Forum
Article Outline
AMPA
Task Force Plans
By the time you have an opportunity to read this issue, ATMC 2009 has come and gone. Hopefully some of the energy and motivation generated there continues to command you to do more and do better!
As I write this Forum, the National Transportation Safety Board (NTSB) has just released their summary of recommendations to the Federal Aviation Admin-istration, Centers for Medicare and Medicaid Services, and other agencies in an effort to improve helicopter EMS (HEMS) safety in the US. This summary comes after the NTSB hearings several months ago and from input of many individual through the NTSB website. While most of the recommendations listed are already in effect at many air medical services, this may promote those who have not taken these measures yet to do so. The newest recommendation is that of tying reimbursement to safety. The NTSB thinks that using money as an incentive may make some services fast-track safety improvements. I am sure that this idea generated much discussion at AMTC.
AMPA's Task Force met in San Jose at AMTC and has gotten a lot of work done that will be presented in the Jan-Feb Forum. The task force was assembled to bring physician members of the air medical community together to review what has transpired in air medicine over the past few years, work on voicing an AMPA opinion on topics that are important today, and to plan ahead. The task force should result in the publication of several position papers and ultimately guide further discussion and, more importantly, study and research needs in air medical transport to allow for more evidence-based practice. AMPA will make sure that all members are aware of the task force's progress. We are also interested in your input, so please make sure we have your comments and thoughts as you read the preliminary work from this task force. As always, you can easily communicate with AMPA's board via the website, www.ampa.org.
The Core Curriculum program has maintained momentum, as evidenced by the large numbers of people who attended in San Jose. As the task force begins to generate material, I am sure it will be incorporated into future core curriculum and medical director forums.
As you all know by now, the medical director's forum was cancelled a few weeks before San Jose. The numbers of attendees were low, and AMPA thought it was best to cancel and put resources into the core curriculum and task force meetings. I hope that it was more a sign of the times with less people travelling this year. AMPA will re-evaluate this program before next year's AMTC. I apologize to those who were planning on attending and hope we can make up for it with future programs.
Again, I want to thank the AMPA board and especially Executive Director Pat Petersen for all they do. I also want to thank all of you for all the work that you do in air medical transport, as well as your support of AMPA. Together we are doing great things; let's look forward to even better. Let's be safe and keep up all the good we do.
Jack B Davidoff, Immediate Past President
ASTNA
Parting Advice
As I begin writing this piece, I took a minute to ponder this, my last message as the current ASTNA president. My career as a transport nurse has been quite eclectic and has led me all over the United States and Canada, meeting and speaking to nurses from all spheres of our industry.
I recently put together a talk on lessons learned from more than 20 years of transport nursing; here is an excerpt.
Just over a week ago my best friend collapsed on a Colorado mountainside, unconscious and suffering from a leaking aortic aneurysm. He was in a remote wilderness area; his companions called for help on a satellite phone. Shortly thereafter Flight for Life Colorado arrived and delivered him safely to a nearby hospital. A few hours later he was having open heart surgery and today is doing well. Brent, in part, owes his life to the air medical team from Flight for Life Colorado.
The take-home message from this experience is my last point. We can never, never forget why we are here. It is to take care of people, get them out of a bad situation and to a better place, hopefully in better shape than when we first met them, and do so safely. Nothing more, nothing less.
Kevin High, Immediate Past President
NEMSPA
I Have a Dream
The words of Martin Luther King, “I Have a Dream,” play in my head from time to time when I think about what I can do to make EMS a better place for paramedics. I too have a dream for a better life and evolution of paramedics in this country. My inspiration has evolved from 15 years of watching “the little guy” always get the short end of the stick. Time and time again I have endured and witnessed my fellow colleagues treated as disposable equipment. As I pondered how I could combat this attitude of disposable employees in the EMS industry, I learned to channel my frustrations and create an environment that would take root in the local cultures of places I worked throughout my years in EMS. My EMS experience has led me to become active and step into the light to bring much needed attention to the EMS world and critical care paramedics (CCPs).
Have you ever noticed that, when an organization's leadership changes, people only appreciate change after the fact? I can still remember the day IAFP President Ron Walter called me to inform me that I had won one of three board positions in the election and would soon begin my journey to represent the members of the International Association of Flight Paramedics. Little did I ever think that my ideas would come to fruition during my service to the IAFP.
When I thought about running for the board of directors, I was not sure what to expect, but I knew that this could be the opportunity for me to share my ideas about how the EMS and critical care industry could change its perception of paramedics. I had big dreams and was ready to dedicate my time to make sure that the IAFP was an organization to be respected and hopefully provide leadership in the future of paramedics in the critical care transport industry.
I think it is very important for not only our members but all healthcare providers to realize the accomplishments the IAFP has made over the past few years. The key components of advancing the IAFP as a professional organization needed to change in infrastructure and operations, develop government relations within the EMS industry, expand our representation to reach the local state levels for our members, perform academic research, and promote new educational opportunities for the development of clinicians and administrators.
With broad brush strokes the IAFP made operational changes within our own organization to reflect Fortune 500 business characteristics, which create environments that promote passion, trust, creativity, and innovation; success cannot thrive without these characteristics, according to former Fortune 500 business executive Kathy Robison. After establishing the new infrastructure, we indentified the need to become more accountable for our actions within the EMS industry. Our strategic plan included action within EMS politics—we joined Advocates for EMS to keep a pulse on the political activities of the EMS world and provide insight to our peers about our profession. We also worked with the AAMS Government Relations Committee to become better integrated with issues that affect all critical care transport programs. We continue to work with all of the above organizations and new ones to provide a voice for CCPs.
In response to the increasing need to define critical care paramedicine, the IAFP, together with Creighton University, conducted a study that revealed inconsistencies between states with limited regulatory education and clinical oversight. This study and a more recent critical care job analysis study conducted by the Board for Critical Care Transport Paramedic Certification (BCCTPC) and Applied Measurement Professionals, Inc., provided the basis for the Critical Care Position Statement released by the IAFP this summer. This statement recommends a national standard for CCPs providing care in an expanded scope of practice. The statement centers on eight content areas, including education, certifications, knowledge, patient management, transport medicine, quality management, and certification through valid examination. For the first time in the history of EMS, a national standard for CCPs—paralleled with a valid, national examination—has been established.
The IAFP embraces the ideals of patient advocacy, human safety, and clinical excellence support through education and research. We have worked diligently to develop new study materials to help paramedics prepare for the FP-C® and CCP-C® exams, not only in print but in electronic format through our website. We strive to prepare CCPs to be critical care leaders. To enhance the success of future leaders, we developed a series of preconference workshops that meet Certified Medical Transport Executive (CMTE) continuing management education credits. Currently the IAFP is working with various organizations to address the National EMS Scope of Practice to include the CCP and a nationally recognized educational curriculum with continuing education and credentialing.
We have come so far and yet we have a long way to go. Rest assured the IAFP will continue to work for the recognition of the CCP in this country. The IAFP is gaining the confidence of the EMS industry as an organization that will be an integral part of the development of the CCP and transport industry of the future!
One key to our success has been the strong support of our past, present, and future board members who also have a dream about developing the profession of the CCP. We continue to expand our organization and will be empowering more of our members to take active roles within the state delegate program, state chapters, government relations, and education development of paramedics. The State Delegate Program will expand the representative seats to include air and ground. We are expanding our chapters and government relations to include more general members who have the passion and desire to become involved. The more we grow, the more responsibility each board member has. We encourage you to get involved with our expansion and become part of a new era that is changing the CCP forever!
As the immediate past president, I will have a slightly different role in the daily operations of the IAFP, yet I will remain very active in the government relations within AAMS and IAFP. I will also be working closely with your new president, Jason Hums, and Vice President Kevin Burkholder. We are excited to continue our current projects and begin new ones that will have a significant impact on the CCPs of tomorrow. Please welcome your new board members and leaders!
I wish to leave all new and future board members of the IAFP one final thought from Ralph Waldo Emerson that will help you in your quest for contributing to the evolution of the CCP: “Do not go where the path may lead, go instead where there is no path and leave a trail.”
James P. Riley, Immediate Past President
NEMSPA
A Busy Year
It seems that this has been a busy year for NEMSPA. We participated aggressively in the NTSB hearing in February. Our preparatory work for that event included producing a document titled “An Opportunity to Improve,” wherein we provided 10 major recommendations for the HEMS industry. Those recommendations were presented from the pilot's perspective and were centered on operational safety issues. As a result of this hearing, the NTSB recently announced a number of recommendations for industry improvement. NEMSPA was very pleased to see that many of those recommendations were closely aligned with those provided in its own document. A complete analysis and comparison can be found at www.nemspa.org.
NEMSPA is continuing to work with Dr. Mark Rosekind, an internationally recognized authority on sleep and fatigue-related issues who was a keynote speaker at AMTC. To analyze the benefits of an alertness management program, Rosekind is conducting a major study with a prominent air medical program in the western United States. We're hoping that preliminary results from that study will be available this year. We are especially excited to continue working with Rosekind on the important issues of fatigue and rest management and its effect on crewmember performance.
We are all quite enthused about the recent introduction of the No Pressure Initiative, which has already garnered a significant amount of attention and an encouraging amount of support. Initiated by NEMSPA, this effort is moving forward through collaboration with AMPA, IAFP, ASTNA, NAACS, and AAMS. The initiative has two primary objectives: to highly encourage a “no pressure” culture, allowing flight teams to make safety-based “go/no-go” decisions based on the conditions and circumstances applicable to each specific flight request without undue pressure applied by themselves, fellow flight team members, or management personnel, and to provide tools and strategies that counter the potential effects of such pressures. The No Pressure Initiative facilitates the second objective by use of two simple, inexpensive, and highly effective tools: a robust risk assessment tool and an enroute decision point protocol. Additional details of the No Pressure Initiative can be found at www.nemspa.org.
We want to publicly thank representatives from the associations that make up the collaborative group, as listed above. Each person we contacted was exceptionally good to work with and quite supportive, and they provided very timely feedback. In addition, other organizations participated with pertinent and thoughtful suggestions, most of which have been incorporated into the substance of the initiative's planned implementation. Since I might omit some person or organization if I tried to list each of them, I'll just say “thanks to all who helped.” In our minds this initiative represents a very good example of good people working together to do the right thing.
NEMSPA continues to work in numerous other safety related areas. These include having our own Ed MacDonald serving as chair of AMSAC, Rex Alexander continuing to research and publish hospital helipad design and safety materials, Ron Fergie serving as chair of the AMTC Education Committee, and Gary Sizemore participating in the IRP Committee, the Scorecard Project, and the new FAA-sponsored SMS Committee. BJ Raysor continues to work with IHST, and Pat Williams is NEMSPA's representative on the Commission on Accreditation of Medical Transport Systems board of directors. Both Gary and Bill Winn have been actively participating in Dr. Ira Blumen's ongoing accident research project. And the list goes on.
Yes, it's been a busy year so far.
Kent Johnson, Immediate Past President
AAMS
Observations on the Industry
AMTC is behind us, and I have turned over the AAMS gavel to a new president after serving the community for 2 years. I think it is safe to say it has been 2 of the most challenging consecutive years in the history of AAMS (I was a brand new flight nurse when ASHBEAMS was started so can't really include that part of history). 2008 was overshadowed by the high number of fatal crashes in the U.S. that led to the NTSB and Congressional Aviation Sub-Committee hearings and, of course, intense public scrutiny. 2009 has found a membership divided about several issues already well documented in several resources and websites.
I am not going to rehash these issues as it took entirely too much time and energy from a board trying to focus on the future. The board was as divided as the membership, mostly from pressure of wanting to do what is best for the patient, for the membership, and for AAMS. That may sound like an easy task, but it took an inordinate amount of time from so many other important issues and created such confusion on the Hill among the legislature that there is no question in my mind that we lost significant momentum toward the other issues, like healthcare reform, that will have an impact on all in the near future.
On a personal note, I found myself losing faith in this industry that I have known so well since 1985 and was not sure what the near-term future ultimately would look like. As I'm writing my last Forum, there has been new movement among the membership that is helping renew my hope. A small group that had been on opposite sides of the divide started talking and decided to meet as the “Friends of AAMS” to see if there was an opportunity to close the gap and help refocus the energies of so many into a unified voice.
When we are such a small segment in the bigger picture of healthcare, specifically healthcare reform, it is vital that we stand together to ensure the highest quality and safest medical transport is available to those in need and to those who have chosen this as a profession. There will always be differing opinions as to how best to accomplish this, yet I firmly believe there are more commonalities in the approach than fully appreciated. We know all too well that no one is immune from the tragedy of an accident, but there are well-known and proven risk-mitigation strategies that can apply to many types and sizes of transport vehicles. Some level of competition is good for any segment as it can help keep teams focused and operating at their highest potential. When members start slinging mud in the press or on the Hill, though, I feel it is disrespectful and damaging to the industry as a whole.
This is why my spirits have been lifted after speaking with the eight “Friends of AAMS” group. With the NTSB recommendations, the anticipated General Accounting Office study, new regulations, and healthcare reform all on the immediate horizon, the more we break down communication barriers and work toward the common goals we all share, the stronger our community will be from a quality, safety, and economic point of view. One cannot separate the economic equation from the valuable service provided by the air and critical care ground programs, whether operating in the “for-profit” or “nonprofit” business models. It all takes money to operate, and no hospital is willing to fund a losing department in this day and age.
I have done my best these past 2 years to facilitate discussion and try to lead the association through these turbulent times. It has been a steep learning curve in many ways, and one that I could not have done without the help of the AAMS board of directors, the AAMS staff, and several good friends around the globe. Thank you all for your support, especially to those who are reaching across the divide to bring the community together for the future.
Sandy Kinkade, Immediate Past President
PII: S1067-991X(09)00282-X
doi:10.1016/j.amj.2009.09.001