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AAMS
The Value of Reasoned Discussion
“I disagree strongly with what you say, but I will defend to the death your right to say it.” Voltaire
As I write this, I have just returned from several meetings in Europe involving the European HEMS and Air Ambulance Committee (EHAC) and a conference put on by REGA, the Swiss air medical transport system. It is very apparent that we are all in the same boat as far as problems and concerns about critical care transport issues go. Part of the week was devoted to planning the AirMed 2011 conference to be held in Brighton, UK, from May 24-27, 2011. Go to http://www.airmed2011.com for details.
Intense discussion about many issues were common to all of the venues I attended: government oversight of HEMS (whether enough or too much), whether night flights will be allowed and under what circumstances, how night vision goggles should best be used. GPS instrument flight rules approaches to helipads are also a source of intense debate there, since none have been implemented and, thus, it is uncharted territory for European regulatory agencies. Safety was a major topic of discussion, as it is here. Incidents and accidents are not unknown in Europe. They are concerned about their own safety issues and, of course, concerned about the appalling accident rate that we have had in the United States. In addition, financial sustainability and support of the air medical system is of great concern there, as it is here. There are as many models of financial structure there as here: subscription programs, insurance payments, government subsidy, and charitable contribution. These models all have their own pros and cons.
In the various meetings, debate and discussion were held about resolution of and approaches to these multiple issues. The discourse was rational, in the spirit of the Voltaire statement above. Entities concerned about air transport, both European and U.S. organizations and individuals, can learn from each other as far as potential solutions for our mutual problems. There are European approaches to problems that would serve us well here and vice versa for U.S. approaches to issues that are similar to European ones.
We are in a great crisis now in air medicine. Our dialog must be reasoned, not shrill or confrontational, in order for our industry to survive. To quote yet another observer who certainly had his share of crises, President John F. Kennedy: “When written in Chinese, the word crisis is composed of two characters. One represents danger, the other represents opportunity.” We can work together to seek a path through the difficulties of state versus federal oversight of air medicine, with the associated aspects of integration and regionalization of EMS. States must have a say in how medical transportation is conducted within the boundary of the state, just as the FAA must maintain uniform national standards for aviation. These concepts are not mutually exclusive.
There are a lot of intelligent and creative people involved in the two major intersecting disciplines here, medicine and aviation, who can resolve this conflict, in my estimation. We must listen to each other in a reasoned fashion. The Voltaire statement above is a fundamental part of the American experience. Thomas Jefferson infused a lot of Voltaire into the Declaration of Independence. It is ironic that the major issue facing us today is one of states' rights versus federal rights, which was obviously a major part of American debate and conflict in the 19th century. If we ourselves don't find the solution, then we are part of the problem. Solutions will be found for us that we may not like. I am dating myself to quote the great Pogo cartoonist, Walt Kelly, when he said: “We have met the enemy, and it is us.”
Please keep in mind always Vision Zero. Remember that we must be concerned not only about air medical accidents, but also about the 30 to 35 people who are killed every year in ground ambulance accidents in this country. Let's be careful out there.
Dan Hankins, President
AMPA
CCTMC Success
The Critical Care Transport Medicine Conference (CCTMC) was, in fact, another success! Beginning with a great turnout for AMPA's Pre-Conference Skills Day and a filled-to-capacity lab and winding up with great speakers and sessions during CCTMC, this was probably the best of the series over the past few years. I need to again thank Scotty Bolleter, EMT-P, Director of Education at San Antonio AirLife, for all the time and energy he put into Skills Day with AMPA over the past few years and for the amazing clinical education we were all able to enjoy while in San Antonio. I also need to send out a huge thank you to Dr. Larry Miller of Vidacare for his assistance both from Vidacare and personally. We could also not have done all without the support of Mr. Shawn Salter of San Antonio AirLife and the University of Texas Health Science Center's Departments of Experimental Surgery and Anatomy, with special thanks to Drs. Stewart and Philo and to Baptist Health Systems. All helped to make our past several years in San Antonio a tremendous success. We will miss all our friends in San Antonio and wish them the very best.
As we move CCTMC to Nashville, we look forward to making new friends, forging new relationships, and continuing with our tradition of offering great educational sessions. I hope to see many of you at CCTMC April 4-6, 2011. With a location that's a little closer for the programs on the East Coast, I hope this will bring critical care providers who could not travel to Texas. I am certain that CCTMC will continue to flourish in Nashville, and we may have the opportunity to see many new attendees. Updates on CCTMC are available at AMPA, ASTNA, and IAFP websites, so watch for dates, applications, and schedules.
A final thank-you note to Pat Petersen for the tremendous amount of work she puts into this conference. The AMPA website is the best place to check on updates and information; go to www.ampa.org.
AMTC is coming up on us quickly, and it will be time to travel to Ft. Lauderdale before we know it—October 11-13, 2010. Keep in mind that the AMPA pre-conferences, Medical Director Core Curriculum: Part III and the Medical Director Forum, will be Sunday, October 10, and the General Membership meeting will follow. As we get closer to AMTC, other activities are being planned, including a get-together for AMPA, NAEMSP, ACEP, and others. We will get that information out on the website and newsletter shortly. Fort Lauderdale is again a great place to bring family, spouse, or others with you, so keep that in mind. The Core Curriculum lineup and Medical Director Forum are going to bring some of the best speakers we have together as a group to present to you, so allow plenty of time to interact and network.
A reminder that several AMPA board seats are up for election this fall, including President-Elect and Secretary-Treasurer. Election information will be posted on the AMPA website and in the newsletter. If you have an interest in being more active in this organization and in air medicine and critical care transport nationally and internationally, I urge you to consider running for a position with AMPA. If you cannot make such a commitment, just consider being active with us in other ways. We are always looking for members to be part of the educational activities that AMPA supports, and as other projects become active, there is always a need for more hands and input. Feel free to contact any of the board members or Executive Director Pat Petersen for more information on how to be more active in AMPA.
The AMPA board voted to extend the position of AMPA president for 2 years, creating an immediate past president's position. The position may well be non-voting but will allow a better transition and continuity at the board level. The board will meet for a retreat in August for several days to finish up work on AMTC and plan ahead for the next few years. This will be reported to the general membership at AMTC.
Work continued on the AMPA-NAEMSP-ACEP initiative on HEMS utilization. The final draft version should have been ready at the end of May or early June. There are several other projects in the works that I hope to have updates on at AMTC. As always, feel free to contact AMPA if any of us can be of assistance with what you do.
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.
Air transport of patients requires the integral involvement of a physician knowledgeable in air medical transport. A physician must be responsible for all aspects of the quality of care the patient receives and must have direction over all medical aspects of the transport. The Air Medical Physician Association is created to support its members in attaining this goal.
The Association seeks to attract all physicians with an interest in air medical transport as members. Its mission is to offer opportunities to collectively study the impact of air transport upon their patients and to share expertise so that patients may receive the best care possible in the safest operating environment.
The Association recognizes the expertise and abilities offered by the other medical and aviation disciplines in air medical transport. It is committed to seeking means of cooperation and collaboration to achieve common goals.
I urge all of you to keep SAFETY in mind at all times, personally, professionally, and in your transport services.
Jack B Davidoff, President
ASTNA
Involvement
In attending the awards banquet at our most recent AMTC in San Jose, I was moved by the words of one of our members, Allen Wolfe, as he received the Barbara A. Hess Award. Allen spoke of having attended a lecture by at an AMTC 10 years earlier and how impressed he was with the content and delivery of his presentation, hoping one day to be able to enjoy a similar opportunity to inspire other up and coming flight nurses. Today, as I write this message to all of you, I enjoyed witnessing receive accolades from yet another international nursing association for his commitment and involvement to nursing. In reflecting on Allen's accomplishments, the word that continues to reverberate is involvement.
Involvement encompasses a variety of levels, ideals, and perhaps forms. Each and every day across the United States, transport professionals are displaying a variety of levels of involvement. These transport professionals are involved in delivering high quality care to the patients they encounter. Others become involved in educating their peers or other healthcare providers in an effort to strengthen their clinical skills. And there are those who are involved in making this industry safer for the transport professionals and the patients and families for whom they are caring.
There are many ways in which you can become involved, too. What opportunity are you pursuing? What are the topics, ideas, or projects that motivate you to become involved in your program, your professional association, and your profession? As we all understand, there is no room for complacency when SAFETY is concerned; I feel similarly in regard to involvement. Use your skills and your passion to better your program, your peers, yourself, and your industry. I both encourage and challenge each of you to find a venue to become involved and make patient transport all that it can be.
Kyle Madigan, President
NEMSPA
Know Where You Are
As the No Pressure Task Force approaches the second phase of the No Pressure Initiative, we are preparing a survey to evaluate safety cultures nationwide, with emphasis on pressures to fly. In this regard, I am reminded of a story I heard a number of years ago. A well-known dog food company was struggling with lackluster sales of one of their highly touted products, “Doggy Loves.” The company CEO called a meeting with his high level executives to try to understand why efforts to promote the product were unsuccessful. One by one, each department head presented his report.
“We have put our top marketing teams on this project.”
“No expense has been spared promoting Doggy Loves. We just don't understand.”
“We have the best distribution channels in the industry moving this product.”
“The package design has earned three national awards.”
“Doggy Loves is priced well below our stiffest competitor.”
Finally, the CEO interrupted his experienced staff, “That's all great, but why, why, why can't we sell Doggy Loves?” After a prolonged silence, a voice came from the back of the room, “I'll tell you why we can't sell Doggy Loves—because the dogs won't eat it!”
The program that I work for is highly involved in Toyota's Lean Process for process analysis and improvement with the objective of creating more value for customers with fewer resources. The Lean Process, while simple in concept, can be somewhat complex in practice and requires a definite departure from the traditional “find it and fix it” approach to problem solving.
One of the key steps in the Lean Process is to understand the current state. It is nearly impossible to effectively improve a system or process unless you really understand how it currently performs. That is, if you don't know where you are, how are you to know the way to get somewhere else? Thus, before jumping into the problem-solving phase of a complex situation, you should first take the time to analyze the current environment or to understand the current state. The logic behind this important step is obvious, and the benefits of taking the time and effort to analyze the current state have been proven time and time again.
As the survey component of the No Pressure Initiative progresses toward implementation, we have received numerous comments and suggestions—mostly positive and upbeat, some negative with hints of pessimism. It is the continuous stream of encouraging remarks that has kept the project moving toward the goal of completion during the fourth quarter of this year. The majority of the doubtful comments seem to center around the belief that there is “no evidence that the air medical industry has problems with pressures to fly, so why waste time, energy, and money going after a problem that may not exist?” Our response to the question is that several informal surveys have clearly suggested that there is pressure to fly. Even so, other than the anecdotal stories that I think most of us have heard, we're not really sure how strongly medical crewmembers feel such pressures or to what degree those pressures may affect their decisions to push safety limits.
The intent of the No Pressure survey is to provide air medical programs with a snapshot of the current state of this aspect of their safety culture. The survey data will enable participating programs to assess strengths and weaknesses in this area and compare them to the aggregate of all survey respondents. When the current state is better known, managers can evaluate needs and make corrections as necessary. In order to evaluate the effectiveness of the corrections made within a program, a follow-up survey will be conducted 12 to 18 months after the first survey.
Of course, each program's specific data will be kept confidential, and there will be an option to compare your program's data to all other programs in aggregate. The identity and individual responses of all team members will be completely anonymous, except that responses will be associated with the responder's program. We have gone to considerable effort and expense to employ expert developers to design the survey in a manner that ensures the question-set's ability to provide a valid measure of the presence and influence of pressures to fly in the respondents' minds. To defray a portion of those expenses, a nominal fee will be charged to programs that would like to obtain a detailed analysis of their survey responses. The software design should allow all participating programs, regardless of whether or not a fee was paid, to see how their program's collective responses compare to the average responses of all survey respondents.
Shortly after this issue of AMJ is published, program directors should receive an information packet, followed by an email describing this process in detail. We are encouraging participation in this survey—which is supported by AAMS, ASTNA, IAFP, AMPA, NAACS, and NEMSPA—by every air medical program, and we ask that program leaders take the time to review the information when it arrives.
Are you among those that doubt that your program feels any pressures to fly? Do you suspect that there might be problems in this regard but are of no consequence? Or do you think that this may be a significant cultural problem? Regardless of what your perceptions might be, knowing or understanding the current state of this issue is a necessary first step toward making important improvements to operational safety.
Kent Johnson, President
IAFP
The 2010 Tim Hynes Award Winner
The International Association of Flight Paramedics (IAFP) is pleased to announce the recipient of the 2010 Tim Hynes Award: Chad Augustin, flight paramedic with PHI Air Medical of Modesto, CA. The award recognizes exemplary abilities in leadership, education, and safety within the paramedic profession.
“Chad is an exceptional individual, demonstrating all the qualities and attitudes of what the Tim Hynes Award embodies,” said Association President Jason Hums. “The IAFP board of directors is honored to recognize Chad's outstanding contribution to critical care transport medicine.”
Throughout his career, Chad has demonstrated a passion for education and is described by a colleague as a “student as well as a teacher.” After pursuing a bachelor of science degree in fire safety management and an associate's degree in fire science, Chad's career path turned after facing his own medical emergency. Desiring to emulate the same professionalism and care that he received, excellence in patient care became his obsession. He is one of the first paramedics to achieve the FP-C and CCP-C certifications, although that was not a job requirement; rather, it exemplifies the passion he has for education and his patient care skills.
During his tenure with PHI, Chad has demonstrated a humble leadership style in leading by example, earning him the admiration and respect of his colleagues. “Always willing to assist or volunteer for a project, Chad's work ethic is outstanding; his ‘can do’ attitude is contagious,” said Graham Pierce, PHI Regional Director. “Chad's quest every day is for a safer, more efficient, and economical way to do things.”
Chad is the base educator for his crew at PHI Air Medical. His creative approach to education and training ensure competency in skills and knowledge with protocols and procedures for flight paramedics and nurses. “New and tenured crewmembers are educated and trained in a way that is safe and goes beyond the norm,” added Bob Hesse, PHI Regional Clinical Manager. “He's the type of person that people want to work and train with.”
Chad is also an instructor for the difficult airway management program and teaches paramedic EMT classes for California State University at Sacramento and for the Sacramento City Unified School District. He was also instrumental in the formation of the Tactical EMS unit in Sacramento, spending a tremendous amount of time performing tactical training with local and regional law enforcement agencies to ensure that officers have the highest level of medical care available in the most hazardous phases of tactical law enforcement. Additionally, he has worked with military special operations forces medical personnel to address medical mission planning, tactical casualty care, and equipment usage in the tactical environment.
As Robert Donovan, MD, PHI California Medical Director, commented, “Chad is one of those people who give 110% all the time. He is very motivated to ‘do what's right,’ the kind of person to whom you know you could trust your life. If I were a patient, I would be very relieved to look up from my gurney and see Chad Augustin's face!”
Tim Hynes, a founding member of the IAFP, contributed endless amounts of time and effort promoting the paramedic profession. On January 11, 1998, Tim was killed when his air medical helicopter crashed while on a mission near Salt Lake City, Utah. The Tim Hynes Award recognizes similar paramedics who have made significant contributions to the critical care profession.
The award is sponsored by Bell Helicopter, a Textron Company, and includes a check for $500 and a certificate of recognition. The recipient also receives complimentary registration for the CCTMC and BCCTPC certification, as well as a 1-year extension of IAFP membership.
The award was presented by Bell Helicopter Representative David Cruz on April 13 during the Critical Care Transport Medicine Conference in San Antonio, Texas.
PII: S1067-991X(10)00135-5
doi:10.1016/j.amj.2010.05.007
