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NEMSPA
My Bucket List—Hopefully, Our To-Do List
Recently I had an opportunity to view “The Bucket List” on DVD during one of my infrequent periods of downtime. As I relaxed and enjoyed the movie, the theme began to hit home. Once again I was compelled to share my thoughts with you. If you have not yet seen the movie, I recommend it and think you, too, will find some inspiration as you watch.
The main theme of the movie is to have a list of things you want to accomplish or do before you die. I found this concept interesting and equated it with our list of goals to achieve for our lives, both professionally and personally. Hopefully all of us have our goals outlined and make changes as necessary. As I watched the actors develop their list, I thought about what my list may include.
In the movie both the main characters have been told they are dying of cancer and only have a short period to live. As one actor developed his list, he added things he felt were of social or moral value. The second character, a very wealthy man, looked at the list and began to add his items. There was a stark difference between the entries.
As I mentally prepared my list, I realized how fortunate I have been for a large portion of my life, both professionally and personally. I won't share my entire list with you, but some categories you may wish to consider for your list.
Many of the things included on the list are second nature to those in emergency services. Things like helping a stranger for no apparent reason. Many argue we do that for pay, but many of us have roots in volunteer services, so we have been there from that aspect as well, and the things we do usually do not take into account the pay. My list also included things like becoming a paramedic, which I accomplished early in my career. It also included becoming a pilot, specifically a helicopter pilot. I have been fortunate enough to accomplish these things as well. Don't get me wrong; I have things I have not yet accomplished and will continue to work on them. One difference is I have not yet been placed in the dilemma situation to add an aspect of urgency to my life's list.
As I thought more about it, I felt I did have a situation that has a finite period and more paralleled the movie characters—that was my time as president of the National EMS Pilots Association. I was elected to a 2-year term, and like the characters, I didn't think about it until it was almost over. When I accepted the appointment, I thought, “Two years is a long time!” Little did I know it would pass so quickly. Of course my presidency list includes the obvious things I think would be on the list of every organizational president, like achieving an accident rate near zero. I would also add promoting the air medical industry on a large scale, incorporating the technology that will enhance safety in the industry, and bringing positive changes to the culture of the industry. All of these things are huge and not easily accomplished.
I look at the things I have witnessed or accomplished during my time in office. The AMTC had the most pilot presentation entries in its history. I presented several times to groups at AMTC and other conferences, we addressed the FAA on many issues and developed a positive partnership to promote safety, and we met with the chairman of the NTSB. We promoted customer service in NEMSPA, redesigned the website, seated a winning team for the board of directors, worked on research project to promote safety in the industry, presented at AirMed 2008 in Prague, and many, many other things. The list is overwhelming. Still there are things too large for me to see to fruition. The list is larger than I am.
At this point it would be easy to crumple the list and just pass it off as not doable or as just a list of great memories. Of course as I thought about that, I ran across a few quotes and taglines of famous people, and again the inspiration welled. Walt Disney probably said it best with his tagline: “If you can dream it, you can do it!” We can do amazing things when we dream big dreams. This is even truer when we think out of the box. I also found a quote from the great coach Vince Lombardi: “The quality of a person's life is directly proportional to their commitment to excellence regardless of their chosen field of endeavor.” This again renewed my vigor to make a difference in the industry I choose to work in.
I know many people are in line to carry on when my time is past. I feel they will be able to carry on when I am no longer in office. Hopefully one of them will be able to cross off the final entry on the list—achieve a zero accident rate. I'm sure the list will continue to grow longer as each new president takes a turn in office.
As a parting thought I would like to paint a verbal picture of my utopian feelings on this subject. After watching the movie, reflecting on my thoughts for a list, and taking a look at all I have been able to witness, I asked myself this question: “If one person can make a list and complete part of it, and two can increase the list and the completion, what would happen if all the organizations in this industry got together and compiled a global list and then went about the business of crossing off the entries?” I can only imagine the great accomplishments that would be made.
OK, Mr. Disney, I dreamt it; now it can come true.
Gary Sizemore, President
AAMS
Safety and the AMTC Memorial Room
The AMTC is right around the corner! It will be a time to see old friends and meet new ones. It will also be a time to reflect on the losses of too many colleagues in air and ground fatal crashes. The Memorial Room will once again be available for us to pay our respects to those we knew personally or simply have the bond of working in the unique environment of medical transport.
This uniqueness is part of the attraction that draws those that like the unpredictability of the next call and the challenges of working in a variety of environmental conditions. The unpredictability and the simple fact that transporting patients in the day, the night, varying weather conditions, and often with a sense of urgency create a high risk situation every time that tone for the next call comes. Yes, high risk. This is different than unsafe, as I will describe later. And yes, I realize that every time you get in the car, you are at risk for the unknown. I would often try to assure my family with that very approach when they would call after hearing of a helicopter crash, fearing they would one day get the dreaded call from my employer. Let me share a comment my 78-year-old mother made when I told her I had accepted a new position and was leaving the flight nurse role I had enjoyed for 13 years: “Now I can rest in peace.”
With the recent string of fatal helicopter crashes, my mother's line came back to me as I was reflecting on the current state. I recalled many a time having a conversation with physicians in the emergency department about how they would consider the “risk” of sending the helicopter into their triage decision matrix for which mode of transport to be used for a patient being sent to the tertiary care center. I would try to assure the physician that our program was the safest and convey the complete faith I had in the pilot and the equipment. How many of you have had similar conversations in your own setting or with your family and friends?
Could it be that we do not feel we are operating in a high risk environment might be a contributing factor to the human factor component associated with the majority of the crashes that have occurred in the air and ground transportation of those who have entrusted us with their lives? I would venture to guess that every program that has had a fatal crash in the last year would tell me they have embraced a strong culture of safety. And I would have no reason not to believe they do. No one took off on a mission thinking it would be their last, yet as of this writing, 18 aviation and medical team members did not return home. It is too early for final NTSB reports for this latest string, but if you review earlier crashes, the common denominator has been human factor and mostly at night.
There is a lot of focus on technology that enables the pilot to operate in what has been assumed a safer manner. Technology such as NVG, HTAWS, ADS-B, cockpit voice and data video recording, etc., is available and on a path to become required for all EMS air medical transport. Recommendation from the FAA and NTSB, as well as data provided by the International Helicopter Safety Team (IHST), supports that some technology will help reach the target 80% reduction in all helicopter crashes by 2015. However, I would like to ask you to step back a moment and rethink your belief that every time you take off, whether it is by air or ground, that all risk-mitigating factors have been considered. This means that grey area, the human factor component that is more difficult to isolate. There is no one approach to this aspect, but it must be included in a true culture of safety.
If we do feel the environment we operate in is high risk, how much value will we place on standard operating procedures, checklists, training, communications, etc.? Could this mean longer response times when the tone goes out? Probably. Could this mean additional paperwork? Probably. Could this reduce the risk of a crash? I would like to propose that answer is yes. By increasing awareness of the risks inherent in the operating environment we function in, we can improve our overall success and deliver on the promise of assuring the safe transport of the patient and the crew.
I ask that those of you attending AMTC 2008 in Minneapolis to look in the on-site program for the location of the Memorial Room to pay your respects to those lost. Mark Mennie and the AAMS C-PR committee have taken on this project every year since we lost Michelle North. My greatest wish is that we will attend an AMTC in which there is no need for the Memorial Room. That will not be 2008, but it doesn't mean we can't start working hard for 2009.
AMTC 2008 will be another great conference, thanks to the work of all the partner associations and AAMS. I hope to see another big crowd on opening day. It is a great opportunity for networking, learning new things, and even blowing off some steam that naturally goes along with the kind of work we all do. See you soon!
Sandra Kinkade, President
AMPA
AMPA Preconference/AMTC Minneapolis 2008
Although it seems like we just met in Tampa, next month brings another AMTC meeting in Minneapolis. I want to take the opportunity to remind you, if you haven't considered it already, to attend one of the AMPA medical director preconferences on Sunday, October 19. This year, there will be two preconferences—a core curriculum course and a Beyond the Core Curriculum course. The core curriculum will provide up-to-date information in the 3-part core curriculum medical director course for medical directors who wish to complete the series. The Beyond the Core Curriculum course has been designed for the seasoned medical director or those who have completed the core curriculum.
As many of you are aware, it was clear from the last membership survey that the majority of members wanted to see more networking and group discussion opportunities in AMPA-sponsored activities. Both clinical and administrative topics will be presented in an open format. This will include a roundtable discussion of several topics that are applicable to medical director's professional activities now, including crew training and skills maintenance, contracts, reimbursement, liability insurance issues, proper utilization, unusual or controversial case studies, and more.
The AMTC, after the preconference, offers many interesting opportunities for physicians who are medical directors or are interested in critical care transport. Many of our members are speaking on a combination of topics, including clinical, administrative, safety, and management subjects. If you haven't looked at the program yet, take the time and plan your schedule soon. (You only have a month to decide!)
Finally, I am sure there will be results with action items that came out of the Safety Symposium held in Dallas on July 25. My last Forum column centered on our industry safety, and unfortunately since that column, we have had 8 more deaths among our colleagues and patients. Please, please—use the AMPA preconferences and the AMTC meeting to gain and share as much information and knowledge you can to help reverse this serious trend.
Hope to see you all in Minneapolis.
Michael W. Brunko, President
ASTNA
Time for a Change?
This column will print in the September/October issue, but in reality I'm writing this over the July 4th weekend. We have not yet laid to rest our colleagues who perished in the Flagstaff crash, and the pain of these recent accidents, injuries, and fatalities weighs very heavily in our hearts and minds. The recent months have been very difficult for all of us. There are no words to express how much shock, disbelief, and sorrow we are feeling. Emotions of anger, frustration, and uncertainty are creeping in, and you may be asking yourself, “Is it worth the risk for me any longer?” Twenty-seven of our professional colleagues have perished since June 2007. Unfortunately, we have experienced 3 fixed-wing and 5 rotor-wing accidents, which all had fatal consequences, along with numerous other accidents/incidents resulting in minimal or no injuries. Much less reported but no less concerning is an average of more than 50 fatal ground ambulance crashes per year.
The issue of helicopter EMS safety is receiving an inordinate amount of attention in the national news media and the federal government. Tough questions are being asked regarding safety and the efficacy of air medical transport in general. In light of the attention, I want to reiterate the hard work this ASTNA board is taking in an effort to improve safety in the transport environment.
ASTNA is devoted to remain engaged in the issue of safety and provide representation and leadership for our members. Nurses make up the largest member organization of the medical disciplines within the transport environment. ASTNA is the only member organization with a transport safety position paper, “Transport Nurse Safety in the Transport Environment.” This association's leadership will continue to promote safety by assertively participating in collaborative efforts with other organizations affiliated with the transport community. ASTNA has a representative on the AAMS Safety Committee and the Air Medical Safety Advisory Council (AMSAC). Additionally, ASTNA has been involved with several industry safety initiatives and has made raising safety awareness among our members a priority.
We support the Vision Zero initiative endeavors to remove the barriers created by “competition” so that information related to safety is shared with all. Furthermore, ASTNA continues to support the Co-Operative Network Call for Emergency Regional Notification (CONCERN) Network. 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, CONCERN is also used to transmit information on a wide variety of situations related to safety. In addition, ASTNA implemented the Hazard Awareness Reporting Program (HARP) on the ASTNA website that allows anonymous sharing of issues and concerns from which everyone could learn. We strongly encourage our members to report issues of concern as they relate to actual or potential hazards.
You may be asking yourself what you can do to make a difference and ensure you are mitigating risk to the fullest extent, so here are few suggestions:
If you are having specific concerns or issues that you feel are not being heard or addressed, I personally encourage you to make contact with the ASTNA office via email or phone and share your concerns. The ASTNA office will put you in contact with your ASTNA regional representative, the ASTNA safety liaison, or me personally. We will do our best to bring these concerns forward to those who are in the best position to make necessary changes.
We are definitely doing something wrong with regards to safety, especially when you compare the accident rates of HEMS in the United States to the many other countries that provide similar services. You need to ask yourself why!
On a lighter note, this year's AMTC will be held in Minneapolis, Minnesota, October 20-22. ASTNA is offering the following precons at this year's gathering; a critical care transport review course will be held on Friday and Saturday, October 17-18, and a TNATC advanced provider course will be held on Sunday, October 19. Download the registration form online at www.astna.org or call the national office at (800) 897-6362.
As always, ASTNA has many activities planned for our members at the conference. The ASTNA board will hold its meeting on October 19. On Monday, the ASTNA Military Committee will host the ASTNA military luncheon. During Tuesday's lunch hour a chief flight nurse luncheon will provide networking and brainstorming opportunities. Keep Tuesday afternoon open for the ASTNA member dessert/town hall meeting. We will hold the ASTNA membership luncheon on Wednesday, and I encourage you to pre-register for this event.
See you in October. Until then, stay safe and diligent!
Karen Arndt, President
IAFP
Drawing Together as a Community
As you read this article, written closely on the heels of the IAFP summer board meeting, we have experienced several devastating losses in our industry. We mourn together at the loss of our friends and colleagues, and we are bonded as a community in efforts to prevent any further losses.
The IAFP met in Long Island June 18 and 19 for its summer board meeting. Among the many items discussed were ways the IAFP could improve safety in our industry. We have several projects in the works, including participation in the OSI-HEMS research with Dr. Ira Blumen, the AAMS Safety Summit, and IAFP's own safety survey.
During some downtime, several of us had the opportunity to travel to Ground Zero. Nestled within the busy hustle-bustle of New York, Ground Zero was eerily quiet. As we reflected on the devastation there, we could not help but think of the heroes who lost their lives in the care of others. Saving lives and caring for others is what we do; it is our chosen profession and vocation. I cannot imagine doing any other job.
I know many of you feel the same way about your careers. We do what we do for many reasons, but when it boils down to it, we are about taking care of people. We have new challenges now, improving our safety record and public confidence.
According to Paul C. Light's Sustaining Nonprofit Performance: The Case for Capacity Building and the Evidence to Support It, public confidence in nonprofit organizations was high prior to September 11, 2001. After September 11, public confidence fell significantly in nonprofits. It would prove interesting social research to see public and professional confidence levels in our industry in light of recent incidents.
All is not doom and gloom. All of the organizations have rallied together to focus renewed energy for our chosen profession, and the IAFP is committed to working toward a safer industry. What are some of the ways we can accomplish this?
As we look at other organizations, we can take nuggets of wisdom and apply them. One of the ways the IAFP will contribute is to identify those areas that are still in silos. As we share information and work in collaboration with local, state, and national organizations, we can mimic what Light describes in terms of a quality movement as “an innovation and diffusion community.” Let's look at that in more detail.
Light advocates that as we develop a national infrastructure, a climate of positive change occurs. Organizational improvement then occurs by supplying the “political, intellectual, human, and financial capital” as well as strengthening the environment in which organizations operate. Light is specifically speaking about nonprofits, but we can take lessons from this sector and apply them directly to ours.
As we gear up for AMTC, we hope to see all of you there. We need the input of all of our members. If you have not been actively engaged in our community, it is time to do so. We have a tremendous amount of work ahead of us and I predict positive changes in store. The road will be difficult and long but the IAFP is committed to long-term change and improvement.
Stay safe out there.
Greg Winters, President
PII: S1067-991X(08)00160-0
doi:10.1016/j.amj.2008.07.010
