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AMPA
CCTMC 2008, 2009, 2010, and Beyond
I am writing this Forum column a few weeks before the 2008 CCTMC in San Antonio but am fairly certain it will be (or was) another successful, well-attended conference. (I do know the attendance statement is true as the registrations are well above last year). Many of you may be aware that the future of the CCTMC conference was “touch and go” for awhile because of diminishing attendance numbers, high costs at preferred venues, and probable decreased education fund availability for the attendees the CCTMC is designed for. Despite these barriers, the organizations that are responsible for planning future conferences (AMPA, ASTNA, and IAFP) remained committed to the successful future of the CCTMC, and the recent conference in San Antonio attests to that.
In an attempt to maintain this success, the planning committee, represented by members of the above mentioned organizations, has decided to commit to San Antonio and the Sheraton Gunter Hotel as the show site for the next 2 years. The 2009 CCTMC will be April 1-8, 2009 (April 6-8 dedicated to the CCTMC course), and the 2010 CCTMC will be April 7-14, 2010 (April 12-14 dedicated to the CCTMC course). The location, weather, great selection of outside activities, outstanding hospitality of hotel staff, and the value of the host hotel all contributed to the decision to commit to San Antonio through 2010. The ability to capitalize on these attractions will help a lot to guarantee the continued success of the CCTMC.
Ultimately, though, the success of future CCTMCs depends on course content and quality. Historically, this conference has centered on topics that have a primary clinical focus. Also, a goal of the conference planners has been to attract speakers from all of the clinical disciplines involved in critical care transport. So, why am I bringing this up now? I would like the AMPA membership to become unofficial members of the planning committee for future CCTMCs. This may involve you personally submitting a topic to lecture on, or it may involve suggesting a cogent clinical topic that should be covered. It also may mean recruiting, recommending, prodding, threatening, etc., members of your own program to develop and submit clinical topics, research, or posters for presentation. The excuse that “I did not have enough time to plan” cannot be used—I am giving you up to 2 years to get ready!
The AMPA Mission: The Air Medical Physician Association is committed to safe, efficacious, critical care transportation by promoting quality medical direction, research, education, leadership, and collaboration.
Michael W. Brunko, President
ASTNA
Safety–Do You Walk the Walk?
Recently on a Friday evening at home, I was channel surfing and came upon an old Stevie Ray Vaughn concert. Flashback to August 26, 1990 …
I and a group of friends were at Alpine Valley Music Theatre in Wisconsin to see a Stevie Ray Vaughn concert. It was a very hot and humid August afternoon, and we did our best to stay cool by drinking plenty of ice-cold fermented beverages! Finally, the show started, and we were completely blown away by the southern rock and bluesy guitars of Eric Clapton, Robert Cray, Buddy Guy, Jimmie Vaughn, and Stevie Ray Vaughn. I still say it was the best concert I have ever been to. Little did any of us know we'd just seen Stevie Ray Vaughn perform for the last time.
I clearly remember how foggy it became that night, and all of us were dreading the long drive in the fog. We finally made it home safely into the wee hours, and I slept in late that morning. When I finally rolled out of bed, I made my coffee, tuned on the TV, and in utter disbelief saw that Stevie Ray Vaughn had died at Alpine Valley when the helicopter he was in crashed while leaving the concert venue. I couldn't believe it!
Story has it, the musicians expected a long bus ride back to Chicago. Vaughan was informed by a member of Clapton's crew that three seats were open on one of the helicopters returning to Chicago with Clapton….enough for Vaughan, his brother Jimmie, and Jimmie's wife Connie. When he found only one place was actually available, Vaughan said to Connie and Jimmie, “Do you mind if I take the seat? I really need to get back.” At 12:44 am, the pilot guided the helicopter off the ground. Moments after takeoff the helicopter crashed into a ski slope and killed all five on board. Although the crash occurred only 0.6 miles from takeoff, it went unnoticed by those at the concert site. A search for the aircraft began at 5 am after the helicopter failed to show up in Chicago. The wreckage was discovered at 7 am. That night, 3 other helicopters departed the venue and arrived safely (luckily) in Chicago.
I was not yet involved in transport nursing at that time and certainly had no knowledge of helicopters, weather minimums, crew resource management, etc. That being said, I clearly remember thinking that next morning, “We could hardly drive in that fog; how could a helicopter fly in it”? Over the next few months, every time I heard Sky is Crying, my eyes welled up and the hair on my arms bristled.
Fast forward to 2008. Knowing what I know now and after watching that concert footage, I got so mad and yelled, “What the bleep were they thinking that night?” Unfortunately, the scenario I just described has repeated itself in our community mutiple times since August 1990. We've lost colleagues and patients in similar fahsion, and we are left wondering how and why.
Over the past few years there has been a heightened awareness of risk mitigation and creating a safety culture. You've heard of the Vision Zero Initiative, but do you actually know what it is?
“The goal of the Vision Zero Initiative is to reduce and eliminate errors of consequence - those events within the transport medicine environment that result in serious injury or fatality - by 80% over the next decade.” “Vision Zero is a belief and cultural values system tied to active policy for implementation based on a premise that errors of consequence can be eliminated.” In March 2005, this initiative was adopted by the AAMS board of directors, and efforts to spread the message have been ongoing since that time.
“Vision Zero is a long term policy initiative, based on developing a better understanding of human behavior. By combining research, engineering, education, and enforcement to goal is to arrive at a zero accident rate. Cost analysis models are developed to determine what “tools” are the most effective in getting to zero singularly or in combination, based on the question: can we achieve the results within a practical framework.”
The accident chain begins the moment we enter the door of our workplace. Can you confidently say there is a safety culture where you work? Can you speak up without fear of reprimand when you point out lapses in safe practice? Are you empowered to refuse or abort a mission you feel is unsafe? When you start your shift, are you consciously doing everything humanly possible to minimize risk? Are you comfortable applying AMRM strategies when dealing with a coworker you feel is unsafe? Do you feel your employer puts priority on safe practices, even when it might give your competition an advantage? If you answered no to any of these questions, it might be time for you to look for a new job.
Over the years, I've often wondered if anyone getting on those helicopters at Alpine Valley that night asked their pilots if it was OK to fly in that fog. If they did ask and the pilot said, “It's OK, no problem,” did he say, “OK, who were they to question?” They were all tired and just wanted to get back to base after a long day's work…see the correlation?
Don't let yourself be the next “rock star” snuffed out before his/her time. Take control of what you can control by making Vision Zero the goal for each and every shift. Remember, the change starts with you!!
Karen Arndt, President
IAFP
Customer Service and Servant Leadership
“Citizens simply expect that their problems will be solved; they care little about who solves them.” Donald F. Kettl, The Transformation of Governance
There is an old cowboy adage that says, “Don't squat with your spurs on.” Basically, do not do that which will bring pain upon oneself. This is pretty good advice; however, how many times have you seen someone cut their own throat or the proverbial throat of their organization with poor customer service? Over the course of my career I have heard many times, “We did not call the ‘other guys' because they are so rude to us.” Ouch! Our customers do not care so much about what type of helicopters or ambulances we have but rather how we can help them and how nice we are when doing it.
In addition, not long ago I was approached by a flight paramedic who stated that he would like to join the ranks of the IAFP but was under the impression that firefighters could not join. I have to admit, I was officially flabbergasted. Someone along the way had practiced some very poor customer service and alienated a group of flight paramedics who are also firefighters. As it stands, the IAFP loves firefighters! (I hope so, I am one!) Paramedics from all affiliations are welcome.
So what is customer service? Elements from leadership concepts, organizational behavior, ethics, psychology and just plain compassion for your fellow man all make up customer service. But first and foremost, who are our customers? The most common response I get to this question is “the patient.” While patients definitely are our customers, let's expand our scope of thought.
Your first customers are your immediate coworkers. Have you ever been partnered with someone that you dread showing up to work with? You know, those kinds of people who cause the lights to dim as they walk in the room. We have all experienced these kinds of individuals in our careers and they are no fun to be around. You do not want to be one of those people! How do you avoid becoming a vampire and sucking the life force out of your partners?
The first thing to do is a mental self-examination. Take a good look at yourself and your career. If you do not find yourself being fulfilled—go find that which fulfills you. Stop making everyone miserable around you! Go find your dream job.
If perhaps, you are in your dream job and have just been crabby for the last few, ahh, say months, then it's time to change your attitude. Develop a servant attitude. Focus on ways that you can make your coworkers' jobs easier. It may be as little as a cheerful smile or you may just have to knuckle down and, heaven forbid, do some hard work.
In 2005, I had the privilege to travel to Cape Town, South Africa to study nonprofit organizations. While there, I met one of the individuals who changed the face of government for his country. He is a tremendous political leader, but I met him doing what he does as part of his chosen career. Archbishop Desmond Tutu said the mass and served me the Eucharist as he has served many thousands over the course of his career. Afterward, I had opportunity to shake his hand and tell him what a hero he was to me. He flashed an awesome grin and began to tease me about my Texas accent. One of the greatest leaders of the world and Nobel Peace Prize winner took the time out to smile, say a few kind words, and make me feel important. I cannot think of a better example of a servant leader, and I went away a very satisfied customer.
Many of you may remember studying the Hawthorne experiments conducted by Fritz Roethlisberger in the 1930s. There are some key lessons about people and customer service that we can take home and apply.
Encompass these customer service principles in your organization and see if they make a difference.
The IAFP will continue to work as servant leaders and welcomes paramedics to join us. Let me share a few of the activities we are involved in.
We are helping in the HEMS Safety project with Dr. Ira Blumen and many of our terrific neighbor associations such as ASTNA, AMSAC, NAACS, and others. Data collected and studied will contribute to improved safety measures for our industry.
We have been working hard to make AMTC 2008 and 2009 worth your while. I cannot wait for the upcoming leadership precons we will host. You definitely do not want to miss them!
Watch for continued growth in our State Delegates area. We have some tremendous individuals taking leadership roles. Watch our website for updates from State Delegate David Stamey. David journeyed to Washington, DC, to attend a stakeholders meeting for the National EMS Education Standards. The IAFP will have an active involvement in the Education Standards, and we are excited to participate.
We continue to advocate leadership and education for critical care transport paramedics. If you have not stopped by our website to visit CentreLearn, do it now. We will continue to offer critical care concepts and review material. We look forward to continued service and creating ways to improve our association and our chosen profession.
Greg Winters, President
NEMSPA
Is There Room in AMRM for Passion?
Passion is one of those things almost everyone feels they understand, and it has been a part of almost everyone's life. But does passion have anything to do with air medicine?
Many times we do things that our friends and family don't understand. We work extra shifts on extremely short notice, or we place ourselves in positions that others run from. We volunteer for positions within our programs knowing our compensation would not be adequate for the time and effort we will expend to complete the necessary tasks associated with the position. We also volunteer for projects outside our programs and many times we volunteer to work on national boards knowing we will spend time and effort for no compensation.
What reason could there possibly be for taking on these additional tasks? The only plausible reason is the passion we have for all the things that make up our careers. But what is that thing we refer to as passion? Dictionary.com states passion is an emotion and refers most often to love and hate. These are the strongest emotions we feel. The most applicable definitions include the following:
It's easy to see how passion can make us an important asset to our program and to the industry as a whole. It is equally easy to see how this emotion can have a negative impact as well. How do these emotion-driven feelings impact how we function on a normal flight, and how does passion impact air medical resource management (AMRM)?
Many of the emotions or feelings we claim cause us to do the things we do, are also cited as things normally attributed to AMRM. There are many parts of AMRM or resource management that parallel what we have talked about as passion; however there are some important differences.
Beliefs are a basic part of resource management as they form our knowledge basis of right and wrong. Passion often discounts our belief system because of the raw emotion that drives passion. Emotion, especially strong emotion such as passion causes us to put blinders on and the information we allow in is not sufficient to make rational decisions. We act without enough information and stand fast behind the decisions we make. Attitude is another item important to resource management that is clouded by passion or emotion. Many of the critical or dangerous attitudes don't enter our thought processes until we allow emotion to take over. Once emotion comes into play, these attitudes are allowed to shade our decisions. As we said earlier, passion can make us behave in a manner we normally wouldn't.
Some of the things essential to the AMRM process can be confused with passion. Critical processes such as “assertiveness” are often confused as passion. Assertiveness is very different from passion, even though they may appear similar. Assertiveness is the forceful, non-threatening statement of a belief, feeling, position, or idea concerning a situation with which one is uncomfortable. Even though assertiveness is forceful it is not violent, as passion can be.
Passion can remove many of the things that make AMRM successful. When passion enters the process, things such as team, leadership style, decision making styles, and communication become ineffective. Allowing strong emotion to enter the equation allows these concepts to become less than rational. Passion allows barriers to enter the processes, and thus failure ensues.
Passion has a place in our lives and our industry. It allows us to achieve many good things. When passion enters our flight regimen, it can result in failure. We need to understand passion and how to use it for our benefit, but more importantly, we need to learn how to control it and prevent the negative effects. Only after we control our passion can we use it to excel.
Gary Sizemore, President
AAMS
Change Agents
“Our only security is our ability to change.” John Lilly
How many interviews have you participated in where you are asked, “Tell me about a time you were successful in making a change at your current employment”? As you cite your response, your mind may be recalling the challenges you faced to bring about that successful change. You may also find yourself remembering some less than successful attempts at change, either led by you or as a participant resisting the “new and improved” effort being promoted. What does all this have to do with AAMS? The simple response is everything.
The definition of a trade association is individuals and companies in a specific business or industry organized to promote common interests. AAMS is a trade association made up mostly of programs and companies that have a common interest in air medical and critical care transport by air and/or ground. The definition of a professional association is: an association of practitioners of a given profession. As we all know, there are many facets involved in the business of transporting the critically ill and/or injured. The professional associations AMPA, ASTNA, IAFP, NAACS, and NEMSPA are doing great things related to their unique area of expertise. AAMS and the professional associations hold monthly calls, and it is exciting to keep up with the initiatives being worked on at many different levels within the associations, as well as exchange dialogue on how we can work together to strengthen our community.
At a recent CEO Symposium conducted by the American Society of Association Executives (ASAE), three keys to sustaining a successful association were presented. The three keys are:
Each one of these keys takes a significant amount of resources to achieve success. Let me touch on a few aspects in which AAMS uses this framework on a short- and long-term strategic basis.
Providing valueAdvocacy is often cited as one of the most important program of activities AAMS provides. The list is long where the work done on local and federal levels has provided significant benefits to the air and ground provider, not only from a financial viability aspect, but from a safety perspective as well. Extensive dialogue continues with regulatory agencies and lawmakers surrounding opportunities to increase helicopter EMS safety such as enhancing the infrastructure for operating in the low altitude environment, expanding federal funding to support safety improvements in air medical operations, and supporting the language in H.R. 3939 that provides valuable and practical safety enhancements. AAMS has also supported the need for the National Transportation Safety Board (NTSB) to increase attention of probable causes of ground critical care transports to help identify methods to improve safety in this important mode of transport.
Another component of the value proposition relates to the networking opportunities created during the Air Medical Transport Conference, the Spring Mid-Year Conference, and the Medical Transport Leadership Institute. Attending events such as these permits the exchange of information across all borders and fosters relationships that often last for many years. By the time this issue is in print, AirMed 2008 in beautiful Prague may have come and gone, and those that had an opportunity to attend will have met new friends from around the world and learned about research findings, operational challenges, safety initiatives, and much more that may prove beneficial to programs back home.
CultureTrust has to be earned, and one of the key ways to earn trust is transparency. When AAMS restructured the board to include four at-large director seats, it provided an opportunity to diversify the leadership and include representation from all segments—including different vehicle types, professional disciplines, corporate structures, etc.—involved in critical care transport. As the communication pathway improved among all the associations, the opportunity for collaboration on various initiatives grew stronger and stronger. AAMS continues to implement lessons learned along the path toward increased transparency and member involvement.
One of the outcomes from the Membership Task Force meeting held in January was the recommendation to refine the AAMS core values. The recommended core values include:
These core values demonstrate a commitment to strengthening the unified voice for the air medical and critical care transport community.
Nimble infrastructureAAMS often has to have the ability to respond quickly. Sometimes it is to field calls from reporters to lessen the burden on a program dealing with a sudden loss of a crew, triage the media to the appropriate subject matter expert in the critical care transport community, respond to legislative issues with short fuses, or even respond to members facing challenges that require access to the resources most readily available in an association, just to name a few examples. What ever the issue or situation may be, the AAMS staff and leadership strive to be accessible on a moment's notice.
So what does this have to do with change? As I said in the first paragraph, everything. As the membership evolves, an association has to evolve right along with it. Evolution is a natural sequence of events that happens as a species, or in this case, an industry matures. In order to ensure the membership continues to find value in joining AAMS, changes in the infrastructure must occur. These changes have been circulated and feedback is currently being gathered. The AAMS and FARE boards meet in June for strategic planning and, based on the feedback gathered over the next few months, will craft recommendations to present to the membership that will most likely include changes to the board representation, voting requirements, and a revised dues schedule. The goal of these changes is to create equity in terms of financial support and fairness in terms of members' ability to provide input to the decision making processes of the association.
AAMS Report CardWe need to continue to hear from the membership regarding how we are measuring up in providing a value for your membership, creating an enjoyable and trusting culture, and developing the agility to respond to external factors that may affect our ability to assure that every person has access to quality air medical and critical care transport.
Sandra Kinkade, President
PII: S1067-991X(08)00055-2
doi:10.1016/j.amj.2008.03.008
