Forum

Answering the Call to Service 

It seems like we all start with the same line of how challenging it is to compose these Forum submissions 2 months before they are actually published. In this case, the Air Medical Transport Conference will be a fading memory in our rear view mirror, a historical presidential election will be right around the corner, and the holiday frenzy is about to begin. We will also be closing a year of huge losses of lives in helicopter, fixed-wing and ground ambulance crashes.

If you attended AMTC, I hope you were able to reconnect with old friends and leave with new ones. The educational sessions were packed full of information for novices and seasoned veterans. I still remember my first “ASHBEAMS” in Reno, Nevada, in 1985. I was the new kid on the block with Care Flight, which meant being one of the few having to work that week. We flew the Alouette in each day, landing in the MGM parking lot, and then I wandered the halls to try and attend sessions when not responding to a call. I remember seeing people with what seemed like a ton of ribbons hanging from their badge, denoting their affiliations within different associations. I also distinctly remember saying to myself that one day, I too would be involved so that I will be able to make a difference, though I had no idea what that actually would entail. Now, 28 years later, I can definitely say there is a check mark next to that goal (make that several check marks).

Each association has put the call out for volunteers, yet there remain many opportunities with no one stepping up to lead the effort. So, once again, my first request for the New Year will be to ask you to get involved. If you are not sure which committee would fit with you or how much time might be expected, please contact me or any board member and we will be happy to answer any questions.

With 2 more months left in 2008 (4 at the time of this writing), it will be too early to state the final tally of crashes, though we are on a trend to exceed the previous highest fatality year on record. This certainly is not a record we can completely assign to the higher flight volume, nor is it acceptable. During war, there are expected and even acceptable deaths while carrying out a mission. Though some may argue we are on a “life-saving mission” every time we are called, we all know this is not 100% true. Nor should any transport that does not return home safely be considered as an acceptable part of providing a service.

Most of the crashes remain human-factor related, often entailing a breakdown in critical decision-making, communication, or complacency. This is nothing new and has been written about in hundreds of reports, yet we continue to crash for the same reasons. Operators and the associations have put a renewed focus on these factors and adding mission-specific safety equipment at a significant cost. Is it worth it? It will be if the crashes stop. Time will tell, and I can only hope that 2009 will be a year of reversing trends.

In closing, please exercise your right to vote! Unless something has happened between the time of this writing and Election Day, it looks to be another close call. Both parties have stated repeatedly the need to reform health care in the U.S. Let me just share a few facts found on National Coalition on Health Care website regarding health care expenditures:

For the corresponding reference material, please check this link: http://www.nchc.org/facts/cost.shtml

I don't mean to sound condescending, but it amazes me that the media seems more focused on talking about the type of glasses a vice-presidential candidate is wearing than the platform they represent. As a professional working in the health care industry, please consider which platform will offer the greatest hope in health care reform, along with the other issues that may be of importance from your perspective. Thank you for indulging my perspective in the importance of voting.

Have a safe and happy holiday!

Sandra Kinkade, President

Saying Farewell 

Mission: The Air Medical Physician Association is committed to safe, efficacious, critical care transportation by promoting quality medical direction, research, education, leadership, and collaboration.

Vision: AMPA will be recognized as the leading physician body in the area of safe critical care transportation. Our focus will be providing the best quality of care for patients requiring critical care transportation. This will be accomplished through knowledge and expertise using formal educational endeavors by developing clinical guidelines, publishing position papers, and promoting trusting, collaborative relationships. AMPA will be a reliable source of information and communication. AMPA will promote and facilitate research to ensure safe, effective, efficient and appropriate critical care transportation.

As I depart the AMPA board in my role as president, I wanted to share some of my thoughts, observations, and feelings about AMPA and those who dedicate extra time, energy, and compassion for this unique organization. I start this column with our Mission and Vision statements because they remind me what we are truly all about.

I have participated on several professional and non-profit boards during my professional career. The one thing in common with all of them is the fiduciary responsibility to always recognize and represent the interests of the membership of the organization. In regards to AMPA, we do not just represent the “dues-paying” members but also the community to whom we dedicate our mission: our patients; our EMS and hospital providers; our local, state, and federal governing bodies; and our sibling professional organizations who share many of our same values and missions. AMPA's membership is at an all-time high in regards to numbers and also in regards to relatively new professionals involved with critical care transportation.

We are also, I feel, at a critical juncture in regards to our mission as negative criticism of air medical critical care transport in safety and efficacy is also at an all-time high—our critics being primarily the “community” that I referred to above. The dedication of AMPA and its leadership to maintaining our mission must always be top priority. Our vision, in my opinion, has become much more of a reality because of this dedication. Have we accomplished our vision? Are we close? My answer to that is that we are not, and if we get close, we must establish new visions because our mission depends on our flexibility and new insight.

I have been honored to be able to share and learn from many of AMPA's members and leaders. I cannot begin to mention everyone, but I do want to recognize those who have volunteered and dedicated their expertise, heart, and soul to AMPA's mission and have earned a tremendous amount of my trust and respect. Thank you to the current and past board members who I have served with: Drs Andrews, Brozen, Davidoff, Hinckley, Knoblock, Martin, McCoy, Pakiela, Sheppard, Swanson, and Vogler.

I also want to acknowledge the continued contribution and leadership of the past presidents who unselfishly share (how is that for being politically correct!) their experiences and expertise: Ira Blumen, Cathy Carruba, Ken Robinson, Frank Thomas, and Ken Williams. Finally, and most important, I cannot say enough about my appreciation, love, and respect for our executive director—Pat Petersen. All those who I have mentioned above have been pillars to AMPA's success, but we all have one thing in common—Pat has been there to be our friend, organizer, confidante, and pilot light to keep the fuel burning.

I look forward to the future of AMPA and its change in leadership. I truly have been privileged to be part of this great organization.

Michael W. Brunko, Past President

Facing Change with Grace 

Writing this column, I know it will be my last as the president of ASTNA. As an association, we have accomplished many things this year. ASTNA continues to work with our military nurses, helping them develop their website. We are also adding a military chapter in the Patient Transport Principles and Practices. Both the Ground Standards and Principles and Practices of Patient Transport are currently under revision and should available early in 2009. We have converted the Wheels, Wings, and Rotors newsletter to an electronic format and have improved our communications to the members via the use of blast email. A Commercial Escort Standards is also in the works.

ASTNA has been active in Safety Summit initiatives since the Summit was held in July. We continue to actively participate in industry-wide safety committees and research projects. We continue to promote transport nursing by exhibiting and presenting transport nursing topics at the conventions of the Emergency Nurses Association and the American Association of Critical-Care Nurses. We were pleased to honor two of our own by presenting the 2008 Katz-Mason Award to Denise Treadwell and the Jordan Award to Carol Rhoades.

I would like to introduce you to the 2009 ASTNA Board of Directors: President Kevin High, President-Elect Kyle Madigan, and Secretary/Treasurer Jodie Hignite. Directors-at-Large: Michael Frakes, Becky Pusateri, Greg Wamack, and Sandy Correia.

Change happens all the time and is inevitable. On occasion it caused by our actions; other times we have no control. Change can be simple or complex. Change can be for the better or for the worse. One can choose to accept change or to fight it.

Planted squarely in the middle of my 40s, I am experiencing many of the changes and events associated with this stage of life. My siblings and I recently celebrated my parent's 50th wedding anniversary—the same week that hospice came into my parents' home to help my mom deal with the final stage of cancer. Just another one of the many bittersweet events we experience in our lives. This rite of passage required I have the awkward conversation with my mother about her final wishes and to plan the details of her funeral. I realized I also needed to have the discussion with my father about his wishes when that time comes and ask for copies of legal things such as wills, trusts, durable power of attorney, and medical power of attorney. Perhaps this is a discussion I should have had long before now, but like most of you, this is something we tend to put off until we are forced to deal with it. The strangest part of this whole experience is figuring out how to proficiently merge my responsibilities as a daughter, a nurse, and a sister. As these days play out, I know the family as we have always known it is about to change.

This experience with my mom has really got me thinking more about life and the choices we make that affect where we end up. More and more I've been thinking about all our colleagues that have perished in the line of duty this year and wonder how the loss of so many dedicated transport professionals has affected each of us that carry on with this work. I'm sure many of you, like me, have started to wonder if the risk is worth it anymore. Perhaps your family is asking you to leave the job and find something less risky. These are hard choices and require thoughtful consideration.

We have the ability to reduce some the risks by adhering to our safety and operational procedures and checklists. The “choice” to practice in a true safety culture starts with each of us as individuals. By not allowing our selves to be complacent or presuming the pilot will keep you out of harms way is a place to start. We have the duty to ourselves, our patients, our families, and each other to speak up when we see or feel something that is “not right.” Lives depend on it.

This has been a frustrating and agonizing year, having lost so many colleagues. The pain of all the recent accidents and fatalities weighs heavily in our minds. Like all of you, I am at a loss to understand how or why we have continued to crash at such an alarming rate this year. There were many opinions, ideas and discussions presented at the Safety Summit this summer, and ASTNA, along with all the other partnering associations and interested parties, has continued to work toward a consensus of recommendations and risk-mitigating initiatives. Of course the biggest challenge remains on how to minimize the human factors. This has and continues to be on of the biggest challenge facing us.

My parting challenge for each of you is to make every day count to the fullest. Never take anything for granted, but rather take control of your destiny as much as fate will allow. No matter what you choose, you need to make a conscious decision to change or accept the present course. You must decide what is best for you and those you love. My hope is that all of us working together can implement change that will allow us to reach our goal of Vision Zero.

Karen Arndt, Past President

Thanks 

The time has come for transition. A wise person once said to always leave early enough so that people are glad when they see you again. I hope it is early enough! Actually, the time as president has flown by, and I have thoroughly enjoyed every second. I have had the pleasure to work with some of the most dedicated and professional people I have ever met. What an honor.

I would like to thank the individuals who donate so much of their time and work to make the IAFP the organization it is. As we go into the New Year, please support the upcoming officers of the IAFP as generously as you have supported me. These individuals will have hard work ahead, but I know that they are up to the task. I am very proud of the folks on the board of directors, and they will serve with distinction. As I transition from one role to a new one—that of immediate past president—I am excited at the opportunities that await.

The IAFP will continue to work hard to meet the needs of its members through safety, education, leadership development, governmental interaction, and advocacy for the many paramedics who work in the air and on the ground. Transport paramedicine is growing and evolving just like the paramedics who are working in the field. The IAFP will continue to represent your interests.

Fortunately, the trail has been blazed by heroes and leaders who have gone before us and continue to blaze new trails in various aspects of our industry. I am humbled and honored to have individuals such as John Clark, Jon Gryniuk, Ron Walter, Gloria Dow, and Anthony Pellicone as friends and they are part of a legacy that has created an association that I am truly proud of.

Know this kind readers, without a doubt—all the presidents listed above stood on the shoulders of the board members who work very hard to make things happen. As for me, any credit for the many successes of the past year must be given to the outstanding board of directors that I have been honored to work with. They are truly phenomenal.

Above all, please recognize the hardest-working woman in the business. Please call Monica Newman at the IAFP office and thank her for all she does. She makes our association run like clockwork. I have yet to meet her equal for organization and innovative ideas. She is worth my weight (and that is a lot!) in gold.

For anyone aspiring to our board, I say go for it. As Ron Walter once told me, grab the reigns and hold on, it's a wild ride! Thank you all again and please continue to support the Association. We are at the fringe and even better things are on the way!

Greg Winters, Past President

Change, Ugh! or Change, Ahhh! 

It has often been said that there are only two things that are certain, death and taxes. I can remember in many of my classes we also talked about the third certainty, change. If these things are certain, why do they strike fear in the heart of most that hear them?

Much of what we know of these three is that they are unknowns. Death brings a thought of what will happen next and, more importantly, what will happen to those I am charged to care for. We spend our time trying to prevent the occurrence of death, and the thought of our own death is unsettling at best. Most of us are more comfortable not even thinking about it.

Everyone has strong personal feelings of taxation, and the history of our country's tax battles is well known. There are numerous stories of people who have encountered the IRS, and most have a less than desirable outcome. The thought of losing the things we have worked hard to acquire is never appealing. Most of us feel we do more than our share when it comes to paying for our government, and that the price is way too high anyway.

The third is a little less legendary, or is it? Change brings the fear of the unknown to a new level. The world around us is in a constant state of change. The seasons, the weather, and most physical states are continually changing. These changes seem of little impact to us. We may dress differently or carry an umbrella, but these changes are not of consequential impact. Small changes like a detour can impact our whole day. If the electricity or water is turned off for a repair or upgrade, our life is turned upside down. Suddenly we are thrown into a world of turmoil. The list goes on and on.

Life changes or more serious changes have been shown to cause major impact on us. The medical and insurance communities understand the impact a major change has on an individual and realize they are major stressors. Mitigating these stressors is important to our health and well being.

What about change in our workplace or in our job? When I first started flying in the military, it was often said that, if you don't like the way things are, just wait a month or two and it will change. Indeed the policies were continuously in a state of flux. The air medical community is also in a state of perpetual change. Many of the changes are driven by the accidents that have occurred of late.

There are many reasons for change, some good and some not so good. We need to focus on changes for the better, especially when it comes to safety. Change for change sake is not very beneficial and should not be attempted in times when safety is a concern and when such a strong focus on improvement is at hand. Studies show how change can be affected in a positive manner, and companies or programs should heed the lessons when trying to make changes. Personnel at all levels should recognize that changes must occur and make transitions as positive and easy as possible.

If you recognize an area that needs to be changed to be more effective or safer, push the information to the point change can be made. We have to make a positive change, or change will be made for us. The change that may be made for us could be less beneficial than the change we make. No one understands our mistakes more than we do, and when accidents occur, we need to make the changes to prevent them. We can only control the accident rate when we work together to change our culture. We need to promote a Culture of Safety, and that requires a change. The change begins with the face in the mirror.

I look forward to working with all of you to make the changes that will bring a reduction to our accident rate and to improve the overall safety of air medical aviation.

Gary Sizemore, Past President