- Email: [email protected]
The ostrich syndrome
GUEST
EDITORIAL
The Ostrich Syndrome By Lura Donnelly,
RN, MBA
Many of us have learned that ostriches bury their heads in the sand. In truth, when their enemies are near, ostriches stand with their necks outstretched on the ground. It is unknown whether the bird is attempting to escape detection by keeping the proverbial low profile, or trying to view its enemy against a lighter horizon. In any event, the result is the same. The ostrich’s rear makes a tempting target for the enemy. An air medical “ostrich” may be a clinician or an administrator who holds some degree of responsibility for the program, but who remains oblivious to the threats the industry is now facing. The ostrich also may be a pilot, a flight nurse, a mechanic, a paramedic, a physician or a communications specialist who thinks that individuals cannot make an impact on the long-term survival of their jobs, their programs or the industry. It can be anyone who believes that simply keeping a low profile and doing their job is enough to sustain the industry and our profession. The end result of this “head in the sand” behavior is that, like the ostrich, we present a tempting target for the budget-slashing administrator and health-care bureaucrat. Fortunately, not all ostriches give themselves up as such williig sac&ices. Their powerful legs allow them to run 40 miles per hour to a safe haven. Once there, those same legs can deliver powerful blows to the enemy. For each ostrich that keeps its head buried in the sand, there will be one or more who will rise up and run or kick out to thwart its enemy. These ostriches are less likely to be attacked from behind because they are moving ahead, running too fast for their enemies to catch up. While running, they are also in a position to defend themselves from an attack from the rear.
Air Medical
Journal
151
January-March
If we want to prevent an attack from the rear, we will need to raise our heads and view the “enemy” squarely. In our case, the enemy is the economic transformation of health care, which is occurring at an unprecedented rate. To survive, we need to be active in proving that air medical transport plays an important role in health care. We need to prove that we make a difference to the patients we serve. We all have anecdotes, such as the one about a hypothermic 12-year-old in cardiac arrest recently aired on “ER.” While it was a thrilling story with a triumphant ending, it was not, just like our anecdotes, scientitic proof. We know that we save lives, but we must prove it to our sponsors, the local HMOs, state and federal legislators, and the bureaucratic regulators. Simply saving lives will not be enough; we need to prove that we positively impact outcome in other ways. Rotor-wing programs must prove that patients’ long-term morbidity is reduced and their quality of life is enhanced as a direct result of rapid transport with an advanced level of care. Fixed-wing programs also must prove that the advanced care provided, combined with appropriate equipment, can overcome the physiologic impact of long-distance transport at high altitude. In addition to improving clinical outcome, we also must prove that we make an economic contribution. We must somehow lower the economic burden to society. The reduction of this burden may be direct by lowering total cost to the patient’s insurer because of earlier access to definitive care, resulting in fewer days in the hospital, etc. Such a direct reduction also may occur because of early and safe repatriation to the patient’s own health-care system. The reduction also may be indirect,
1996
with more patients returning to their former status as economic contributors to society. The end result in all these cases is a quantity of money saved that offsets the cost of air medical programs. We will be required to prove that the same benefits and cost savings would not be realized if the patient had been transported by ground ambulance. This proof will require several largesample multi-site research projects. Aircraft manufacturers, aircraft operators, programs and program sponsors, and every individual who works in the air medical industry must “belly up to the bar” and provide money to support this research effort. It will be costly, and it must be done right. It also must be done soon-yesterday would be good. Once the research is under way, programs must participate, and each member of a program must give the extra effort necessary to collect valid data. By doing so, we can become ostriches, not with our necks outstretched, but running with our heads up, and in a position to defend ourselves. It will take time to accomplish this research. In the interim, wise ostriches should take sight of more immediate predators and deal with them accordingly. As a program manager or administrator, you need to know what financial impact your program has on the sponsoring institution(s). You should be prepared to answer the following questions: l How much does it actually cost you to operate your program? l How much do you actually collect on your transport charges, and what is the discrepancy between those charges and your operating expenses? l What is the financial impact to your institution(s) from patients transported 11
by the program that would not have been realized if the program did not exist? The answers identify your economic viability as you are structured currently. If the answers are favorable, make sure the people who need to know are aware of the program’s financial contribution. If the answers are unfavorable, do what you can to reverse the situation. If you are the medical director, make sure that the quality of care delivered by your program is the best it can be. You also must support alliances with other services in your institution. If you are a trauma surgeon, you must recognize the potential contribution of your program to the neonatology program or cardiac service. Make sure your air medical program has policies and pro-
12
cedures in place that support every service, not just your own. Include other services in your education program and quality improvement activities. Make sure your air transport program has the support of every specialty within your sponsoring institution(s) . As pilots, nurses, paramedics or communicators, you must realize that you are operating in a highly visible environment. You cannot have a “bad day” when you answer the phone, interact with the first-responders on the scene, or retrieve a patient from a community hospital. You need them more than they need you, and their perception of you often determines the demand for your services. There has been more than one case in which the helicopter was not
called because someone did not want to deal with a condescending paramedic or an overly critical flight nurse. This not only jeopardizes your program and your job, but it can have a negative impact on the patients who would have otherwise been transported by air. These individual actions, in combination with collective progress on appropriate research, will help establish the role of air medical transport in the continuum of health-care services. Since we are all, to some extent, “air medical ostriches,” be a wise one. Don’t stretch your neck on the ground and wave your rear in the air. Stand up, run and kick up a storm.
January-March
1996
151
Air Medical
Journal
EDITORIAL
The Ostrich Syndrome By Lura Donnelly,
RN, MBA
Many of us have learned that ostriches bury their heads in the sand. In truth, when their enemies are near, ostriches stand with their necks outstretched on the ground. It is unknown whether the bird is attempting to escape detection by keeping the proverbial low profile, or trying to view its enemy against a lighter horizon. In any event, the result is the same. The ostrich’s rear makes a tempting target for the enemy. An air medical “ostrich” may be a clinician or an administrator who holds some degree of responsibility for the program, but who remains oblivious to the threats the industry is now facing. The ostrich also may be a pilot, a flight nurse, a mechanic, a paramedic, a physician or a communications specialist who thinks that individuals cannot make an impact on the long-term survival of their jobs, their programs or the industry. It can be anyone who believes that simply keeping a low profile and doing their job is enough to sustain the industry and our profession. The end result of this “head in the sand” behavior is that, like the ostrich, we present a tempting target for the budget-slashing administrator and health-care bureaucrat. Fortunately, not all ostriches give themselves up as such williig sac&ices. Their powerful legs allow them to run 40 miles per hour to a safe haven. Once there, those same legs can deliver powerful blows to the enemy. For each ostrich that keeps its head buried in the sand, there will be one or more who will rise up and run or kick out to thwart its enemy. These ostriches are less likely to be attacked from behind because they are moving ahead, running too fast for their enemies to catch up. While running, they are also in a position to defend themselves from an attack from the rear.
Air Medical
Journal
151
January-March
If we want to prevent an attack from the rear, we will need to raise our heads and view the “enemy” squarely. In our case, the enemy is the economic transformation of health care, which is occurring at an unprecedented rate. To survive, we need to be active in proving that air medical transport plays an important role in health care. We need to prove that we make a difference to the patients we serve. We all have anecdotes, such as the one about a hypothermic 12-year-old in cardiac arrest recently aired on “ER.” While it was a thrilling story with a triumphant ending, it was not, just like our anecdotes, scientitic proof. We know that we save lives, but we must prove it to our sponsors, the local HMOs, state and federal legislators, and the bureaucratic regulators. Simply saving lives will not be enough; we need to prove that we positively impact outcome in other ways. Rotor-wing programs must prove that patients’ long-term morbidity is reduced and their quality of life is enhanced as a direct result of rapid transport with an advanced level of care. Fixed-wing programs also must prove that the advanced care provided, combined with appropriate equipment, can overcome the physiologic impact of long-distance transport at high altitude. In addition to improving clinical outcome, we also must prove that we make an economic contribution. We must somehow lower the economic burden to society. The reduction of this burden may be direct by lowering total cost to the patient’s insurer because of earlier access to definitive care, resulting in fewer days in the hospital, etc. Such a direct reduction also may occur because of early and safe repatriation to the patient’s own health-care system. The reduction also may be indirect,
1996
with more patients returning to their former status as economic contributors to society. The end result in all these cases is a quantity of money saved that offsets the cost of air medical programs. We will be required to prove that the same benefits and cost savings would not be realized if the patient had been transported by ground ambulance. This proof will require several largesample multi-site research projects. Aircraft manufacturers, aircraft operators, programs and program sponsors, and every individual who works in the air medical industry must “belly up to the bar” and provide money to support this research effort. It will be costly, and it must be done right. It also must be done soon-yesterday would be good. Once the research is under way, programs must participate, and each member of a program must give the extra effort necessary to collect valid data. By doing so, we can become ostriches, not with our necks outstretched, but running with our heads up, and in a position to defend ourselves. It will take time to accomplish this research. In the interim, wise ostriches should take sight of more immediate predators and deal with them accordingly. As a program manager or administrator, you need to know what financial impact your program has on the sponsoring institution(s). You should be prepared to answer the following questions: l How much does it actually cost you to operate your program? l How much do you actually collect on your transport charges, and what is the discrepancy between those charges and your operating expenses? l What is the financial impact to your institution(s) from patients transported 11
by the program that would not have been realized if the program did not exist? The answers identify your economic viability as you are structured currently. If the answers are favorable, make sure the people who need to know are aware of the program’s financial contribution. If the answers are unfavorable, do what you can to reverse the situation. If you are the medical director, make sure that the quality of care delivered by your program is the best it can be. You also must support alliances with other services in your institution. If you are a trauma surgeon, you must recognize the potential contribution of your program to the neonatology program or cardiac service. Make sure your air medical program has policies and pro-
12
cedures in place that support every service, not just your own. Include other services in your education program and quality improvement activities. Make sure your air transport program has the support of every specialty within your sponsoring institution(s) . As pilots, nurses, paramedics or communicators, you must realize that you are operating in a highly visible environment. You cannot have a “bad day” when you answer the phone, interact with the first-responders on the scene, or retrieve a patient from a community hospital. You need them more than they need you, and their perception of you often determines the demand for your services. There has been more than one case in which the helicopter was not
called because someone did not want to deal with a condescending paramedic or an overly critical flight nurse. This not only jeopardizes your program and your job, but it can have a negative impact on the patients who would have otherwise been transported by air. These individual actions, in combination with collective progress on appropriate research, will help establish the role of air medical transport in the continuum of health-care services. Since we are all, to some extent, “air medical ostriches,” be a wise one. Don’t stretch your neck on the ground and wave your rear in the air. Stand up, run and kick up a storm.
January-March
1996
151
Air Medical
Journal