Forum

Gosh, I Feel Tired Tonight 

As you come off of your third straight night of a lot of flying and very little rest, all you can think about is that nice, comfortable bed waiting for you at home and the chance to catch up on some much needed sleep. Even though you worked almost 2 hours past your normal shift time this morning, you know that you should have plenty of time to get adequate sleep before returning at 1900 tonight.

As you stumble toward the bedroom, your wife reminds you that it is your son's 10th birthday and that he has invited his seven closest friends over at noon for what should be a “mellow and quiet” party. “Don't worry,” she says emphatically, “we won't disturb you. You get all the sleep you need.”

About 3 hours later you hear what sounds like the Battle of Gettysburg being re-enacted in the family room. The midday sun streams through an un-shaded window in your bedroom, and you think, “I really need to put blinds up in here.” In fact, you think many things to yourself as you toss and turn, trying to get back to sleep. Downstairs in Gettysburg, the Yanks have begun an artillery barrage.

It's hard to tell how much “sleep” you really got. All you know is that it's time to get up and spend some quality time with your son. You can't believe he's already 10 years old.

You feel more tired than usual on the drive into work, and you hope tonight is not like the past three. As you finish your preflight and crew briefings, the inevitable happens—another flight request. This first transport goes off without a hitch. You tie your blades down, finish up all your paperwork, and head straight to bed. “All that coffee really helped,” you think to yourself. Not only does it help, it seems to keep you from falling asleep.

The next flight request comes just after 0200, and this time you know you're tired. Thoughts of “I've been through this before, I know I can do it” go through your mind as you start your helicopter, but something isn't right. What's that noise? In the co-pilot's seat your medic yells something at you and grabs your shoulder. You look out the window and watch the blade tie-down strap fly by on its way toward the tail rotor. A second later…

With the exception of the ending, does this scenario sound familiar? I suspect there aren't many EMS pilots who can't relate in one form or another. A recent survey conducted by NEMSPA of nearly 700 EMS pilots confirms that fatigue remains a significant concern in our industry. (The final results of the NEMSPA Sleep and Fatigue survey should be published by the time you read this article.) While it is very difficult to pin fatigue down as a significant contributing factor to an aircraft incident or accident, I believe that it plays a much larger role than most of us realize.

It's clear that many of our fatigue-related issues are directly related to the schedules we maintain. There is no doubt also that there are many countermeasures that we as pilots and flight crew members can take to minimize the effects of sleep loss. These include the judicious use of caffeine, strategic napping, understanding your personal sleep requirements, how you can obtain the optimum amount of sleep, etc. NEMSPA continues to promote the basic motto that, when working night shifts, you should “sleep when you can and as much as you can.”

NEMSPA has been working closely with Dr. Mark Rosekind, an internationally recognized expert in sleep and fatigue, to develop training and fatigue risk assessment materials that are specific to air medical EMS needs. Those of you who have conducted research in this area know that it is very difficult to find published material on fatigue in aviation that does not have his name attached to it. We feel very fortunate to have his help in this very important area, and we look forward to a long relationship with him. Most of all, we hope the outcome of that collaboration provides a significant benefit to the safety of our operations.

Kent Johnson, President

Recognizing the Contribution and Needs of CCT Teams 

The summer months are upon us once again (except for our Down Under friends who are in the middle of their winter), and many of us are still dealing with challenges as a result of the economic times. I am currently on international travel as I write this submission, and the true global impact is glaring. Even the beautiful city of Amsterdam, where residences along the canal were hardly ever available for rent or sale, numerous signs cannot be ignored as one takes a canal boat tour.

In the United States, many programs are feeling the effects of decreasing revenue for a variety of reasons, forcing cutbacks in staff, base closures, delays in acquisition of new equipment, etc. In speaking with members, one consistent message emerges: there will be no backing off the momentum of improving safety that has been increasing.

The past 2 years have been heavily focused on the air medical industry, while our critical care ground transport (CCT) teams have been facing challenges of their own. You may have noticed the phrase “rural safety net” used in many AAMS-related press releases as we talk about the benefits of air medical transport. What has been neglected in these reports is the inclusion of the valuable role the CCT contributes in this rural safety net. This was in no means meant to discredit this mode of transport by highly skilled and professional teams across the country. It is a well-known fact that there is a significant differentiation of the capabilities offered by the CCT teams in comparison to many community-based EMS ambulances. Unfortunately, the scope of the transport world we take for granted is often unknown to the general public and media. With the intense scrutiny placed on HEMS due to the tragic loss of too many lives, it became confusing when AAMS attempted to include other modes of transport of the critically ill and/or injured patients.

As momentum is gaining and more helicopter programs are implementing safety management systems, adding equipment, and modifying training and operations, it is high time for AAMS to focus a renewed effort on the unique needs the CCT community must meet to ensure the safety of the teams and patients, as well as the financial viability in the unknown future of healthcare reform. This is in addition to educating the community, media, lawmakers, etc of the role.

I will admit I am not the expert in identifying these needs, as my background is as a flight nurse. However, I still remember sitting with significant angst as I listened to Dr. Nadine Levick's presentation at last year's MTLI graduate program and watched a video of the ground ambulance patient compartment during crash scenarios. Standardized data monitoring of ambulance crashes does not exist (just as in HEMS) that could identify trends to implement risk-mitigating strategies.

I would like to call once again on those experts in the CCT field to help AAMS educate the general public and legislators on those unique requirements that have been shared yet not acted on while the focus was narrowed on air medical transport. There are active special interest groups (SIGS) for the CCT segment within AAMS, and much strong work such as standards for crew configuration, safety-related topics, and appropriate utilization have been published. Please continue to e-mail or call with your thoughts, as well as when an inaccuracy has been noted in a released statement so that we can all work together toward ensuring the highest quality and safest transport of our teams and patients in whatever vehicle is being used. I hope it does not take a year like 2008 in the HEMS industry to get the attention needed to hear your voices and your passion in CCT.

Sandy Kinkade, President

CCTMC Kudos, Award Nominations 

Well, I am happy to say that CCTMC was again a success! A minimally smaller attendance did nothing to deter from tremendous speakers and sessions. Thanks to Pat Petersen, all the participating organizations, speakers, vendors, instructors, and of course the attendees for making this conference what it is—the premiere clinical conference for ground and air transport of critically ill/injured patients. I am already looking forward to next year in San Antonio!

I need to send a special thank you to VidaCare and Dr. Larry Miller and Scotty Bolleter, Abbott Labs, Simulab, and Impact Instrumentation, whose efforts made the Clinical Skills Day a wonderful success. My congratulations to Dr. John Pakiela and the Education Committee for a job very well done.

AMPA continues to receive requests for endorsement of projects, concepts, legislative bills, etc. It is difficult for AMPA as an organization to make such endorsements. AMPA does welcome and encourage all efforts that promote and facilitate the safest and most appropriate possible environment for air and ground medical transport, but our focus is to provide the best quality of care for patients requiring critical care transport through quality medical direction, research, education, leadership, and collaboration. I believe that AMPA can and should work with all parties that have the same philosophy, and I invite them to approach AMPA with their material.

Elections are coming up in October; three board member-at-large positions will be open, as well as our international representative position. Please consider running for one of these positions and submit your nomination. More information regarding elections will be found in the newsletter and website soon.

The AMPA Medical Director of the Year Award is intended to recognize a physician who has made outstanding contributions to his or her program. The nominee will be an AMPA member who has shown exceptional personal involvement in his or her program, is considered an invaluable part of the team's success, and whose contributions to medical direction, education, quality care, outreach, safety and team morale are considered to be essential to the fabric of the program—in short, a leader! This is an award that is nominated by a medical director's own program members, and having been a recipient several years ago, it is a true honor! If you feel your medical director meets these criteria, submit your nomination this year.

Dates to remember:

“AMPA Medical Director Core Curriculum: Part II” and “Medical Director Forum: Beyond the Core Curriculum” will be presented concurrently on October 25 prior to AMTC. AMTC is October 26–28 in San Jose.

AirMed World Congress 2011 is May 24–27, 2011, in Brighton, England. Check out their website at www.airmed2011.com.

Summer is hopefully upon those of us that have spent the past 6 months or so lowering our Vitamin D levels. Let's take advantage of the better weather to get out and enjoy. The good weather brings increased patient transports for many of us as well.

Let us all think safe, fly safe, and be safe as we enjoy and work through the summer months!

Jack B Davidoff, President

Testimony 

First and foremost I have to say that the 2009 Critical Care Transport Conference was great! The speakers were some of the best I've heard in recent years. Attendance was good, considering the current state of the economy. Kudos to the planning committee! Mark your calendar now for AMTC 2009 in San Jose.

Just recently like many of you, I watched the House Transportation and Infrastructure Committee hearings on helicopter EMS (HEMS) operations via webcast. I saw several of my professional colleagues giving personal testimony as to their thoughts on safety in the helicopter EMS environment. I am a native Tennessean and son of the South; Southerners have lots of sayings. One is asking someone to “testify”—asking them to speak their mind or give their opinion on a specific topic, issue, or concern. It's easy to testify on something you feel passionately about; for me it's almost effortless. I speak what I believe or believe to be the truth.

With the dynamics of the past 24 months of our industry I've taken some time and really examined my personal beliefs and opinions about the current state of air medical transport. As a nurse and a healthcare professional, I looked at medical evidence, both pro and con, for what we do. I looked at my own career as a transport nurse and draw on experience. I also used my personal values that shape or mold my opinions or beliefs.

I ask each of you to take a moment to examine what you believe; how did or do you arrive there? This is a time when we all need to be thoughtful and perhaps introspective. As time goes on change in our industry is inevitable; our practice as transport nurse should be consistent with our beliefs and values. The organizations or entities we work for should have beliefs and values consistent with our own.

If asked to testify, what would you say? Whatever it is, say it; let your daily practice reflect what you believe and value. Go forth, live it, be safe.

Kevin High, President

Looking for a Few Good Leaders 

Have you thought about what it takes to be a good leader? Some people are natural born leaders, and some people will have to work hard through education and training to become good leaders. We all have the propensity to become leaders. The style of leadership is what can limit the individual from moving forward in certain leadership roles.

A study published April 10, 2009, investigates what makes a natural born leader. According to Dr. Carl Senior and other researchers, “Behaviors that drive leadership style are linked to our genes”; this is the finding of a study presented at the British Psychological Society Annual Conference in Brighton.

One of the most powerful leadership styles is called transformational leadership, a social-based style of leadership in which leaders motivate their team members to reach their maximum potential through charisma, individual consideration, support, and intellectual stimulation. Researchers found there was a link between inefficient version of the dopamine gene and low scores on two core leadership behaviors: intellectual stimulation and charisma.

What does this mean for those of us who wish to become managers and leaders? Take a deep breath, your future in management has not been washed out yet! Mr. Danny Cox, author of Leadership When the Heat's On, speaks about how leaders are not self proclaimed but receive honorary degrees that can be bestowed only by those who are led. He states, “Those who have been assigned to lead others, but lack the skills or motivation to do so, will forever remain mere managers.” He believes effectiveness as a leader is directly proportionate to the effectiveness as a human being.

Cox has three steps everyone should follow when searching for effective leaders. First, we should identify those who are willing to genuinely accept the challenges and responsibilities of leadership. Second, we need to indentify people who are willing to be led. Remember, this is not a popularity contest, and above all else, the nominated leader must be able to earn their respect. Third, we need to assess the leader's performance in real, non-scientific terms, understanding that people are not machines. “Leaders must be merchants of hope,” Cox said.

We have many paramedics who possess the propensity for leadership within our association and our industry. I have had the pleasure of meeting many potential leaders at conferences and meetings around the United States. Many of you may not feel like you have what it takes to be leaders, yet I would argue otherwise.

I would like to thank all who submitted their candidacy for board positions within the IAFP. This year we received many submissions from qualified candidates. It is encouraging and inspiring to see an increased interest in serving on the IAFP board, as I believe it is a true reflection that there are many passionate professionals with a desire to take on the responsibilities of leadership and tackle issues facing the critical care transport industry.

As our association continues to evolve, I encourage all of you who were not elected to a board position this year to become involved in other areas of the IAFP. We always need members willing to participate in the following areas: state delegate program, government and legislative committee, and our education, research, and safety subcommittees. We have more than enough work for the board of directors to tackle, and the more we can involve our members, the more cohesive our association becomes.

IAFP members who have any special talents—whether it is with business, finance, marketing, website design, graphics, fundraising, writing, or wanting to get into writing columns in journals—please step forward. The IAFP would like to capitalize on the talents of our membership and use them to enhance our association to continue to move our profession forward in the critical care transport industry.

James P. Riley, President