Forum
2006; Elsevier BV; Volume: 25; Issue: 3 Linguagem: Inglês
10.1016/j.amj.2006.03.001
ISSN1532-6497
AutoresRon Fergie, Edward R. Eroe, Kenneth R. Robinson, Jacqueline C. Stocking, Gloria Tavenner Dow,
Tópico(s)Cardiac Arrest and Resuscitation
ResumoShould I have been scared? This is the question posed to a flight nurse from a new paramedic after they had come very close to becoming the first people at the scene of a fatal helicopter crash. Coming from someone new to air medicine, I can understand the question. When that question or similar statements by those who have been flying for a while come up, I wonder if we will ever make any real progress in the fight against accidents. Most flight programs embrace air medical resource management (AMRM) in one form or another. The degree to which it is practiced probably varies as much among different crews as it does among different programs. The dynamics of human relations dictate that any program such as AMRM will have a broad spectrum of participation. The spectrum varies from no participation and resistance to overparticipation and abuse. The goal, of course, is maximum participation in a balanced program, well planned to promote AMRM without having non-aviation personnel crossing the line into the cockpit. In late January the National Transportation Safety Board released its findings after investigating accidents occurring in the air medical industry. In at least three of the crash presentations discussed, the following statement was made: “Although the company had a policy stating anyone could cancel a flight, most medical staff deferred that decision to the pilot.” On most of the flights we do, that attitude isn't a problem. It is a problem when weather, maintenance, fatigue, and ignorance come in to play. I should say right now that I am in no way advocating that everything a pilot does should be questioned. I am saying that, if you have a question, ask! Most of the pilots I know don't have any problem answering questions, nor do they mind explaining the why and how of a situation to someone. The problem some people have is either not asking a question or waiting too long to speak up. The following scenario has been played many times in many different places. A medic (nurse or paramedic) hears or feels something odd in the aircraft and tells the pilot. The pilot lands the aircraft to check out the problem, either immediately or at the nearest airport or helipad. Once on the ground, the second medic on board says, “Man I'm glad you said something. I felt it too but didn't want to say anything.” What will it take for this person to say something? Not wanting to say anything isn't new. That attitude has been around since the beginning of time. Nobody wants to sound like a chicken or a nag. The option could be that you won't sound like anything because you are a name on a blacked-out web page. You are now the topic of discussion among air medical personnel worldwide. You are the cause of your family getting together for an unplanned reunion. Emotions throughout the EMS community are running the gambit from anger to fear to frustration to disbelief, but mostly to sadness because we have lost more of our friends and family. That, of course, is a worst case scenario. The best case would be the medic spoke up and the pilot also had heard or felt whatever it was, recognized it, and took the appropriate action. That action could be anything from explaining to the crew something about the aircraft to landing it immediately. That is the way it is supposed to work. Of course we all know that; we also know there are people who just won't say anything. I believe we have reached the point when we need take a hard look at ourselves. If you are a pilot who comes to work tired or with your mind on things other than work, you should look at another profession. If you are a medic who is afraid to ask a question, you need to move on. If you are a manager at any level who is more concerned about numbers than the safety of your staff, you should get out. As president of AAMS, I see firsthand the many initiatives that our critical care transport community is involved in and working on and the many individuals, both volunteers and staff, who make things happen. It is a very unique perspective and one that is quite awe inspiring. On January 25, 2006, the National Transportation Safety Board (NTSB) held a public hearing to review a special report they had completed on both helicopter and fixed-wing air ambulance operations. Based on this study, the NTSB issued a set of findings and four recommendations to the Federal Aviation Administration (FAA), which were finalized in a Safety Recommendation Letter on February 7. While AAMS supports the intent and goals of the NTSB's report, we remain concerned and troubled that the NTSB reached their conclusions and issued recommendations based on limited data and information. If the recommendations were implemented as proposed, it would have a significant financial impact on the delivery of out-of-hospital care and decrease public access to needed emergency care without, in our view, a corresponding increase in safety. At the time of this publication, our official response was still in draft form, but specific responses to all four recommendations are included and will be published on the AAMS website. AAMS and the NTSB are in complete agreement that it is essential to reduce and ultimately eliminate errors of consequence in the air medical community, and that is why we have invited them to participate in the AAMS Core Safety Committee and the International Helicopter Safety Team so that we can collaborate together to improve air medical safety. Many thanks to Tom Judge, Irene Howie, Bob Dodd, Ed Rupert, and Chris Eastlee for their work on our official response. As I write this column, there is breaking news that the administration did have sufficient advance warning of the devastating effects of Hurricane Katrina as shown in video clips of the Federal Emergency Management Agency and the president. This evidence, along with the final report of the bipartisan committee to investigate the preparation and response to Hurricane Katrina called “A Failure of Initiative,” published February 15, 2006, hopefully will improve our government's ability at all levels to coordinate resources so this type of natural disaster will not have such devastating effects in the future. On January 9, 2006, AAMS released our report, “Air Medical Community Response to Hurricane Katrina Disaster: Hospital Evacuation and Patient Relocation by Helicopter and Fixed Wing Aircraft,” so that our firsthand experience could be included in the bipartisan committee report. Approximately 30 air medical services, both fixed wing and rotor, committed over 60 aircraft to aid federal emergency management agencies. Many hospitals in and around New Orleans experienced significant damage in the wake of the storm, which created the need to airlift critically ill and injured patients in otherwise inaccessible areas and transport them safely to facilities less impacted by the storm. Many services in the region committed management support staff and maintenance crew to affected areas in order to maintain a long term air medical presence in the disaster zone. Numerous air medical personnel volunteered for the mission, including staff from Acadian Air Ambulance, Air Methods LifeNet Division, PHI Air Medical, Air Evac LifeTeam, Angel One from Arkansas Children's Hospital, Hawaii Air Ambulance, and AirHeart Air Ambulance from Sacred Heart Health System. Our community's response, however, was for the most part uncoordinated with federal and state officials but rather informally made at the request of affected hospitals attempting to care for and transfer critically ill patients. Our report to the bipartisan report included this finding: “The government did not effectively coordinate private air transport capabilities for the evacuation of medical patients.” Hopefully this will not happen again as we are a vital part of coordinated disaster response! I am a big proponent of the development of AAMS state and regional chapters. I have been fortunate in my career to be an active participant in the Virginia EMS Transportation Subcommittee, the Michigan AAMS chapter, the North Carolina Aeromedical Affiliation, and the South Carolina Area AAMS Chapter. I am a firm believer that we must think nationally and internationally but act locally. For this reason I was very pleased to have the opportunity to speak to the Indiana AAMS Chapter on February 10, along with my colleagues Tammy Chatman and Glenn Lyden, on media relations in both normal and crisis modes. Of course we had not planned on speaking right after the PHI crash in Chesterfield, Indiana, a week before. I was extremely pleased how the Indiana AAMS chapter took a coordinated approach to the crash by not only assisting each other but having Rex Alexander, chapter president, field all media calls. Yes, we are all competitive, but the bottom line is that we are all there for safety and patient care, and by working together, the Indiana AAMS Chapter showed how true this is. As many of you know, I am a regent and instructor for the Medical Transport Leadership Institute (MTLI) held at Oglebay in Wheeling, West Virginia, each spring. This coming year is unique in that, as of this writing, we have sold out both the first year class and the graduate school. We are making plans to expand the graduate school since we actually sold out at the Air Medical Transport Conference, thanks to the efforts of Robert Freitas and Kris Nelson in the MTLI booth. We apologize to the many individuals who wanted to attend the graduate school but could not this year. MTLI has been successful not only because of the vision of Denise Landis and Dawn Mancuso, along with Bill Koegler at Oglebay, but through the active networking that has been created by attendees. If you have not participated in MTLI, please plan on it. If you are a program director, send members of your leadership/management staff because it is an invaluable experience and will add to the development of your team at home. Now if only I could find a way to become “instructor of the year,” which of course is not likely with the all star regents and instructors that I work with! 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 our efforts to improve safety. Many thanks to the Vision Zero Steering Committee not only for the development of this paper but also their continued efforts with Vision Zero. Wear that bracelet if you are not already doing so! There are many other initiatives that AAMS is working on, including the Federal Excise Tax rebate on fuel purchases and Medicare condition codes. Your association, 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 as we are always looking for volunteers for committees. Contact Dawn Mancuso at the AAMS office—we need everyone! Every association has members who have made a great contribution to both their association and the air medical transport industry. Often these individuals do not receive the recognition they deserve. I plan to use the last few submissions of my term to highlight a number of AMPA members who have, in my opinion, made a significant impact on AMPA and the air medical transport industry. Dr. Laurie Romig started in ground EMS about 16 years ago. She became the medical director of Sky Care Critical Air Transport, Inc. in St. Petersburg, Florida, in 1994. In that same year she also became the medical director for Bayflite Airmedical Transport in St. Petersburg, Florida, a position she held for 8 years. She has served as comedical director of LifeNet 5 Airmedical Transport in Bartow, Florida, and is currently the medical director of Pinellas County EMS, Pinellas County, Florida, and the executive medical director for LifeNet, Florida Air Medical Transport. Laurie's EMS interests are not limited to medical direction. She continues to be an active EMS educator. She is a charter member of the National Association of EMS Educators, has held the position of professor of emergency medical services at The American College of Prehospital Medicine in Navarre, Florida, and is presently an adjunct faculty at St. Petersburg Junior College Emergency Medical Services Training Program in St. Petersburg. In addition, Dr Romig is a frequent speaker at AMPA preconferences, AMTC, and CCTMC. Laurie joined AMPA in 1995 and has been a board member since 2000. She has served a term as board member at large and two terms as secretary-treasurer, the position she currently holds. Laurie was an integral part of the Planning Committee for the Air Medical Leadership Congress in September 2003. She has been one of the leaders in safety for AMPA and is the AMPA liaison to both the Air Medical Safety Advisory Council (AMSAC) and the AAMS Core Safety Committee. Her dedication to safety and concern for others is demonstrated by the fact that she always personally calls the medical director of a program that has suffered an accident to offer assistance and support. Dr Romig has spoken widely in Florida, nationally, and internationally, and her contributions to the literature are significant. She has received numerous awards for her contributions to EMS, including the Governor's Commendation for “extraordinary sense of purpose and commitment to Florida's emergency medical services program” in 1998, the Footprint Award in recognition for outstanding contribution to 2003 Air Medical Leadership Congress, and the Raymond H. Alexander EMS Medical Director of the Year Award for 2005, which recognized the year's most outstanding Florida EMS medical director. Laurie has contributed tremendously to AMPA's growth and productivity over the past 6 years. AMPA and the air medical transport community have greatly benefited from her efforts. This is an exciting time to be part of the transport community! It is a time of change, and with that change comes the opportunity to create great systems and enhance great teams. However, without a systematic approach—including a clear vision, mission, and core values—how will you know where you are going? How will you know when you have arrived? Or when you have veered dangerously off course? If you are part of a program that is experiencing change, have you participated in a multidisciplinary tabletop analysis to brainstorm where you are, where you want to be, and how you plan to get there? Do you have specific, measurable, attainable, realistic, and tangible goals written down? Do you have buy-in from all in your program? One change many programs will face this year is the need to interview, hire, and train new crewmembers. There is much discussion about competency, which I will address briefly here. Sadly, there is less discussion about interviewing techniques that allow you to pinpoint the person(s) who will be the right fit for your program. It is costly and can be morale-draining for all involved to hire someone who turns out not to be a good fit. Surely we all want to hire competent transport professionals. What exactly is competence? How do we define it so we can train to it and recognize when it has been attained? When I spoke on the subject of competency at AirMed last summer, the definition I used was “the integration of a set of specific, observable, and measurable behaviors that are critical to successfully perform a specific job function.” These behaviors encompass three domains: cognitive (knowledge), psychomotor (skills), and affective (attitude). Knowledge refers to didactic knowledge or “book smarts.” Can the transport professional list the program-specific sequence for rapid sequence intubation? Skills refer to hands-on ability. Can the transport professional demonstrate proper oral intubation technique on a human patient simulator? Attitude, the most nebulous but quite possibly the most critical of the three, refers to emotional intelligence, a combination of personal attributes, critical thinking skills, and “street smarts/street savvy.” Does the transport professional understand when intubation is not the best choice for the patient, and can s/he collaboratively involve the patient, family members, EMS, hospital staff, and his or her partner as appropriate in the decision making process? One must be competent in all three domains to be a truly successful transport professional. Like most of you, I have found the majority of people who are not successful during the orientation process lack the necessary attitude, not the necessary aptitude. This is supported by the literature and begs the question: Can we teach attitude, or must we hire for it? Some would argue that we must hire for attitude and train for knowledge and skill. This group would further argue that the best predictor of future success in a particular situation is past success in a similar situation. This is the basis of the behavioral interviewing technique. It matters not if we are looking at the situation from a manager or a peer perspective. How do you know if a crewmember will act competently in any given situation? It is one thing to give an interviewee a scenario and ask “How would you handle this situation?” It is quite another to ask a question such as: “Tell me about an instance where you were not in agreement with your partner about a treatment decision. Describe the situation, what your action was, what the end result was, and what you learned from the process.” With the former method, most interviewees are savvy enough to say, “I would…,” and give you the answer they think you are looking for. With the latter method, however, the interviewee must actually describe all components of his/her behavior in a previous similar situation. Thus, the interview panel gains significantly more insight into the interviewee's experiences and behaviors by listening to how s/he has acted in a previous situation, what s/he learned from that situation, and how they s/he can be expected to act in a future similar situation. In essence, this interviewing technique is successful because it forces you to define the traits you are looking for, design questions to elicit whether or not the interviewee is likely to possess those traits, and, thus increase your chance of hiring someone with the right attitude—someone who will be the right fit or have the right emotional intelligence for your program. What follows is an abbreviated outline of the process. 1Perform a job task analysis: What do crewmembers do? How do they do it? What results do they achieve?2Define core competencies: Assemble a multidisciplinary work group and perform a tabletop analysis to define core competencies. What traits do you expect of a team member?3Define key performance indicators: Within each core competency, what essential behaviors are you looking for?4Design your “Situation-Action-Result” interview questions: The goal is to elicit whether or not the person you are interviewing can demonstrate that s/he possesses the traits for which you are looking. This has been but an introduction to this topic. Look for ASTNA to provide future, more in-depth guidance on the subjects of competency and hiring for fit. As always, do not hesitate to contact me or any ASTNA board member with questions, suggestions, or comments. “…emotional intelligence emerges as a much stronger predictor of who will be most successful, because it is how we handle ourselves in our relationships that determines how well we will do once we are in a given job.” Daniel Coleman Develop the Leader Within! Management Made Easy! Career Development 101! You get the same flyers in the mail that I do. Simply give any one of a multitude of companies 2 days and half a gazillion dollars and you can learn everything you need to know about ___________ (leadership, management, human resources, employee motivation, career development, feng shui in the workplace, gourmet coffee as a motivational tool). Personally, I've never taken advantage of preregistration for a limited number of openings. I guess the 2 days and half a gazillion dollars haven't ever been in cosmic alignment. But I've heard the some of the courses are really good. Conversely, some of the courses are reported to be dismal rehash of bad books. So what is a competent critical care professional to do? How do you know which courses are good and which are not? How do you make the move from field to management? What if I can't get the time off for the Medical Transport Leadership Institute? The IAFP has a solution! The IAFP is sponsoring the First Annual Leadership Development Preconference at AMTC. This precon is developed for you, the professional leader who wants to enhance your workplace, organizational, and industry contributions. You may be looking for a formalized management or administrative role. You may be looking for tools to use as a consultant. Or you may be struggling with how to be more effective in the job you're in now. Each year, the IAFP will analyze your feedback and industry trends to bring you relevant, take-home tools to use every day. We are recruiting leadership and management experts to help you develop your talents. And we are inviting critical care administrators, recruiters, and icons to get to know you. They will offer valuable insights and advice to help you make the most of your career. Dr. Kathleen Gallo will welcome you to our first leadership development precon on Sunday, September 24, in Phoenix. She is the chief learning officer for North Shore-Long Island Jewish Health System. An international instructor who has just returned from Japan, she is also the leader of the Center for Learning and Innovation, developed in cooperation with Harvard University and General Electric. You are already leaders. That's obvious by your dedication to critical care. You support your professional organizations. You work on community-wide safety initiatives. You stay current through education and reading publications like AMJ. Take a quick break and take stock of how many people you have positively influenced just in the past few months. “Good managers do things right.” “Leaders do the right thing.” The IAFP wants to applaud you for your leadership and give you the management tools to maximize your natural potential. See you Sunday, September 24!
Referência(s)