Forum
2007; Elsevier BV; Volume: 26; Issue: 5 Linguagem: Inglês
10.1016/j.amj.2007.07.001
ISSN1532-6497
AutoresDenise Treadwell, Gary Sizemore, Edward R. Eroe, Anthony Pellicone, Michael W. Brunko,
ResumoIn a previous column, when describing the differences between regulatory bodies and professional associations, I noted, “Professional membership associations represent their members through collaborative efforts with other similar organizations or allied associations, defining standards of the profession through publications and position statements, and promoting the profession through continuing educational and professional development.” In representation of ASTNA, I was privileged to do just that at a recent meeting in Washington, DC. ASTNA became involved as a direct result of our efforts to promote the practice of advanced airway management by transport nurses with state boards of nursing and other partnering associations. As many of you have experienced first-hand, the administration of the medications used in drug-assisted intubations (DAI) or rapid sequence intubation (RSI) by transport nurses is being evaluated in many locations and restricted by boards of nursing in several states. DAI includes RSI, the use of neuromuscular blocking with or without sedative agents to rapidly facilitate endotracheal intubation, as well as other techniques.Air & Surface Transport Nurses Association, 2007Air & Surface Transport Nurses Association. Advanced Airway Management Position Paper. Available at www.astna.org/documents/ASTNA2007AdvancedAirwayManagementPositionStatement.pdf. Cited July 10. 2007.Google Scholar This heightened attention is due to recent anecdotal reports describing the unanticipated negative impact of this skill on patient outcome, which has led to unresolved questions regarding the role and safety of this skill in the prehospital environment. These reports continue to gain attention, notwithstanding peer-review studies with published data that support the use of RSI in the transport environment. ASTNA worked closely with the International Flight Paramedic Association and the Air Medical Physician Association (AMPA) in an effort to resolve these restrictions in several locales. In response to the growing attention of the use of DAI or RSI in the transport environment, ASTNA published its Advanced Airway Management position paper with support from AMPA and the Emergency Nurses Association (ENA). During these endeavors, it was brought to our attention that the use of procedural sedation was being restricted in emergency departments, outpatient settings, and intensive care unit in several states. Procedural sedation is a clinical technique using a combination of three general classes of pharmacological agents (sedatives, analgesics, systemic agents) to create a decreased level of awareness for a patient without the loss of protective airway reflexes and adequate spontaneous ventilation. The objective is to provide analgesia, amnesia, and anxiolysis to the patient undergoing a potentially uncomfortable, painful, or frightening procedure. While this differs from DAI or RSI, the techniques share enough similarities to support partnering with these other associations in championing both causes. This led to ASTNA being invited to the Procedural Sedation Stakeholders' Summit, sponsored and organized by ENA. The summit was attended by representatives of more than 15 other professional associations, including the American Association of Critical Care Nurses (AACN), American Association of Nurse Anesthetists (AANA), American Academy of Emergency Medicine (AAEM), American College of Emergency Physicians (ACEP), American Nurses Association (ANA), American Society of Pain Management Nurses (ASPMN), National Council of State Boards of Nursing (NCSBN), and ENA, just to name a few. The original purpose of this meeting was to formulate a consensus statement for evidence-based and safe patient practice in the emergency and critical care settings in relation to procedural sedation and to provide clarity and recommendations to state boards of nursing. Through ASTNA's participation, this was expanded to include RSI. By the end of the day, the group had completed the draft consensus statement, which included an introductory statement of the problem or identified need, defined principles for use of procedural sedation and RSI, and agreed beliefs or supportive statements. The statement closes with an addendum of defined terms and cited references or resources. After all revisions are submitted and discussed by the group through a series of conference calls and email, the statement will be released publicly. As stated by Kathi Ream, ENA Washington Representative, this collaborative effort will greatly assist in addressing RN scope of practice issues surrounding procedural sedation and RSI. ASTNA was honored to join this prestigious group and participate in such a productive and much needed undertaking. ENA deserves much recognition and gratitude for their strong work in organizing this meeting. Specifically, the ASTNA board of directors is grateful to ENA President Donna Mason, ENA Executive Director David Westman, and ENA Washington Representative Kathleen Ream for unifying the collaborative efforts of these professional associations to this common goal. There really is strength in numbers! Denise Treadwell, President Inspiration can come from many places, often the last place we expect. I recently picked up a newspaper from a small Appalachian community in eastern Kentucky. While flipping through the pages, I came across an interesting article titled, “The White Cat.” As I read, I must admit it sparked a moment of thought. Later that week while watching television, a commercial ran and brought my thoughts back to the article I had read in the small paper. Call it deja-vu or whatever term you wish to use, but again it made me think. I think it is pertinent to life in general, as well as air medical aviation. The article explained that a stray cat appeared on the door step of an eastern Kentucky mountain home. I won't attempt to explain the culture, but most there would not turn away any stray that appeared as long as there was something they could feed it. The family took in the cat, and since they did not know its name, they referred to it as the White Cat, a suitable name considering the cat appeared white when they looked at it. The cat remained with the family for the rest of the year. One day the man of the house called the family together to see the white cat as it stood outside against a freshly fallen blanket of snow. When they looked at the cat, it no longer appeared white but instead yellow The underlying lesson is that we often see things based on the background we view it against. When the background changes, what we see may be drastically different than what we thought we saw earlier. We should strive to look at things based on a pure or upright background. Later in the week I was attempting to relax at home before reporting to work. I sat on the couch not thinking about much, when a commercial aired about carpet cleaning, of all things. The commercial talked about deep cleaning and showed a sofa and area rug over a carpet in a room. Everything looked the same, and no real dirt or spots were evident. The person in the commercial pulled back the corner of the area rug to reveal a stark difference between the rest of the room and the carpet under the area rug. You could instantly tell how dirty the carpet was and how drastically it needed to be cleaned. The lesson here again is be careful what you think you see. Are you making a comparison with the background, or are you really seeing the true essence? You may be feeling a bit confused about how this pertains to air medical aviation, and I understand. There are several instances in which this is a valuable lesson for us. When we do an audit, either a personal fitness audit or a safety audit, are we looking at a background that skews our observation, or are we looking at things against a pure background that allows us to see the flaws? If we want to ensure we are fit for work, we need that pure background and we need to see all the flaws so we can correct them When we do a safety audit, the same theory applies. We need to know what the true story is, and we need to change the parts that are not safety oriented. We can't afford to let things get lost in an obscured view of the world around us. We can't be numbed by the camouflaged view we may see when we allow things to blend into the background. Attention to detail and true situational awareness are our safety nets. The next logical question is, “How do we find the pure background to use when we view ourselves or our program?” September is a good time and AMTC is a good place to get those answers. By keeping up with continuing education and taking advantage of the numerous sessions offered at AMTC, we can view ourselves and our programs against what an air medical service provider or a flight crewmember should look like. That will give us our pure background to compare ourselves to. In addition to AMTC, keeping up with national trends and standards will also help. Continued training, a constant awareness of the world around us, and, more importantly, the changes in the world around us will help keep us safe Gary Sizemore, President Welcome to the Air Medical Transport Conference in Tampa, Florida. I, along with all the associations, hope that this year will set an all-time record for attendance and continue that record-breaking attendance we have experienced the past 3 years! Please make the most of the conference by attending all the great educational programs and visiting all the companies that will be exhibiting in the conference exhibit hall. The AAMS board of directors had their June meeting in Kansas City this year. At the June meeting we update our strategic plan, so this year we spent several hours reviewing where we have been and what our goals are for the future. We identified six goals, with one being new from last year. They are: 1.Membership dues initiative. As I have written in my AAMS News & Views column, this is critically important for the future of the association, given the changing nature of our members from hospital-based to community-based. The AAMS Membership Committee, under the leadership of Gina Blevins, has been exploring a number of different alternatives that are fair and equitable to all members.2.Role in health care. We need to communicate our critical role in the health care system, especially now with the real possibility of some type of national health plan being developed.3.Public relations/media relations/public education. The AAMS Community & Public Relations Task Force is nearly complete with their recommendations to the board, which will include an expansion of AAMS' work in proactively telling the very positive story about our critical care services.4.Role of the foundation. Fortunately, through the work of Kevin Hutton and many others on the FARE Board, the foundation is moving forward at a very rapid pace now, especially in obtaining donors. This work will be continued, and extra staff at FARE are being added to assist with this process.5.International focus/niche markets/partnership relationships. AAMS has worked closely with many international organizations and most notably with the upcoming AirMed 2008 conference in Prague. We continue to value these relationships, as we stand to learn just as much as the knowledge we impart.6.Financial viability & sustainability/modeling. This new goal was identified as being important with the changing nature of reimbursement. We will be working on a financial and service delivery model that will serve us now and into the future so that we guarantee the viability of the critical care services for the patients in need. Each year the AAMS president, with input from the board of directors, provides awards to individuals who have made an impact in the air medical community over the past year. While there are many persons to recognize, these particular individuals have gone over and above the call of duty. They are in alphabetical order: The AAMS Staff. Dawn Mancuso and her staff go above and beyond their individual job descriptions to deliver great services to our members, the AAMS board of directors, our affiliated associations, and especially to me in my role as president. Rex Alexander. Rex is the rotor wing lead pilot at Lutheran Air, based in Fort Wayne, Indiana, and also serves at the president of the Indiana AAMS. Rex has done an outstanding job in providing leadership to the Indiana AAMS and developing innovative new projects such as the recently completed Hospital Education webpage at the Indiana AAMS site. Tammy Chatman. Tammy is the PIO for Flight For Life in Northern Illinois and Wisconsin and has been a huge assistance to me as the president of AAMS. It seems like Tammy is always the first one to know of events in our community, and she does a wonderful job in communicating that information to many of us. Kevin Hutton. Kevin is the president of Golden Hour but has also been serving as the chairperson of the FARE board of directors. Through his leadership, FARE has put together a comprehensive development plan and has raised a tremendous amount of money to support research and other important projects in our community. Kevin has continued the great leadership that was provided by both Connie Eastlee and Christine Zalar before him. Denise Landis. Denise is the program director for Survival Flight at the University of Michigan and also has served as the chairperson of Medical Transport Leadership Institute (MTLI) since its founding 11 years ago. Denise has provided that consistent and enjoyable leadership to the Board of Regents that has made the program so successful over the years. MTLI Staff. This was a recording breaking year for attendance at the MTLI, which AAMS holds in Wheeling, WV. There is so much work that goes on behind the scenes year-round at Oglebay, and we are very thankful to them for their support and great customer service. Rollie Parrish. Rollie is a flight nurse at Northwest MedStar in Spokane, Washington, who I have known for years but got to know even more personally when my company, MedServ, began offering management services to Northwest MedStar a few years ago. Rollie, as many of you know, is the webmaster for FlightWeb, which has become the real go-to website for up-to-date information on our air medical community. Rollie does this as a labor of love, and we are thankful to him for this wonderful work. Sandy Kinkade. Sandy is with Bell Helicopter Textron, serving in their Six Sigma Program, but is also an at-large member of the AAMS board of directors. Sandy graciously hosted a meeting at Bell for the AAMS Communications and Public Relations Task Force to explore alternatives for meeting member needs in this important area. The group used Six Sigma techniques to arrive at their conclusions, which made for a very thorough and comprehensive report, thanks to Sandy. William Koegler. Bill is in charge of development, planning, and continuing education at the Oglebay Resort and Conference Center and works directly with AAMS each year on MTLI. Because of Bill and his staff, MTLI is now the 2nd largest school at Oglebay. 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, especially as we are always looking for volunteers for committees. Contact Dawn Mancuso at the AAMS office; we need your expertise and assistance. Thank you and Vision Zero! Edward R. Eroe President The word vision may be seen as a connotation of something magical or even grandiose; the International Association of Flight Paramedics refers to vision as a picture of the future with some understanding of why people should strive to create that future. Although a great vision can offer a useful purpose, even if a small number of key people understand it, I would like to communicate clearly the purpose and steps taken for the visionary changes in motion. The IAFP has undergone numerous changes the past years, including a name change and the redesign of the board to a business model, to make a great profession soar to new heights and regions as a united body. In a change process and a planned vision, three vital principles must be served: clarification, motivation, and coordination. The IAFP has and will continue to lead the representation and change of paramedicine, with the support of its members. We have decided to simplify the direction of change that needed to take place, and that is “to represent all aspects of critical care transport.” With this clarity came direction and the ability to make decisions. A collective team embraced this vision and removed time-consuming deliberation and inappropriate projects, therefore dedicating resources toward the transformation process. The projects that contribute to transformation are the embodiment of the ever-changing arena of EMS, as well as the needs and desires of physicians and hospital staff. The second step in our transformation was to facilitate major changes through motivating actions that were not necessarily in people's “short-term” self-interests. These adjustments called for a vision that caused some anxiety. Did we have anxiety? Of course! Does it still exist? Of course! However, this anxiety is suppressed by the excitement and direct involvement of the membership. It is clearly seen in the coordination and lobbying of the state delegate program and the board. This vision of change allows us, as an organization, to overcome any lack of enthusiasm to do what is necessary by being positive and therefore motivating the vision and each other. We continue to challenge each other and use this anxiety to fuel the momentum of the association's success. The third thing we did was share the direction of change with other factions. We felt that, without a shared sense of direction, our association could end up in a constant conflict. We created autonomy on the local, state, and federal level and decided that communication will be our greatest tool of success. We have realized that the development of a transformational vision often requires those who champion the change to spend a tremendous amount of time collecting information, assimilating it, considering viable options and alternatives, and then making decisions. We understand that accepting a visionary change can be a challenge to all, both mentally and emotionally. The need to transform the representation of IAFP to embody all aspects of the paramedic profession is great. The air medical industry has been at the forefront of the development and application of critical care transport for years. An ingenious collection of minds has created professional and educational opportunities across this industry. These individuals have soared to new heights, and that vision needs to be shared with other modes of critical care transport. The same support and success that created our current structure and opportunities in the air medical world are needed desperately for ground critical care paramedics. The greatest difficulty that we may face is an incremental transformation of our association. In the past our association was centralized, inwardly focused, political, and reluctant to take risk. While these characteristics and approaches have brought us thus far, the future of critical care warrants a culture change. We encourage and support an open and candid approach; we also put great thought into our decisions but are quick in making them. Empowering the members to be more involved locally and federally will create an environment that is more risk tolerant and keep the vision of progression alive. Open communication has and will continue to be the approach of our association. In the upcoming months, we will undertake projects and events that will need the support of the association, such as the coordination and participation in a national survey that will target all paramedics. This will allow us to understand what your needs are, as well as what function each paramedic undertakes, whether it is 9-1-1 or interfacility, by air or by ground. We will coordinate advocacy as a collective group to our federal lawmakers and assist with the development and representation of critical care paramedicine. We will also participate in forums, lecturing and presenting at national conferences. All this effort is being created to understand the issues that affect paramedics nationally and internationally. While I appreciate that gaining the understanding and commitment to a new direction is never an easy task, I want to share the sense of a sought-after future as motivation and to share the coordination that is taking place during this transformation. This is possible with the input and feedback from you to lead this profession as we strive for representation and soar to new heights. Anthony J. Pellicone, President As many of you are well aware, AMPA is celebrating its 15th anniversary as an organization. There were 70 founding members who met at Snowbird, Utah—29 of whom are still active members (about a 40% retention rate—not bad). The Hoshin Technique still brings back memories! If you were one of those original members, I am sure you are like me and find it quite interesting if you look back at the changes you have experienced, both professionally and personally. If you have children, they likely have grown, moved out, are in college or even have had children of their own since 1992. Likewise, our professional interests and involvements in critical care transport have changed. Some of us may be with the same program, may be with a new program, have seen our program grow, or watched our program change names or add “offspring” as we have branched out and changed with the times. The industry itself has undergone many changes; for example, I imagine that at least half of the founding members who were originally involved with hospital-based programs now are medical directors of nonhospital-based or vendor programs. I could probably continue with numerous changes that we have seen or experienced first-hand as medical directors but would be willing to guess that one thing that has not changed, especially for the original founding members— our dedication and belief in the AMPA mission: The Air Medical Physician Association is a unique association comprised of physicians and professionals involved in medical transport who are committed to promoting safe and efficacious patient transportation through quality medical direction, research, education, leadership, and collaboration. AMPA, as an organization, has come a long way in 15 years and owes much of that to the dedication of its members and leadership to the above statement. AMPA members have been leading the way to back up our mission: our dedication to safety with Ira Blumen's A Safety Review and Risk Assessment in Air Medical Transport document, the Safety First conference, and participation in the Air Medical Task Force and Core Safety group; research with numerous studies, publications, and the CCT CORE group involvement by AMPA members; education with the Core Curriculum, Principles and Direction of Air Medical Transport; presentations at the annual AMTC and CCTMC meetings, AIRMED and various other meetings at which AMPA members lecture; and collaboration with our sibling organizations AAMS, ASTNA, IAFP, and NEMSPA. I personally find this 15-year milestone to be important. It seems that it usually takes about 15-20 years for most medical professionals to accomplish what they set out to do when they are involved in leadership roles. A reason for this may be attrition but more important, I feel, is that new, energetic, bright, motivated, talented people who join the group with new ideas and vision. I see AMPA to be coming upon that next stage in its existence. The potential of the new members and leaders who were maybe college or high school students 15 years ago is huge. The future generations of AMPA that will have a major role in how we look in another 15 years are reading this now, I hope, and have ideas that will shape our future. If you are a recent or new member or are considering membership, try to attend the AMPA 15th anniversary on Sunday, September 16, to meet and talk with some of the founding members, current leadership, and the future leaders of AMPA. Then 15 years from now, you can look back and see what AMPA has accomplished. Michael W. Brunko, President
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