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IAFP Momentum Over the past few months we have witnessed the tragic loss of life and property in Haiti after the initial earthquake and the effects of the subsequent aftershocks. The initial outpouring of support and the willingness to help were worldwide, from the individual responder to the USAR teams who flew into the Dominican Republic to the Red Cross and governmentsponsored airlifts that made it directly to Haiti. During the initial response, the IAFP received calls from individuals who wanted to go and help. They were directed to the Red Cross and encouraged to contact their local DMAT or USAR group. While we mourned the loss of life and celebrated the too few who were saved in the days and weeks that followed, the energy has seemed to wane now that time gone on. Many individuals went there with good intentions, but without the support and structure of an organized response, these freelancers ended up using valuable resources that were meant for the victims of the tragedy. Each individual within our profession has something to offer that will improve our system. Individually, we can make a difference, but we need to be careful not to be that freelancer who takes up time and energy that can be better spent as a team. As with any event or project that requires long-term assistance, it can be challenging to keep up the momentum, support, and energy. We see how hard it is to play catchup after tragedy strikes. Preplanning and preparation for the worst case scenario prepares us for almost anything thrown at us. It is not uncommon for those of us in the air medical and critical care transport industry to step up in times of crisis and do what is necessary to accomplish our goals or help a complete stranger. I ask that we take the same enthusiasm in the time of crisis and direct that energy inward toward our profession and safety. Last
year during the NTSB hearings, there was industry-wide energy and initiative. We cannot afford to let that wane or turn into a second thought. The IAFP just completed a survey and report on our membership regarding safety, operations, and the attitude that comes down from management regarding a safety culture. The results will be released soon, but I will say they are not what we expected. I applaud NEMSPA for keeping the momentum going from the No Pressure Initiative to their meetings this January, at which the IAFP was an active participant. Keep the energy alive. Look back at where we have been and where you want to go in the future. The IAFP continues to support and be an active participant in multiple safety initiatives. We recently appointed a new board member who comes from the ground critical care transport profession. The primary area of responsibility is to champion the paramedic in the ground critical care transport arena. The scope of practice between air and ground critical care paramedics should meet the needs of the patient; the mode of transport should not dictate the level of care. Our decision to add this position was in the planning stage for months and was implemented through a preplanned process. The IAFP has represented paramedics in the air and on the ground for years. As time has passed and the needs of our membership have changed and expanded, the IAFP has adapted to meet those needs. This position would not have developed if it were not for the input and ideas of our membership. Thank you for all of your hard work and assistance in bringing ideas to the board and your work on projects that will keep the IAFP in the forefront of critical care transport medicine, safety, and professional development of the critical care paramedic. Jason Hums, President
NEMSPA The Right Direction One of my favorite stories comes from Stephen R. Covey’s Seven Habits of Highly Effective People, in which he describes a road-building crew working their way
March-April 2010
through a dense jungle in some faraway place. As this crew dutifully clears thick foliage and smoothes the ground, someone in the group climbs one of the tall
73
trees ahead, looks around, and shouts down to the rest of his team, “Hey guys, we’re going the wrong direction!” The remaining workers immediately yell back in unison, “Shut up, we’re making great progress!” In January, as about 15 members of the air medical community met to discuss the next phase of the No Pressure Initiative, I was reminded of this story again and again. Why? I had gone into our meeting with preconceived notions of the kinds of pressures that a flight crewmember would likely encounter during the course of a duty shift. I walked away with a much broader perspective of the cultural issues that challenge our industry. The No Pressure Initiative retreat team was composed of an excellent cross-section of the air medical community, including representatives from AAMS, ASTNA, IAFP, NAACS, NEMSPA, AMOA, ACCT, HAI, and the FAA. Although AMPA was unable to provide a representative, Dr. Jack Davidoff expressed their full support for the endeavor. Also in attendance was Dr. Mark Rosekind, an expert in sleep and fatigue management, a nominee to the NTSB board of directors, and a great friend to NEMSPA and the air medical industry as a whole. The stated objective of the No Pressure Initiative, specifically of this phase of the project, is to “mitigate or eliminate pressure” that a flight team might be exposed to. The term pressure was defined as attempting to influence any member of a flight team to accept or continue a flight into potentially unsafe conditions. The group agreed that the Measure-Mitigate-Measure or 3M method would be the ideal approach to solving what is believed to be a significant safety issue. The intent, therefore, of the 3M method is to measure the cultural issues within individual programs that may impact pressure in a negative way, allowing those programs to make adjustments (through training, policy change, etc.) and then measure again to ascertain whether their mitigation techniques actually worked. The entire process will likely span nearly 18 to 24 months, possibly even longer. As you can imagine, the majority of our 1-day retreat was spent discussing the first “M” of the 3M method,
the measurement (survey) component. I should mention that the measurement tool will be a survey with a twist. In essence, individual programs will be able to compare their own cultural environment to that of the rest of the nation. That is, at the conclusion of the first measurement phase, participating programs will receive comparative data depicting their program’s cultural strengths and weaknesses in relation to the averages of all participating programs. Dr. Frank Thomas facilitated the majority of the discussion, where much of the time was spent brainstorming pressure-related issues into two major categories—flight crew and program level influences. Using the Hoshin Planning process, Dr. Thomas did an excellent job of keeping this very diverse and dynamic group on track, producing a lengthy list of cultural elements that may pressure crewmembers into accepting greater risk. The process concluded with a technique that established a preliminary weighting system for these elements, which were separated into 10 fairly well-defined groups identified with titles such as financial, external factors, and work environment. The group is continuing to work together to further prioritize the elements, with the objective of producing a question set that will identify and validate what now appear to be some of the most significant cultural issues facing the air medical industry. As I indicated in the beginning of this article, it was a tremendous educational experience for those involved to not only undergo the brainstorming and subsequent filtering process but also to see the numerous ways in which air medical flight teams may be subjected to pressure. I believe the entire group was pleased with the way the process unfolded and the results that were produced. I think that we’re all excited to see this initiative move forward and expect that the project will help improve cultural deficiencies within our industry. And, after spending a very productive day with this very esteemed group, I also believe that we’re going in the right direction through this forest. Kent Johnson, President
AAMS The Pillars of HEMS We have just passed the 40th anniversary of non-military HEMS in this country. The Maryland State Police started their program in 1969. Like many 40-year-olds, HEMS is going through a midlife crisis, in view of the external scrutiny and conflict, both internal and external. What do we need to do to overcome this crisis and mold the new and improved HEMS system of the future? We need to look at the pillars of our community and work together to rebuild and repair them. The 4 pillars are as follows: • Quality patient care
74
• Safety, from both an aviation and patient standpoint • Public safety/EMS system aspects • Financial stability Quality patient care has always been in the forefront of our culture. We are all about patient care. However, we need standardized levels of care across the whole US that are consistent from one state to another. EMT basics, paramedics (at both ALS and critical care levels), and critical care transport nurses all need to be equivalent at their care level from state to state. Right now,
Air Medical Journal 29:2
transport medical personnel at any level in one state may be completely different than the supposed same level in another state, as far as scope of practice and equipment to be used. This leads to crazy situations like an intervention or care mode being stopped or started at a state border in the middle of a bridge over a river because of differing state laws. Assessing quality of care means comparing apples to apples, not oranges. We cannot truly assess outcomes of patient care through large multicenter or multistate studies without equivalence of care from one state or region to another. One task, then, for the future is nationwide definitions of scope of practice for all levels of transport personnel, so that an ALS or critical care crew is the same no matter what state you happen to be in. Another crucial aspect of quality of care is the definition of what actually constitutes quality. Quality of care must be defined by physician oversight of the care rendered and the appropriateness of air or ground transport with the level of crew selected. National benchmarks must be devised to determine clearly what level of care is expected for a particular patient transport based on specific criteria. Evidence-based criteria arise from large studies that look at transport teams using consistent interventions from state to state. Safety must be everybody’s concern. This does not mean just aviation safety. This means ground ambulance safety, also. It means safe patient care with no sentinel events as a result of giving wrong medications, running out of oxygen during a transport, or not recognizing a misplaced airway. All of us must work to support such important safety projects as the No Pressure Initiative (as outlined by NEMSPA President Kent Johnson in the last issue of this journal), the revitalized Vision Zero and the AAMS Safety Management Training Academy in June (see link on www.aams.org). We also have to work together on moving forward with implementation of the NTSB recommendations to improve safety. Aviation safety is everybody’s concern. Risk management strategies involving both aviation and medical personnel that are consistent for every air and ground service should be developed and implemented. The public safety and EMS system aspects of transport services mean adequate coverage by different transport modes to ensure timely access to care for every ill or injured citizen. Medical systems for time-dependent emergencies are becoming increasingly centralized to large medical centers. The ability to get those patients to
the right destination in the right vehicle while being cared for by the right crew is a critical systems issue. States or regions need to develop these systems to ensure appropriate access to needed care in a timely fashion. State oversight of public safety aspects of medical care as it interfaces and conflicts with federal oversight of aviation has been a major contributor to our industry’s midlife crisis. Solutions to the conflict between these two important aspects of what we do must be sought and actively hammered out. If we don’t do this ourselves, then it may be done by parties outside of our industry in a way that none of us like and may result in a system that we would not envision in our own mind’s eye. The fourth pillar of our industry is financial stability. Financial stability is needed for system maintenance to ensure that appropriate transport with a well-trained crew is there when needed. A quality system requires adequate resources to maintain it. An important part of this system will be to fund critical care ground transport adequately. A large system of critical care ground transport cannot be maintained currently because of poor reimbursement. An adequate system of critical care ground transport would allow for quality transport of non-time-dependent patients in a more cost-effective manner. This would provide another tool in the EMS toolbox to transport patients who are too sick to go by ground ALS but not sick enough to warrant air transport. Our current reimbursement system is focused on paying for individual patient transports, not on maintenance of the air and ground transportation system. Healthcare reform will change medical reimbursement, but it is not clear how this will affect the out-of-hospital transport system. In the long run, a completely different mode of stable system financial support must be developed. The medical transport system should be funded for what it is: the third part of the public safety triad of law enforcement, fire departments, and EMS. Any vision for the future of ground and air transport has to include a more stable and rational funding model. To get our industry through this midlife crisis, all of the involved disciplines, whether medical or aviation, have to work together on improving and remodeling the four pillars of our industry. As Dr. Frank Thomas told me recently: “We are a community trying to deliver quality health care in a safe, cost-effective manner.” To accomplish this goal, we must strengthen and remodel our four pillars. Dan Hankins, President
AMPA Physicians Collaborate on Model Air Medical Transport System Hello again! Hope everyone is managing to get just enough sunshine to maintain their vitamin D levels. Several of us met in Phoenix in early January at
March-April 2010
NAEMSP and had some great discussions. This was a combined meeting of AMPA, NAEMSP, and ACEP physicians and members interested in air medicine and
75
a continuation of talks started in San Jose at the AMPA Task Force meeting. Everyone attending had an opportunity to speak. Many different thoughts and ideas were heard. It is clear that physicians need to maintain their ability to determine which patients need transportation and what mode of transportation will be best for that patient. Trying to determine transportation mode in the prehospital setting is a little more difficult, based on the variability and availability of services from one area to another, local and state recommendations, and levels of training and comfort. The goal we all have in mind is providing a simple method to determine this need that everyone can understand and use. Currently nicknamed the AMPANAEMSP-ACEP Initiative, drafts of a white paper outlining a model air medial transport system should be out soon, if not already by the time this Forum is published. I have to thank Doug Floccare, MD, for all the work he put into the meetings in Phoenix and for his efforts to bring all the physician groups together. As there are updates to this project, I will outline them in the AMJ Forum, AMPA newsletter, and the Task Force Google Group. Stay tuned for more. Education is the key to many of the issues that have been and will continue to be discussed. Education at all levels needs to be better. AMPA continues to follow its mission statement in that regard with Core Curriculum, Medical Directors Forum, continued support and participation in CCTMC and AMTC, and participation in the joint efforts with the other professional organizations involved in air medicine and EMS. Educating all physicians, whether medical directors or physicians, who use air medical transport for their patients is of utmost importance when dealing with interfacility transports. Educating physicians who work with EMS agencies and getting the correct messages to the ground providers who have the authority to determine mode of transport on scene calls is the other goal and probably more difficult. The AMPA board will continue to work towards providing what its members want. Education seems to be at the top of the list, with Core Curriculum and the Medical Directors Forum. Although the Forum was cancelled in San Jose, we are looking into the possibility of resuscitating it for AMTC in Fort Lauderdale later this year. I would certainly like to hear comments and suggestions from AMPA members or others regarding this.
Many of you showed an interest in medical director certification. AMPA is exploring this as a possible future project. NEMSPA held a meeting in Salt Lake City recently to continue work on their No Pressure Initiative. Unfortunately, it was the same week as NAEMSP’s conference, and I was unable to attend. This is a tremendous project for safety in our field, and I look forward to all of us hearing about the great work they are doing. Work continues on the AAMS Safety Scorecard as well, and I expect we will hear updates on this project soon. Remember that CCTMC is in San Antonio April 1214. This is the last time CCTMC will be in San Antonio for some time; if you have not experienced this tremendous educational opportunity before, you need to book your trip to San Antonio ASAP. If you have been to CCTMC before, you know it is not something you want to miss. The Critical Care Anatomy Procedural Skills Day will be Sunday, April 11, and is an opportunity to practice skills already known or learn skills that are absolutely mandatory for critical care providers in a setting that is rarely found elsewhere. Sign up at the AMPA website (www.ampa.org) before all the seats are gone. AMTC 2010 is not all that far off—October 11-13 in Fort Lauderdale, FL. Make sure those dates, along with the AMPA Pre-Conference on October 10, are in your calendar and travel plans. Whether or not you are an elected board member of AMPA, you are all invited to attend board meetings, always held the day before preconferences at CCTMC and AMTC. If you cannot attend but have questions or issues, please contact me or another board member to bring your information forward. Let’s all remember to promote safety as we provide quality care for our patient, thank you. The Air Medical Physician Association (AMPA) is committed to safe, efficacious, critical care transportation by promoting quality medical direction, research, education, leadership, and collaboration. Although AMPA does not endorse products or services, we do welcome and encourage all efforts that promote and facilitate research that results in the safest and most appropriate possible environment for air and ground medical transport. Our focus is to provide the best quality of care for patients requiring critical care transport. Jack B. Davidoff, President
ASTNA Getting it Right Every Time I would like to begin by encouraging you to attend the Critical Care Transport Medicine Conference (CCTMC) in San Antonio, Texas, from April 12 -14. The conference will be held once again at the Sheraton Gunther Hotel, just off
76
of the famous San Antonio Riverwalk. The CCTMC always provides current, cutting-edge topics pertinent to the transport profession, and this year’s schedule looks to build on that strong tradition. It is a great opportunity to catch
Air Medical Journal 29:2
up with former colleagues, participate in outstanding educational sessions, and relax and enjoy the wonderful Texas hospitality of San Antonio. I hope to see you there. In light of the devastating earthquake that occurred in Haiti, the air medical community has again surpassed my expectations with its response. I have heard from a number of transport nurses who are involved in some sort of disaster response, through either the numerous national DMAT teams or the innumerable charitable organizations providing relief efforts. Our profession and the air medical industry always impress me by our willingness to get involved no matter where or when the need arises. In accordance with ASTNA’s continued commitment to safety, we had the opportunity to participate in the recent No Pressure retreat sponsored by the National Emergency Medical Services Pilots Association (NEMSPA). We look forward to the recommendations brought forth from this multidisciplinary group as they work to improve the safety of our industry.
March-April 2010
Each and every one of you goes to work each day with a similar focus in your mind: to provide the best care possible for the patients you will encounter. Whether that is at the bedside or on the roadside, what matters is the quality of care you provide. I ask you now: do you have the same passion for safety? Do you focus on safety each and every time you board the vehicle that will take you to that patient’s side? Do you still focus as sharply on each and every step of the safety process with every transport you do? A fellow transport nurse once was describing how transport crews work when he said, “These are a group of people that have to get it right every time.” ASTNA has and will continue to keep safety as our top priority. Are you committed to safety? I challenge each and every one of you reading this message to focus on safety and renew your commitment. Let’s get it right, each and every time. Kyle Madigan, President
77
year during the NTSB hearings, there was industry-wide energy and initiative. We cannot afford to let that wane or turn into a second thought. The IAFP just completed a survey and report on our membership regarding safety, operations, and the attitude that comes down from management regarding a safety culture. The results will be released soon, but I will say they are not what we expected. I applaud NEMSPA for keeping the momentum going from the No Pressure Initiative to their meetings this January, at which the IAFP was an active participant. Keep the energy alive. Look back at where we have been and where you want to go in the future. The IAFP continues to support and be an active participant in multiple safety initiatives. We recently appointed a new board member who comes from the ground critical care transport profession. The primary area of responsibility is to champion the paramedic in the ground critical care transport arena. The scope of practice between air and ground critical care paramedics should meet the needs of the patient; the mode of transport should not dictate the level of care. Our decision to add this position was in the planning stage for months and was implemented through a preplanned process. The IAFP has represented paramedics in the air and on the ground for years. As time has passed and the needs of our membership have changed and expanded, the IAFP has adapted to meet those needs. This position would not have developed if it were not for the input and ideas of our membership. Thank you for all of your hard work and assistance in bringing ideas to the board and your work on projects that will keep the IAFP in the forefront of critical care transport medicine, safety, and professional development of the critical care paramedic. Jason Hums, President
NEMSPA The Right Direction One of my favorite stories comes from Stephen R. Covey’s Seven Habits of Highly Effective People, in which he describes a road-building crew working their way
March-April 2010
through a dense jungle in some faraway place. As this crew dutifully clears thick foliage and smoothes the ground, someone in the group climbs one of the tall
73
trees ahead, looks around, and shouts down to the rest of his team, “Hey guys, we’re going the wrong direction!” The remaining workers immediately yell back in unison, “Shut up, we’re making great progress!” In January, as about 15 members of the air medical community met to discuss the next phase of the No Pressure Initiative, I was reminded of this story again and again. Why? I had gone into our meeting with preconceived notions of the kinds of pressures that a flight crewmember would likely encounter during the course of a duty shift. I walked away with a much broader perspective of the cultural issues that challenge our industry. The No Pressure Initiative retreat team was composed of an excellent cross-section of the air medical community, including representatives from AAMS, ASTNA, IAFP, NAACS, NEMSPA, AMOA, ACCT, HAI, and the FAA. Although AMPA was unable to provide a representative, Dr. Jack Davidoff expressed their full support for the endeavor. Also in attendance was Dr. Mark Rosekind, an expert in sleep and fatigue management, a nominee to the NTSB board of directors, and a great friend to NEMSPA and the air medical industry as a whole. The stated objective of the No Pressure Initiative, specifically of this phase of the project, is to “mitigate or eliminate pressure” that a flight team might be exposed to. The term pressure was defined as attempting to influence any member of a flight team to accept or continue a flight into potentially unsafe conditions. The group agreed that the Measure-Mitigate-Measure or 3M method would be the ideal approach to solving what is believed to be a significant safety issue. The intent, therefore, of the 3M method is to measure the cultural issues within individual programs that may impact pressure in a negative way, allowing those programs to make adjustments (through training, policy change, etc.) and then measure again to ascertain whether their mitigation techniques actually worked. The entire process will likely span nearly 18 to 24 months, possibly even longer. As you can imagine, the majority of our 1-day retreat was spent discussing the first “M” of the 3M method,
the measurement (survey) component. I should mention that the measurement tool will be a survey with a twist. In essence, individual programs will be able to compare their own cultural environment to that of the rest of the nation. That is, at the conclusion of the first measurement phase, participating programs will receive comparative data depicting their program’s cultural strengths and weaknesses in relation to the averages of all participating programs. Dr. Frank Thomas facilitated the majority of the discussion, where much of the time was spent brainstorming pressure-related issues into two major categories—flight crew and program level influences. Using the Hoshin Planning process, Dr. Thomas did an excellent job of keeping this very diverse and dynamic group on track, producing a lengthy list of cultural elements that may pressure crewmembers into accepting greater risk. The process concluded with a technique that established a preliminary weighting system for these elements, which were separated into 10 fairly well-defined groups identified with titles such as financial, external factors, and work environment. The group is continuing to work together to further prioritize the elements, with the objective of producing a question set that will identify and validate what now appear to be some of the most significant cultural issues facing the air medical industry. As I indicated in the beginning of this article, it was a tremendous educational experience for those involved to not only undergo the brainstorming and subsequent filtering process but also to see the numerous ways in which air medical flight teams may be subjected to pressure. I believe the entire group was pleased with the way the process unfolded and the results that were produced. I think that we’re all excited to see this initiative move forward and expect that the project will help improve cultural deficiencies within our industry. And, after spending a very productive day with this very esteemed group, I also believe that we’re going in the right direction through this forest. Kent Johnson, President
AAMS The Pillars of HEMS We have just passed the 40th anniversary of non-military HEMS in this country. The Maryland State Police started their program in 1969. Like many 40-year-olds, HEMS is going through a midlife crisis, in view of the external scrutiny and conflict, both internal and external. What do we need to do to overcome this crisis and mold the new and improved HEMS system of the future? We need to look at the pillars of our community and work together to rebuild and repair them. The 4 pillars are as follows: • Quality patient care
74
• Safety, from both an aviation and patient standpoint • Public safety/EMS system aspects • Financial stability Quality patient care has always been in the forefront of our culture. We are all about patient care. However, we need standardized levels of care across the whole US that are consistent from one state to another. EMT basics, paramedics (at both ALS and critical care levels), and critical care transport nurses all need to be equivalent at their care level from state to state. Right now,
Air Medical Journal 29:2
transport medical personnel at any level in one state may be completely different than the supposed same level in another state, as far as scope of practice and equipment to be used. This leads to crazy situations like an intervention or care mode being stopped or started at a state border in the middle of a bridge over a river because of differing state laws. Assessing quality of care means comparing apples to apples, not oranges. We cannot truly assess outcomes of patient care through large multicenter or multistate studies without equivalence of care from one state or region to another. One task, then, for the future is nationwide definitions of scope of practice for all levels of transport personnel, so that an ALS or critical care crew is the same no matter what state you happen to be in. Another crucial aspect of quality of care is the definition of what actually constitutes quality. Quality of care must be defined by physician oversight of the care rendered and the appropriateness of air or ground transport with the level of crew selected. National benchmarks must be devised to determine clearly what level of care is expected for a particular patient transport based on specific criteria. Evidence-based criteria arise from large studies that look at transport teams using consistent interventions from state to state. Safety must be everybody’s concern. This does not mean just aviation safety. This means ground ambulance safety, also. It means safe patient care with no sentinel events as a result of giving wrong medications, running out of oxygen during a transport, or not recognizing a misplaced airway. All of us must work to support such important safety projects as the No Pressure Initiative (as outlined by NEMSPA President Kent Johnson in the last issue of this journal), the revitalized Vision Zero and the AAMS Safety Management Training Academy in June (see link on www.aams.org). We also have to work together on moving forward with implementation of the NTSB recommendations to improve safety. Aviation safety is everybody’s concern. Risk management strategies involving both aviation and medical personnel that are consistent for every air and ground service should be developed and implemented. The public safety and EMS system aspects of transport services mean adequate coverage by different transport modes to ensure timely access to care for every ill or injured citizen. Medical systems for time-dependent emergencies are becoming increasingly centralized to large medical centers. The ability to get those patients to
the right destination in the right vehicle while being cared for by the right crew is a critical systems issue. States or regions need to develop these systems to ensure appropriate access to needed care in a timely fashion. State oversight of public safety aspects of medical care as it interfaces and conflicts with federal oversight of aviation has been a major contributor to our industry’s midlife crisis. Solutions to the conflict between these two important aspects of what we do must be sought and actively hammered out. If we don’t do this ourselves, then it may be done by parties outside of our industry in a way that none of us like and may result in a system that we would not envision in our own mind’s eye. The fourth pillar of our industry is financial stability. Financial stability is needed for system maintenance to ensure that appropriate transport with a well-trained crew is there when needed. A quality system requires adequate resources to maintain it. An important part of this system will be to fund critical care ground transport adequately. A large system of critical care ground transport cannot be maintained currently because of poor reimbursement. An adequate system of critical care ground transport would allow for quality transport of non-time-dependent patients in a more cost-effective manner. This would provide another tool in the EMS toolbox to transport patients who are too sick to go by ground ALS but not sick enough to warrant air transport. Our current reimbursement system is focused on paying for individual patient transports, not on maintenance of the air and ground transportation system. Healthcare reform will change medical reimbursement, but it is not clear how this will affect the out-of-hospital transport system. In the long run, a completely different mode of stable system financial support must be developed. The medical transport system should be funded for what it is: the third part of the public safety triad of law enforcement, fire departments, and EMS. Any vision for the future of ground and air transport has to include a more stable and rational funding model. To get our industry through this midlife crisis, all of the involved disciplines, whether medical or aviation, have to work together on improving and remodeling the four pillars of our industry. As Dr. Frank Thomas told me recently: “We are a community trying to deliver quality health care in a safe, cost-effective manner.” To accomplish this goal, we must strengthen and remodel our four pillars. Dan Hankins, President
AMPA Physicians Collaborate on Model Air Medical Transport System Hello again! Hope everyone is managing to get just enough sunshine to maintain their vitamin D levels. Several of us met in Phoenix in early January at
March-April 2010
NAEMSP and had some great discussions. This was a combined meeting of AMPA, NAEMSP, and ACEP physicians and members interested in air medicine and
75
a continuation of talks started in San Jose at the AMPA Task Force meeting. Everyone attending had an opportunity to speak. Many different thoughts and ideas were heard. It is clear that physicians need to maintain their ability to determine which patients need transportation and what mode of transportation will be best for that patient. Trying to determine transportation mode in the prehospital setting is a little more difficult, based on the variability and availability of services from one area to another, local and state recommendations, and levels of training and comfort. The goal we all have in mind is providing a simple method to determine this need that everyone can understand and use. Currently nicknamed the AMPANAEMSP-ACEP Initiative, drafts of a white paper outlining a model air medial transport system should be out soon, if not already by the time this Forum is published. I have to thank Doug Floccare, MD, for all the work he put into the meetings in Phoenix and for his efforts to bring all the physician groups together. As there are updates to this project, I will outline them in the AMJ Forum, AMPA newsletter, and the Task Force Google Group. Stay tuned for more. Education is the key to many of the issues that have been and will continue to be discussed. Education at all levels needs to be better. AMPA continues to follow its mission statement in that regard with Core Curriculum, Medical Directors Forum, continued support and participation in CCTMC and AMTC, and participation in the joint efforts with the other professional organizations involved in air medicine and EMS. Educating all physicians, whether medical directors or physicians, who use air medical transport for their patients is of utmost importance when dealing with interfacility transports. Educating physicians who work with EMS agencies and getting the correct messages to the ground providers who have the authority to determine mode of transport on scene calls is the other goal and probably more difficult. The AMPA board will continue to work towards providing what its members want. Education seems to be at the top of the list, with Core Curriculum and the Medical Directors Forum. Although the Forum was cancelled in San Jose, we are looking into the possibility of resuscitating it for AMTC in Fort Lauderdale later this year. I would certainly like to hear comments and suggestions from AMPA members or others regarding this.
Many of you showed an interest in medical director certification. AMPA is exploring this as a possible future project. NEMSPA held a meeting in Salt Lake City recently to continue work on their No Pressure Initiative. Unfortunately, it was the same week as NAEMSP’s conference, and I was unable to attend. This is a tremendous project for safety in our field, and I look forward to all of us hearing about the great work they are doing. Work continues on the AAMS Safety Scorecard as well, and I expect we will hear updates on this project soon. Remember that CCTMC is in San Antonio April 1214. This is the last time CCTMC will be in San Antonio for some time; if you have not experienced this tremendous educational opportunity before, you need to book your trip to San Antonio ASAP. If you have been to CCTMC before, you know it is not something you want to miss. The Critical Care Anatomy Procedural Skills Day will be Sunday, April 11, and is an opportunity to practice skills already known or learn skills that are absolutely mandatory for critical care providers in a setting that is rarely found elsewhere. Sign up at the AMPA website (www.ampa.org) before all the seats are gone. AMTC 2010 is not all that far off—October 11-13 in Fort Lauderdale, FL. Make sure those dates, along with the AMPA Pre-Conference on October 10, are in your calendar and travel plans. Whether or not you are an elected board member of AMPA, you are all invited to attend board meetings, always held the day before preconferences at CCTMC and AMTC. If you cannot attend but have questions or issues, please contact me or another board member to bring your information forward. Let’s all remember to promote safety as we provide quality care for our patient, thank you. The Air Medical Physician Association (AMPA) is committed to safe, efficacious, critical care transportation by promoting quality medical direction, research, education, leadership, and collaboration. Although AMPA does not endorse products or services, we do welcome and encourage all efforts that promote and facilitate research that results in the safest and most appropriate possible environment for air and ground medical transport. Our focus is to provide the best quality of care for patients requiring critical care transport. Jack B. Davidoff, President
ASTNA Getting it Right Every Time I would like to begin by encouraging you to attend the Critical Care Transport Medicine Conference (CCTMC) in San Antonio, Texas, from April 12 -14. The conference will be held once again at the Sheraton Gunther Hotel, just off
76
of the famous San Antonio Riverwalk. The CCTMC always provides current, cutting-edge topics pertinent to the transport profession, and this year’s schedule looks to build on that strong tradition. It is a great opportunity to catch
Air Medical Journal 29:2
up with former colleagues, participate in outstanding educational sessions, and relax and enjoy the wonderful Texas hospitality of San Antonio. I hope to see you there. In light of the devastating earthquake that occurred in Haiti, the air medical community has again surpassed my expectations with its response. I have heard from a number of transport nurses who are involved in some sort of disaster response, through either the numerous national DMAT teams or the innumerable charitable organizations providing relief efforts. Our profession and the air medical industry always impress me by our willingness to get involved no matter where or when the need arises. In accordance with ASTNA’s continued commitment to safety, we had the opportunity to participate in the recent No Pressure retreat sponsored by the National Emergency Medical Services Pilots Association (NEMSPA). We look forward to the recommendations brought forth from this multidisciplinary group as they work to improve the safety of our industry.
March-April 2010
Each and every one of you goes to work each day with a similar focus in your mind: to provide the best care possible for the patients you will encounter. Whether that is at the bedside or on the roadside, what matters is the quality of care you provide. I ask you now: do you have the same passion for safety? Do you focus on safety each and every time you board the vehicle that will take you to that patient’s side? Do you still focus as sharply on each and every step of the safety process with every transport you do? A fellow transport nurse once was describing how transport crews work when he said, “These are a group of people that have to get it right every time.” ASTNA has and will continue to keep safety as our top priority. Are you committed to safety? I challenge each and every one of you reading this message to focus on safety and renew your commitment. Let’s get it right, each and every time. Kyle Madigan, President
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