Forum: AAMS, AMPA, ASTNA, NEMSPA, NFPA
2002; Elsevier BV; Volume: 21; Issue: 4 Linguagem: Inglês
10.1016/s1067-991x(02)70063-1
ISSN1532-6497
AutoresKen Williams, Jill R. Johnson, Gary L. Campbell, Thomas P. Judge,
ResumoProbably to your relief, this is my next-to-last Forum contribution. My AMPA presidency concludes this fall, so I get to reach you one more time after today. Before saying farewell, I thought I'd mention a few things about AMPA. AMPA has something for everyone involved in critical care transport. Although physicians constitute the majority of the AMPA membership, categories are available for residency programs (a real bargain) and individual students or residents, and an affiliate category is available for everyone else. No, I'm not trying to draw members away from ASTNA, NFPA, or anywhere else—but if you get your residency program to sign up for an academic membership, I owe you one. What I'm trying to do is suggest that members of other organizations can benefit from AMPA, just as AMPA members benefit from other groups. What does AMPA have to offer? Let's start with Pat Petersen, our executive director. If you haven't met Pat, you should. She is the role model for nice/productive/thoughtful/efficient/thorough/energetic leader, among other good things. Because of Pat (recipient of AMPA's President's Award this year), AMPA has developed the organizational mentality that we are here to help, support each other, and serve those we work with and care for. Many others have helped make AMPA the excellent organization it is today. This year we honored Dr. Richard Orr, medical director of the Children's Hospital Transport Team in Pittsburgh, Pa., as Distinguished Physician, and Dr. Eric Swanson, medical director for AirMed at the University of Utah, as Medical Director of the Year. These two physicians exemplify the best of AMPA—dedicated, bright, giving, and visionary. AMPA has about 400 physician members, nearly 30% of whom are from outside the United States. Chances are that, if you have a question about air medical transport anywhere, one of our members knows the answer. We regularly get E-mail with these questions, and our membership is wonderfully helpful. The AMPA Medical Director's Handbook isn't for physicians only. With chapters ranging from a history of air medical transport to infection control, the handbook serves as a resource for us all. Members can view or download chapters on line at www.ampa.org. Copies come with all levels of membership, or you can purchase one without becoming an AMPA member. A CD version should be ready soon. AMPA also has a variety of task forces and has produced a range of position statements. These efforts are available for all in the transport community. With excellent partnership, AMPA participates in at least two major educational meetings each year—a preconference before AMTC and the CCTMC. For the past few years, AMPA also has been featured at AirMed in Europe, which will be held this year in Switzerland beginning September 17. Everyone is invited to attend AMPA's educational events, as many nonphysicians have done so over the years. AMPA physician members are emergency physicians, surgeons, pediatricians, intensivists—many specialties are represented. Many of us belong to other professional groups and are active in local, national, and international specialty efforts. If you or your group has an issue, concern, problem, research question, or other topic related to the broader medical community and critical care transport, AMPA can help you make the right contacts and carry your issue forward. In short, AMPA has something for everyone involved in critical care transport. Use us, just as we use our partner organizations for their expertise and guidance. Join us if you want, but use us when we can help. We're here for you. —Ken Williams, President Safety is always a priority in transport. Crew resource management (CRM) is the buzzword. But what is CRM truly? Do we learn from our various experiences in transporting, or are we waiting for a tragedy to teach us? In talking with other transport professionals and ASTNA members, we all agree that safety comes first. In general, we all believe our programs are safe, but we admit to complacency, and sometimes we have been in positions that were a little uncomfortable. I thought it strange to hear a person talk about how the medical crew debriefed together and the pilots debriefed separately after a stressful flight. I have heard crewmembers talk about feeling uncomfortable on a flight but didn't say anything because no one else did. How many people have been in an aircraft when a bird struck? Have you ever been in the back of the aircraft or ambulance and not had your seat belt on? It is hard to provide care if you're strapped in, but it also hard if you're injured. Many lessons can be learned and shared from these experiences. I remember being a new flight nurse with less than 2 months under my belt and not fully understanding the safety aspects. My naiveté was quite evident when we flew into a cloud, and as we popped out, so did an American Eagle aircraft. I was excited that I could wave to the people on the plane, and they were waving back. Our pilot wasn't excited, however. When the air traffic controller apologized over the radio to our pilot, I could tell by his tone that he wasn't pleased. Later he said that, if we were about 5 to 10 seconds slower, they would have hit us. We can learn from debriefing after our transports, attending safety training classes, talking with other programs, and reviewing the past. We can't eliminate risk, but if we can identify the risk and the potential for it to occur, we can reduce the chance of an incident occurring. One way to learn is through collaboration. AMPA plans to distribute a safety report—“Safety Review and Risk Assessment in Air Medical Transport”—at AMTC in Kansas City. Karen Ardnt, an ASTNA board member, helped compile the report, which identifies ways to enhance program safety and reduce our risks. Another way to learn is by sharing. The Hazard Awareness Reporting Page (HARP) on the ASTNA website was designed as a first-person reporting tool to share what you have learned with others. The report centers on “This is what I/we did and this is what I/we learned from it.” This anonymous report doesn't point fingers, criticize, or identify individual programs. Here we can share near tragic or embarrassing events that could have lead to tragedy but didn't and what approaches others can view, evaluate, and use to avoid similar mistakes. Be a safety advocate. Share what you have learned. When you feel comfortable, open your eyes and take a better look to be sure you haven't missed something. Open your mouth and be heard when you are uncomfortable. If you have new ideas, share them with colleagues and with us. Be safe and have a great summer! —Jill Johnson, President NEMSPA has a new address. We share our headquarters with AAMS, and when they moved to new offices, so did we. The new address is NEMSPA, 526 King St., Suite 415, Alexandria, VA 22314-1434. The phone numbers are the same. Preparations are well under way for the upcoming AMTC in Kansas City. The Aviation Education Track is set with a wide range of topics, including firsthand accounts of the difficulties air medical operators faced in responding to the scene on September 11, a 2-hour presentation on “Flying in the Wire Environment,” and a detailed safety report on air medical accidents. Make plans now to attend. In addition, NEMSPA is sponsoring the Air Medical Safety Advisory Committee “Train the Trainer” preconference course. Look for information on our website, nemspa.org, and in the conference brochure. Nominations are being accepted for the NEMSPA Pilot of the Year Award. This award is presented annually to an active EMS pilot who has demonstrated exceptional performance in the areas of EMS flight, safety, and peer mentoring. Nomination information and forms may be obtained from our website by clicking on 2002 Pilot of the Year. —Gary L. Campbell, President During the past 2 years, the AAMS board has undertaken a wide strategic review of where AAMS is, where the association is going, and how it's going to get there. A year ago, the board set out a principles document regarding the direction of change, and in the May/July issue of AMJ, President Greg Powell described the re-engineering process. Beginning with a new set of proposed values to drive the organization, Greg went on to describe new proposed vision and mission statements and the first iteration of a possible new governance model and board structure. Tecker describes an association as a “group of people who voluntarily come together to solve common problems, meet common needs, and accomplish common goals.” The value of belonging to and participating in the association is perceived and measured at once. Participation in AAMS over the years is driven by individual and organizational goals. For some the attraction is AMTC; for others it is networking; for others it has been a relentless drive to improve safety and standards, leading to the creation of CAMTS, FAR, the CORE Industry Safety Committee, and more recently, the Air Medical Safety Advisory Council (AMSAC). Over the years, as our community has grown in numbers and sophistication, new specialized professional organizations have developed and grown to become focal points in the community, such as ASTNA, AMPA, NFPA, NEMSPA, NAACS, and specialty core interest groups, such as fixed-wing and ground critical care providers. As the community continues to develop, the role of AAMS needs to evolve as well. Tension in understanding the boundaries among all the organizations has been an important driver toward evolution, and the overarching role of AAMS has morphed through the newly proposed values, vision, and mission. Rather than an association focusing on “how” air medical and critical care services are delivered, AAMS is moving toward advocating “what” should be done to “ensure that every person has access to needed quality air and critical care medical transport” as articulated in the proposed vision and mission statements. The “how” must increasingly be filled in by the entire community of AAMS members, professional organizations, the newly merged AAMS and FAR foundations through research and education, and the AMSAC as the expert panel on safety. A prime example of this sea of change is the Medicare fee schedule, which is now at the implementation stage. More than any other single initiative, the reg-neg process indicated that AAMS must play an essential and growing role in the regulatory and health care reimbursement arenas. In addition to organizational changes, the community also must undertake a strategic review of how these changes will come about. One core element in this level of review is the financing of AAMS. Currently, the association has two major funding streams: member dues and net revenues from AMTC. A number of other member services and publications make up the balance of the budget. The financial dependence on AMTC is problematic in that the overall revenue is variable, while such fixed and recurrent expenses as salary, office rent, and the need to provide improved financial support to the professional organizations are ever increasing. In the current fiscal year, dues income is budgeted at $299,604, and core operations and government relations are budgeted at $558,000. As a result of the events and subsequent government relations (GR) activities necessitated by the tragedies of September 11, as well as the continuing work needed on the fee schedule, GR activities will exceed the budget substantially. The current year gap—in excess of $250K in these two core activity lines—also will grow because of the ending of the HCFA (now CMS) fundraising project. As a result, given the underbudget revenue from AMTC and increased workload, AAMS will operate in the red for both the current and new fiscal year. So what does this shortfall mean? One of the great Felician Sisters, testifying before the Senate on Medicare changes some years ago, pointed out that “without a margin, there is no mission.” To assume a growing advocacy and coordinating role, AAMS needs to change its financing plan fundamentally. In returning to the above principle set by the AAMS board, dues income needs to increase substantially to deliver current services. Overall, the dues issues might be summarized as follows: •Current dues do not cover costs of core operations and GR; the overall gap is roughly 40% between what was being collected in dues and the HCFA project and current budget needs.•There is an increasing reliance on AMTC to fund core operations.•The current dues structure is not perceived as equitable or fair with small and large programs equally burdened by dues.•There is increasing reliance on “multiple requests” to air operators and manufacturers to fill the gap and support core operations.•Dues are based on program members, yet the definition of programs is increasingly uncertain because of corporate change and consolidation.•The number of aircraft/bases/programs that were roughly in equal proportion in early years and defined the “value” of dues is unclear now. Currently, the AAMS board is modeling different funding formulas, seeking to develop a more equitable system that recognizes the economies of organizational size and ability to generate revenues. Clearly, the board recognizes that a voluntary association must have a member value proposition—my organization receives a return on investment in exchange for membership dues. On a personal level, as a program director, I strongly believe that our program needs an active, recognized voice in the policy and regulatory arenas. The success of AAMS' leadership and consulting team in the Medicare fee schedule negotiation makes up my dues contribution in a single flight. During the next few months, the AAMS board will finalize a draft model to submit to the membership at the annual meeting at AMTC. We will be going out to members to test the models and look forward to your comments. —Thomas P. Judge, Treasurer
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