Forum
Article Outline
IAFP
Will the Economic Downturn Affect Your Professional Association?
Professional associations struggle during economic hardships, and the IAFP will strategize to mitigate the effects the economy will have on our profession association. Professional associations typically place much emphasis on tangible items, like discounts on insurance, magazines, and perhaps car rentals. I believe the most important aspect of a professional association is providing the intangible benefits to its members. The intangible provides credibility in the marketplace through items like credentialing and political advocacy.
The IAFP is no different than any other professional association in that we want to provide a voice to speak on behalf of our members and to help advance our profession in the critical care transport industry. One vision of the IAFP is to advocate to State EMS offices a credential for paramedics working in the critical care transport industry. The IAFP is excited to see the Board for Critical Care Transport Paramedic Certification (BCCTPC) develop a new credential for the ground critical care paramedic. The advent of this new certification provides the IAFP the opportunity to present a solid, national credentialing standard for all paramedics working in the critical care transport industry.
Advocacy can be found in many other areas of our professional association. As we continue to mature as an organization, we collaborate with our industry colleagues to advance a unified voice for a better EMS and HEMS industry. We submitted a supplemental document of our testimony pursuant to a request by the NTSB during the hearing in February. The additional information that we provided was the second of two safety surveys of IAFP members. The NTSB was pleased to have our participation and found our information very helpful as they close the first wave of their fact-finding mission.
We believe that all critical care paramedics deserve the opportunity to continue their education and enhance their clinical knowledge. The IAFP strives to expand educational opportunities at venues like CCTMC and AMTC. CCTMC 2009 was a great conference with a phenomenal clinical skills day and will be back again by popular demand next year. The AMTC 09 in San Jose should be very exciting as many new changes are coming up on the horizon.
2009 begins the 11th year of the Tim Hynes Award. This award, as many of you know, recognizes a peer who possesses exemplary abilities in leadership, education, and safety within the paramedic profession. I would like everyone to welcome our 2009 Tim Hynes Award recipient, Mr. Michael Clumpner, flight paramedic for Regional One Air Medical Services in Spartanburg, SC. I have had the privilege to work with Michael through the state delegate program as he serves as the South Carolina delegate. He has been extensively involved in providing lectures around the U.S. for the pre-hospital and critical care transport industry. Michael is very passionate about the critical care transport industry and truly portrays a desirable image and disposition of professionalism that I hope all paramedics aspire to achieve as our profession evolves.
Michael was presented a check for $500 and a certificate of recognition. He also receives complimentary registrations to the CCTMC, a $175 FP-C Exam credit, and a 1-year extension of IAFP membership. The award was presented during the Critical Care Transport Medicine Conference, April 6-8, 2009, in San Antonio. The Tim Hynes Award is sponsored by Bell Helicopter, a Textron Company.
Finally, I encourage all to focus your passion on patient advocacy, human safety, and clinical excellence. In the months to come, as many of us may face adversity, remember that the best approach to crisis is to take a deep breath, remain calm, and start with the basics. The IAFP will remain focused on serve paramedics working in critical care, just as you remain focused on caring for your patients.
James P. Riley, President
NEMSPA
Nothing but Sea
Just after 12 pm on Friday, March 10, 1989, Captain George C. Morwood, a 24,000-hour seasoned pilot, and his first officer, Keith Mills, also very experienced with more than 10,000 hours of flight time, advanced the throttles on a Fokker F28 1000 jet and began their takeoff roll from runway 29 at the small provincial airport of Dryden, Ontario, Canada. Covered with wet snow and ice, the aircraft lifted briefly and then crashed into a ravine not far from the airport, killing 21 passengers and 3 crewmembers, including Captain Morwood and First Officer Mills.
Why would an experienced flight crew ignore all the warning signs that were present that wintry morning and take off with contaminated lifting surfaces? I'm sure that question was asked over and over again as the initial reports poured in. The Honorable Mr. Justice Virgil P. Moshansky, the appointed commissioner for the Commission of Inquiry, was not content to follow in his predecessor's footsteps and label the cause of this accident as “pilot error.” Rather he would oversee what would be one of the most extensive aviation accident investigations ever conducted, one that would literally dissect the entire Canadian aviation system. This unparalleled project, commonly referred to as the “Dryden Investigation,” would become a classic in the annals of aviation history and would reveal the many layers of causation that lurk beneath the superficial verdict of “pilot error.”
Together with four other members of the NEMSPA board of directors, invited as “interested parties” to the proceeding, we sat through nearly 4 days of testimony from more than 40 expert witnesses at the recent NTSB hearing. At the end of it all, I was very impressed with a system that I believe is legitimately trying to identify the root causes of our accident-prone industry, and I left Washington somewhat encouraged that the days of the simplistic “pilot error” conclusion to an accident investigation might be replaced by a more comprehensive search for each of the key elements that led to a disastrous ending.
Numerous topics covering a broad range of subjects were explored in depth during the hearing, including night vision goggles, pilot training, HTAWS, billing practices, scene preparation, IFR operations, and so on. The NTSB's intent was to understand the current state in the HEMS industry and then, based upon that understanding, provide recommendations for improvement. (You can download a complete report from www.nemspa.org).
Unfortunately, while I believe the FAA and the NTSB are diligently working toward long-term solutions, I also have to believe that we as industry participants could do much better at applying some of the proven tools that are available to us here and now. We don't need to wait for a ruling from the FAA to implement night vision goggles, increase AMRM training, and improve our safety culture. A recent survey revealed that nearly half of EMS pilots continue to feel pressure from management, fellow crewmembers, and competitive pressure to accept flights. This “pressure to fly” problem was ranked second (behind night vision goggles) in the NEMSPA paper “An Opportunity to Improve” as an area that should receive attention from the FAA and NTSB. There is simply no excuse for operators and programs to cultivate a culture that permits pressures to be placed on flight crews to accept flights into marginal conditions.
NEMSPA provided two significant recommendations to the NTSB that we believe are fundamental to countering the “pressure to fly” problem. Both can be implemented at no cost to the operator or program. Both can be very effective. And of course, both require full and consistent support from management personnel. The first is to implement an effective risk-assessment protocol that requires consultation with someone outside of the flight team when marginal conditions exist. The second is to require an En-route Decision Point (EDP) protocol that sets predetermined altitude and airspeed limits. Upon reaching either of those limits, the pilot is required to alter course, turn around, or land.
I have hanging in my office a quotation from the Dryden transcript, along with a key commentary from Dr. James Reason – something that I can refer to on a daily basis that reminds me of my own responsibilities as an aviation manager. Part of Moshansky's concluding remarks include the following statement: “Captain Morwood, as the pilot-in-command, must bear responsibility for the decision to land and take off in Dryden on the day in question. However, it is equally clear that the air transportation system failed him by allowing him to be placed in a situation where he did not have all the necessary tools that should have supported him in making the proper decision.”
Dr. Reason provides the following additional comments: “…if what we seek is to avoid future tragedies like Dryden, rather than sweeping the dust under the rug, we must examine the organizational processes which generate gaps in the system defenses and induce properly qualified, healthy and well-intentioned individuals to make such damaging mistakes… On the one hand, there should be no doubt: there is still no substitute for a properly trained, professional flight crew. They are the goalkeepers of aviation safety. But on the other hand, no matter how hard they try, no matter how professional they might be, no matter their care and concern, humans can never outperform the system which bounds and constrains them. If in contest, system flaws will sooner or later inevitably defeat individual human performance” (Beyond Aviation Human Factors by Maurino, Reason, Johnston, and Lee).
Samuel Johnson is credited with saying, “There are ill discoverers who think there is no land when they can see nothing but sea.” The participants of the Dryden Investigation could see beyond the simple yet woefully incomplete initial verdict. As aviation professionals and managers working in high-risk environments, we must embrace the struggle of seeking, articulating, and implementing safety enhancements that will ultimately correct the defects in our industry and protect those we serve. Many times this requires looking well past what may seem as the obvious and understanding what is really occurring within the total system.
Kent Johnson, President
AAMS
Yin and Yang
2009 has not been dull for anyone involved in our industry. With the recession leaving its mark on all of us, it seems difficult at times to look beyond the day-to-day activities that have prompted many to operate in a reactive mode rather than with a proactive approach. It is challenging to find balance when one may be fighting for the survival of their position or their program. However, this is exactly the time to take inventory, to make sure one is prepared to embrace whatever changes are coming. And yes, change is coming. It is inevitable and should be embraced.
The professionals I have met over my 22 years in this industry never cease to amaze me in their breadth of knowledge and the passion for service provided to their community. I have had an amazing ride—some situations better than others, but that is part of life. When I have faced personal hardships, it has been overwhelming to see the gates open from all over the world. And I have witnessed that same scenario happen countless times to others. It truly is a small world, and the one we work in is even smaller since it has such a narrow scope and niche in the bigger healthcare picture.
Many of you are familiar with the terms “yin” and “yang.” I have been diving a bit deeper into this philosophy and find it can apply to everything. Yin force is expansive, while yang force is contractive. Think of the heart expanding and contracting with each beat. Or that tense (yang) feeling you have after a long day at work and how a cocktail (yin) seems to relax you. There is a belief that good health and happiness depend up these two forces being balanced. We often talk about creating balance between work and home life yet find ourselves putting off projects, family visits, and vacations in the name of getting work done. I have been guilty of this for a number of years and am now facing a time where I truly have more control over finding that balance.
If one is operating at one extreme of the yin and yang forces, one might argue that the ability to adapt might be hampered. One might also consider the possibility that someone making a costly decision may have been operating out of balance, potentially impairing clear thinking. This is not the forum to get into a deep discussion about yin and yang; I just offer it as food for thought in terms of the importance of taking care of ourselves on emotional and physical levels. If you are in a leadership position, set a good example by incorporating practices that encourage a balanced life. If you are the one out in the field, suggest ideas and activities that can be used on a daily basis to ensure the team is harmonized, to facilitate open communication, and to help prevent the potential of tunnel vision that may impair the ability to operate safely.
Spring is a great time to look forward and start putting strategies into play to bring that balance to your work and personal life before the hot summer (yin) comes into full force. AAMS is focusing on strategies related to safety, and we spent an entire day at the March board meeting developing ideas and prioritizing them so they can be implemented in a timely, proactive manner. As always, there will be opportunities to get involved, so stay tuned for more information.
Thank you for your continued support, professionalism, and passion for driving safety as the number one priority while we strive to deliver the safest and highest quality patient care possible.
Sandy Kinkade, President
AMPA
The Time for Membership Is Now
The NTSB hearing in Washington, DC, has come and gone. I was truly honored to have been invited to represent AMPA among some of best known and respected members of our air medical community. I believe that each of us brought our knowledge, expertise, and passion for what we do and that this will help guide those that now seek to regulate or make changes in what we do.
CCTMC in San Antonio will have come and gone by the time you read this. While numbers were low early on, as I write this I hear that registrations are still coming in, and I suspect our turnout was good. Thanks to all of you who taught and attended and helped to make it successful.
Over the past few months I have written about how important it is for us to pull together during these difficult times so that our voice is louder. While it is difficult to say just how many medical directors, flight nurses, flight paramedics, EMS pilots, and communication specialists there are throughout the industry, I am fairly certain that the various professional organizations really represent a smaller number of them than we would like. With the industry under scrutiny, there cannot be a better time for memberships of all the organizations to increase to represent a larger portion of these professionals. I know I am urging all to join their respective groups, if not a member already, and I ask all of you to do the same. We can much better represent if we speak for a larger number of individuals.
“The Air Medical Physician Association is a unique association comprised of physicians and professionals involved in medical transport who are committed to promoting safe and efficacious patient transportation through quality medical direction, research, education, leadership, and collaboration.”
I believe that the AMPA mission statement still well describes those of us who are air medical physicians. If you are not a member already, I urge you to join and to appeal to your non-member colleagues to do the same. If you have crewmembers who are not affiliated with their professional groups, urge them to do so now.
Remember to mark your calendars now for AMTC09, October 26-29 in San Jose, California. AMPA will again sponsor “Core Curriculum for the Medical Director” and a second preconference session for seasoned medical directors.
Many of us have had one of the worst winters that we have seen in several years and are looking forward to warmer weather. Please let us remain safe as we enjoy this better weather and the increased flights it brings.
For more information on educational offerings, Ask AMPA, or to contact any of us, visit our website at www.ampa.org.
Jack B Davidoff, President
ASTNA
Freedom
As I write this I am leaving Washington, DC, and the annual AAMS Spring Conference. I was here just a few weeks ago for the 4 days of NTSB hearings. Yesterday I had some time and walked the length of the Washington mall from the Capitol Building to the Lincoln Memorial. Many of the monuments there speak of age-old ideals and principles; one I read repeatedly was freedom. For one reason or another, this principle has always resonated with me. We are living in a historical time; the air medical community or industry, whichever you prefer, is changing before our eyes. There is unprecedented scrutiny and attention focused on us from myriad agencies and the public at large.
As a flight nurse you have a lot of freedom—freedom to make decisions, some of which can be life-changing. With this freedom comes huge responsibility. You also have the freedom to choose how you practice; you can do so in a way that exalts excellence, discourages mediocrity, advocates for the patient, and fights complacency or not. You also have the freedom to say no, to use the “three to go; one to say no” rule. You can and should do so at your discretion and live that principle out daily.
The person in the equation that doesn't have much freedom is the patient; most often they are not there by choice. They typically don't get to choose who their provider or caregiver(s) will be. They depend on surrogate decision makers; those decision makers decide who will come for them in their time of need. You decide for them what type of treatment they'll receive.
Our patients deserve our best, period. As nurses, we are the backbone of critical care transport. We are the expert at the bedside, the patient advocate, and numerically we are the largest group of the healthcare disciplines involved in air/critical care transport.
My goal as ASTNA president is to make sure that transport nurses have a seat at the table for any and everything that impacts us professionally or personally, especially in the areas of personal and patient safety. I was honored to testify at the NTSB hearings and to be the only person there representing transport nurses. It was empowering, and I am thankful I have the freedom to do such as thing as a professional and as an individual.
I urge each of you to recognize the freedom you have and use it. Stand up, be heard, and take your rightful seat at the table.
Kevin High, President
PII: S1067-991X(09)00069-8
doi:10.1016/j.amj.2009.03.003
