Forum

AMPA Taking it to the Next Level By the time you read this issue of the AMJ Forum, we will be well into 2008—a new year for all of us and for me, on the downhill portion of my term as AMPA’s president. I am always amazed how quickly time can pass in some instances and then with other’s, it seems to stand still. Our hospital recently instituted MEDITECH, one of the electronic medical record products that are out there. Our CMO made a comment: “Pulling a complex system from the 19th century—(yes, we skipped the 20th century entirely from an information technology standpoint)—to the 21st century has its challenges.” Wow—after spending about a month getting ready and then going “live” and witnessing numerous hurdles to get there, I would say having its “challenges” is an understatement. For me personally, after using MEDITECH for over a month now (at the time of this writing), I don’t think I could ever go back to the “old way” of using paper, handing it to someone to get processed, and then waiting for paper to return in order for me to make decisions. In fact, when the current system goes down for maintenance, and we have to temporarily go back to the “old way”, it seems so inefficient and archaic. I find myself asking—what took us so long? As I have mentioned in the past, I feel AMPA is “taking it to the next level” and moving forward in

strengthening our values and mission statement—to be the leaders in providing quality medical care to our patients. The Evidence Based Air Medical Practice Guidelines (EBAMPG) project, led by Reed Brozen, MD, is well on its way with many leaders interested and committed to a final product that should be of great use to all in the transport community. So far, a treatment guideline has been chosen as the initial Beta test by polling AMPA members and objectively using their opinions for where to start. This Beta test guideline will be developed after numerous AMPA members and fellow critical care transport professionals have objectively reviewed and assembled the evidence available, culminating in a final guideline that we can say is the best treatment possible for our patients in the environment we all work in. Reed has a timeline in place so that this initial Beta test guideline will be presented in April 2008 at the Critical Care Transport Conference in San Antonio. I truly believe that once this train leaves the station, it will be hard to stop it with the EBAMPG group anxious and energetic to provide guidelines that hopefully will impact the medical care we provide —the result being a product that all of us will ask ourselves—what took us so long? Michael W. Brunko, President

ASTNA The Year Ahead It is hard to believe another AMTC has come and gone. I’m not sure if the time flies so quickly because I’m getting older, or because multitasking never seems to stop. AMTC in Minneapolis will be here before we know it I’m extremely honored to have the opportunity to serve as the president of ASTNA for this next year, and would like to take this opportunity to introduce the 2007-2008 ASTNA Board of Directors. Sandy Correia, Michael Frakes, Kyle Madigan, Alex Markwell Cathy Spry, and Major Christopher Paige comprise our Directors-at-Large. President-Elect is Kevin High, and Jodie Hignite our Secretary/Treasurer. I want to thank immediate Past-President, Denise Treadwell for her strong leadership during this past term, and for the hard work she continues to do. Dr. Renee’ Holleran also completed her term on the Board and will be greatly missed. January-February 2008

Karen Wojdyla, ASTNA Executive Director and Nikole Hill, ASTNA Administrator should be commended for their dedication and tireless work at the National Office. Each year ASTNA honors individuals who have made a positive impact on transport nursing practice. The following nurses were recognized at the ASTNA membership meeting in Tampa. Allen Wolfe, RN, BSN, CFRN was presented with the Katz-Mason Award. This award recognizes the exceptional leadership of an individual who has made a positive impact to transport nursing on a global scale. Steven Neher, RN, BSN, CEN, CFRN, NREMT-P was presented the Jordan Award. This award recognizes significant contributions in the field of transport journalism. Steve’s name may sound familiar to many of you, as he’s been the Editor for ASTNA’s Wings, Wheels & Rotors newsletter since 23

2004. Finally, William Cyr, RN, BSN, CCRN, CFRN, NREMT-P was presented the ASTNA Ground Award. This award recognizes exceptional leadership of an individual who has had a positive impact on ground transport nursing on a global scale. When the calls for nominations come out next year, who will you nominate? Come on, We all know at least one person who would be deserving being nominated! Last year a detailed strategic plan was developed for ASTNA by Ms. Jackie Stocking. This plan has assisted the Board in setting short and long term goals to ensure our Association keeps moving in the right direction. Committed to our mission statement, “Advance the practice of transport nursing and enhance the quality of patient care”, this year will see the first revision of the Standards for Critical Care and Specialty Ground Transport. The standards for Rotor & fixed-wing will follow a short time later. The revised version of the Flight and Ground Nursing Core Curriculum, and the Competency Based Orientation Manual, are just a few of the ASTNA publications available for purchase through the National Office. ASTNA continues to support our Military nurses and commend them for their hard work and dedicated service to our country. ASTNA will continue to actively promote safety by actively participating in collaborative efforts with other organizations in the transport community. We support the Vision Zero initiative and the Air Medical Safety Advisory Council (AMSAC), endeavors to remove the barriers created by “competition” so that information related to safety issues are shared with all. Additionally, we have been involved in several industry initiatives and have made raising safety awareness among our members a priority. ASTNA was the first Association to develop a position paper, entitled “Transport Nurse Safety in the Transport Environment” that addresses Safety in the transport arena. Furthermore, ASTNA continues to support the Co-Operative Network Call for Emergency Regional Notification (CONCERN) Network, originally used as a mechanism to alert the air medical community of situations in which crewmembers had been injured or killed in helicopter or airplane crashes, but presently may be used to transmit information on a wide variety of situations even though no one was

injured or killed. In addition, ASTNA implemented the Hazard Awareness Reporting Program (HARP) on the ASTNA website to allow anonymous sharing of issues and concerns from which everyone could learn. I personally pose a challenge to each and every transport nurse: NOT to let competition or pressure from management, peers or customers allow you to make stupid decisions! Transport nurses make up the largest professional group committed to safe patient transport, and I challenge every one of you to speak up when you identify unsafe practice or attitudes. We owe that to our patients, their families and most importantly, to ourselves. Transport nursing is enhanced by collaborating with other nursing organizations, such as the Emergency Nurses Association, the Nursing Organizations Alliance, and National Teaching Institute & Critical Care Exposition sponsored by the AACN. ASTNA will continue to work closely with these and other nursing organizations. You may recall that ASTNA was working with ENA and AACN with the support of many other nursing organizations to develop procedural sedation and RSI consensus statements. ASTNA is now spearheading the effort to develop the RSI consensus statement in an effort to ensure acceptable national practice standards for nurses performing this procedure During this year as president I will continue to encourage all nurses in the transport environment to be come certified in our unique area of practice by taking the Certified Flight Registered Nurse (CFRN) or the Certified Transport Registered Nurse (CTRN) examinations. Validating your practice through certification is something we should all strive for. I also encourage you to attend a TNATC course. Many are offered in various locations throughout the year. Here are a few dates to pencil in: Critical Care Transport Nurses Day is recognized February 18th, 2008. ASTNA will be mailing out transport day posters in our year end mailing. The Critical Care Transport Medicine Conference (CCTMC) will be held in San Antonio, Texas March 31-April 2, 2008 and the Air Medical Transport Conference (AMTC), October 20-22, 2008 in Minneapolis Minnesota. Be Smart-Be safe! Karen Arndt, President

NEMSPA Am I Fit to Be Here? With the memory of AMTC 2007 still fresh on my mind, I go about my daily involvement in air medical aviation. AMTC can be and is an uplifting and renewing event. We return to our programs with a vigorous burst of energy to make ours the best program in the known universe.

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As we return it’s easy to spend long hours and a great deal of work to try and improve our service, get things cleaned up, fixed up and everyone retrained to make a difference. We seem to walk taller and easier as we go about our routines, and feel almost bullet proof. It’s easy

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during this time to forget about “us”, and just continue forward in a fast and furious manner. One thing we need to focus on is our need to take care of ourselves as well as our program. During times like these we are very susceptible to stress. In aviation, stress is a significant safety concern. Stress s everywhere and just waiting to crop up on us as we go about our business. What is stress? Stress is the condition that results when person-environment transactions lead the individual to perceive a discrepancy, whether real or not, between the demands of a situation and the resources of the person’s biological, psychological or social systems. In plain words we feel we don’t have what it takes to resolve the situation we are in. Stress has been a concern documented in the early 1900’s and classified many ways. During our training we learned that stress is classified as either Acute or Chronic. Chronic stress is stress that has been present for a long period of time and may manifest itself in many ways including physical or psychological disorders. Acute stress is of shorter duration, however can be equally as debilitating. The term ‘stress’ in this context was coined by an Australian-Canadian endocrinologist Hans Selye, who defined the General Adaptation Syndrome or GAS paradigm in 1936. This was the first time stress was given a physical component or seen as a disease process. All stress is not bad. Some of the feelings we gain from AMTC are stress related. We need a certain amount of stress to survive and without it we would cease to live. Stress can be physical, physiological or psychological, and either type can cause problems or either may be a good stressor. In addition to the stresses mentioned previously, some stresses are self imposed. These are the things we control. Drug use, Exhaustion, Alcohol use, Tobacco use and Hypoglycemia are all self imposed stressors. Stress can cause many symptoms both behavioral and physical. Behavioral symptoms can be irritability,

difficulty making decisions, loss of your sense of humor, suppressed anger, difficulty concentrating, not being able to complete tasks, feeling like a target for others, feeling unable to cope, feeling like crying, a general lack of enthusiasm or interest in doing things, feeling tired or exhausted, or being continually tired even after adequate rest. These can manifest in more dangerous activity as well such as depression, attempted suicide or violence. The physical symptoms include lack of appetite, craving comfort foods when under pressure, indigestion and heartburn, constipation and diarrhea, insomnia, sweating for no reason, twitching, nail biting, headaches, cramps or muscle spasms, nausea, breathlessness without exertion, fainting spells, impotency, frigidity or eczema. This is just a partial list of the manifestations seen with stress. You can readily see how these are contradictory to flying. I recently had the opportunity to take a stress level test, and I was surprised by the number of stressors present in my case. I don’t feel stressed normally and love working in the air medical arena. I recommend each of you take a similar test and know what your stress condition is. You need to identify stress before you can deal with it. Once we identify stress, what can we do about it? Obviously if it is good stress, keep it going. If it helps you to make positive changes, you’re probably better off by having the stress. If it isn’t good stress we need to get it under control. Controlling stress involves coping methods. Your company Employee Assistance Program is one means to help you cope. There are professionals that can help you with your needs, and help you to develop a coping mechanism. Sometimes it just takes someone to listen to make a difference. What ever it takes, make a positive step toward dealing with your stress. At least do your research on stress. Gary Sizemore, President

IAFP “It takes courage to challenge the basic views of a mainstream perspective in any profession or academic discipline.” –J. Steven Ott from “Understanding Organizational Culture” When I was elected to the IAFP Board of Directors in 2004, the organization was in a state of dynamic transition. Active efforts were being made to develop our Association into a business model and we continue to make great strides in that area. Paramedic leaders like Jon Gryniuk, Ron Walter, Gloria Dow, and Anthony Pellicone have all become heroes to me. I am also proud to call these individuals friends. I have big shoes to fill. Fortunately, as the new president I am not alone in carrying on the organizational change we have set forth for the IAFP. I have a whole cadre of individuals who sit on

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our board with a wealth of talent and intelligence. These are some of the most creative, motivated and terrific people I have ever had the honor to work with. Want to see who they are? Visit our website at www.flightparamedic.org. Arrange to get to know them personally. They are not only leaders in our Association but industry leaders as well. So where are we headed? What is our vision? Leadership The IAFP will continue to develop paramedics as leaders in their organizations and communities. In

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2006, we sponsored a leadership precon at AMTC. Dr. Kathy Gallo, RN PhD presented, “Developing Leaders from inside the Organization,” followed by a panel discussion with noted EMS and air medical leaders. This year at AMTC, Todd Hatley, CEO of Integral Performance Solutions presented “An Integral Approach to Leadership,” a very sophisticated model on leadership styles, personalities and organizational cultures. Again, the leadership session included a panel discussion with noted industry leaders. Feedback was terrific! We will continue to sponsor this leadership session and advocate for paramedics to be great leaders in the air medical community. In addition we will continue with board development. Strategic plans include board member education in areas of administration and leadership. Critical Care The IAFP represents both ground and air critical care paramedics. We are working with established organizations such as Creighton University to define exactly what a critical care paramedic is and does. The IAFP will have definitive knowledge of the roles our members play in their communities. We can better represent and “raise the bar” of what is expected of a critical care paramedic— whether they work on the ground, in the air or both. Organizational Growth Our membership numbers are at an all-time high. We expect continued growth especially with our State Chapter program and international members. At AMTC and recently at EMS Expo, I had the honor to meet State Delegates from all over our country. These are men and women who take an active role in their organizations and serve as state representatives of our organization. They have taken issues that concern us all—safety, legislative changes, reimbursement, industry changes and tackle them head-on. Look for more dynamic growth in this area.

I had the honor to meet IAFP members from Switzerland, Austria and Canada recently. The international folks face many of the same challenges we do, they also bring fresh perspective and ideas. What a great process for collaboration! Government and Legislative Affairs Committee (GLAC) Under the capable and innovative leadership of IAFP president-elect, Jim Riley, and GLAC chairman, Jim Reeves, the GLAC has taken an active role in political issues that impact paramedics. Working projects include the formation of an EMS caucus, partnerships with the National Association of EMTs and Advocates for EMS. The GLAC supports the AAMS initiative to include air and ground medical crews to be eligible for federal money through the Public Safety Officer Benefit. Military Liaison The IAFP salutes and supports those serving in our military! Board member, Cap. Frank Rella, USAF currently serves as our military liaison. We offer IAFP members who are actively deployed, free CE courses through CentreLearn. Call the IAFP office to learn more about this benefit. The IAFP is honored to support our troops and will continue to find additional ways to serve. The Future is Bright The above list just scratches the surface of some of the projects our Association is working on. I am proud to be a part of this organization. Friend and past president, Ron Walter, gave me some advice when I took office—“the organization moves fast—hang on and enjoy the ride!” Given the leadership and members of our Association, I expect and look forward to tremendous things from our group. Greg Winters

AAMS The Purpose of Life is a Life of Purpose When I submitted my last Air Medical Journal Forum submission as president of ASTNA in 1999, I certainly figured it would be signaling the end of an incredible ride of serving in a leadership role of an association in the critical care transport community. If I’d had my cards read back then and was told I’d be working in the corporate world and not as a flight nurse, be serving as an at-large board member with AAMS, and then as president, I’d ask for my money back and think they were looking at someone else’s future. Life has an interesting way of keeping us jumping and often hum-

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bled, because, here I am, writing for the AMJ Forum as the new president of AAMS. When AAMS restructured the board of directors in 2001, it gave an opportunity for diversifying the representation which was more aligned with the membership, and to bring the community together to work towards the many common initiatives we all share in the critical care transport arena. This actually meant several current board members lost their region and would have to run for an at-large position. If my memory serves me correctly, eight members ran for the first

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four at-large positions, the largest contested election for an AAMS board position in a long time. In the ensuing three elections since then, the slate has grown with the most recent one having a slate of 14 highly qualified candidates. In my humble opinion, seeing more names every year indicates the restructuring done six years ago has permitted a diverse board working hard to attain the vision of ensuring every person has access to quality air and ground medical transport. Please take a few minutes to visit the AAMS web site and learn more about the 2007-8 board of directors. We have representation from the aviation, clinical, operations, international, administrative, legal, associate and affiliate membership. It is a huge privilege to be working with such talented, professional and dedicated board members as well as the FARE board and AAMS staff. Tampa proved an ideal setting for this year’s AMTC. A lot of work goes on in the background to put on a conference of this magnitude. It is impossible to thank everyone by name, but a special call out goes to the generosity of our sponsors, the Contributing Sponsor associations, the AAMS staff, and the volunteers from the host programs who seemed to be everywhere when you needed help the most. At the time of this writing, with 2540 registered participants (just one shy of tying 2nd place Phoenix) and a sell-out 150 exhibiting companies, Tampa marked another banner AMTC. Be sure to mark your calendars for AMTC 2008 in Minneapolis, MN October 20–22nd. Don’t let the northern latitude worry you too much. Minneapolis is a beautiful city and most of downtown is connected by covered skywalks. The call for presentations and abstracts is currently open so go to the AAMS web site for details and the application. At the AAMS membership meeting, an open dialogue ensued sharing various concerns about the proposed dues increase, definition of a member and board structure changes that had been distributed prior to AMTC. Based on this valuable discussion, it was decided to form a Membership Task Force led by Ed Eroe which will be comprised of an equitable number of representatives from the various segments of the membership. A call went out with great response of volunteers for this important effort. A facilitator with extensive experience in organizational management will be brought in to work with the task force. This will be transparent in that communication of the process will be shared with the membership. When this AMJ hits your mailboxes, 2008 will be here. I like to take some time to reflect on the past and to dream and plan for the future. As many of you know, I left flight nursing in 2000 to test the waters in the corporate world. It has been quite a transition, not only in relation to the skill set, but in realizing something about the people who make up the transport community. How many of you are told how special you are to be working

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in this line of work? How often do you shrug your shoulders and simply say something like “It’s what I’m trained to do”? Whether you’re a Communication Specialist talking to a volunteer first responder desperately asking for help, the pilot and mechanic who carries the heavy responsibility of assuring a safe transport for the medical team and patient, the administrator who has the burden of difficult decisions revolving around fiduciary responsibility, or the medical team who’s decision making skills in the most difficult circumstances on a regular basis is almost unequaled, you are all serving a much greater good than many people ever will in a lifetime. I did not fully appreciate this until I left it. Now, I seek ways to fulfill that void in new ways, and have been very fortunate to have found some unique opportunities to do so. One of my favorite movies is called “Pay it Forward”. It’s a simple concept a young boy thought up as a school project. If one person performs an act of kindness for another person, then he figured that person would do the same for another, the chain would continue and the world would become a better place. Granted, it’s just Hollywood. But I try to live by that concept on a regular basis. In my opening paragraph, I shared how serving in the capacity of president of AAMS was something I never thought possible just a few years ago. By serving on the board, and now in a leadership role, one of my goals is to return the gift many of you have given; not only by your vote of confidence, but in the profession you have chosen to do so well. I encourage you to think about how you can get involved to give back to your community. Whether it is on the local or national level, volunteering is a great way to meet new people, mentor those just starting out, share your expertise to help guide the critical care transport community we are so passionate about. Best wishes for a safe and happy holiday season and for a Happy New Year! Sandy Kincade

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