- Email: [email protected]
What's SAFE Look Like?
Safety Matters
Ed MacDonald
What’s SAFE Look Like? Several years ago, when I was chairman of the Air Medical Safety Advisory Council, I asked what seemed to be a relatively simple question, “If we are striving for SAFE, what does it look like?” That seemed to be a simple enough query in a room full of Part 135 director of operations, chief pilots, program directors, safety managers, maintenance managers, pilots, nurses, paramedics, communications specialists, and Federal Aviation Administration (FAA) representatives. SAFE is one of those words that we throw around cavalierly, yet to actually define that “simple” concept proved to be a little more elusive than it appeared at first glance. What I was looking for was something a bit more specific than “accident free” or “safety is job one!” I had seen more than 1 air medical program that touted their lack of accidents as their badge of safety yet experience a tragic accident that sobered up that view the hard way. The Air Medical Safety Advisory Council, formed in 2001 by Part 135 air medical operators as a response to high air ambulance accident rates in the air medical community, was essentially a group of those actually responsible for the operational control and safety in the helicopter air medical industry. All of the professional organizations were actively involved in the organization as well. We attempted to get air medical operators to come up with recommended practices and solutions to major safety issues free of local financial and/or competitive pressures. These recommended practices that were developed over the next several years were significant in that they had a positive effect on air ambulance safety and were adopted in one form or other by accreditation agencies such as the Commission on Accreditation of Air Medical Systems and/or the FAA. The lack of competitive pressures allowed this group to be unbiased and effective in the process of improving safety in our community. After several years and numerous recommended practices that truly made a difference, we disbanded the group as the FAA, and other organizations became more forceful and effective in their oversight of the community. The result of my earlier question about “What’s SAFE look like” culminated in the following consensus. Many of us could add or subtract from this list, but it is a good start for any safety program. I thought it might be helpful to new and established air medical programs alike:
Safety Program Basics Any safety program is as effective as the culture within that organization. A strong safety culture is most affected by the organizational mission and core values and must be fully supported at every level of management, from the top down. Free-flowing 2-way communications are critical to any safety program’s sucJanuary-February 2015
cess. It is recommended that a safety program at any base or higher level consist of at least the following components: 1. An active safety management system a. A dynamic and valued safety committee consisting of all program disciplines and/or functional area representatives b. A designated safety officer who also can lead the safety committee and be the eyes and ears of the chief executive officer or program director. This individual should be able to access all functional areas of the program, be able to report objectively and honestly to the program director, and be able to insure accountability and follow-up. c. Each individual in a program must understand that he or she is individually responsible for safely performing their own duties and insuring others are accountable as well. 2. Managers and supervisors must insure accountability at all levels. Written policies and procedures that insure compliance with Commission on Accreditation of Air Medical Systems accreditation standards for operations, flight following, crew rest, and all safety-related standards at a minimum. 3. Close adherence to recommended practices and national guidelines for Air Medical Safety from the FAA, general operations and maintenance manual, advisory circulars, HBATs, OSHA, NFPA, Air Medical Safety Advisory Council–recommended practices, and those from national professional organizations (eg, Helicopter Association International (HAI), National EMS Pilots Association (NEMSPA), Association of Air Medical Systems (AAMS), Air and Surface Transport Nurses Association (ASTNA), International Flight Paramedics Association (IFPA), National Association of Air Medical Communications Specialists (NAACS), Air Medical Physicians Association (AMPA). 4. Safety enhancement programs should be in place such as the following: a. Internal and external safety audits b. Safety incentive program c. Wellness programs d. Drug and alcohol screening e. Timely and relevant safety training to include the following: 1. Air medical resource management training 2. Rotor wing or fixed wing safety as appropriate 3. Landing zone and/or prehospital safety training 4. Mission-oriented pilot and crew training 5. Survival training 21
The hard work and competition-free dialogue that resulted in this consensus document would serve programs well today. What continues to surface is that a very few new or unenlightened managers and programs give mere lip service to “SAFE” and have “safety programs” in name only. A just and robust safety culture is essential. The drive to increase flight volume frequently leads managers to fix the perceived problem by turning up the pressure to fly under the guise of “accountability” rather than recognizing other key business factors such as a saturated market or poor customer service skills. Pressuring the pilot and crewmembers seems an easy fix but is a great big hole in the Swiss cheese. We learned this lesson over the last 30 or so years—let us not have to learn it again the hard way. Ed MacDonald is an EMS pilot for San Antonio Air Life, past president of the Air Medical Safety Advisory Council, past president of the National EMS Pilots Association, past co-chair of the AAMS Safety Committee, and a major in the US Army Medical Service Corps, retired. He can be reached at [email protected]. 1067-9991X/$36.00 Copyright 2015 by Air Medical Journal Associates http://dx.doi.org/10.1016/j.amj.2014.10.004
22
Air Medical Journal 34:1
Ed MacDonald
What’s SAFE Look Like? Several years ago, when I was chairman of the Air Medical Safety Advisory Council, I asked what seemed to be a relatively simple question, “If we are striving for SAFE, what does it look like?” That seemed to be a simple enough query in a room full of Part 135 director of operations, chief pilots, program directors, safety managers, maintenance managers, pilots, nurses, paramedics, communications specialists, and Federal Aviation Administration (FAA) representatives. SAFE is one of those words that we throw around cavalierly, yet to actually define that “simple” concept proved to be a little more elusive than it appeared at first glance. What I was looking for was something a bit more specific than “accident free” or “safety is job one!” I had seen more than 1 air medical program that touted their lack of accidents as their badge of safety yet experience a tragic accident that sobered up that view the hard way. The Air Medical Safety Advisory Council, formed in 2001 by Part 135 air medical operators as a response to high air ambulance accident rates in the air medical community, was essentially a group of those actually responsible for the operational control and safety in the helicopter air medical industry. All of the professional organizations were actively involved in the organization as well. We attempted to get air medical operators to come up with recommended practices and solutions to major safety issues free of local financial and/or competitive pressures. These recommended practices that were developed over the next several years were significant in that they had a positive effect on air ambulance safety and were adopted in one form or other by accreditation agencies such as the Commission on Accreditation of Air Medical Systems and/or the FAA. The lack of competitive pressures allowed this group to be unbiased and effective in the process of improving safety in our community. After several years and numerous recommended practices that truly made a difference, we disbanded the group as the FAA, and other organizations became more forceful and effective in their oversight of the community. The result of my earlier question about “What’s SAFE look like” culminated in the following consensus. Many of us could add or subtract from this list, but it is a good start for any safety program. I thought it might be helpful to new and established air medical programs alike:
Safety Program Basics Any safety program is as effective as the culture within that organization. A strong safety culture is most affected by the organizational mission and core values and must be fully supported at every level of management, from the top down. Free-flowing 2-way communications are critical to any safety program’s sucJanuary-February 2015
cess. It is recommended that a safety program at any base or higher level consist of at least the following components: 1. An active safety management system a. A dynamic and valued safety committee consisting of all program disciplines and/or functional area representatives b. A designated safety officer who also can lead the safety committee and be the eyes and ears of the chief executive officer or program director. This individual should be able to access all functional areas of the program, be able to report objectively and honestly to the program director, and be able to insure accountability and follow-up. c. Each individual in a program must understand that he or she is individually responsible for safely performing their own duties and insuring others are accountable as well. 2. Managers and supervisors must insure accountability at all levels. Written policies and procedures that insure compliance with Commission on Accreditation of Air Medical Systems accreditation standards for operations, flight following, crew rest, and all safety-related standards at a minimum. 3. Close adherence to recommended practices and national guidelines for Air Medical Safety from the FAA, general operations and maintenance manual, advisory circulars, HBATs, OSHA, NFPA, Air Medical Safety Advisory Council–recommended practices, and those from national professional organizations (eg, Helicopter Association International (HAI), National EMS Pilots Association (NEMSPA), Association of Air Medical Systems (AAMS), Air and Surface Transport Nurses Association (ASTNA), International Flight Paramedics Association (IFPA), National Association of Air Medical Communications Specialists (NAACS), Air Medical Physicians Association (AMPA). 4. Safety enhancement programs should be in place such as the following: a. Internal and external safety audits b. Safety incentive program c. Wellness programs d. Drug and alcohol screening e. Timely and relevant safety training to include the following: 1. Air medical resource management training 2. Rotor wing or fixed wing safety as appropriate 3. Landing zone and/or prehospital safety training 4. Mission-oriented pilot and crew training 5. Survival training 21
The hard work and competition-free dialogue that resulted in this consensus document would serve programs well today. What continues to surface is that a very few new or unenlightened managers and programs give mere lip service to “SAFE” and have “safety programs” in name only. A just and robust safety culture is essential. The drive to increase flight volume frequently leads managers to fix the perceived problem by turning up the pressure to fly under the guise of “accountability” rather than recognizing other key business factors such as a saturated market or poor customer service skills. Pressuring the pilot and crewmembers seems an easy fix but is a great big hole in the Swiss cheese. We learned this lesson over the last 30 or so years—let us not have to learn it again the hard way. Ed MacDonald is an EMS pilot for San Antonio Air Life, past president of the Air Medical Safety Advisory Council, past president of the National EMS Pilots Association, past co-chair of the AAMS Safety Committee, and a major in the US Army Medical Service Corps, retired. He can be reached at [email protected]. 1067-9991X/$36.00 Copyright 2015 by Air Medical Journal Associates http://dx.doi.org/10.1016/j.amj.2014.10.004
22
Air Medical Journal 34:1