Forum

As the pendulum swings 

Proud. Honored. Excited. Those are just some of the feelings I have as I look back on the past year of our association. As in past years, I have seen a tremendous shift in our profession's representation and am especially proud of paramedics and the IAFP.

This year, we as a board set goals and objectives that we wanted to accomplish and address and have met each of those goals and then some. We used a joint approach of teamwork and constant communication to breakdown pre-existing barriers and have built strong bridges with other organizations and associations of all professions. We have expanded our reach from the small towns of our nation to across the Atlantic to European nations. Membership is at an all-time high, and the voices of the membership are louder than ever. US representation is brewing with activity and productivity. I encourage continued support and participation in the delegate program; we want to and need to hear from every paramedic.

With the position of IAFP president came responsibility and a good amount of work. Our accomplishments, strength, and momentum do not solely fall on me. I was surrounded by some of the smartest, hardest working visionaries in our profession. During the hard times—and there were hard times—I was supported by individuals who were complete strangers a few years back and are some of my dearest long-time friends now. The commonality in the beginning was our profession. Individuals from all parts of the country with a wide range of experience have supported the vision, mission, and goals. This has been an eye-opening and awesome experience. To any paramedic aspiring to work with true visionaries at a rapid pace who won't settle for second—please get involved!

The association is made up of nearly 1,200 paramedics, just over a dozen of which sit on the board of directors. This board keeps the momentum and steers our profession in the direction that the members identify, but the coworker who kept me grounded, brings cheerfulness to me personally and to the entire board, serves as the voice on the telephone each of you have spoken with and the silent partner who continues to support each of us is our account executive, Monica Newman. She deserves remarkable recognition. Thank you, Monica, for everything you have done for us all.

The future is wide open, without boundaries, and the barriers are sliding aside. The next few years are going to be groundbreaking, and the profession that we have chosen will soar to new heights. Each of you, as well as 50,000 other paramedics, will be receiving a survey in the near future; I implore each of you to participate in this assessment.

During this time of transition, I offer words of appreciation. I thank my colleagues, my team, and indeed my friends for all they have done for me and our profession.

Everything achieved is because of the unwavering hard work support and perseverance of my fellow board members and the members of the association. The entire association is made up of many different groups with varying interests and opinions and, I might add, is very vocal about such opinions, expecting our board members to be as equally vocal on their behalf.

I have been very fortunate to have been president of an association that leads the industry. I have tried in my presidency to cut through bureaucracy and break down barriers on behalf of all those with whom I have shared beliefs. I am very glad to share today with those who, though they do not always share my opinion, do share my passion for true leadership success and vision.

As I write this, the AMTC in Tampa ends my tenure as president, but I will take with me many memories of a position that was stimulating, challenging, and usually busy. I will take with me memories of people who have been challenging, stimulating, and inspiring.

I thank all of you for your assertiveness and the amazing experience it has been to work with many of you. It will be a constant reminder of an achievement to what my time as president has allowed; I made many, many good friends.

“Playing to win means visualizing a future far loftier than you ever thought possible. Have a plan; work the plan by implementing necessary steps. Couple this vision with a sense of urgency, and develop a strategy that contains the critical ingredients for success.”

Again, I thank each of you for your continued support and vigilance to our profession. Please continue to support the association and continue to steer this exhilarating profession into the future. Enjoy the successes and continue to have the pendulum swing into the future and pursue the excellence of paramedicine.

Thank you all again. God bless and be safe.

Anthony J. Pellicone, Past President

How safe is safe? 

Every day as we participate in life, we are faced with many opportunities to be involved in an accident. The American Heritage Dictionary defines an accident as “An unexpected and undesirable event, especially one resulting in damage or harm: car accidents on icy roads.” Normally we think of accidents in relation to our jobs, and since flying is a routine part of our job, we can look at aviation-related definitions for the term. As defined by the National Transportation Safety Board (NTSB), this is an occurrence associated with the operation of an aircraft where, as a result of the operation of an aircraft, any person (either inside or outside the aircraft) receives fatal or serious injury or any aircraft receives substantial damage. The occurrence is also not caused by the deliberate action of one or more persons and that leads to damage or injury.

The Federal Aviation Administration (FAA) and NTSB continue to categorize accidents by severity; however, as we strive to reach the “Vision Zero” goal of no accidents, we will consider an accident as just that—an accident. By any definition, an accident is an unwanted event, usually causing an injury or damage to our property, so we generally attempt to avoid them.

In order to prevent our involvement in an accident, we do many things. All of these things fall under a general heading of risk abatement. Many times we do our risk assessment and mitigation without thinking about it. For my morning commute to work, I may choose a route based on the amount of traffic or the condition of the road and never consider my action a risk analysis or mitigation event. I may choose to leave earlier on a rainy day to give myself extra time and prevent rushing or taking unnecessary chances. I keep a running evaluation of my vehicle, so I know if my tires are bald or my mirrors are broken, imposing an extra risk for me. These are only a few examples of the types of risk assessment each of us performs without consciously considering them a risk assessment.

If no accident occurs, is it because we are inherently safe or incredibly lucky, or is a comprehensive safety program in place? I have asked many people if their program is a safe program, and the response I get most often is, “It must be, we haven't had an accident.” Is this a fair assessment of a program's safety? Based on my training as a U.S. Army Aviation Safety Officer, I would offer a resounding “no.”

In offering an explanation to the statement above, I will offer the following. The safety anecdotes I have heard deal largely with luck as an answer to a program that lacks a true safety program not having an accident. The one most often heard is, “Even a blind hog finds an acorn once in a while.” This statement reflects that, even though a program has not had an accident, possibly they have just been lucky so far. While luck may be a force of nature, it is not something we can control. If I could control luck, I would be a regular visitor to the casino and play the lottery every time there was a drawing. As such I prefer not to leave my safety to this uncontrollable force.

If not luck, what can we rely on to ensure our safety? The best answer for this question is by taking what we do unconsciously and making it a conscious effort. We need to consciously perform a risk assessment on our actions, and based on that assessment, mitigate every possible risk. For our jobs, the FAA has regulated that we have a risk assessment program in place and to use it for every flight.

A risk assessment that is part of a comprehensive safety system is the most preferred method of ensuring safety. A comprehensive program has the ability to change thinking and culture to promote safety as a part of a program's normal activity. When the transformation occurs, safety becomes a thought for every operation a program completes. That includes training, flight operations, public relations, management, and even social activities the program is engaged in. Safety becomes a conscious part of the life of the program, as well as the members of the staff.

There are many resources available to help develop a safety system. These range from simple to complex and should be tailored to the organization they support. The International Helicopter Safety Team's JSAT is a good reference for information about safety systems. Their current work includes creating a definition of what a safety system is, and a definition is the first step in understanding, developing, and using a safety system. In addition many independent consultants are available if required. There are many enhancements to a safety system that improve the outcome, as well. These are principles such as training and standardization.

By reading this article, you have taken the first step toward improving your safety. Moving safety awareness from the subconscious to the conscious is the first step.

Gary Sizemore, President

My last column 

This will be my last column as president of AAMS and, in fact, by the time this issue is published, I will be the immediate past president. I want to thank the AAMS board of directors and our membership for the incredibly wonderful opportunity to lead our great association. I hope I leave the office of presidency with the association in better shape financially and with existing and new relationships with government officials, our partner associations, our very diverse membership, and other important stakeholders better than ever. We had a lot of challenges over the past 2 years, and we will continue to have additional ones. The important thing is that, no matter what kind of member you are—from a traditional hospital-based program, a community-based operator, a hybrid, fixed wing, or ground ambulance program—by working together we can accomplish great things together.

I would also like to give a heartfelt thanks to my family, especially my wife, Carol, who has had to endure many extra hours that I took away from family time to keep both my regular position as CEO of MedServ Management Services and AAMS operating smoothly. Thanks also to my partners, Jay Fitch, Christine Zalar, and Richard Keller, for supporting my time as president of AAMS.

I will continue to serve on the AAMS board as past president, and I look forward to making sure that AAMS continues to stay focused on our strategic objectives as Greg Powell and Tom Judge did before me, after we changed to the more consistent parliamentary style leadership structure for our executive team.

Evidence-based air medical practice guidelines 

As many of you may remember and may have participated, the Air Medical Leadership Congress: Setting the Health Care Agenda for the Air Medical Community was held to address important concerns facing the air medical community. This meeting left us with several recommendations. The 3-day summit in Salt Lake City, Utah, gathered 149 air medical transport leaders, providers, consultants, and experts from September 4–6, 2003, to discuss top air medical transport issues in four core areas: safety, medical care, cost/benefit, and regulatory/compliance, which had been identified using data from a Web-based survey. The report published in Air Medical Journal summarized the discussions, findings, recommendations, and proposed industry actions for the top 3 issues in each of the core areas.

The Medical Care Work Group's number-one issue was clinical practice, and under “Standards of Care” they recommended, “Convene a group to define standards of care and develop guidelines that may be implemented on a large scale. These guidelines will necessarily vary by mission profile, geography, local laws, and regulations.” The standard of care for medical practices may vary by region since it may not necessarily reflect best practice but rather the care that is practiced.

The AMPA board of directors, at their August 2007 strategic planning retreat, unanimously decided to organize and complete a convention of such a group. By the time you read this, after many of us have met in Tampa at the 2007 AMTC, the “ball should be rollin'” and (to borrow a phrase from one of my previous Forums) “the momentum is continuing.” Dr. Reed Brozen, medical director of Advanced Response Team at Dartmouth-Hitchcock Medical Center, is organizing the group to complete these evidence-based guidelines.

We propose to identify the standard of care for air medical transport (AMT) and develop recommendations based on the best available evidence for the standards or evidence-based air medical practice guidelines (EBAMPG). These could be freely used by AMT medical directors to assist in writing medical practice protocols (MPPs) for their programs. These would obviously need to be modified to conform to “mission profile, geography, local laws, and regulations.” The types of recommendations made would be based on the literature that relates to the current standard of care and would be divided into guidelines, recommendations, and inadequate data to comment.

To begin, an initial call has gone out to AMPA members and other program medical directors to submit their current MPPs (blinded to program). Using this “table of contents,” a comprehensive list of MPPs to be addressed will be developed. Using a Web-based survey we then will rank them in terms of importance for development (likely the most time-sensitive illnesses will be addressed first).

We will use an organizational structure for the conference similar to that used for the Air Medical Leadership Congress (see figure 1 from Thomas F, et al. The Air Medical Leadership Congress: Setting the Healthcare Agenda for the Air Medical Community. Air Med J. Sept-Oct 2003;22(5):34–39). The “DoBees” (you all know who you are) for this congress will be doing literature searches to determine which evidence will be associated with each MPP. We will try to identify specialty organization guidelines that have already been developed so as not to duplicate reviews of individual articles. Conference participants will be invited based on their interest and ability to participate in the evidence review and the working congress, where the participants will come together to discuss the evidence and categorize it so that specific actions in the MPPs can be supported as guidelines or recommendations, or if there is insufficient literature to either support or refute the action. If consensus is not easily achieved, we will use the Delphi method to provided participant consensus.

The working congress will be in a 2-day format and will start with introductory lectures covering the evidence-based medicine (EBM) format to categorize and tally the evidence to make final recommendations. Participants then will divide into prearranged groups to work on the process for their particular MPPs. Group leader “DoBees” will facilitate the process and move the groups forward to cover as many MPPs as possible.

The goal will be to hold the Evidence Based Air Medical Practice Guidelines Congress on March 28–29, 2008—the 2 days prior to CCTMC in San Antonio, Texas. The cost for the congress has not yet been determined, and the format will again be working groups with the goal of finishing several MPPs. If this program works out, it will be used to finish off all the MPPs and then as a potential model for operational guidelines and safety guidelines for the critical care transport industry.

If you have not been approached or tasked with a responsibility and would like to participate in this Congress, please contact Reed Brozen (Reed.Brozen@Dartmouth.edu) ASAP.

Reed Brozen, Project Coordinator and Congress Director, and Michael Brunko, President

Thank you! 

We have now reached the time to welcome the newly elected board and executive council for the upcoming year. But before doing so, I want to take a moment to reflect on this year's accomplishments and to recognize those contributors that made it happen! All of these accomplishments were made possible thanks to the exceptional dedication of an outstanding board of directors and a core group of ASTNA members.

Our membership has continued to grow this past year, with Cathy Spry serving as the board liaison and Kolby Kolbert as the Membership Committee Chair. As you will see, this growth is true evidence of the great work completed this year.

At the beginning of the year, we were faced with the challenges of the controversies surrounding the administration of medications used for rapid sequence intubation. This reminded us of our mission, “Advance the practice of transport nursing and enhance the quality of patient care,” and prompted the completion of the Advance Airway Management Position Paper, now available through ASTNA's publication library. Under the direction of Reneé S. Holleran, RN, PhD, CEN, CCRN, CFRN, FAEN, the position paper gained the endorsement of the Air Medical Physician Association and the Emergency Nurses Association (ENA).

Recognizing the similarities of the procedural sedation issues experienced by nurses who staff emergency departments and intensive care units and controversies surrounding the administration of medications used for rapid sequence intubation that transport nurses are facing, ENA invited us to participate in the Procedural Sedation Stakeholders Summit they hosted earlier this year. ASTNA will continue to address this very important matter with ENA and other professional associations.

Karen Arndt and Kyle Madigan represented the ASTNA board of directors this year by participating in the Air Medical Safety Advisory Council (AMSAC) training that was held in April. AMSAC is a community-wide venture to remove the barriers created by rivalry between competitive programs that prohibit open sharing of information related to safety issues or concerns, thereby decreasing the promotion of safe practices. ASTNA will remain steadfast in our efforts to represent the transport nurse in our commitment to the promotion of safety in the transport community through our participation in meeting such as this.

Likewise, ASTNA will continue to support the CoOperative Network Call for Emergency Regional Notification (CONCERN) Network and maintain Hazard Awareness Reporting Program (HARP). You will find the CONCERN Network on the ASTNA website. The Network was originally used as a mechanism to alert the air medical community of situations in which crewmembers had been injured or killed in helicopter or airplane crashes. Presently it is used to transmit information on a wide variety of situations, regardless of death or injury. HARP provides an avenue to anonymously share issues and concerns from which everyone could benefit.

Combining the efforts of our Safety Committee, expertly lead by Kevin High, and our Research Committee, under the skillful direction of Michael Frakes as board liaison and Dennis Taylor as Committee Chair, ASTNA completed the first Safety Survey of community members. The data have been compiled and demonstrate some astounding findings. Because it is one of the first studies of this kind in our industry, ASTNA believes the implications of its findings are far reaching and are due in part to its proficient design. These committees will continue to work together to complete data extrapolation and present and publish their findings next year.

Another of our benchmarks this year was to promote the transport nursing profession through educational opportunities. In addition to the ASTNA hosted preconference offerings, under the leadership of Jodie Hignite, the board liaison for the Trauma Nurse Advanced Trauma Course (TNATC), the TNATC Advisory Committee increased the number of provider courses 30% over last year. Continuing in this spirit, plans are in place to continue the availability of the curriculum while maintaining a quality program. We are also promoting the Advanced Provider Course through continued marketing and redefining the qualifiers of participants eligible to attend course.

In line with advancing the practice of transport nursing, we have continued to approve continuing education for transport nurses outside ASTNA offerings this year and, once again, with Angie Golden's expert leadership, provided continuing education credits for both the Critical Care Transport Medicine Conference (CCTMC) held in San Antonio, Texas, and the Air Medical Transport Conference (AMTC) in Tampa, Florida. Scott DeBoer has accepted the CECH Committee Chair for the upcoming year, and with Angie's mentorship, is now ready to successfully fill this role. On behalf of the ASTNA board and its members, I want to recognize Angie's assiduous efforts and express our sincere appreciation for the remarkable job that she has done over the years. Thanks, Angie!

ASTNA persists in its campaign to advance professional transport nursing excellence through professional development. By hosting review classes through the year and encouraging transport nurses to demonstrate their commitment to the profession and validate their nursing expertise by becoming certified in their specialty, ASTNA continues to promote the Certified Flight Registered Nurse (CFRN) and Certified Transport Registered Nurse (CTRN).

Through Reneé Holleran's guidance as the board liaison and Amy Mills' and Susan Smith's leadership as the Committee Chair and Co-Chair, respectively, the Educational Committee has been instrumental this year in reviewing ASTNA publications and continuing education offerings. Such reviews include the new Competency Based Orientation program completed by Jill Johnson, which is now available for purchase on the ASTNA website, as well as the new Transport Certification Review Manual II edited by Angie Golden and Jill Johnson. Other publications that will be available next year include the ASTNA Standards for Critical Care and Specialty Ground Transports, currently under revision, and the newly offered ASTNA Standards for Critical Care and Specialty Commercial Medical Escort Transports.

The ASTNA Military Committee has continued to gain momentum with the expert leadership of board liaison Major Christopher Paige and Military Committee Chairs Captain Paula Crawford-Gamble and Major Teresa Duquette-Frame. Their attention to detail and continued commitment to quality work is evident in the enhancements of the military web page. They have also increased military member involvement by representing our military transport nurses through presentations, speaking engagements, actively involving military professionals in ASTNA publications and product reviews, and promoting the association to military personnel and government leaders. With this strong leadership, the ASTNA Military Committee will continue to grow next year. ASTNA is proud of our military counterparts and will continue to recognize their work and support their efforts.

Throughout the year, the board of directors worked diligently to define the association's strategic plan and, in turn, finalize the budget. With Jackie Stocking's excellent guidance, we were able to complete a very thorough, detailed, well-written plan that includes the activities of each ASTNA committee, task force, advisory group, and all products in current publication and those planned for future publication and sales. We were industrious in our efforts to coordinate this plan with the budget for the upcoming year by working collaboratively with the Finance Committee.

On behalf of the board of directors and the association membership, it is my privilege to thank our sponsors this year, Air Methods, IMPACT, AirMed International, and Friends of AirLife of Denver. The financial contributions and commitments of these corporations made our accomplishments and much deserved honors possible. Thank you very much, and we hope to continue to work with you in the future.

I also want to recognize the ASTNA award recipients this year.

Congratulations to each of these especially deserving individuals.

Lastly, I want to personally thank the ASTNA board of directors for 2006-2007, committee chairs, and committee members. With your direction, mentorship, guidance, representation, and management, the association has seen a tremendous year. It was an honor to work with such consummate professionals and astounding leaders.

Under the leadership of 2007-2008 board of directors, I am confident that the momentum will continue. To see how you can get involved, contact any board member or committee chair. Their contact information is available at astna.org. This is an exciting opportunity. We need you!

Denise Treadwell, Past President