Forum

Saying farewell 

As my term as president of the Air and Surface Transport Nurses Association draws to a close, I want to thank you, the membership, for giving me the opportunity to serve and represent you as president of this outstanding organization. It has been an eventful and rewarding year! I would also like to express my heartfelt gratitude to our management firm, Great Western, and this year's board of directors for all of their hard work on the many initiatives that we, as an association, envisioned and implemented this past year. Many of those initiatives would not have been possible without collaboration with the leadership of literally dozens of professional associations. You know who you are—know that we thank you for your continued commitment to safety and clinical excellence!

At AMTC this year we kicked off a year of celebration in honor of ASTNA's 25th anniversary. I encourage each and every one of you to get involved in shaping the future of transport nursing. Each and every one of you has the potential to be a great ASTNA leader. Within our membership are nurses who possess a multitude of talents, who envision a plethora of positive change, and who can muster the momentum to make it happen. The time has come for you to get involved. Ask yourself what special talents you possess that can advance your profession and make it a safer place for your colleagues and the patients for whom we are entrusted to care. Next, contact the ASTNA office or any board member and ask how you can get more involved.

“There are risks and costs to a program of action. But they are far less than the long-range risks and costs of comfortable inaction.” John F. Kennedy

Dare to step out of your comfort zone and jump into action. I look forward to working with you on the initiatives you are passionate about!

The past year has been filled with events that will affect our lives and impact our profession for years to come. First and foremost on everyone's radar screen should be the issue of safety—safety in the transport environment includes aircraft/vehicle safety and safe clinical practice.

I am sure many of you have been following with great interest the issue of operational control. For many of you, there has already been a significant impact on how you conduct daily flight operations. For those of you who do not fly but do critical care ground transport, the July/August issue of Air Medical Journal contained an excellent article, “From the air to the ground: air medical safety practices applied to ground critical care.”

Regardless of your choice of transport vehicle, the latest version of the ASTNA Safety Position Paper addresses many safety issues of critical importance to you as a professional. The position paper contains updated air safety issues and, for the first time ever, addresses several ground transport safety issues. If you were unable to pick up your copy at AMTC, please visit www.astna.org.

During AMTC, ASTNA also conducted a safety survey to help us strategically plan safety initiatives that are of importance to the ASTNA membership. Expect to see the survey results shortly.

There is a wealth of safety information currently available; what you choose to do with that information is up to you. Who among us would dare to practice clinically without staying abreast of the latest evidence-based research? I encourage you to have that same passionate focus on safety information—be informed, be rested, be safe!

“They always say time changes things, but you actually have to change them yourself.” Andy Warhol

My challenge to each and every one of you: Be a change agent. Strive for safety and excellence in everything you do! Do your part to impress upon others the criticality of safe operations.

As I close out my term, I want to express to you again my gratitude for the opportunity to serve such an incredible professional organization. I look forward to continuing to work with you in the future.

Be safe!

Jackie Stocking, President

This I believe 

Do you multi-task? Depending on definition, natural propensity, and the amount of psychiatric disorder mixed in, multi-tasking is boon or bane, talent or curse. I commute to work, some days short distances and some days long. “Aha!” say fellow drivers, “You commute, therefore you multi-task!” Yes, I do, catching up on a few phone calls, planning and strategizing, formulating concepts for articles and projects. I do not apply make-up while I drive, read the newspaper, or give myself a manicure (nothing against those things—job security for us!).

I also listen to as many national and international radio programs as I can. (You know how absolutely crucial to critical care medicine it is to be current on international cricket scores.) Really, in part it's travel nostalgia. In part, it's good for me to hear dramatically different points of view. A fresh perspective adds depth and dimension to everyday events, and on the very good days, I'm inspired. National Public Radio's essay series “This I Believe” challenged and inspired this last AMJ article as IAFP president. What do you believe?

I believe in the strides the IAFP is making. Throughout my year as president, this board has focused on infrastructure, member service, and national and international recognition. From the first international chapter of the IAFP, to hosting the Japanese HEMS contingent, to representing critical care paramedics on national EMS projects (EMS Scope of Practice, critical care curriculum, NIMS, and a host of others), the IAFP is increasingly representing your interests nationally and internationally. We are focusing on member services with the state delegate program, government and legislative affairs committee, AMTC Leadership PreCon, new website, and FP-C review materials update. And we are building financial and process infrastructure to ensure this momentum continues.

Congratulations to 2007 IAFP President Anthony Pellicone, President-elect Greg Winters, and newly elected IAFP BOD members Dana Anderson, Matthew Cathcart, Mike Morrow, and Francis J. Rella.

I believe in good. No matter what death, destruction, or injustice I respond to, I believe in good. Optimism, delusion, call it what you will, I am consistently awed by the humanity and good that prevail, even in the most dismal circumstances. I believe that hard work and perseverance yield results. OK, maybe something wasn't the exact result you were looking for. Perhaps nothing followed your projected time line, but good happens on the foundation you build. The good you do each day matters, whether you see it or not!

I believe in gracious generosity. Those who are the brightest and best of our peers don't demonstrate it through grand stories and unimaginable heroics. They are truly gifted enough to make others feel smart and competent. They make what we do look easy, seamless, and polished. They are the mentors we speak of in reverent tones. They are the examples we follow as we hone our professional selves. They are the references we turn to when there is no “one right answer.” The next time you form some less than flattering critique, ask if it is about your colleague or about you. Are you good enough to be kind, generous, and gracious with others?

I believe sharing knowledge makes everyone smarter. Knowledge is one gift that is never depleted when you give it away. It's not like ice cream or jewelry. Sharing knowledge makes both participants smarter. By explaining a concept to someone who truly wants to learn, you force yourself to understand it completely enough to answer questions. Nothing cements a fact like explaining it seven different ways! If you're wearing an “I'm with stupid” T-shirt under your flight suit, check which way the arrow's pointed!

I believe in everyday safety. Thank you for all the work to improve air medical safety. When my friends died, I re-examined the way I think about safety and what we do. The initiatives, standards, and regulations are important to provide guidelines and awareness, but no one successfully regulates attitude. Safety isn't a one-time self-reported award. Safety isn't one article or one initiative. It's the attitude you pack with your uniform each shift. It's how you educate yourself about all aspects of your job. It's how you choose safety over comfort. It's how you refuse to tolerate ambivalence in others. And it's how you value yourself – we are each important enough for everyone involved to put in a little extra effort. I love to fly with a prepared team, in the right aircraft, and with the right communications and electronics for the mission and conditions.

I believe we make our own luck. I loudly and publicly make the statement that lucky and safe aren't the same thing. But there's a caveat: you have to prepare for and be receptive to luck. Gary Sizemore won the IAFP condo raffle 2 years ago. Lucky guy! Oh, by the way, he bought raffle tickets. You need to set yourself and your team up to be lucky. Educate yourselves, prepare, and work toward luck. Lucky IV start or patient outcome last week? It was because you were educated, prepared, working hard, and open to even the most miniscule signs and signals around you. Acknowledge the difference between lucky and brilliant. Learn to recognize and revere both. Invite both to stay a while.

I believe I am extremely privileged to do the work I do. New EMTs talk to me about saving lives. So do new flight paramedics. There's that optimism I love. OK, once in a while, in the life or death conundrum, we get to give a big shove one way or the other. But most days, I show up, do the very best medicine I can, and am nice to people in the process. Whether a fragile new being enters the world or an adventurous life well-lived reminisces during departure, the privilege is not in determining life or death but in being a positive force through each process.

And I believe I have been blessed to work with and learn from you. You all have taught me so much in the 4 years I've served on the IAFP board of directors. To my husband, family, and friends, thanks for the generous encouragement. To the gifted characters I've served with on the board, the generous community icons I've been privileged to meet, and the talented team members from other associations, thanks for the education. And to the true professionals of the IAFP, all the field providers who reach out to people every day, thanks for the inspiration and confidence.

I am privileged and honored to continue to work with you. And tomorrow, I am lucky enough to get to fly…

Gloria Tavenner Dow, President

Finding the good in our industry 

I believe my first submission to this Forum was about how the news media reported only the negative aspects of the air medical community. That was 2 years ago, so I thought I would revisit that topic in a much shorter form.

Over the past 2 years I have seen very little positive press regarding EMS aviation. I didn't expect to see anything different from a media that focuses only on stories that will draw ratings. Good news very seldom gets big headlines. Using that rationale, one would think that aviation medicine is an extremely dangerous business staffed by thrill-seeking individuals, all of whom have a death wish. Most of us recognize that perception as being very far from the truth.

The reason I bring it up again is because those who focus only on the negative aspects of an undertaking will see only negatives. Unfortunately, that thinking has a way of affecting all those it contacts. I think people sometimes should be reminded of the good they do.

Despite all the negative press, despite those who say this industry (community) is too dangerous and, in many cases, unnecessary, you continue to do a great job. The press will continue to ignore the thousands of flights conducted safely every day; they will focus only on the ones wrapped in tragedy. Some people in management positions focus only on numbers and the bottom line, disregarding their most valuable asset, the people flying the line.

I am not saying we don't have to address the downside of this business. I am just saying that “it ain't all bad.” In fact, there is much more good than bad. Don't forget the good stuff. There is lots of it out there.

I am also not saying that our industry is made up of heroes. I am saying it is made up of mostly good people doing a great job in an honorable profession. Keep it up.

Fly safe.

Ron Fergie, Past President

AMTC – Phoenix 

By the time this is published, the Air Medical Transport Conference in Phoenix will have come and gone. This year's theme was “Shaping Our Future,” and there were several excellent keynotes, sessions, and preconference workshops. As always AMTC was the place where our entire community came together to network, exchange ideas, and educate each other on the many issues that face air medicine now and into the future.

FAA operational control rule change 

Representatives of AAMS, NEMSPA, HAI, and several air operators met with the FAA on August 29 in Alexandria to discuss the proposed changes to OpSpec A008 and how they affect air medical operations. The FAA is very concerned about the possible transfer of any element of operational control to a noncertificated person or entity, not only with HEMS operations but with any Part 135 certificate holder. Included in their concern are program websites, PR materials, contracts between a Part 135 certificate holder and other entities that might impact operational control, communication/dispatching centers, billing operations, and any aspect of how a program is holding itself out to the public. AAMS has several issues with these actions, from regulations with Medicare and Medicaid billing, the cost and real impact on safety, and how local FAA offices will be enforcing these changes as the FAA has not come out with specific guidelines as yet.

Chris Eastlee, government relations manager with the AAMS office, sent out a member alert, and there is updated information on the AAMS website. There was also a special session at the AMTC where the FAA made an air medical-specific presentation. AAMS will be publishing this information, too. The proposed OpSpec changes were set to be released in late September, and after a 30-day comment period, they will become effective 30 days from the official release of the proposed changes.

In a related development, the FAA's Enforcement Division has been visiting several of our member operators, conducting safety audits and asking questions on operational control and the relationship between the Part 135 holder and the program.

CMS proposed rule change 

CMS has proposed a rule that would reclassify a number of counties in the United States from rural to urban and, to a much lesser extent, urban to rural. The concern with this change is that, through the negotiated rule-making process with CMS, AAMS and all of the Negotiated Rulemaking Committee members agreed on a set methodology for identifying rural counties. This change would institute a new methodology that would lower reimbursement for many of our needed services.

Board implements strategic planning initiatives 

As reported in the last issue, the AAMS and FARE board of directors participated in an all-day strategic planning meeting on June 10 in Washington, DC. The five initiatives currently being worked on are:

GAO investigation of air medical safety 

Also reported in the past issue is that the General Accounting Office (GAO) is continuing its 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. AAMS supplied a number of key contacts in our community, and they have all been notified of possible contact by GAO staff. One of the areas being assessed is the need for regulatory or legislative action to address ambulance safety. We have been told that the final report will be completed in February 2007.

Thank you and remember Vision Zero!

Edward R. Eroe, President

AMPA awards and election results 

Catherine Carrubba, MD, AMPA Distinguished Physician

Dr. Carrubba is an AMPA founding member and was president of AMPA 1994-1996. She is currently medical director for Aeromed at Tampa General Hospital in Tampa, Florida.

The Distinguished Physician Award was established in 1993 to recognize a physician who has significantly contributed to the air medicine profession and to recognize lifetime achievement and service to the air medical community. The AMPA board of trustees selects the award recipient from nominations of members.

Past AMPA Distinguished Physicians

1993 Alex Jablonowski

1994 Henry C. Bock

1995 Nicholas Benson

1996 Lenworth Jacobs

1997 Norman Snow

1998 Frank Thomas

1999 William Rutherford

2000 Ira J. Blumen

2001 Richard Orr

2002 David J. Dries

2003 Kenneth Williams

2004 D. Gregory Powell

2005 Robert E. Falcone

Current AMPA board of trustee members are not eligible.

Charles W. Sheppard, MD, Medical Director of the Year

Dr. Sheppard is the medical director of St. John's Life Line in Springfield, Missouri.

In 2000, the Air Medical Physician Association instituted an additional annual award. In contrast to the Distinguished Physician Award, which is intended to recognize lifetime achievement and service to AMPA and the air medical community, the Medical Director of the Year is intended to recognize that physician who has made outstanding contributions to his or her own program. For that reason, nominations are solicited from individual programs—flight crews, administrators, and/or program staff.

This award recognizes the medical director for outstanding contributions and exceptional personal involvement in their program. The nominee should be considered an invaluable part of the team's success and whose contributions to medical direction, education, quality care, outreach, safety, and team morale are part of the essential fabric of the program—in short, a leader.

Past Medical Directors of the Year

2000 Jeff Hillesland, MD

2001 Eric R. Swanson, MD

2002 Jack B. Davidoff, MD

2003 James G. Leker, MD

2004 Mark E. Maertins, MD

2005 Andrew C. Hawk, MD

2006 AMPA Election

President

Michael Brunko, MD

President-Elect

Jack B. Davidoff, MD, EMT-P

Secretary-Treasurer

P.S. Martin, MD

Board Members at Large

Steven S. Andrews, MD

William R. Hinckley, MD

John A. Pakiela, DO

The above board members join the remaining members at large:

Reed Brozen, MD

Kevin Hutton, MD

Eytan Ish Tov, MD

Eric Swanson, MD

Principles and Direction of Air Medical Transport, edited by Dr. Blumen, was presented by AMPA at AMTC. Books and CDs can be ordered at the AMPA website (www.ampa.org) or by calling the office (801-263-2672).

Kenneth Robinson, Past President