matter who, what, or where, be nice. Be nice to patients, families, bystanders, other providers, coworkers, and yourselves. It doesn't take more time, more resources, or more money; it takes a change in mindset. Eventually a culture develops that accepts nothing less. People still wake you up at 3 am whether you're nice or not. There's still congealed blood under the seat that you can't reach whether you're nice or not. Some days they still call it “work” for a reason, but in each situation:
Go home healthy. Chief Brunacini was one of the first public safety leaders to give us permission to go home healthy. Until that point, generations of true heroes died in the line of duty. Think about the following terms: ultimate sacrifice, line of duty hero, job worth dying for. We all sacrifice. We work holidays, weekends, nights, and late calls. Death doesn't minimize any of those. I will argue that the line of duty heroes are those that do the right thing, be nice and fly safe, in the most trying of circumstances. And they tolerate nothing less from others. If the job is worth dying for, it's worth the extra effort to be healthy for. On the job physical training, department-wide lifestyle changes, and work and procedural controls make personnel safety the priority. All help you go home healthy. It's good for you! It's good for your team! And it's good for Mrs. Smith!
I really like EMS. Critical care flight medicine is my passion. I loved the time I spent with the Anchorage Fire Department, but the first time I ever thought about work culture or leadership philosophy was in a crowded auditorium, raptly listening to a wise, bespectacled man in a Hawaiian shirt. After the session, he took the time to speak with the myriad of participants. He remembered names. He answered requests. He graciously shared publications, presentations, and philosophies. And he expected us to Do the Right Thing, Take Care of Mrs. Smith, Be Nice, and Go Home Healthy. I hope you do the same.
NEMPSA
Defer it or deny it!
This past April I attended the “Safety First” preconference in Las Vegas, Nevada. I had the privilege of listening to several outstanding presentations. While preparing for my own small part in the conference, I was reminded of a couple of things I had not thought of in quite some time. It also struck me that I had not heard much discussion on this subject either.
The subject is what I call “Defer it or deny it” or “Maybe it won't happen on my watch.” The recent disaster brought on by Hurricane Katrina is an example of my topic on a very large scale. The potential for large-scale damage from a storm like Katrina had been well known and documented for almost 40 years. Leaders at all levels of government just kept hoping it wouldn't happen to them. Well, it did.
Several years ago I flew an army accident investigation team to the scene of a helicopter crash. The pilot in command was killed; the other pilot survived. The aircraft in which they were flying was, at the time of the accident, under a flight restriction. Except for takeoff and landing, it was not to be flown at less than 400 feet above ground level. Witnesses to the accident stated that, just prior to the crash, the helicopter was seen flying about 5 to 10 feet above the water over a very large lake.
Several factors were revealed during the course of the accident investigation. The pilot was known to be a “hot dog” or “cowboy.” Other pilots and crewmembers in his organization had voiced their concerns to the unit leadership, both verbally and in writing. Unfortunately, the unit's mission load was very high, and pilots were in short supply. The pilot had made the following statement to the commander: “You aren't going to ground me, you won't be able to complete all our missions.”
A few days prior to the crash, one of the unit pilots informed a higher commander of the problem. That commander said he was on his way to a meeting and would be back in his office the following Wednesday. He would take care of the “Cowboy” immediately upon his return. The crash occurred on Tuesday, one day before the commander returned from his trip.
Several years later an EMS pilot and a nurse died under similar circumstances. Their program was short on pilots, they had a relatively high mission load, and the pilot was known for showing new nurses just what a great pilot he was. Unfortunately, the nurse he was showing on this particular flight didn't live long enough to be awed by his superb flying skills.
This entire discussion goes back to the idea that, in a high percentage of accidents, someone, somewhere, at some time had a piece of information that could have prevented the accident if acted upon.
In both cited accidents almost everyone knew something wasn't right with these two pilots. In both cases their managers knew there was a potential for disaster. In both cases management either denied or deferred the problem, hoping nothing would happen until they could do something. In both cases, lack of action contributed to fatalities.
So the question is do you have someone in your organization who could fit into this category? Are you in a position to do something about it but would rather not? Who among us are in the denial or the defer mode?
In this discussion I pointed the finger at pilots and managers. Although they hold the ultimate responsibility, they are certainly not the only ones at fault. Many of us are under the false impression that our own immortality will ensure that accidents happen only to someone else. Many of us don't want to make waves for our coworkers. Most of us would hate to think that, due to our lack of action, someone died or was injured. Wouldn't you rather offend someone as opposed to bury someone? When in doubt, speak out!
PII: S1067-991X(06)00145-3
doi:10.1016/j.amj.2006.05.002
© 2006 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.
