- Email: [email protected]
NFNA Conference
ASHBEAMS/NFNA Conference The Third Annum ASHBEAMS (American Society of Hospital-Based Emergency Air Medical Services) Conference was held in conjunction with the Second Annual NFNA (National Flight Nurses Conference in Jacksonville, Florida early in December. Several events took place during the three day session. Two are reported in this issue - the addresses by the outgoing president of each organization. Other ASHBEAMS/NFNA happenings will be reported in future issues.
Joe Tye President
ASHBEAMS 1982 marks two very important ten-year anniversaries. The first is the issuance ten years ago by the U.S Department of Transportation a report of their study of 8 experimental helicopter medevactype programs. In their report, they concluded the only way it was feasible to use a helicopter for medical evacuation purposes was to combine it with other public service functions like traffic patrol, chasing criminals, fire fighting...whatever helicopters can be used for. Also ten years ago, an experiment started at St. Anthony Hospital in Denver where they trained critical care nurses and stationed a helicopter at the hospital 24 hours a day, dedicated strictly to emergency medical functions. As we know, that particular model has been very successful and it's the basis for the whole ASHBEAMS experience. The success of this model is reflected by the profile of hospital4 HOSPITALAVIATION,DECEMBER1982
based helicopters today, which at last count included 41 programs meeting the recommended minimum quality standards of ASHBEAMS, with 47 helicopters in 24 states transporting about 30,000 patients a year. I believe the future of the helicopter as an integral component of the health care delivery system is quite good. There are many revolutionary new developments occurring in medical science, which will result in increasing regionaiization of health care delivery in this country. Physicians are now able to transplant major organs and organ systems such as bone marrow, liver, pancreas, and heart and lung. Last week, history was made when the first artificial heart was transplanted into a human patient. New, highly sophisticated technology such as nuclear magnetic resonance and positron emission tomography will allow physicians to more accurately diagnose complex diseases. As a result of recent research with patients who have suffered serious head injuries, (which is the leading cause of death in fatal automobile accidents), an increasing number of patients with serious brain injuries are returning to normal, productive lives. ii
i
i
II
i
i
rain
"Despite the bright future, I think there a r e a number o[ challenges that n e e d to be a d d r e s s e d by ASHBEAMS over the next several years. "~ in
For the most part, these health care services as well as many others currently under research will be performed in major medical centers. This will require an increasing ability to transport patients between levels of care. Many of these patients will be seriously ill or injured, and for many the appropriate method of transport will be hospital-based helicopters with critical care nurse staffing aboard. Despite the bright future, I think there are a number of challenges that need to be addressed by ASHBEAMS over the next several
years. Probably the most important is that of financial feasibility for these services. In the past, cost based reimbursement by many third party payors has allowed hospitals to take services that were not profitable, such as a helicopter, but still were socially worth-while, and provide a subsidy for those by including them in their overall cost base. Recent federal budget cuts, plus changes in the financing mechanism that are doing away with cost-base reimbursement and substituting types of prospective fixed reimbursement will increasingly place pressure on hospitals that have services that do not support themselves. The helicopter is probably the most noteable example. In order to make these services self-supporting, ASHBEAMS and others are going to have to work very hard to get third-party insurors to recognize the full cost of these services in establishing their benefit packages. In addition, in order to do this, we're going to have to document the cost and clinical effectiveness of these services through research. A second challenge is that as the cost of these services increases, and as we try to improve the quality by getting bigger helicopters or twinengine helicopters, and as we try to improve access by taking services out into unserved rural areas that really don't have the volume to justify them (if you look at it strictly in cost accounting basis). we have to develop more costeffective methods of operating. We have to look at shared services, we have to look at the regionalization of support services. We have to look at greater hospital responsibility for the operation of services. All of these things are now underway at various hospitals around the country. I think ASHBEAMS can do a great deal to support and facilitate that on a national basis. A third problem that I think we need to address is the potential for development of numerous competing helicopter services within a given region. I feel very strongly that this is inappropriate for two reasons. The first is cost.
Helicopter services have about a 75% rate of fixed cost, and there is also a fixed number of genuine emergencies in a region. As such, the cost per patient transport is very highly dependent on a number of patients that are being transported. If you take a fixed number of emergencies, and you have to spread a much higher fixed cost base over those, the cost per patient is much higher. This was documented in the ASHBEAMS financial profile of its own membership done in 1980 which shows a 50% cost differential between programs that fly more than or less than 500 patients per year, on the basis of cost per patient. I also believe that, if a program has a low utilization rate because competing services are taking patients away, quality is likely to suffer. Flight nurses need to practice their skills continually in genuine, bonafide emergencies in order to be proficient. Pilots need to fly enough hours in order to be safe pilots. I think we need to continue in the promulgation of our recommended minimum quality standards to make sure that all hospital-based programs in the country are of high quality. We also may want to consider development of site visit programs by ASHBEAMS to help programs upgrade their services to meet our recommended minimum quality standards. Another issue, which I think ASHBEAMS will need to come to grips with in the near future is that of safety. There have been a ~number of serious incidents over the last couple of years. Every time something happens it is very :alarming, regardless of whether ~statistically we fall well within a range of acceptable safety ~,according to helicopter industry ;~tandards. We need to make sure ~that the safety aspects of our xecommended minimum quality standards are adhered to by all ~9rograms. We also need to consider establishment within our Organization some sort of safety monitoring system. A final thing that I think may become a problem is that of crew burnout - nurse burnout, dispatcher burnout - there have
been a number of articles in the literature. We have relatively new services - nobody really yet knows what the effect of being a flight nurse or an emergency dispatcher over a long period of time will be. I think it's worthwhile that we have had sessions on stress management for flight nurses and for dispatchers at both this and the past ASHBEAMS conferences, and that's something I think we need to be aware of. In closing, in order to address all of these problems, I would like to
urge all of you to participate in the ASHBEAMS committee structure. One of the things that has been frustrating in the past year is tha t many of our committees have been committees of one, with the chairperson having to do a tremendous amount of work. I would like to see more participation from the grass roots in those committees because that is where the work and the responsibility for the progress of ASHBEAMS over the next two years will lie. •
WE'RE NOT THE BIGGEST JUST THE BEST.
St. Louis Hehcooter Airways. inc
St. Louis Helicopter Airways, Inc. is ready to offer your hospital a c o m p l e t e hospital based helicopter transport package. We can tailor a total program to match your hospital's requirements. Let us put our eleven (11) year accident - free nationwide operating history to work for you. CONTACT: P.O.Box 134"/, (800) 325-4046
St. Louis Helicopter Airways, Inc. MarylandHeights,Missouri63043 (314)872-g330 HOSPITALAVIATION,DECEMBER1982 5
Jean Mason, R,N, President National Flight Nurse's Association I have learned so much through my association with the National Flight Nurse's Association. I have grown not only professionally but personally. I feel the same holds true for the National Flight Nurse's Association. We have learned so much and matured a great deal over the past year. I am very proud of our accomplishments. We began developing the organization with o u r primary objectives in conjunction with ASHBEAMS. These objectives are to promote the highest level of quality patient care for emergency air medical services, to be accomplished by developing minimum standards of care, providing continuing education for flight personnel, and by sharing flight nursing knowledge. As a young organization, we knew where we were headed, and it was just very frightening taking those first few steps moving toward those objectives. Just as I have grown, so have we as a national organization. I would like to summarize the progress we have made over the past year. We are now incorporated as a national organization. This incorporation process happened with the assistance of Marcia Katz at Saint Joseph Hospital in Omaha, Nebraska. Our educational committee under the direction of Maggie Tole has been 6
HOSPITALAVIATION, DECEMBER 1982
developing a modular program for training of flight personnel. This core curriculum should assist all programs in continuing education of their flight crews. Davette Shea from the Flight for Life program in Las Vegas has been compiling a list of current literature useful for flight crews which appears in each issue of Flight News. The committee has also worked very closely with Jane Miller, the Chairperson for the ASHBEAMS Standards and Clinical Practice Committee. Their assistance has helped Jane in developing the minimum standards of care of both organizations. Our publication committee, the work of John Jordan, editor of the flight news - and the publication committee speaks for itself in each issue of Flight News - have continued to develop the clinical emphasis of the newsletter. They have developed themes for each issue. The themes include not only clinical articles, but a review of pertinent literature, an equipment section, program descriptions, committee reports of our organization, educational opportunities, and an updated ASHBEAMS information section. They have increased the issues from 4 to 6 issues per year, and are upgrading the newsletter into an 8-page magazine as of January, 1983. The title of our magazine will be Flight Nurse, the Journal of
Aeromedical Transport. At our first national meeting, we had 100 members, and have grown to a membership of 293 during this first year. We have a representation from programs all across the country. We have divided our membership into 4 regions - Rocky Mountain West, Midwest, Southern, and Eastern regions. We have a fairly equal representation in each region. Our members include registered nurses, paramedics, EMT's, dispatchers, and respiratory therapists. We also have military medical personnel involved in our organization. The variety of expertise involved in the National Flight Nurse's Association offers excellent opportunities for all of us to share and exchange ideas and knowledge. The liaison committee for the National Flight Nurse's Association - their major goal in
our first year has been to establish and maintain a liaison with new and existing programs. Each program across the country differs in so many ways. It has been hard to know who might have similar experiences, equipment, aircraft, etc. Ford Kyes from the Pittsburgh Life Flight program, and Bill Swanson from the Hermann Hospital Life Flight program have developed a basic data collection instrument. With the help of flight nurses and data processing from Allegheny General Hospital, a program has been written so that this data can be analyzed. This list enables the National Flight Nurse's Association to answer the numerous inquiries that we have, such as which programs use paramedic/nurse staffing. A computer report can be quickly and easily generated to give programs this information. The committee has also been involved in strengthing our relationship with other organizations, such as EDNA and AACN. We are now working toward recognition and special interest groups to these organizations, and hope to participate in conferences around the country, offering topics regarding flight programs. The Flight Nurse's Association has worked closely with the planning and program committee under the direction of Jim Akers and Jim LaGrua. We appreciate their hard work and are certainly anxious to participate in all their activities of the week. We truly have come a long way this past year. As a young organization, we've experienced a few growing pains. But I'm proud of our progress and I'm also proud of the strong relationship we've developed in our association with ASHBEAMS. As each organization learns more about each other, we learn the importance of a strong bond between the two organizations. As the National Flight Nurse's Association moves forward into 1983, we incorporate into planning of our organization educational activities, research, and strengthening our relationship with ASHBEAMS and other organizations. •
The Lighter Side What has three Hawkeyes, two hot lips, and one klinger? Lest anyone misjudge this riddle, I hasten to provide the answer: The First Annual M*A*S*H Banquet at ASHBEAMS. The adjective first must be emphasized, as secret plans are already underway for the second annual banquet in Denver next year. The following pictures show no hawkeyes (I think they retired to the "swamp," and both "hot lips Houlihans" threatened video difficulties if I printed their picture. Klinger finally received his "Section 8" and was not available for comment. However, filling in was a chorus line of the "Flight Nurse Singers," and the evening's only casualty awaiting airlift out the following day. The banquet was a sM*A*S*Hing success.
Who's Who for '83 ASHBEAMS OFFICERS President VP/Pres Elect Sec'y/Treasurer
Karl Gills (Des Moines) Nina Merrill, R.N. (Long Beach) Ann Darling (Oklahoma City)
ASHBEAMS COMMITTEES Membership Planning Communications Research Standards & Clinical Practice Finance & Reimbursement Program Medical Advisor
Marguerite Badger (Houston) (vacant) Jeff Pepper (Kansas City) Bill Baxt, M.D. (San Diego) Pat Yancy, R.N. (Toledo) Jim Smith (Danville PA) Dan Reich (Denver) Henry Bock, M.D. (Indianapolis)
NFNA OFFICERS President VP/Pres Elect Secretary Treasurer/Membership Coordinator
Marcia Katz, R.N. (Omaha) Roy Evans, R.N. (Long Beach) Mary Hagney, R.N. (Denver) Susan Herron, R.N. (Tulsa)
NFNA BOARD Ann Goscko, R.N. (Denver) Bill Swanson, R.N. (Houston) Marty Bennett, R.N. (San Diego) Bonnie Longino, R.N. (Jacksonville)
When 300 people crowded into t h e M~A~S*H m e s s tent, something fractured. It was Cindy Hensleigh's foot. The chief Flight nurse from Nightingale in Norfolk, VA was treated by Hawkeye Pierce and B.J. Honeycutt of the 4077th.
The "Flight N u r s e Singers" from Jacksonville's Life Flight p r o g r a m entertained a t the M-A-S-H banquet. HOSPITAL AVIATION, DECEMBER 1982
7
Joe Tye President
ASHBEAMS 1982 marks two very important ten-year anniversaries. The first is the issuance ten years ago by the U.S Department of Transportation a report of their study of 8 experimental helicopter medevactype programs. In their report, they concluded the only way it was feasible to use a helicopter for medical evacuation purposes was to combine it with other public service functions like traffic patrol, chasing criminals, fire fighting...whatever helicopters can be used for. Also ten years ago, an experiment started at St. Anthony Hospital in Denver where they trained critical care nurses and stationed a helicopter at the hospital 24 hours a day, dedicated strictly to emergency medical functions. As we know, that particular model has been very successful and it's the basis for the whole ASHBEAMS experience. The success of this model is reflected by the profile of hospital4 HOSPITALAVIATION,DECEMBER1982
based helicopters today, which at last count included 41 programs meeting the recommended minimum quality standards of ASHBEAMS, with 47 helicopters in 24 states transporting about 30,000 patients a year. I believe the future of the helicopter as an integral component of the health care delivery system is quite good. There are many revolutionary new developments occurring in medical science, which will result in increasing regionaiization of health care delivery in this country. Physicians are now able to transplant major organs and organ systems such as bone marrow, liver, pancreas, and heart and lung. Last week, history was made when the first artificial heart was transplanted into a human patient. New, highly sophisticated technology such as nuclear magnetic resonance and positron emission tomography will allow physicians to more accurately diagnose complex diseases. As a result of recent research with patients who have suffered serious head injuries, (which is the leading cause of death in fatal automobile accidents), an increasing number of patients with serious brain injuries are returning to normal, productive lives. ii
i
i
II
i
i
rain
"Despite the bright future, I think there a r e a number o[ challenges that n e e d to be a d d r e s s e d by ASHBEAMS over the next several years. "~ in
For the most part, these health care services as well as many others currently under research will be performed in major medical centers. This will require an increasing ability to transport patients between levels of care. Many of these patients will be seriously ill or injured, and for many the appropriate method of transport will be hospital-based helicopters with critical care nurse staffing aboard. Despite the bright future, I think there are a number of challenges that need to be addressed by ASHBEAMS over the next several
years. Probably the most important is that of financial feasibility for these services. In the past, cost based reimbursement by many third party payors has allowed hospitals to take services that were not profitable, such as a helicopter, but still were socially worth-while, and provide a subsidy for those by including them in their overall cost base. Recent federal budget cuts, plus changes in the financing mechanism that are doing away with cost-base reimbursement and substituting types of prospective fixed reimbursement will increasingly place pressure on hospitals that have services that do not support themselves. The helicopter is probably the most noteable example. In order to make these services self-supporting, ASHBEAMS and others are going to have to work very hard to get third-party insurors to recognize the full cost of these services in establishing their benefit packages. In addition, in order to do this, we're going to have to document the cost and clinical effectiveness of these services through research. A second challenge is that as the cost of these services increases, and as we try to improve the quality by getting bigger helicopters or twinengine helicopters, and as we try to improve access by taking services out into unserved rural areas that really don't have the volume to justify them (if you look at it strictly in cost accounting basis). we have to develop more costeffective methods of operating. We have to look at shared services, we have to look at the regionalization of support services. We have to look at greater hospital responsibility for the operation of services. All of these things are now underway at various hospitals around the country. I think ASHBEAMS can do a great deal to support and facilitate that on a national basis. A third problem that I think we need to address is the potential for development of numerous competing helicopter services within a given region. I feel very strongly that this is inappropriate for two reasons. The first is cost.
Helicopter services have about a 75% rate of fixed cost, and there is also a fixed number of genuine emergencies in a region. As such, the cost per patient transport is very highly dependent on a number of patients that are being transported. If you take a fixed number of emergencies, and you have to spread a much higher fixed cost base over those, the cost per patient is much higher. This was documented in the ASHBEAMS financial profile of its own membership done in 1980 which shows a 50% cost differential between programs that fly more than or less than 500 patients per year, on the basis of cost per patient. I also believe that, if a program has a low utilization rate because competing services are taking patients away, quality is likely to suffer. Flight nurses need to practice their skills continually in genuine, bonafide emergencies in order to be proficient. Pilots need to fly enough hours in order to be safe pilots. I think we need to continue in the promulgation of our recommended minimum quality standards to make sure that all hospital-based programs in the country are of high quality. We also may want to consider development of site visit programs by ASHBEAMS to help programs upgrade their services to meet our recommended minimum quality standards. Another issue, which I think ASHBEAMS will need to come to grips with in the near future is that of safety. There have been a ~number of serious incidents over the last couple of years. Every time something happens it is very :alarming, regardless of whether ~statistically we fall well within a range of acceptable safety ~,according to helicopter industry ;~tandards. We need to make sure ~that the safety aspects of our xecommended minimum quality standards are adhered to by all ~9rograms. We also need to consider establishment within our Organization some sort of safety monitoring system. A final thing that I think may become a problem is that of crew burnout - nurse burnout, dispatcher burnout - there have
been a number of articles in the literature. We have relatively new services - nobody really yet knows what the effect of being a flight nurse or an emergency dispatcher over a long period of time will be. I think it's worthwhile that we have had sessions on stress management for flight nurses and for dispatchers at both this and the past ASHBEAMS conferences, and that's something I think we need to be aware of. In closing, in order to address all of these problems, I would like to
urge all of you to participate in the ASHBEAMS committee structure. One of the things that has been frustrating in the past year is tha t many of our committees have been committees of one, with the chairperson having to do a tremendous amount of work. I would like to see more participation from the grass roots in those committees because that is where the work and the responsibility for the progress of ASHBEAMS over the next two years will lie. •
WE'RE NOT THE BIGGEST JUST THE BEST.
St. Louis Hehcooter Airways. inc
St. Louis Helicopter Airways, Inc. is ready to offer your hospital a c o m p l e t e hospital based helicopter transport package. We can tailor a total program to match your hospital's requirements. Let us put our eleven (11) year accident - free nationwide operating history to work for you. CONTACT: P.O.Box 134"/, (800) 325-4046
St. Louis Helicopter Airways, Inc. MarylandHeights,Missouri63043 (314)872-g330 HOSPITALAVIATION,DECEMBER1982 5
Jean Mason, R,N, President National Flight Nurse's Association I have learned so much through my association with the National Flight Nurse's Association. I have grown not only professionally but personally. I feel the same holds true for the National Flight Nurse's Association. We have learned so much and matured a great deal over the past year. I am very proud of our accomplishments. We began developing the organization with o u r primary objectives in conjunction with ASHBEAMS. These objectives are to promote the highest level of quality patient care for emergency air medical services, to be accomplished by developing minimum standards of care, providing continuing education for flight personnel, and by sharing flight nursing knowledge. As a young organization, we knew where we were headed, and it was just very frightening taking those first few steps moving toward those objectives. Just as I have grown, so have we as a national organization. I would like to summarize the progress we have made over the past year. We are now incorporated as a national organization. This incorporation process happened with the assistance of Marcia Katz at Saint Joseph Hospital in Omaha, Nebraska. Our educational committee under the direction of Maggie Tole has been 6
HOSPITALAVIATION, DECEMBER 1982
developing a modular program for training of flight personnel. This core curriculum should assist all programs in continuing education of their flight crews. Davette Shea from the Flight for Life program in Las Vegas has been compiling a list of current literature useful for flight crews which appears in each issue of Flight News. The committee has also worked very closely with Jane Miller, the Chairperson for the ASHBEAMS Standards and Clinical Practice Committee. Their assistance has helped Jane in developing the minimum standards of care of both organizations. Our publication committee, the work of John Jordan, editor of the flight news - and the publication committee speaks for itself in each issue of Flight News - have continued to develop the clinical emphasis of the newsletter. They have developed themes for each issue. The themes include not only clinical articles, but a review of pertinent literature, an equipment section, program descriptions, committee reports of our organization, educational opportunities, and an updated ASHBEAMS information section. They have increased the issues from 4 to 6 issues per year, and are upgrading the newsletter into an 8-page magazine as of January, 1983. The title of our magazine will be Flight Nurse, the Journal of
Aeromedical Transport. At our first national meeting, we had 100 members, and have grown to a membership of 293 during this first year. We have a representation from programs all across the country. We have divided our membership into 4 regions - Rocky Mountain West, Midwest, Southern, and Eastern regions. We have a fairly equal representation in each region. Our members include registered nurses, paramedics, EMT's, dispatchers, and respiratory therapists. We also have military medical personnel involved in our organization. The variety of expertise involved in the National Flight Nurse's Association offers excellent opportunities for all of us to share and exchange ideas and knowledge. The liaison committee for the National Flight Nurse's Association - their major goal in
our first year has been to establish and maintain a liaison with new and existing programs. Each program across the country differs in so many ways. It has been hard to know who might have similar experiences, equipment, aircraft, etc. Ford Kyes from the Pittsburgh Life Flight program, and Bill Swanson from the Hermann Hospital Life Flight program have developed a basic data collection instrument. With the help of flight nurses and data processing from Allegheny General Hospital, a program has been written so that this data can be analyzed. This list enables the National Flight Nurse's Association to answer the numerous inquiries that we have, such as which programs use paramedic/nurse staffing. A computer report can be quickly and easily generated to give programs this information. The committee has also been involved in strengthing our relationship with other organizations, such as EDNA and AACN. We are now working toward recognition and special interest groups to these organizations, and hope to participate in conferences around the country, offering topics regarding flight programs. The Flight Nurse's Association has worked closely with the planning and program committee under the direction of Jim Akers and Jim LaGrua. We appreciate their hard work and are certainly anxious to participate in all their activities of the week. We truly have come a long way this past year. As a young organization, we've experienced a few growing pains. But I'm proud of our progress and I'm also proud of the strong relationship we've developed in our association with ASHBEAMS. As each organization learns more about each other, we learn the importance of a strong bond between the two organizations. As the National Flight Nurse's Association moves forward into 1983, we incorporate into planning of our organization educational activities, research, and strengthening our relationship with ASHBEAMS and other organizations. •
The Lighter Side What has three Hawkeyes, two hot lips, and one klinger? Lest anyone misjudge this riddle, I hasten to provide the answer: The First Annual M*A*S*H Banquet at ASHBEAMS. The adjective first must be emphasized, as secret plans are already underway for the second annual banquet in Denver next year. The following pictures show no hawkeyes (I think they retired to the "swamp," and both "hot lips Houlihans" threatened video difficulties if I printed their picture. Klinger finally received his "Section 8" and was not available for comment. However, filling in was a chorus line of the "Flight Nurse Singers," and the evening's only casualty awaiting airlift out the following day. The banquet was a sM*A*S*Hing success.
Who's Who for '83 ASHBEAMS OFFICERS President VP/Pres Elect Sec'y/Treasurer
Karl Gills (Des Moines) Nina Merrill, R.N. (Long Beach) Ann Darling (Oklahoma City)
ASHBEAMS COMMITTEES Membership Planning Communications Research Standards & Clinical Practice Finance & Reimbursement Program Medical Advisor
Marguerite Badger (Houston) (vacant) Jeff Pepper (Kansas City) Bill Baxt, M.D. (San Diego) Pat Yancy, R.N. (Toledo) Jim Smith (Danville PA) Dan Reich (Denver) Henry Bock, M.D. (Indianapolis)
NFNA OFFICERS President VP/Pres Elect Secretary Treasurer/Membership Coordinator
Marcia Katz, R.N. (Omaha) Roy Evans, R.N. (Long Beach) Mary Hagney, R.N. (Denver) Susan Herron, R.N. (Tulsa)
NFNA BOARD Ann Goscko, R.N. (Denver) Bill Swanson, R.N. (Houston) Marty Bennett, R.N. (San Diego) Bonnie Longino, R.N. (Jacksonville)
When 300 people crowded into t h e M~A~S*H m e s s tent, something fractured. It was Cindy Hensleigh's foot. The chief Flight nurse from Nightingale in Norfolk, VA was treated by Hawkeye Pierce and B.J. Honeycutt of the 4077th.
The "Flight N u r s e Singers" from Jacksonville's Life Flight p r o g r a m entertained a t the M-A-S-H banquet. HOSPITAL AVIATION, DECEMBER 1982
7