Physician Authority for Medical Transport
As I write this Forum article, many of us are returning home from AMTC 2009 in San Jose. In my opinion this meeting was truly a success! Despite early concerns that the turnout might be low, the numbers of attendees were good. The conversations and meetings were great, and the educational sessions were superb. I can only say thank you to everyone who participated in making this meeting the success that it was.
Over 70 national and international medical directors and flight physicians attended the AMPA Core Curriculum conducted by John Pakiela, DO. The AMPA Task Force attracted another 20 or so and was led by a talk from AMPA President-Elect P.S. Martin, MD. Both had very good discussions and were well enjoyed. Minutes from the Task Force will be going out to all Task Force members shortly. Doug Floccare chaired the NAEMSP/AMPA/ACEP combined meeting on Monday, with another good turnout and more good discussion.
In all the meetings attended by air medical and EMS physicians, it was made clear that there are very strong concerns about the threats of regulations or legislation that will restrict the physician's authority to determine how and when a patient needs to be transported. Current EMTALA rules mandate that the sending physician determines how a patient is transported and is responsible for that patient until the patient arrives at the accepting facility. The transportation method and what level of care they receive during transport may play a very important role in the patient's outcome. The provider who can best determine what the patient requires is usually the sending physician, with some guidance from the receiving physician. The thought of taking this decision away from the sending physician is extremely concerning, especially to those of us who still transfer patients as part of our practice. To be held responsible for the patient's outcome but not have the ability to determine how he or she will be transported is a scary thought.
For those of us who are active in air medicine, we know how poor reimbursement is now. Linking reimbursement to certain requirements, as suggested by the NTSB, is also worrisome. Depending on where we fly, what our mission is, and what resources are available, flight services opt to do things differently, and what is important for one service may be a hindrance to another. Having an outsider decide what a specific service should or should not have and then link reimbursement to this decision may prove to be very damaging to some services that provide safe, necessary care to some areas. I hope that this is recognized before it is too late.
Dr. Mark Rosekind, a world-recognized expert in sleep and fatigue management, was selected to present the keynote address at AMTC. He gave an excellent talk regarding sleep debt, fatigue, and sleep inertia. Dr. Rosekind has been working with NEMSPA (National EMS Pilots Association) and the NTSB to evaluate the effects of rest/sleep in aviation. He previously worked for NASA. Keep your eyes open for more of his material, some of which can be found at the NEMSPA website, www.nesmpa.org
FARE (Foundation for Air Medical Research and Education) is now the MedEvac Foundation International. In addition to funding research that is very important for the air medical industry, they support families of crewmembers who have died in the line of duty and offer an educational scholarship for family members. If you have not donated to this cause, I urge you to consider doing so. A link to the foundation is available at the AAMS website, www.aams.org
Congratulations to Dan Hankins, MD, an AMPA founding member, who was just elected president of AAMS at AMTC.
All of us are probably tired of winter by this time. I know I am not enjoying the thoughts of cold, snow, and ice as I write this, but for many of us, winter is a large part of our year, whether we like it or not. Winter brings with it many challenges for those of us involved in air medicine and EMS. Increased numbers of requests because of the weather often result in conditions that make responses slower and, at times, require turndowns as a result of weather limitations. This can be a frustrating time for many.
As we suffer through the bad weather, let's all remember to keep safety in mind at all times. As medical directors we need not worry only about our patients, but our crews as well. I think it is important that we mind their mental health and their physical health. The bad weather, seasonal affective disorder, financial down times, and all the other stressors that exist can do a lot more harm to our crews than flu. We need to be very vigilant for changes in level of care, attitude, and activity in crewmembers that can be a clue that they are in trouble and need our help.
Don't forget that there are some important meetings coming up soon: NAEMSP in Phoenix, AZ, January 7–10; CCTMC in San Antonio, TX, April 12–14; and AMTC 2010 in Fort Lauderdale, FL, October 11–13. Start paying attention to information regarding AirMed 2011 in Brighton, England, too.
CCTMC in San Antonio will again feature AMPA's Critical Care Skills Day, with the assistance of VidaCare. Please pass the word around to your crews and colleagues. This is one of the best opportunities to practice life-saving procedures, including intraosseous access, chest tubes, central lines, surgical cricothyroidotomies, cut downs, and what ever else we can squeeze into our lab time. Everyone who has attended in the past has thoroughly enjoyed it—don't let this opportunity pass.
Remember, AMPA is the association comprising 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 need to finish with a sad ending. It is with great sorrow that I heard of the death of Gerhard Kugler, the founder of European HEMS and Air Ambulance Committee and a huge advocate of air medical transport. He will be remembered for his commitment to safe medical transport and, ultimately, better patient care.
Jack B. Davidoff, President