Investigative reporter delivers diagnosis

Investigative reporter delivers diagnosis

Viewpoint Investigative Reporter Delivers Diagnosis The following speech was deliver ed by Andrew Schneider, medica l editor for the Pittsbu rgh Pres...

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Investigative Reporter Delivers Diagnosis The following speech was deliver ed by Andrew Schneider, medica l editor for the Pittsbu rgh Press, at the annual Awards Lunche on at the ASHBE AMS Conference held Dciober 14, 1987.

I usually avoid speakin g about a project until it is over, until everyth ing has been publish ed. But in return for ASHBEAMS' agreem ent to help us gather the researc h and data that we needed, I had to agree to come and speak here. When 1 made that agreem ent, we assume d we were looking at three or four months of learnin g what we needed to know and writing the story. We are now eleven months into it, and we still don't know everyth ing we need to know. We're still workin g on it. We did get a lot of coopera tion and we appreci ate it, and we need more. All but one of the 231 program s we surveye d respond ed with the informa tion. Ail but one of the vendors agreed to be interviewed at length and discuss their perspective of the industr y _. how it works and the problem s. All but one of the manufa cturers were willing to discuss at great depth their percept ion of the safety problem s, the equipm ent issues, the things that they deal with. Many of you in this room spent hundre ds of hours with me and my colleagues, teachin g US what we needed to know, helping us underst and what your problem s truly are. After surveyi ng the 230 program s, visiting about 60 of them, and flying more than 250 missions, we came up with one overwh elming conclusion that probably the vendor s and the hospita l admini strators are not going to like to heal'. And that conclusion is that just about everyon e in this room is horribly underpaid! And we think someth ing should be done about it. But all joking aside, we did find some shortco mings out there. We went to hospita ls and program s and found beautifully worded weathe r minimu m policies, strongl y endorse d by the admini strator, the program director, the lead pilot. But sometim es later that very day, we saw aircraft from those very same program s, launchi ng in the fog or snow so heavy that you couldn' t see the skids 30 feet above the pad. We were lectured on how closely program s work with their compet ing program s to ensure safety. But later the

same day, we'd see that same program accept three flights when a program only 4 miles away with identical equipm ent declined it because they though t the weathe r was unsafe. Admini strators insisted they never pressur ed pilots to take mission, that the final decision was always with them. But we were on a flight 15 miles away from the base when the pilot ran into sloppy weathe r and wanted to abort, and reporte d back to medical comma nd and a shrill voice came over the earphon es saying, "How can you do this? If you don't go, the baby will die." We met mechanics who treated their aircraft with more care and love than they probabl y show their wives or girlfriends · who work for long hours trying to track down that one weird noise or an unexpe cted vibration. But we also found cases where records were falsified and daily inspect ions require d by airworthines:l directiv es weren't done. We found lots of tired pilots, hut we found lots of other people tired at three o'clock in the mornin g. We saw program s with four pilots workin g 12 hour shifts where the RNs and the parame dics were workin g 24 hour shifts. Much has been said about what fatigue does to pilots. 1 think someon e should look at the quality of medical care being given on the floor of that helicop ter by flight crews at the end of those 24 hour periods. We were Iectured by medical directo rs that their aircraft w~s.a~ integra l part of their CQmmunltles emerge ncy medical care system and

they worked hand in glove. But later that same afterno on, we bypassed three hospitals that could offer more approp riate treatme nt and had ~eople available, so we could fly the patient back to the sponso ring hospital. We found lots of problems. I don't think I have to belabor them because you deal with them everyday. You know what they are. You're profess ionals in your field. We tell you that we do P,ut it into perspective. In one of our stones earlier this month, we wrote: "With all the shortco mings, the pittsbur gh Press found that a vast majorit y of the program s operate safely, and are staffed by dedicated and highly trained Crews that save thousan ds oflives a year." We believe it; we say it in many of our stories. Let me give you an opinion. The biggest enemy of ~erom.edical " .. evacuation is not 60 Mmutes, It s not "20/20," it's not me and my.wor k for the Pittsburgh Press or Scnp~s/ Howard, it's not even a certam U.S. senator who, when the TV cam~ras arc rolling, likes to compar e the acciden t rate of med-ev ac helicoptc~s to that of commercial jets. I truly believe your biggest enemy is yourself1 . Four years ago I was teUmg my friends in your profess ion t~at they had better start letting the public know exactly what it is that yOU do, how you do it and why you do it. You have a , great story to tell.and yOU truly haven t been telling it. It IS someth mg yo~ should have been talking about since the time you turned your first rotor. You are very lucky. You've got Howard Collett and Jim p~ge putting (Jut great magazines that diSCUSS at great length what you do. You've got your own outstan ding journal which address es import ant issues. But these are trade publica tions. These arc profess ional journal s wri:ten by profess ionals for profess ionals. But the public doesn't get to see the issues ; they aren't exposed to them. They should he. Almost every hospita l out there is very good at publish ing slick, multicolor quarter ly newsle tters but as a rule the public doesn't see these either. And it is the public that must clearly unders tand what you're to do if you are to have its support . To those hospita l public relation s people that might be in the room, I gi\'l' you my apologies. YOU 'Tl' probab ly not

Andrew Schneider :::

HOSPITAL AVIATION. NOVEMBER 1987 1 1

Viewpoint going to like what I say. There are some significant exceptions, but as a rule, hospital public relations people should not be handling the routine daily relationships between the media and the flight programs themselves. And I'll take that a step further, public service programs should have people on their flight staff dealing with the press, the military M.A.S.T. units should have people on their flight staff dealing with the press. I say this because most public relations people, while very skillful at keeping embarrassing statements from appearing, truly don't understand what you do, because they are usually not

right through them." In Virginia, I was given this critical information by a hospital spokesperson, "He was probably dead when they loaded him on the helicopter, but one of the nurses electrocuted him while the other one poured gas or something down his throat." But by far the most disturbing comment that I've heard from hospital P.R. types from allover the country is, "Our helicopter saves hundreds oflives." My apologies to Agusta, Bell, MBB, Aerospatiale, Sikorsky, and the rest of the manufacturers, but my partner and I have flown on more than 250 missions this year. Yes, we were sped to the scene

risks involved. There will be crashes. You could put ten pilots on each aircraft. You can install full IFR on everything with a rotor. You can fly only when the sun is shining very brightly. You can paint the helicopters pink. You can do anything you want to make it safe, but with 231 programs flying more than 442 helicopters everyday of the year, you're going to lose some, no matter how cautious you are, or what you do and I think that is a fact of aviation. For days after those crashes, it will be allover the front pages of your local newspapers and lead every newscast on radio and television stations. Nothing you can do will prevent the coverage of the crash or diminish the pain and loss , that will be felt by many. But what you do before the crash will help keep it in perspective. The public has got to understand the benefits in perspective to the risks. It is not only the public that needs to understand your mission and your problems. The government needs help also. There is an amazing lack of knowledge specific to your industry in the Federal government, in the people that are developing recommendations "iii and regulations. In the last year, I've ~ ?nly been able to find a handful people CD In the FAA and the NTSB who really ~ understand the Med-Evac mission. Max ~ Haliburton, who is in this room does .Q important rotorcraft things for the ~ FAA. Bob Dodd from the NTSB who is it doing this one person investigation and Andrew Schneider fliesaboard a BK-l17 withflightnurses from Ufe Flight busting his fanny on it, spends the time. . p'ttsburgh PA. The flight was one of more than 250 made nationwide. Dr. John Lauber, a b~ard l?ember of In I , NTSB, has been fightmg air ambulance quickly in a helicopter, but if that issues for years. These three people given the time and unfortunately some don't have the interest to learn what machine saved a single life, we missed understand. They've taken the time to you do. If you can somehow get people it. talk to you, they've visited your from your program to be the We saw lots of people saving lives. We programs, they've spent hours with you. spokespersons to the media and to the saw mechanics who cared enough to They've partied with you. But there are public, I have a feeling that life would make it work. We saw dispatchers who very few of them. There are other issues being be a hell of a lot easier for you. Let me got involved in the right direction and give you a couple of the examples of sorted out the emotional gobbledy-gook considered that go beyond the some of the statements made to me in coming from the field. We saw pilots upcoming words of David Kress in the the last ten months by P.R. people we who got us there and back quickly and Advisory Circular that we are all encountered around the country. safely, often landing in LZs that were waiti~g for. There arc other factors now just criss-crossed with wires that a bird entering the picture, and a lot of those In Michigan, a press spokesman told me, "Our helicopter can fly in the couldn't fly through. We saw medical factors don't deal solely with aviation heaviest ice storm because the blades on teams who knew what they were doing, issues. There are strong rumors that top spin so fast that they knock all the did it when they got there, and gave suggest that HHS [Health and Human ice ofT." that patient every chance to survive. Services] is going to recommend or Helicopters did not save the lives -demand some type of system where In Northern California I heard, "We have no problem flying in fog because people did. Too many hospital public Med-Evac programs are either we have this big sunlight on the bottom relations people and administrators accredited or certified by a joint and it can cut through anything." rush to give the credit to the shiny commission type body. Rumors from In Ohio, a public relations person two-million dollar aircraft sitting on the people within the agency indicate that told me, "We don't have to worry about pad and not the people it carries. the leverage on this may in fact be some hitting wires. We have the biggest The public has got to understand type of spinofT from Medicare what you do and why you do it and the reimbursements, not from helicopter made and it can just crash

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12 HOSPITAL AVIATION, NOVEMBER 1987

What Pat Walker doesn't know just saved her life. This reconditioned Sikorsk y S-76 EMS is roughly the same price as a much smaller, less capable helicopter. But you'd never know it. Sikorsky's S-7() is the best EMS helicopter in the world, a flying emergency room with space for a medical team of four and a patient. Modular design permits any EMS configuration to be set up quickly, from Trauma to Neonatal to organ transplant missions. Built originally for rugged offshore oil duty, the S-76 has a 400-mile range. And when it really matters, it can really move, Ask Pat Walker. A number of previously owned S-7()s arc available now, each completely reconditioned tor EMS lise, at about half the original cost. For information, please tclcphone Mackie n Mott at (203) 3HI-(115o.

~

UN ITED

TECHNOLOGIES

KORSKY

A RCRAFT

Viewpoint reimbursement on the Medicare patients you fly but some kind of tie into the hospitals. Whether it ever succeeds or not remains to be seen, but I assure you that there at least two groups who are spending a lot time looking at it. If you choose not to set yourself up as the accreditation group for your Industry, please don't complain when someone else less qualified gets the responsibility. The medical area is going to get much more attention in the coming year, and not just from the government. The seven million dollar lawsuit in Knoxville that alleges that a seventeen year old boy died because he was taken by an aircraft to an inappropriate sponsoring hospital is just the beginning. I know personally of four other similar cases around the country that lawyers are getting ready to me. I know of six other cases where lawyers have investigators gathering other information. I am worried that you of the medical area have got to start protecting yourself. Ifyour area or your community doesn't have a strong triage guideline, you may find yourself listed on that lawsuit. You may find yourself

caught in the middle. I think you've got to pay some attention to what your liability is in your community. You've come of age. In the beginning of this year, we couldn't get through a week without a newscast discussing your industry and usually veJY critically and sometimes with a negative slant. Now you can't get through a night without having your real estate company telling us how dedicated flight nurses are and why they make good customers for their houses. You've got "Dallas" showing the world how you saved a bum victim and you've got Buck Jones, trauma surgeon, climbing out on the skids of his helicopter 300 feet above the ground to assess a couple of patients clinging to a steel beam. You've become part of the mainstream now. You've made it to prime time entertainment. I would wOfJY about what is going to happen if your clients start demanding you do what Dr. Jones does because I think we're really going to have some problems then. I am going to share with you some views that you have shared with me. And at this point, I would like to

STATEMENT OF OWNERSHIP, MANAGEMENT AND CIRCULATION (Required by 39 U.S.C. 3685) 1A. Title of Publication: HOSPITAL AVIATION; 18. Publication Number:0740-8315; 2. Dateof Filing: December 1, 1987; 3. Frequency of Issue: Monthly;4. Complete mailing address of known office of publication: 90 EastFirst South, Suite 103, St. George, UT 84nO; 5. Complete mailing address of the headquarters of generalbusinessoffices of the publisher: Sameas #4; 6. Full namesand complete mailing addressof publisher,editor and managing editor: Aviation Press, Inc. 90 East First SouthSuite 103, St. George, UT 84nO; Howard M. Collett, Editor,90 EastFirst South Suite 103,St. George, UT84770; 7: Owner: Aviation Press, Inc., 90 EastFirstSouth Suite 103,S1. George, UT 84nO; Stockholders owning or holding 1 percentor more of total amount of stock of Aviation Press, Inc. are: HowardM. Collett, 90 EastFirst South Suite 103, St. George, UT 84no; 8. Known bondholders, mortgageesand othersecurityholdersowning or holding 1 percent or more of total amountof bonds, mortgagesor other securities: None.

10. Elden\ lind natura 01clrculallon

Awraga Number Coplet Each lnua Durtng Preceding 12 month,

A. Total numbarolcopl.. (nelpr_ run) 1409 B. Paldand!Ofrequested clrculatlon: 1. Sal.. lhtough daale.. lInd carrie.., 0 IIr... vendors and counter aaJat . 2. Mail lubscrtpllonl 727 C. Tclal paid and!Ofreqlletted Circulation 7ZT O. F_ dlltrtMon by mall. carrieror other means eamplet, compllmentaty lind other frae COP/Oil ~ E. Total dlltribullon 1326 F. Copies not dlalribuled: 1.0111<:41 u",lall owr, u~nted,lpolled 83 alIerprinling 2. Retum from news agents 0 G.Total (Sum of E, Fl lind 2l 1409

Aclual Number Copl.. Single ISlue PubUlhed Nearest 10 FlIIng Cata

2000

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11.I certify that the statements made by me above are correctand complete. Signature and title of publisher.HowardM. Collett

14 HOSPITAL AVIATION. NOVEMBER 1987

remind that I was asked to come here and share with you some things that we didn't publish. Three o'clock in the morning is a great time to do interviews. The administrators aren't there. The chief flight nurses and the lead pilots are rarely there. Everyone is so wired on coffee and 50 tired that they will just talk. I had lots of late night discussions in some of these ready rooms. And one of the things that quickly become apparent is that there is a lot of discord in this industry of yours. Some civilian groups bad-mouth the public service sector. Some pilots strongly denounce the nurses. Some nurses strongly denounce the pilots. The only thing everybody denounces equally is the hospital food. There a lot of people out there who have strong opinions and concerns. ASHBEAMS is criticized by some of its own members as being ungodly slow on taking a stand on anything, and thought by some to be obsessed primarily with the interests of hospital administrators and vendors. NEMSPA is perceived by many to be overzealous in its approach and concerned only with

EXECUTIVE DIRECTOR A neWly formed consortium of three major medical centers in St. Louis, Missouri has purchased the M.A.R.C. program of 81. Louis University Medical Center. The new program, ARCH, will operate three helicopters as a region-wide resource in eastern Missouri and western Illinois serving morethan 225 hospitals and EMS agencies. ARCH is currently seeking an executive director. Candidates should have solid administrative experience in operations and financial management of a helicopter program. Medical training a plus, but not necessary. Send resume with clear salary history to:

BOARD OF DIRECTORS ARCH 8401 Hanley Industrial Court 51. LOUis, MO 63144

Viewpoint the issue of fatigue and not necessarily speaking for all the pilots. There is a feeling out there that it can no longer be a question of ASHBEAMS talking to the pilots. There is a feeling out there that pilots and their concerns and inputs must be a full and equal part of this group just as flight nurses, the paramedics, and the physicians must be. There is also concern that doctors must take a more active role not only in what they do in their own backyard but in perhaps developing guidelines that could be instituted throughout their state and perhaps even nationally. There is an amazing amount of dedicated talent in your ranks. There are brilliant ideas being instituted and implemented by some programs and just across town where they could desperately use the same thing, they don't know about it. I don't think you people are talking to each other enough. If you are talking, I don't think you are listening. You have got lots of the answers out there. You have got to develop a forum where this information is going to get to where it is needed. I believe that political bickering and back-stabbing

has got to end. ASHBEAMS has served a vital function during the formative years of this profession. Great work was done and is still being done. But it is 1987 and things are changing. You are in the spotlight and you're going to be for a while. You are considering changing the name of ASHBEAMS to the Society of Air Medical Services or whatever you hopefully decide. I think that's great because half of the people in this room can't tell you what ASHBEAMS means, let alone the public. But that change is just not enough. I think now is the time for you to do more. You've got to begin working together to really communicate with each other, to share your problems, to share your solutions, to speak with a loud, clear, single voice because that is the only way you can control what happens to your profession. If you do not control your profession, your industry, there are outside factions that will eagerly jump in to do it. You have got to take a more active role in deciding your fate. Decisions are being made that will affect your profession and your future. You've got to get

Chief flight Nurse J Head Nurse The successful ca ndid ate will be responsible for the management of 28 flight nurses and flight par amedics. Responsibilities will include mt ervrewing/hiring, scheduling, QA, traming/educanon, performance evaluation, program development and budget d eve lopment. AirMed provides critica l care, intrahospital and scen e transport serv ice through th e Intermountain West WIth 2 helicopters, 2 MU-2's and a Cessna, and nat ionwide tran sp ort wit h Lear Jets. Candidates wh o are con sid ered mu st meet the following requirements:Successful history of at least 4 years RN Critical care experience, a min imum of 1 year flight nurse experien ce, 1 year ER or field experience and current ACLS provider cert ificat ion , ATLS COurse comp letio n, APLS course completion, CEN or CCRN . Demonstrated skills in leadership, teach ing. couns ehng or cornmurucations requ ired . BSN or equ ivalent education and experience, (those in a posit ion wh o do not have a BSN would be required to obtain such with in 4 years ), and current licen se to practice as an RN in the State of Utah required . MSN and previous management experience pr eferred. The Universit y Hospital is a progressive 370· bed teaching an d referrant center for the Intermountain West. We are located at the foot of the Wasatch Mountains which offer year-round outdoor activities and some of the best snow ski ing available. Interested candidates please send resume to: Nancy J, Grabowski, RN, MBA, Chief Flight Nurse, AirMed Adult Transport, University of Utah Hospital, 50 North Medical Drive, Salt Lake City, UT 84132. Telephone toll- free 1-800662-0062 Ext 2999. Eq ual O ppoe tu nuy Em ployer

involved in guiding these decisions. I want to close with a quote that we ended one of our stories with on Sunday and it is from Dr. John Lauber from the Safety Board. And John says, "We'll never be able to stop all accidents. Aviation doesn't work that way. But these Med-Evac helicopters and the people who staff them know what it is that is causing their accidents and problems. We have got to listen to them and give them the laws, regulations, and the support they must have so they can solve those problems that are solvable and save their own lives 50 they can get on with the business of saving the lives of others.• Andrew Schneider is the medical editor ofthe Pittsburgh Press, national correspondent with the Scripts-Howard news service serving 250 newspapers in this country. He is a two-time Pulitzer Award winner for his investigative reporting. He has worked very closely with the aeromedical industry, completing 2,000 interviews.in a ten-. month period. He has been inuolued zn EMS for 20 years beginning in Vietnam with medevac coverage.

EMS HELICOPTER PILOT Position available for full-time EMS helicopter pilot in northwestern U.S. with established multi-aircraft program. Must meet ASHBEAMS criteria and hold helicopter instrument rating. Please contact: T.J. Miller PO Box 11877 Spokane, WA 99211 509-535-9011

Advertiser Index Aerospatiale Helicopters 214-641-3613

ARCH EMS Helicopters 800-633-3818 Foxtronics 214-358-4425 MBB Helicopter Corporation 215-431-4150 Sikorsky Aircraft 203-381-6162 Tana Wire Markers 314-796-3812 University of Utah 800-662-0062 ext 2999

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