Portal de Periódicos da CAPES

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2007; Elsevier BV; Volume: 26; Issue: 3 Linguagem: Inglês

10.1016/j.amj.2007.03.001

1532-6497

Edward R. Eroe, Denise Treadwell, Anthony Pellicone, Gary Sizemore,

Trauma and Emergency Care Studies

We were all very saddened at the loss of a Benefis Mercy Flight fixed-wing aircraft from Great Falls, Montana, on February 6, 2007. Our thoughts and prayers go out to the Mercy Flight crew and the friends and family of pilot Vince Kirol, flight paramedic Paul Erickson, and flight nurse Darcy Dengel. On January 24, an Air Trek fixed-wing air ambulance overshot a runway while landing in Butler County Airport in Pennsylvania. Even though there was major damage to the aircraft, pilot Stephen White, copilot Angela Amon, flight nurse Vicki Carr, and therapist Kerry Dudley survived with only a minor injury. We are thankful that no one was seriously hurt and wish the best to Air Trek and their entire team. Overseas a Saudi Red Crescent Society (SRCS) air ambulance helicopter crashed on January 22 outside of Madinah, Saudi Arabia. The helicopter went down after returning from a mission; pilot Najat Dastog and flight physicians Abdussalam Al-Sheikh and Mahmoud Al-Howail all perished in the crash. Our thoughts and prayers reach out to the entire SRCS team and their families. On January 7, another fixed-wing aircraft, owned by Transwest Air, crashed in northern Saskatchewan, killing the pilot and sending three other crewmembers to the hospital with non-life threatening injuries. Our thoughts and prayers are with the entire Transwest Air Team and families with the loss of their pilot. I hate to hear about these crashes, but I feel it is important to highlight them so we can all learn and forever remain diligent to Vision Zero! Rollie Parish at FlightWeb announced that he is assisting a group of family members who have lost loved ones in air medical crashes with the formation of The Air Medical Survivors Network, an informal support group of family members and loved ones of crewmembers who have been lost in the line of duty. The group is still in the formation phase, but AAMS is dedicated to fully supporting their efforts and assisting them in publicizing the group to other family members who have lost loved ones in air medical crashes. If you know anyone who would be interested in joining this group, please have them contact Rollie at [email protected]. He is also working on a Web site for the group, but it is not ready as yet. The formation of the National EMS Advisory Council was announced on December 18 in the Federal Register by the Secretary of Transportation to provide advice and recommendations regarding EMS matters. The Department of Transportation and the National Highway Traffic Safety Administration (NHTSA) are taking nominations for council members. Only individuals can apply, so EMS organizations, including AAMS, do not automatically have representation on the council. Tom Judge, past president of AAMS, is interested in serving, and at the last AAMS board meeting, it was decided to send a supporting letter to NHTSA for Tom's nomination. Tom has been a strong advocate for EMS through not only his work at AAMS but with the National Association of EMS Physicians, and we all know that he would be a strong voice for air medical services. The next Air Medical Caucus meeting, as of this writing, will be held Friday, March 23, at 10 in the Longworth House Office Building. This will be the fourth meeting of the caucus, so please make sure your House of Representatives members are invited to join as we want to have as many representative offices present! More information can be found on the Government Relations page on the AAMS Web site at http://www.aams.org. The Congressional Air Medical Caucus is an important part of AAMS' public policy agenda so that we can continue to pursue the issues of our air medical community. For more information, contact Christopher Eastlee in the AAMS office at (703) 836-8732. Mike Paston from Aerocare MTI announced on January 11 that Jake, his service dog, passed away. I am sure many of you remember Jake from past AMTC and AAMS Spring Conferences, as he was known as the unofficial mascot of the air medical community, especially when wearing his flight suit! More information can be found on FlightWeb at http://www.flightweb.com. Mike, the entire air medical community will miss Jake! This has been a crazy winter this year, with large snowfalls further south and a dearth of snow in the upper Midwest, where I go Nordic skiing every year. My ski buddies and I only had a few inches of snow the third week of February with many run-ins with dirt patches, rocks, and stumps. The American Birkebeiner 51K ski race was shortened to 25K, but we were just happy that they held it, as the trail groomers deserve a medal. I finished my 20th year, which makes me an official member of the Birchleggings Club; interestingly enough, I am only one of 7 Birchleggings skiers in the world outside the upper Midwest! Mother Nature then proceeded to play a cruel trick by dumping over a foot of snow Saturday night and Sunday morning after the race, which caused all the flights out of Duluth to be cancelled. I travel almost every week in my position as partner/CEO of MedServ Air Medical Transport. It is very challenging to remain fit, but having the American Birkebeiner as a personal goal each year keeps me biking, weight lifting, doing stairs, and other forms of stationary exercise throughout the year, which is not easy with all the travel. Given that health care is such a stressful business, I urge you all to take the time for your own personal wellness plan. Mine is far from perfect, but it is a start. 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 as we are always looking for volunteers for committees. Contact AAMS executive director/CEO Dawn Mancuso ([email protected]) at the AAMS office—we need your expertise and assistance. Thank you and Vision Zero! Edward R. Eroe, President Understanding the role of regulatory boards or agencies and differentiating these from professional membership associations is a challenge for most professionals. 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. Unlike membership associations, regulatory or professional boards are established on the basis of legal mandates, and their primary activity is to protect the public. They usually comprise a group of people in a learned occupation who are entrusted with maintaining control or oversight of the legitimate practice of that occupation or profession. The regulatory board's purpose may be stated in various ways, but they all involve the general aspect of safeguarding or protecting public or consumer interest, safety, welfare, health, etc. While the regulatory board may also protect the interests of the professionals it regulates, the balance between the protection of public interests and those of the professional may be difficult to determine. It is important to recognize that the principal purpose of the regulatory board is to protect the individuals served by the profession or those who may be directly impacted by the professional's behaviors or actions in the performance of duties. This is done by regulating practice or the procedures allowed by individuals through the enforcement of legal or recognized standards and may require training, education, and licensure. To better understand, it may help to recognize that this practice is not exclusive to one profession. Every profession's practice is dictated through legal mandates, defined standards, or regulations defined by their respective regulatory or professional board. For example, aviation is regulated by the Federal Aviation Administration; public municipalities are governed by agencies such as Environmental Protection Agency or other regulatory agencies that set standards for those practices. Physician practice is regulated by their respective medical associations, paramedic practice is defined by their respective departments of emergency medical services or public health, nursing practice is set by state nursing boards, and so on. At times these standards may appear to be broad in nature and restrictive, but keep in mind that they are in place to govern the practice of all the individuals who hold that professional title, without respect to their expertise, education, or training. It is also essential to appreciate that the regulatory board may be empowered to represent its own self-interest and may act to maintain its own privileged and powerful position as a controlling board. The “teeth” of the regulatory board's authority manifests in the legal ramifications if these standards are not followed as they are written. Confusion regarding these governing bodies' role and how they affect professional practice escalates when conflicts between the defined scope of practice and the recognized practice or routine practice arises. Not unlike other professions, transport nurses face this same dilemma from time to time when conflicts arise between standards set by state nursing boards and the practice performed in the transport environment by the professionals they govern. In order to identify methods to resolve conflicts that may arise, or to come to an agreement on acceptable alternate practice, it is the professional nurse's duty to gain an understanding of the role of his or her governing board. This can be done by reviewing the board of nursing's mission statement, purpose, values, and beliefs. Generally, these are available on each state board's Web site, but they may also be obtained in print by direct request to the board. Furthermore, most nursing boards write their standards or nurse practice acts to allow for special privileges or approvals as needed, depending on the education, experience, and competence of the individual. For example, state boards of nursing may restrict the practice of all nurses by not allowing them to perform oral tracheal intubations but may grant approval for a specified group of nurses, such as transport nurses or nurses practicing in areas that require the performance of these skills by the nurse, provided they can document training, education and/or certification, and continued competency as defined by the regulatory board. This, too, is not exclusive to our industry. For example, local and state municipalities restrict personnel from changing natural gas regulator pumps unless they have been trained and certified to do so. It is imperative that the professional nurse identify the process necessary to obtain approval of additional procedures and, to provide competent and proficient care to the patients they serve, complete the process as required. Denise Treadwell, President Every day as I prepare for yet another day of work, like the rest of the world, I am enlightened by the newscasters of the events that have happened or the dealings that we need to be aware of happening. The part of the news that I enjoy the most is sports—why? The reality is that I appreciate the current events, the weather (for planning the route of least traffic), and the financial report, but sports is the part of the news that allows us to be taken away from the reality of the tragedy or wrongdoings that have occurred. Throughout history, whether we are at war or there are elections or even worldwide tragedies, one thing endures, and that is sports. The main purpose behind this viewpoint is not sports, per se, but the idealism of teamwork. I value the position of numerous individuals from different backgrounds all coming together with a common goal. Wherever we are from, we all recognize the word “team;” there are professional football teams, college basketball teams, even chess teams for those that are not into athletics. For health care professionals, there are critical care transport teams. There are such things as groups that are not teams. A group is individuals assembled together without organization, whereas a team is people associated together in a specific activity with a common goal, and not one person more important than the other. Team members share a complimentary skill set and work toward a common purpose. Additionally they are held to performance goals for which they hold themselves mutually accountable. •Teams can bring together a broader mix of skills that exceed those of any single individuals.•An effective team can be a major factor in overcoming a business, association, program or even an undesirable outcome to change. Individuals with their own strengths and weaknesses with clearly defined roles and complimentary skill sets, united with strong and level communication, can easily create the optimum team. Although this may seem achievable, all members need to be prepared to help all other members on their team. With team members coming from different backgrounds and various levels of training or licensure, we need to respect each other. We all have bad days—be sure to be the motivator, not the manipulator, for this will only strain the mission of a collective team. If one team member comes upon an issue or concern, acknowledge the problem but stay focused on the solution. Communicate with open dialogue and an open attitude because some day sooner than later it may be you having that bad day. Although there is leadership at every program and every hospital, it is the duty and responsibility of each team member to do their part and keep their program moving ahead. Take on additional responsibilities; ask management for the opportunity to work with other members that you do not usually work with. This promotes teamwork and allows views and skills to be shared among all. This also allows all members to stay focused and excited about progress and work toward the common goal of delivering quality patient care. A content workplace produces productive employees. Conflicts do not become things of the past, but they have the ability to be resolved when people are comfortable and able to communicate openly and share a total project. The top five things I have learned and recommend in promoting an energetic, dynamic, and successful team are: •Commitment by all individuals of the organization, front line to leadership•Communications that are respectful to each other and to those we are responsible for and responsible to•Contribution so that all share the wealth and the burden. The responsibility of positive patient outcomes and the success of the organization rely on all team members. Promote creativity and interest.•Cooperation—it's all about give and take. Emphasize the importance of each person's job function, stress the common goal.•Conflict management should not wait until things are dreadful. Treat each other with respect, identify the issue and get problems out in the open, clarify thoughts and feelings, and create new solutions. I am honored to be supported by members of a professional board and all its members. At the same time, it is also a pleasure to be encircled by fellow associations that share the same interest, mission, and values. Together we are a team, a great team that has done and will continue to do amazing things for our profession and the patients we serve. Anthony J. Pellicone, President Every day, each and every one of us participates in marketing. Most of the time we don't even stop to consider the things we are doing are marketing. Our activities may be formal marketing, as we do for the programs we work at, or informal marketing. This process started when we were young and heard, “You only get one chance to make a good first impression.” Indeed it is important to make a good first impression, and usually the first impression lasts. We do that when we meet people, whether on a personal or professional level. Our marketing may become creative when we are looking for a personal relationship, especially one that may lead to a lifetime commitment. When we market ourselves for professional reasons, we need to emphasize the qualities that make us more desirable than others we compete with. In this process we take certain liberties without breaching the point at which we actually become dishonest. We stop short for many reasons, including the fact that we know someone may check and find out what we are truly about. We may stop short of being dishonest because it is the right thing to do. The values we were each brought up with play an important role in this process as well. I recently was asked to explain why I do the things I do and what drives me to make the decisions I make. That was an interesting and difficult question to answer. As I pondered what made me uniquely me and what made my decisions equally as unique, I decided it was the values I had been taught during my childhood and had reinforced or relearned as I grew up. In addition to the experiences I've had, the education I have completed, and the numerous people I have had the opportunity to interact with all influence the way I live my life and the way I make my decisions. My core values are integrity, honesty, responsibility, and accountability. I revert to these values when faced with a dilemma or choice to make. As I thought about this a little more, I thought about all the corporate misgivings that have been part of the news over the past couple of years, and why someone in those positions would make such decisions—even more thought provoking, would I ever make mistakes like these? One thing that may lead us to poor judgment and bad decisions is competitive pressures. Competition can be small or large and usually affects all of us at one time or another. When you apply for a job, you must face competition. It is easy to explain why you overinflate your résumé; you need the job and you are willing to do what ever it takes to get it. We often engage in self justification to explain away the wrongs we commit. The more we participate in this, the easier it gets. When we market our program, we may find ourselves doing the same on a grander scale. After all, our program is the best in the land, right? We may find ourselves overstating the capabilities of our program, its employees, or its equipment. Why do we do this? Is it just the pride we feel, or are we bowing to the competitive pressures? In order for me to remain gainfully employed, the program must be successful; therefore I have to represent it in the best possible way. Are we doing ourselves a service by this action? I don't think so, and soon enough we will be caught in something we claimed we are able to do but can't. This is especially critical when we do something that is inherently unsafe because we have “advertised” we could do it. I recently attended a meeting where a question was raised about the abilities of air medical services in the area. The question revolved around flight in times of bad weather. One community member said instrument flight rules (IFR) is not the problem because the programs in the area are not IFR programs. He went further in the explanation to state his program is in the process of acquiring night vision goggles (NVG). In his explanation he stated NVG will allow them to see at night and through the bad weather, so it won't be a big impact when the NVG are used. This overstatement of technological capabilities equates in many ways to developing a culture of unsafe activity. Why would someone make these statements? Was it overconfidence in the technology, misunderstanding the technology, or just bowing to the pressure of competition? We must all guard against doing things that are not entirely true just to beat the competition. When we do, we risk not only our reputation when we are found unable to do what we said we can, but we risk having someone do something unsafe. It is acceptable to do what is possible as often as possible and make our service or ourselves shine. We must ensure above all that people put safety first and disregard the capabilities we are supposed to have if they are unreasonable or untrue. Competitive pressure should be left on the football field, basketball court, or other sports venue, not brought into areas where it can cause undue risk to our community. Gary Sizemore, President