Focus on accidents provides opportunities

Abstract

It is no secret that air medical transport services have been popular with the press recently. Although some reporters only want to print the sensational, negative news, even bad press has its advantages. It has provided the air medical community with the opportunity to identify a course of action with a stronger resolve to collaborate, lower the accident rate, and put the emphasis back on safe, quality transport for our patients and peers. Over the past several months, I have attended and represented the Commission on Accreditation of Medical Transport Systems (CAMTS) at several national meetings, starting with the HAI EMS Committee Meeting in Anaheim, Calif., in February. In the past, this meeting was usually attended by no more than 35 people. But this year—probably in response to the FAA's Notice 8000.293, issued on January 28, 2005—more than 100 attended. The FAA and the NTSB were well represented at this meeting, along with many aviation operators and air medical program managers. FAA officials Matt Rigsby and John Cox explained the study they did on air medical accidents and their findings, which resulted in Notice 8000.293. The Notice makes many recommendations, not mandates, to the air medical community that include training and equipment. Training in decision-making skills is emphasized for all disciplines within an air medical service, including managers. More management oversight also was discussed by Dick Healing from the NTSB, who strongly encourages the use of risk-assessment tools, such as those developed by the military and off-shore pilots. These risk-assessment tools provide the line pilot with a checklist to assist in decision making so that when a number of conditions—such as marginal weather, night conditions, and new pilot situations—occur, a manager is consulted. Several programs' risk-assessment tools are featured in the CAMTS Best Practices publication, but the FAA also announced they are collecting risk-assessment tools to make available to the air medical community. In March, several of our board members and I attended the AAMS Mid-Year conference in Washington, DC. The safety portion of this conference was very informative and involved not only air medical providers and organizations but also government officials from the FAA and the NTSB. James Ballough, FAA director of flight standards, spoke about air medical accidents and agency recommendations. He emphasized that creating tighter regulations would not be the answer to lower the accident rate and encouraged participants to enhance training and safety. He suggested that we police ourselves with auditing processes, such as CAMTS. The CAMTS board members had scheduled meetings while in Washington DC with Ballough and Healing. Again, the spirit of collaboration was evident, and we now have a hyperlink from the faasafety.gov Web site to the CAMTS page. The CAMTS board also met with Indian Health Services (IHS) while in Washington. The IHS requires CAMTS accreditation in order to award a service with a business operating agreement for air medical transport. Because of the remote location of many Native Americans, the CAMTS board wanted to bring to IHS' attention the need for paved runways, electricity, running water, and weather-reporting systems at these locations. We also agreed to provide a presentation for their emergency department physicians and nurses who request air transport to address “shopping” for air transport by emergency department personnel when weather conditions are unfavorable. Finally, Tom Judge, president of AAMS, announced a new initiative called Vision Zero during his talk at the Mid-Year conference. There is no downside to a heightened awareness about safety. Looking back at the mid-1980s rise in air medical accidents and resulting bad press, we drew together and developed standards. In 1990, the Commission on Accreditation of Air Medical Systems was incorporated as a voluntary accreditation process to address many of these safety issues. In that same year, there was only 1 air medical accident because we worked together and focused on setting a new course. That is what Vision Zero is about. None of us is naive enough to think we can prevent all air medical accidents, but an accident is something that could not have been predicted. What we want to stop are crashes caused by careless practices or bad choices. And we certainly do not want to lose any more patients or peers. As we move toward a new year, we all need to look for opportunities to make air medical transport safer and share our ideas in a spirit of enthusiasm for a brighter and safer future.