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What position my position is in 

As long as I have been involved with AMPA, the organization has been approached by individuals, organizations, and other entities to support or author various positions. For the most part, this usually represents recognition and respect for an organization by those who are asking for a specific position or support. The difficult task for an organization, such as AMPA, is how to decide when to take a position that represents the philosophy, views, ethics, and opinions of the majority, if not all, of the membership.

My initial litmus test when I look at position statements that AMPA is asked to author or support is simple—does the position support the mission statement of AMPA and thus its members? Ultimately, the position must support our primary goal in providing quality medical care to the patients that our programs transport. Unfortunately, some of these issues can become a little cloudy after this question is answered. Quality medical care can be interpreted in a broad way—from actual treatment interventions to appropriate destination and utilization priority. Some of these issues, as most of us are aware, can be controversial, depending on the environment, geography, etc. that we are working in. What may be accepted as standard quality of medical care in one area may not be in another. This may involve the scope of practice of our clinical crews, destination protocols of individual states and EMS localities, or even the interpretation that transport crews lack legal rights to make contact with a patient in hospitals in which they are not credentialed.

In an ideal world, it would be nice to have outcome-based, proven standards that cover all of the areas in which we have conflict with in critical care transport. We are making progress in some of these areas, but we do have a way to go. As physician medical directors, we should take individual responsibility in educating our peers, local regulatory boards, EMS agencies, communities, etc. in regard to what we are capable of and how we provide quality medical care to the patients with whom we come in contact. I have found that there is an interesting depth of understanding and knowledge among various state EMS, nursing, and medical boards across this country in regard to what our clinical crews are capable of and should be able to do to care for the majority of patients we transport. As medical directors, we can make a difference in changing the opinions and “positions” of some of these regulatory agencies by direct involvement in showing that we can train, maintain, and demonstrate quality competency in what our crews can do.

The Commission on Accreditation of Medical Transport Systems standards provide some minimum requirements in training and maintenance of skills for airway intervention and allow for some flexibility according to individual program policies for other invasive interventions. The ultimate responsibility for deciding what these policies are falls to us as the medical directors. It may be apparent that it is difficult for AMPA, as an organization, to author or support a position that covers some of these various controversies that occur both nationally and internationally. But there is a depth of experience within the AMPA membership that can help without taking an organization-wide position.

If you haven't read them lately, check out AMPA's position statements (at www.AMPA.org or in Principles and Direction of Air Medical Transport). If you have ideas, comments, changes for new or current position statements, contact the AMPA board.

Michael W. Brunko, President

The benefits of the Medical Transport Leadership Institute 

I had the opportunity to complete my second year of the Medical Transport Leadership Institute (MTLI) this year and highly recommend it to all medical transport professionals. MTLI provides an excellent opportunity to spend individual time with the leaders of the medical transport field. The most accomplished and successful members of our community, often credited with setting the future direction of the industry, spend the entire week providing valuable insight into the challenges exclusive to medical transport. Attendees are afforded excellent networking and mentoring opportunities with other professionals, often facing similar issues or sharing the same concerns as they are experiencing. MTLI promotes professional development, cultivates management proficiency, and improves leadership aptitude through formal educational programs using didactic sessions and practical applications.

MTLI is designed to accommodate all levels of personnel, from the front-line employees to the executive manager, and is beneficial to all who attend, regardless of their length of tenure within the transport profession. It gives participants a better understanding of all the considerations required in making managerial decisions and the implications these decisions hold for the entire operation.

Why is MTLI important? By encouraging professional development, medical transport programs are assured that their employees are providing cutting-edge service through advanced training and a well-rounded insight of current happenings within the medical transport community. It also demonstrates a value-added commitment by the program to both their customers and their employees. By participating in curriculum such as MTLI, personnel are able to validate their dedication of providing top-notch performance encompassing all aspects of the service, from patient care to team management, from leadership to business development.

The intense training requires attendance of a week-long session each year for a 2-year period and involves mandatory attendance of all scheduled classroom sessions, completion of a written exam, oral dissertations, and requisite professional conduct. The first year consists primarily of formal instructive presentations that introduce the participants to management theory and also demonstrates direct applications to the medical transport business. The second year expounds on the materials presented in year 1 through advanced informative classroom tutorials but also requires attendees to apply the theories to everyday situations using group-assigned, scenario-directed projects. The attendees are introduced to concepts of group dynamics and must identify and manage the different stages of team development while completing their group assignments.

Graduates of the program advise students to exercise control when completing their projects. Professional presentations and materials are possible without hiring an outside public relations firm and can be completed within 3 days.

Participants are also challenged with maintaining equilibrium between work and play, much like is experienced in real life. One afternoon is provided for free time whereby participants are encouraged to take the afternoon and play golf with the group or take advantage of the other activities available on the Oglebay Resort properties, such as visiting the zoo, shopping, enjoying relaxing strolls on the immaculately kept grounds, or touring the museum located on the property, all of which can be visited by a short walk from the resort or taking a ride on the trolley. If staying on campus is not appealing, the surrounding area of Wheeling, WV, located along the Ohio River, offers lots for visitors to see and do, from talking a walk across the spectacular 150 suspension bridge to enjoying dining in some local restaurants.

In the evenings, attendees are encouraged to relax in the “library” but are also cautioned to be disciplined with the propensity to spend too much time in there or to visit too often. The entire experience promotes the development of lasting relationships that might not have been anticipated, both professionally and personally. Many graduate attendees professed to foster those relationships long after their graduation.

Successful completion of the second year is followed by a ceremonial graduation service whereby graduates are recognized individually and presented with their MTLI diploma, certifying each graduate as a certified medical transport executive (CMTE). For more information about MTLI, visit the Association of Air Medical Services (AAMS) Web site (www.aams.org).

Overall, previous attendees have had only the highest compliments for the entire MTLI experience. It's hard to stress enough the importance of our industry professionals being available to each other, to share insights, obtain advanced education, and to support fellow medical transport professionals. After all, no one truly understands the day-to-day issues we face but others in our extremely specialized field. With programs like MTLI, we are made aware that other professionals in our industry want to make a difference for their companies, their employees, and those they serve.

Denise Treadwell, President

An association without representation is tyranny! 

I have always appreciated American history and the amazing parallels that occur within history. The slogan of 13 separate colonies, uniting for a common good, was one of the first displays of strength, rendered by “one” for the good of many… Well, we know how that worked out—here we are over 200 years later.

“No taxation without representation” was a slogan in the period 1763-1775 that summarized a primary concern of the American colonists in the 13 colonies. The colonists complained that taxes were imposed by Parliament without their consent. The point was that the colonies had no representation in Parliament, and the British responded that they were “virtually” represented. The Americans said these “virtual representatives” knew nothing about America. The complaint was never over the amount of taxation but always on the decision-making process by which taxes were decided in London without representation for the colonists.

The fundamental idea of representation is that it should reflect interests and support of all aspects of those represented. Another view is the ability to influence the political process and how members of an association are empowered. Ultimately, representation must embody the idea that it reflects the prevailing interests and idealism of the association, as well as the prevailing professional interests in society, even though it may not have been presented in such conditions in the past.

The International Association of Flight Paramedics (IAFP) has reached programs and paramedics across the globe with this philosophy. We as an association must advocate for the decision making abilities of the future direction of critical care transport. It should not be made in a vacuum, nor should it come from those with ulterior motives. It should not be made by those who do not perform the tasks that paramedics do, in the conditions that paramedics work, or in the transport vehicles in which paramedics move patients.

The future and voice of paramedicine must be made based on the real needs that we identify. No matter where our patients are transported or by what mode we may do so, there has to be a unification in our profession, and over the past few years, with gaining strength this past year, I see it. Our members see it. Politicians and other professions see it. This is a tremendous success for a profession that has not nearly been around as long as other health care professions, and an even greater accomplishment for an organization that has been around just 20 years! We should celebrate this success but not relish in it long; there is still a great amount of work to be done and fellow paramedics and programs that need to be heard.

The IAFP has created, with great success, an opportunity for all paramedics in every state to communicate the needs and current events between the IAFP and our members—the State Delegate Program. This comprehensive part of the IAFP promotes state delegates' ability to expand and develop professional interactions with state officials and leaders inside the critical care industry. Identifying real needs locally or statewide and communicating with other states allows for a transparent network to share and resolve “heartburn issues” or process improvement.

On the national side of things, the IAFP has another avenue of representation for the paramedic profession—the Government & Legislative Affairs Committee. This committee provides support in the political arena to advocate for the development of the critical care paramedic profession, continually supporting patient and professional safety.

Our slogan, like our forefathers', exemplifies the basis and cornerstone of our association: “We are working for today's Paramedics to change tomorrow's future as we continue to revolutionize critical care transport.”

Advocacy through representation has been history's way of successful progression. Stay involved with your profession to advocate for the betterment of paramedicine, safety, and all aspects of critical care transport. Join the IAFP on your state and local level to continue breaking down barriers and advocating for paramedics that represent all modes of critical care transport and those that extend themselves for the well being and safe transport of others.

Be safe and advocate.

Anthony Pellicone, President

How what we say is perceived 

Every day as we go about our business, we are required to communicate. Our effectiveness in communication can be a determining factor in our successes as we attempt to complete the tasks we must complete. How do we determine if our communication is effective and meeting our needs? Examining our communication methods can be enlightening, to say the least.

When we communicate, regardless of the method we use, we have information to pass to someone else. If our interpersonal communication is ineffective, the information may be lost or unusable by another. We discuss communication in our AMRM or crew resource management programs and how effective communication is essential to safe operations. Many of you will remember the basic communication model:

From this diagram we realize that a message must be sent from a sender to a receiver and that the process isn't complete until you get a response that the message has been received and understood. Anyone with teenage children understands the complexity of this model.

This model is a basic and simple illustration of the communication process, but there are many other aspects to communication that also impact the success we have communicating. For our discussion we will include oral, written, and non-verbal methods of communication, as we use each of these daily, often not even realizing we have just made a statement.

There are four principles that underlie interpersonal communication. These basic principles cannot be ignored.

AMTC 2007 

Remember to make your plans for the Air Medical Transport Conference being held from September 17–19, 2007, in Tampa, Fla. Since the conference is early this year and because the conference has set records the past 3 years for attendance, go to the AAMS Web site under Education & Meetings and make your hotel reservations now! AMTC has all the workings of being another bigger and better meeting for our entire community! Please check the AAMS Web site for up-to-date information.