Forum
2006; Elsevier BV; Volume: 25; Issue: 4 Linguagem: Inglês
10.1016/j.amj.2006.05.002
ISSN1532-6497
AutoresEdward R. Eroe, Kenneth J. Robinson, Jacqueline C. Stocking, Gloria Tavenner Dow, Ron Fergie,
Tópico(s)Disaster Response and Management
ResumoThere have been many things going on over the past few months at AAMS. Most recently we had another great Spring Conference from March 8–11. We had excellent feedback from the conference and had 147 attendees and 14 exhibitors. Our sponsors included AgustaWestland, Air Methods Corporation, American Eurocopter, Bell Helicopter, FARE, and Heli-Dyne Systems. I saw one of the written comments that I think sums up the spring conference: “The AAMS Spring Conference is a must attend for the leaders of our community.” We like to think so, too, as we strive to provide excellent management sessions and, through the Hill Day, positive impact on future public policy for our critical care transport community. Thanks to all who attended and to the AAMS Education Committee and staff for pulling it all together. Great work! During the Spring Conference we heard the tragic news of the Hawaii Air Ambulance crash on March 8 in Maui. Andrew Kluger, AAMS Region I director, is the president of the company and was fortunately in Hawaii at the time of the crash to provide support for his team. Our thoughts and prayers go out to the families and friends of pilot Peter Miller, nurse Brien Eisaman, and paramedic Marlena Yomes. The crash is under investigation as of this writing. We also received sad news from Eagle III in Bellevue, Wisconsin, with the crash of their BO105 helicopter while on a maintenance flight on April 13. Our thoughts and prayers go out to the family, friends, and colleagues of pilot James Vincent, who lost his life in the crash. Tom Judge, Dustin Duncan, Tammy Chatman, Glenn Lyden, and I had the opportunity to spend an evening with Tracey Friedman, the sister of Erin Reed, one of the crew that perished in the Airlift Northwest crash last September off of Puget Sound, Washington. Tracey is both trying to understand our community and how she and other family members of staff lost in the line of duty can positively impact improving overall air medical safety. We of course embrace safety efforts so that we can truly see the day of Vision Zero. The General Accounting Office (GAO) is conducting an investigation into air ambulance safety at the request of Congressman Jerry Costello (D-Illinois), a member of the U.S. House of Representatives Transportation and Infrastructure Committee. Senior investigators and analysts for the GAO requested input from AAMS on April 5, 2006. AAMS has supplied a number of key contacts in our community, and they have all been notified of possible contact by members of the GAO. The AAMS office will fully cooperate in providing information as needed. One of the areas that will be assessed is the need for regulatory or legislative action to address ambulance safety. Johnny Delgado, our AAMS Region VI director, resigned from his position as he has accepted a job in Washington, DC, with the department of Homeland Security. We are sorry to see Johnny leave not only our board but also our community but wish him the best of luck in his exciting new position. It is also nice to know that the Department of Homeland Security now has a very knowledgeable person on critical care transport issues. We have had a number of individuals interested in filling the Region VI position, and like with past vacancies, we will ask for input from the members in Region VI. Director vacancies are appointments made by the president. The AAMS board is conducting some focus groups with AAMS members over the next several months. The board thought that, since it had been over 3 years since our restructuring and the subsequent dues change, we want to check in with members to see how we are doing. Regional directors, as well as Dawn Mancuso and I, will be contacting programs in their areas. Of course we are always open to feedback, so please feel free to contact our office if you have something on your mind. As I said in the last issue, I am a big proponent of the development of AAMS state and regional chapters. Tim Pickering has reported that there is AAMS chapter development going on in Iowa and Kansas. I am delighted to hear this because, as I said last time, we must think nationally and internationally but act locally. There is so much that can be accomplished at the state level by working together. There are draft articles of incorporation and bylaws available, so if you are interested in starting a state or regional chapter of AAMS, contact your regional director. The Medical Transport Institute (MTLI) had another great year with a sold-out 1st year class and graduate school. I thank all the regents, especially Denise Landis, Dawn Mancuso, and Bill Koegler, for their hard work in making this such a wonderful program for our community. Next year will be the 10th anniversary, which is hard to believe. Being a regent I can honestly say, as I think my fellow regents and instructors would echo, this is the best work week of the year! It was also great to see Jackie Stocking, president of ASTNA and Gloria Dow, president of IAFP, in the first year class, along with Shelley Sholl, president of NAACS completing her second year and CMTE. Shelley had to suffer through a new project that Gina Blevins and I developed this year titled “Intense Competition,” but I am happy to report that she and her colleagues came through with flying colors. It was wonderful to have the leadership of our affiliated associations at MTLI! I had the opportunity to attend the Critical Care Transport Medicine Conference in Las Vegas for a day on April 3. It was nice to see such a successful meeting with over 200 in attendance. Congratulations to AMPA, ASTNA, IAFP, and NAACS for a job well done! The Vision Zero White Paper has now been published at visionszero.aams.org on the AAMS website. Please take the time to read this important work as it outlines are efforts to improve safety. Many thanks go to the Vision Zero Steering Committee with the development of this paper and in their continued efforts with Vision Zero. Wear that bracelet if you are not already doing so! AAMS, in collaboration with all the associations in the critical care transport community, continues to add value to your individual programs. Be a part of things; we are always looking for volunteers for committees. Contact Dawn Mancuso at the AAMS office—we need your expertise and assistance. It is that time of year again to begin thinking of nominations for the upcoming AMPA elections. The positions open for election are president-elect, secretary-treasurer, and three board-member-at-large positions. I would like to encourage nomination of those who have not participated on the AMPA board in the past. It is only through the continuous changing of the board and the new ideas and efforts that result from participation that AMPA continues to grow. The recent Safety First preconference and the CCTMC in Las Vegas were both great successes. The reviews for the Safety First program were excellent. The attendees especially liked the multidisciplinary approach to safety and the varied topics. In addition, the feedback on CCTMC was strongly positive. This continues to be considered an outstanding educational opportunity for clinical topics. Thank you to all who made this year's conference a success. The call for speaker submissions for the 2007 CCTMC has just gone out. I encourage participation by AMPA members. All topic submissions are due no later than July 10, 2006. Please submit your topic electronically to Pat at [email protected] ; she will confirm your submission. CCTMC offers the speaker a $200 honorarium and complimentary registration to the conference. All members are reminded to visit our new website at www.AMPA.org. Lastly, the Handbook is coming. The updated edition of the AMPA Handbook will be available at AMTC in Phoenix in September. Thanks to Ira Blumen and the other editors and contributors for their continued attention to this project. The following is the next in a series highlighting AMPA members. Kevin Hutton, MD, is a board-certified emergency physician practicing in San Diego, California. He attended USC as an undergraduate, then Georgetown University School of Medicine, and completed the University of Pittsburgh Affiliated Residency in Emergency Medicine. Kevin began his career in EMS in 1980 as an EMT in Los Angeles. Since then he has worked as an emergency medical service command physician with the City of Pittsburgh Bureau of EMS, a flight physician with STAT Critical Care Transport Program at the University of Pittsburgh, the base hospital medical director at Scripps Memorial Hospital, and as the medical director of Life Flight-San Diego Air Medical Service at UCSD Medical Center. He has also served on the National Disaster Medical Assistance Team (DMAT) in Pittsburgh and was the assistant director of the department of emergency medicine at UCSD Medical Center from 1990 to 1995. In addition, he has served multiple administrative roles in the local EMS system, including a member of the Medical Audit (QA) Committee for Trauma for the San Diego County Trauma System from 1990 to 1993, the Liaison to Medical Audit Committee from Prehospital Audit (QA) Committee for San Diego County from 1992 to 1993, and as the Chairman of the San Diego County EMS Prehospital Audit Committee from 1995 to 1999. Kevin's involvement in the air medical transport industry is as extensive as anyone's. He is a founding member of AMPA and has been a member since 1993. He served three terms on the AMPA board, one term on the AAMS board, and 6 years as a board member for Foundation for Air Medical Research (combined into AAMS Foundation). He has been a reviewer for the Journal of Emergency Medicine since 1990, Air Medical Journal since 1994, and AirMed from 1994 until it was combined with Air Medical Journal in 2000. He is the president of the Foundation of Air Medical Research and Education and is or has served on numerous AAMS committees, including Research, Government Relations, Standards, Membership, Executive, and the Foundation of Air Medical Transport, Research Grant Review committees. Kevin is a recognized educator. In 1991 he was awarded the Outstanding Teacher Award from the Family Medicine Residency Program at UCSD Medical Center. He has spoken widely, both nationally and internationally, on topics ranging from clinical care and administration of HEMS to compliance and financial issues related to air medical transport. He has published over 14 papers in the air medical transport, disaster medicine, and emergency medicine literature. The most important contribution Kevin has made to the air medical transport industry is his prolific authoring of position papers. He is the principal or affiliate author of 7 position papers, including: •Medical Condition List – AMPA, 2002•Determination of Medical Necessity in Air Medical Transportation – AMPA, 2003•Patient Follow-up letters and HIPAA-AMPA, 2003•Appropriateness of Medical Transport and Access to Care in Acute Cardiac Syndromes – AMPA and AAMS, 2005•Appropriateness of Medical Transport and Access to Care in Acute Stroke Syndromes-AMPA and AAMS, 2005•Appropriateness Use of Critical Care Transport – AMPA and AAMS (for publication in 2006)•Determination of Closest Appropriate Facility in Air Medical Transport – AMPA and AAMS (For publication in 2006) Although widely known for his participation in AMPA and AAMS, Kevin is also an entrepreneur. In 1997 he founded Golden Hour Data Systems Inc. EMS Information and Revenue Management and since then he has been the CEO. From 2000 to 2005 he served as the chief compliance and privacy officer for Golden Hour Data Systems, and he has been the chairman of the board for the last 4 years. Last year he became board certified in healthcare compliance from the Healthcare Compliance Association. Even before his board certification, his knowledge of compliance issues in air medical transport has been invaluable to many individuals, associations, and programs who have sought his guidance. Kevin Hutton, MD, continues to be an important leader in the air medical transport industry. His efforts and contributions have enabled AMPA and AAMS to continue to grow and evolve. AMPA is proud to have him as a member and is grateful for his contributions to our association and industry. I often hear colleagues ask some variation of this question. Honestly, I think it is a very fair question. After all, in today's busy world and in an era of shrinking educational budgets, it is important to know why you should take the time to become an ASTNA member and what value you will receive in return for your annual membership dues. As you know, the mission of ASTNA is to “advance the practice of transport nursing and enhance the quality of patient care.” For a summary of the more obvious mission-aligned benefits ASTNA provides to its members, please visit the ASTNA website at www.astna.org. You will find that safety is woven throughout each and every product and member benefit. In this column you will find some additional, and perhaps less obvious, ways in which the ASTNA board of directors works on your behalf. In transport nursing, safety must be a core value, and we must all do our part to promote a safety culture. The ASTNA board of directors has been hard at work raising awareness on safety issues and collaborating on transport community and nursing profession safety initiatives to lend the perspective of the specialty of transport nursing. While this important work is partially funded by membership dues, it would not be possible without the generous financial support and donation of time from the programs that employ our board members. A hearty thank you to all for supporting ASTNA! Collaborative Venues So far this year ASTNA board members have been hard at work representing the safety interests of members in many venues: •The NTSB hearings in Washington D.C. in January •ASTNA attended the NTSB hearings at the request of family members of Erin Reed, a flight nurse and ASTNA member who was killed in a helicopter crash in 2005.•ASTNA continues to work collaboratively with AAMS and government officials from the NTSB and FAA on safety issues stemming from the hearings.•The AAMS Mid-Year Conference in Washington DC in March •ASTNA participated on the Association Safety Panel Report Card Presentation at which each professional association gave a status report on current safety initiatives and also committed to support Vision Zero.•The Critical Care Transport Medicine Conference in Las Vegas in March •ASTNA participated in the AMPA Safety First preconference panel discussion.•The Air Medical Safety Advisory Council meeting in Dallas in May •The goal of AMSAC is “to make it safer for everyone in the AMS industry by doing those things that can be accomplished more effectively by the group rather than the individual” (www.amsac.org).•ASTNA continues to attend every AMSAC meeting.•At this meeting the NTSB recommendations and FAA response were reviewed, a weather shopping recommended practice was adopted, and the pilot survey done by AAMS was reviewed by the attendees.•AACN's National Teaching Institute in Anaheim in May •ASTNA board members, local chapter representatives, and military committee representatives will provide eight presentations as part of the Transport Nursing Display in the Exhibit/CE Program. Topics include: •How to Select an Air Ambulance•Use of a Triage Tool to Make Pediatric Airway Decisions•Safety Issues Affecting Pediatric Transport Programs•Physiologic Stressors of Transport•Are You At Risk? Human Factors in Critical Care Transport•Before You Leave the ICU and Jump into the Ambulance•How High is Too High? Altitude and Critical Care Transport•War Time Instructions on Critical Care Transports within a Joint Theater of Operation: The EnRoute Care Program ASTNA board members will also represent ASTNA at the following venues later this year: •ENA's Scientific and General Assemblies in San Antonio in September •Two ASTNA board members and a military committee representative will hold a Transport Nurse Safety Forum at the 2006 Annual Meeting. The Forum will include a panel presentation and question and answer session.•Much thanks to ENA Past President Kathy Robinson and current ENA President Nancy Bonalumi for their vision and commitment to the issue of safety in transport nursing. Visit the ENA (www.ena.org) and ASTNA (www.astna.org) websites for more information.•The Air Medical Transport Conference (AMTC) in Phoenix in September •ASTNA will conduct a convenience sample safety survey and report the results in aggregate format shortly thereafter. This will allow us to further tailor our activities to meet the needs of ASTNA members. Please plan to attend AMTC and participate in the survey!•The Nursing Organization Alliance (NOA) 2006 Fall Summit in Memphis in October •NOA (www.nursing-alliance.org) comprises 67 professional nursing associations.•For the second year in a row, ASTNA will present on the topic of Transport Nurse Safety during the President's Forum. Last year's presentation set the stage for collaboration with several professional nursing organizations; this year's presentation will take those collaborative projects to the next level. A Short Note on CONCERN and HARP The ASTNA office recently received an email indicating that not all transport professionals are aware of these two reporting and information sharing venues. What follows is a brief excerpt, taken from the FAQ page, describing the purpose of CONCERN and HARP. For more information, please go to www.concern-network.org. •Begun in 1984 by the National Flight Nurses Association (now the Air & Surface Transport Nurses Association) as a simple telephone tree, the CoOperative Network Call for Emergency Regional Notification was envisioned as a mechanism to alert the air medical community of situations in which crewmembers had been injured or killed in helicopter or airplane crashes. In the ensuing 20 years, CONCERN has evolved through various incarnations to serve as a means of collecting and distributing information about a variety of air medical and critical care ground transport mishaps.•The CONCERN Network provides information regarding accidents and incidents in the air medical and critical care transport community. This information is provided by the transport service involved and then distributed via email by the CONCERN Network.•The purpose of the CONCERN Network is to increase awareness of safety hazards in the medical transport community.•In many situations, no damage or injury occurs, yet the experience may provide a useful warning for others. The Hazard Awareness Reporting Page (HARP) provides a mechanism to alert the transport community of events or conditions which nearly or could have resulted in a CONCERN bulletin. Safety Position Paper Maximizing safety of transport crewmembers has always been a priority of ASTNA. In 1986 the National Flight Nurses Association (now ASTNA) published Practice Standards for Flight Nursing. Within that document the “Aircraft Standards for Flight Nursing” (Comprehensive Standard IV: Crew Safety) stated “the actions of each crew member may affect the safety of other crew members or the entire aircraft…the flight nurse shares the responsibility of assuring the safety of aircraft and crew.” By creating this standard, ASTNA was at the forefront of changing a long-standing myth that the safety of the aircraft and its occupants was the sole responsibility of the pilot(s). A copy of the current ASTNA Position Paper, “Flight Nurse Safety in the Air Medical Environment,” is available on the ASTNA website. This document is being revised to include Critical Care Ground Transport Safety. The revision will be available by AMTC and is expected to be endorsed by other professional nursing associations. AMTC 2006 Please join us in Phoenix, Arizona, September 25–27 for AMTC. ASTNA will be celebrating its 25th anniversary, so don't miss out on the important milestone, which we will celebrate at the ASTNA Membership Luncheon! As always, feel free to contact the ASTNA office or any ASTNA board member for additional information. We look forward to working with you on important association and community initiatives. Through your involvement, we can work together to shape the future of transport nursing safely! “Leadership and learning are indispensable to each other.” John Fitzgerald Kennedy Be a leader—continue to learn all you can about safety and teach all you know to others so we may all enjoy a SAFE summer. I am here today to celebrate the accomplishments of an illustrious career that spanned decades and forever altered the way we approach EMS in this country and throughout the world. Far from mourning the passing, join me in celebrating the joy we've shared. Sounds a like the beginning to a eulogy, but I'm not talking about a death. I'm talking about a life, a passion, and a commitment so profound it is contagious. In June of this year, Chief Alan Brunacini retires from the Phoenix Fire Department. Yes, I know I'm writing for AMJ. Yes, I know nothing in your hangar has burned since the Playstation and surround sound overloaded the extension cord. But Chief Brunacini most graciously asked that people thank him by passing on the universally applicable “A-Ha” moments he inspired. Thank you, Chief. Do the right thing. In an era of lofty mission statements and protocol books encompassing volumes, Chief Brunacini made it simple. Except during the week of your CAMTS visit, can you recite your mission statement? Does it personally guide you through each conundrum you face? Keep it simple. •The job of a field provider is to do the right thing for each patient in each situation.•The job of the manager or supervisor is to clear the debris and distractions out of the way so the field provider can do the right thing for each patient in each situation.•The job of the administrator is to secure the resources necessary for the field provider to do the right thing for each patient each in each situation.•And the job of a leader is to inspire and support the field provider as he or she confidently and universally does the right thing for each patient in each situation. Take care of Mrs. Smith. Why do you come to work each day? Is it for the glory? To buzz your neighborhood? Because you look good in a flight suit? As you are toned out for each call, I hope you're here to take care of Mrs. Smith, Chief Brunacini's universal designator for customer. No matter the time of day or the nature of the call, Mrs. Smith needs help. There are a multitude of Mrs. Smiths: •The EMS provider that calls you because you're the only ALS for 50 miles•The nurse with a CT scanner on the fritz•The spouse who's afraid or unable to let the patient die•Or the parent who wants his or her child at the pediatric center They are all Mrs. Smiths. They may all need resources more difficult to muster than your considerable medical expertise. You have the trust, confidence, and responsibility to do the best you can for each of them. It's not about you; it's about Mrs. Smith. Be nice. No matter who, what, or where, be nice. Be nice to patients, families, bystanders, other providers, coworkers, and yourselves. It doesn't take more time, more resources, or more money; it takes a change in mindset. Eventually a culture develops that accepts nothing less. People still wake you up at 3 am whether you're nice or not. There's still congealed blood under the seat that you can't reach whether you're nice or not. Some days they still call it “work” for a reason, but in each situation: •Nice makes a difference in how you feel about yourself.•Nice makes a difference within your team.•Nice is how truly competent, confident providers respond to other people.•Nice is part of how you do the right thing. Go home healthy. Chief Brunacini was one of the first public safety leaders to give us permission to go home healthy. Until that point, generations of true heroes died in the line of duty. Think about the following terms: ultimate sacrifice, line of duty hero, job worth dying for. We all sacrifice. We work holidays, weekends, nights, and late calls. Death doesn't minimize any of those. I will argue that the line of duty heroes are those that do the right thing, be nice and fly safe, in the most trying of circumstances. And they tolerate nothing less from others. If the job is worth dying for, it's worth the extra effort to be healthy for. On the job physical training, department-wide lifestyle changes, and work and procedural controls make personnel safety the priority. All help you go home healthy. It's good for you! It's good for your team! And it's good for Mrs. Smith! I really like EMS. Critical care flight medicine is my passion. I loved the time I spent with the Anchorage Fire Department, but the first time I ever thought about work culture or leadership philosophy was in a crowded auditorium, raptly listening to a wise, bespectacled man in a Hawaiian shirt. After the session, he took the time to speak with the myriad of participants. He remembered names. He answered requests. He graciously shared publications, presentations, and philosophies. And he expected us to Do the Right Thing, Take Care of Mrs. Smith, Be Nice, and Go Home Healthy. I hope you do the same. This past April I attended the “Safety First” preconference in Las Vegas, Nevada. I had the privilege of listening to several outstanding presentations. While preparing for my own small part in the conference, I was reminded of a couple of things I had not thought of in quite some time. It also struck me that I had not heard much discussion on this subject either. The subject is what I call “Defer it or deny it” or “Maybe it won't happen on my watch.” The recent disaster brought on by Hurricane Katrina is an example of my topic on a very large scale. The potential for large-scale damage from a storm like Katrina had been well known and documented for almost 40 years. Leaders at all levels of government just kept hoping it wouldn't happen to them. Well, it did. Several years ago I flew an army accident investigation team to the scene of a helicopter crash. The pilot in command was killed; the other pilot survived. The aircraft in which they were flying was, at the time of the accident, under a flight restriction. Except for takeoff and landing, it was not to be flown at less than 400 feet above ground level. Witnesses to the accident stated that, just prior to the crash, the helicopter was seen flying about 5 to 10 feet above the water over a very large lake. Several factors were revealed during the course of the accident investigation. The pilot was known to be a “hot dog” or “cowboy.” Other pilots and crewmembers in his organization had voiced their concerns to the unit leadership, both verbally and in writing. Unfortunately, the unit's mission load was very high, and pilots were in short supply. The pilot had made the following statement to the commander: “You aren't going to ground me, you won't be able to complete all our missions.” A few days prior to the crash, one of the unit pilots informed a higher commander of the problem. That commander said he was on his way to a meeting and would be back in his office the following Wednesday. He would take care of the “Cowboy” immediately upon his return. The crash occurred on Tuesday, one day before the commander returned from his trip. Several years later an EMS pilot and a nurse died under similar circumstances. Their program was short on pilots, they had a relatively high mission load, and the pilot was known for showing new nurses just what a great pilot he was. Unfortunately, the nurse he was showing on this particular flight didn't live long enough to be awed by his superb flying skills. This entire discussion goes back to the idea that, in a high percentage of accidents, someone, somewhere, at some time had a piece of information that could have prevented the accident if acted upon. In both cited accidents almost everyone knew something wasn't right with these two pilots. In both cases their managers knew there was a potential for disaster. In both cases management either denied or deferred the problem, hoping nothing would happen until they could do something. In both cases, lack of action contributed to fatalities. So the question is do you have someone in your organization who could fit into this category? Are you in a position to do something about it but would rather not? Who among us are in the denial or the defer mode? In this discussion I pointed the finger at pilots and managers. Although they hold the ultimate responsibility, they are certainly not the only ones at fault. Many of us are under the false impression that our own immortality will ensure that accidents happen only to someone else. Many of us don't want to make waves for our coworkers. Most of us would hate to think that, due to our lack of action, someone died or was injured. Wouldn't you rather offend someone as opposed to bury someone? When in doubt, speak out!
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