SafetyMatters

SafetyMatters
JULY-SEPT. 2014
America’s Medical Transportation Safety Newsletter
A quarterly, collaborative publication
from MedFlight and HealthNet
Aeromedical Services
Association of
Air Medical Services
Welcome AAMS Members!
SafetyMatters is published collaboratively on a
quarterly basis by MedFlight, based in Columbus,
Ohio, and HealthNet Aeromedical Services, based in
Charleston, West Virginia.
These not-for-profit programs operate the nation’s
only jointly sponsored air medical helicopter base
and have fully integrated the safety programs of their
respective systems.
SafetyMatters is just one example of the MedFlight/
HealthNet Aeromedical Services partnership.
The Great American
Safety Drive
By Rod Crane
President/CEO
MedFlight
The Great American Safety Drive (GASD) was
an epic safety event that stretched from Santa
Monica, Calif., to Hilton Head, S.C., from May
31 to June 13, 2014. Conceived by a former
Vietnam helicopter aviator, former Helicopter
Emergency Medical Service (HEMS) pilot and
now executive with the Air Methods Corporation,
Howard Ragsdale wanted to use the Route 66
drive to bring a national focus on air and ground
ambulance safety.
What began as a couple of industry grey-beards
talking about their bucket lists over a couple of
glasses of chardonnay ended up being a 2,700
mile sprint across America’s south-land.
Ragsdale had a dream of getting his 1962
Corvette restored and then taking “The Cruise” on
Route 66 as far east as possible and then ending
up in Hilton Head for a family reunion. Somewhere
along the dream route he convinced me to join
Special Edition for
AMTC ‘14!
THIS ISSUE INCLUDES:
him in my newly-acquired red, 2002 Thunderbird.
That led to his idea of “let’s raise money by selling
sponsorships” that would support the various
safety initiatives of the MedEvac Foundation.
The more we talked the bigger the dream cruise
got as he further expanded the bucket list drive
to include scheduling 2-4 hour “safety seminars”
hosted by local air medical providers in each
state we drove through. We were fortunate that
along the route there were Air Methods bases in
most of the 10 states we would pass through;
Metro Aviation and PHI had air medical programs
in those states that Air Methods did not, so they
were asked to help host safety seminars in their
respective communities.
As the original bucket list drive became more
complicated we engaged Rick Sherlock, President
of the Association of Air Medical Services and his
associate administrator, Blair Beggan, to support
Continued next page >
• The Great American
Safety Drive
• We Are Not Alone Up There!
• Ambulance Safety:
Where We Are and Where We
We Are Going
The Great American Safety Drive Continued
our efforts from her office in Alexandria, Va. At last report the GASD raised
more than $100,000 for the MedEvac Foundation.
While Ragsdale and I solicited men, women and children to sponsor
our journey, Beggan began to organize the hosts and seminar locations.
Ragsdale's company, Air Methods, and my company, MedFlight of Ohio,
became engaged in various capacities including creating safety presentations
(thanks especially to Lynn Malstrum of CAlSTAR for sponsoring our first
speaker, Linda Galindo; Marc Rusthoven, Corporate Safety Manager at Air
Methods; Colin Henry, Vice President of Safety at MedFlight; Tarek Lofty,
Director of Safety at Metro Aviation).
Many others behind the scenes helped with travel arrangements over
the 14-day trip across America and getting logos created for sponsors that
would be placed on each of the two cars. Without their help Ragsdale and I
would not have been successful in the GASD.
I must give a special “thank you” to our host air medical programs that
included: CalStar Mercy Air Service, Victorville, Calif.; Guardian Air at Flagstaff
Medical Center; PHI Air Evac, Albuquerque, N.M.; Northwest Texas (NWTX)
Lifestar, Amarillo, Texas; Medi Flight, Oklahoma City, Okla.; MedFlight of
Baptist Health Medical Center, Little Rock, Ark.; Hospital Wing, Memphis,
Tenn.; North Mississippi Air Care, Tupelo, Miss.; Lifesaver, Birmingham, Ala.;
and LifeNet of Georgia, Carrolton, Ga.
The one key theme throughout the two weeks of travel and safety
education was “accountability” to ourselves to make the right decisions
to minimize risk and our accountability to our company to report unsafe
performance of others. As a “consumer” of operator services, it was insightful
for me to learn, from key operators, what they have done to mitigate risk over
the past decade by implementing Safety Management Systems within their
companies.n
Safety training is presented at the Tupelo stop.
A check is presented to the ARC during the GASD stop in Tupelo, Miss.
Flight team members from the Memphis, Tenn., area gather during that stop
of the GASD.
Rod Crane and Howard Ragsdale with their GASD cars during a stop at the
Talladega Speedway.
We Are Not Alone Up There!
Colin Henry
Vice President of Safety
MedFlight
Jeff White, BA, MCCP
Safety Officer
HealthNet Aeromedical Services, Inc.
reported citings over the City of Charleston, WV
close to a landing helicopter air ambulance. The
An unmanned aerial vehicle (UAV) is a type of aircraft which has no onboard
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since the earlier days and are currently also usedare
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civilian market. They
management skills will help protect you and your crew.n
are now referred to as unmanned aircraft systems (UASs).
In the past, the military’s use of UASs has been somewhat controlled and
has not created a significant threat to manned civilian aircraft flight. Since
DJI Phantom 2 Vision+ Quadcopter
the list of potential uses for civilian UASs in the form of drones is growing
with FPV HD Video Camera and
we must expect and be vigilant for these vehicles in the airspace. These
3-Axis Gimbal by DJI
UASs are now used in activities such as aerial photography, surveying land
and crops, communications and broadcast, monitoring forest fires and
environmental conditions, and protecting critical infrastructures. For example,
the UAS can be fitted with a camera that records data to be downloaded
later and some can even stream live video feeds. Alaska oil companies have
also recently received permission to survey the thousands of miles of pipeline
using UASs. In the West Virginia area, there is anecdotal evidence of surface
coal operators using drones to monitor truck routes to maximize efficiency
We need to be acutely aware that these vehicle
Above:
of operations. They are providing new ways for commercial enterprises and
looking
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As this online sale depicts,
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public operators to increase operational efficiency and decrease cost.
approximately
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Last year, the FAA published its roadmap to integrate civil UASs into the
airspace use has left a lot of UAS operators out
National Airspace System (NAS). This roadmap
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Today, UASs are given access to the airspace through the issuance of a
Certificate of Waiver or Authorization (COA) to public
operators
and a special
Effective
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techniques together with goodLeft:
crew resource management
airworthiness certificate is issued in the experimental category for civil UASs.
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and threat/error management skills will help protect you and
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in flight
The problem here is that some uncontrolled airspace (lower at 700 feet
above ground level and in other areas lower than 1,200 feet above ground
level) may not be a part of this NAS. Our helicopter air ambulance (HAA)
population spends a considerable amount of time conducting operations in
this uncontrolled airspace. We are constantly landing in unimproved areas
such as on roadways, in fields, inside of this uncontrolled airspace.
In the recent months there have been numerous reports of UAS/drone
citings. In the Dayton, Ohio, area, “a Clark County man flying a drone was
arrested for allegedly hindering the landing of a medical helicopter.” We are
Right:
definitely seeing an increase in the number of drones operated for personal
Phantom Drone that can be
and private use. There has been two reported citings over Charleston,
purchased online or at many
W.Va., where a drone was being flown very close to a landing helicopter air
hobby stores
ambulance. The suspected UAS is called a phantom drone (pictured right)
and can be purchased at any hobby shop or online for about $1,000. There
is no license required to own or operate these and the FAA regulations are
minimal.
Ambulance Safety:
Where We Are and Where We Are Going
Ground ambulance
safety has lagged
behind other parts
of our jobs for
many years. In the
aeromedical segment
of our industry we
view safety as a
priority. Patient care
is ever evolving and
has extensive training
and controls in place
to insure that quality
is not compromised. However, ground ambulance safety has been allowed
to be placed on the back burner and little commitment dedicated to its
advancement. While some agencies are more advanced with safety than
others, as an industry, we are not where we should be. Several years ago,
some industry leaders and government agencies realized this and a push
was initiated to correct these deficiencies.
The National Highway Traffic Safety Administration (NHTSA), through its
Fatality Analysis Reporting System (FARS), has determined that EMS suffers
3,200 fatalities per 100 million miles traveled. This figure is 27% higher than
for police vehicles and 33% higher than for fire department vehicles. While
other parts of their occupations may be more hazardous, the report clearly
shows that EMS personnel face more danger during vehicle operations
than police officers or fire fighters. The report also states that 60% of the
crashes involving ambulances occur when the ambulance is using its lights
and sirens. In addition, 58% of the fatalities occurring in ambulance crashes
are produced in the crashes when the ambulance is using lights and sirens.
Since most ambulance operations do not include the use of lights and sirens,
this statistic shows how much greater the chance of being involved in an
accident either with or without a fatality increases while running hot on a call.
Another telling statistic from the NHTSA report is that while only 40% of
ambulance occupant miles are recorded in the patient compartment of the
vehicle, 72% of the fatalities occur in the patient compartment. While most
of the fatalities in the patient compartment occur because the occupant is
unrestrained and contacts the front bulkhead upon a frontal impact of the
ambulance, there are other factors that contribute to this number. These
factors include structural deficiencies, design factors and occupants being
struck by unrestrained equipment in the patient compartment.
Statistics such as these and from other reports demonstrate a need
for increased safety in the ground ambulance industry. The largest leap
in ambulance safety in the last few years has simply been in awareness.
The compilation of these statistics has made governmental agencies and
ambulance operators more aware of the dangers faced during vehicle
operations.
The jobs that we perform during ground ambulance operations involve
two main functions. Those functions are to provide quality medical care and
to provide transport for the patient to medical facilities. The medical care
aspect of our job has for decades had numerous controls and guidance
such as policies and procedures, protocols, testing and proficiencies,
medical direction, QA/QI programs, continuing education, etc. Air medical
transportation has many controls and guidelines from vendors, the FAA as
other agencies. These controls and crew education continuously grow for
By Robert Adkins
Ground Team Leader
HealthNet Aeromedical Services
the air medical operators. However, the ground transport component of EMS
has largely been ignored. Minimal training and controls have been the norm
in the industry. Extra training for crews can cause out-of-service time and
the personnel costs can be expensive; therefore, cost becomes a factor in
adopting additional controls and training.
Extensive research and guidance is needed to mitigate many of the
hazards that ground transport crews face. There has been a push over the
last few years to correct these deficiencies, but those programs are in their
infancy. Many European countries are far ahead of the U.S. in ambulance
safety and several advancements will be made just by copying things that the
Europeans have been doing for a few years. One visible example of the U.S.
copying from European countries is the reflective chevrons on the rear of the
ambulances. This has been the norm for years in many countries to increase
vehicle visibility, but has only recently become standard in the U.S.
Some of the agencies involved in the push for higher safety standards for
ground ambulance operations are the NHTSA, the National Fire Protection
Association (NFPA) and the National Institute for Occupational Safety
and Health (NIOSH). Strides are also being made by vendors and industry
publications.
In March 2013 the NFPA released NFPA 1917: The Standard for
Automotive Ambulances. This standard replaced the KKK-A-1822 Federal
Ambulance Purchasing Guide (KKK standards) that has been used for many
years. The 1917 standard presents minimum requirements for ambulance
design and performance, along with stand-alone chapters for ambulance
components including chassis, patient compartment, low voltage electrical
systems and warning devices and line voltage systems. The standard also
specifies provisions for testing methods for ambulances. The full standard
can be found on the Internet at www.nfpa.org.
NIOSH is working with manufacturers and other agencies making
recommendations to improve safety, concentrating on safety for crew
members riding in the patient compartment. These recommendations include
seating, restraints, cots and patient restraints and equipment mounts.
Vendors are advancing ambulance safety through extensive product
research and development. It is advantageous for the vendor to make these
advancements to keep product lines fresh and allows them to sell more
updated products. The industry benefits by having safer equipment with
which to work. One example of vendor product development advancing
safety is the recent introduction of ambulance stretchers and systems that
allow for the patient to be loaded and unloaded from the vehicle automatically
without lifting by the EMS crew. This can result in significantly fewer back
injuries on the job. The crew members benefit from fewer personal injuries
and the agency benefits from fewer lost time injuries by the crew and
ultimately realizes cost savings.
There are many things going on in the ground transport industry to
increase safety. As mentioned earlier, the extensive research that is being
performed and making participants aware of the hazards that are present has
been a huge leap in safety compared with where we were just a few years
ago. Many other changes are coming to the industry over the next few years.
Although no one knows for certain what these changes will be, our jobs will
be safer in the coming years.
One advance that is gaining popularity is driver monitoring systems. There
are several different types of these systems available, but all allow for the
agency to monitor habits of their drivers and make corrections as needed.
Continued next page >
Some systems have video recorded both out the windshield and the driver.
Some of these systems also have audio recordings. These systems use
a recording device such as an SD card and can be reviewed to discover
dangerous driving habits or cell phone use while driving and allow training
officers and supervisors an opportunity to coach the drivers. These systems
can be set to record continuously or just when the vehicle reaches a
predetermined G-force level. Other systems allow for real time auditory
feedback for the driver. If the vehicle reaches a certain parameter such as a
speed threshold or turning forces, a dispatcher or supervisor can coach the
driver in real time. Either of these or any other monitoring system allows for
the collection of data and can determine trends within a specific agency and
allows for the training officer to mold agency-wide classes to concentrate on
areas of concern.
The use of Electronic Stability Control (ESC) systems on vehicles is another
change that will reduce the number of accidents involving EMS vehicles.
These systems detect skids and losses of steering control on vehicles and
assist the driver. The system uses a combination of brakes and engine power
adjustments to help the driver regain control of the vehicle. According to
NHTSA and the Insurance Institute for Highway Safety, up to one third of fatal
accidents may be eliminated with the use of these systems. ESC systems
are primarily available only on van ambulances, but availability is expanding
to other vehicles.
The data that is being collected to determine risks to care providers riding
in the patient compartment will influence ambulance design for the future.
Designs will trend toward smaller vehicles and patient compartment layouts
that will allow providers to perform most of their tasks without having to
leave their seats. Some of the European countries have been making these
changes for the last several years and this is another area that will be copied
by the industry in the U.S. Some of these designs have the cot mounted at
an angle or have the providers in a pedestal seat that can be repositioned.
This allows full access to the patient while staying seated and restrained.
Rather than being stored in cabinets, the most commonly used supplies
are mounted in pouches attached to the wall of the ambulance and is within
reach of the crew without leaving their seats. In larger vehicles, procedures
and technologies are being developed to mitigate some of the known risks.
One trend is toward mounting portable equipment such as cardiac monitors,
ventilators and portable suction units toward the front of the vehicle to reduce
the chance of them striking a crew member if they become dislodged during
an accident.
Some agencies are using policies to mitigate some of the risks to their
personnel. One example is not using lights and sirens on cardiac arrest calls.
A cardiac arrest call usually means that two or more care providers are riding
unrestrained in the patient compartment performing functions such as CPR,
intubation or IV starts/drug administration that can’t be done while restrained.
With the known risks involved with running lights and sirens, this policy greatly
reduces the risk of an accident, and in doing so, reduces the risk of a fatality.
Risk and fatigue assessments are another tool that many agencies are
using to increase safety. A fatigue assessment can be completed at the
beginning of the shift and can be used to determine the readiness of a crew
member to complete transports during their shift. A mission risk assessment
sheet can be used on each individual transport to assign a tangible amount
of risk to the transport using factors such as time of day, weather conditions
and the amount of rest a crew has had up the that point during their shift.
Supervisors can use the scores on these assessments to make adjustments
to reduce risk to an acceptable level. Changing out a crew member or
delaying the transport for a couple of hours can change a high risk transport
into a transport with a risk level that is acceptable.
While there is a lot of work to be done in many areas, ground ambulance
safety is moving in the right direction. Change will come in increments,
and costs will be realized, but over time everyone will benefit from the
developments that are being made. The ultimate goal is increasing the odds
that everyone will go home at the end of their shift. n
Safety Communication
Contact Information
1. VP of Safety
2. VP of Risk
3. Infection Control Officer
866-745-2445, 614-734-8047 or
chenry@medflight.com
614-734-8024 or
lhines@medflight.com
614-734-8044 or
kswecker@medflight.com
Intranet Website Resources:
•Safety Awareness Form – The link to the form is located under the
Safety section
• Unusual Occurrence Form – The link to the form is located under the Forms section then under Administrative Forms
• MedDebrief System – The link is found under the quick links on the intranet and is automatically activated after a medical transport
1. Safety Director, Colin Henry
2. Safety Officer, Jeff White
3. Infection Control Officer,
Nick Cooper
614-204-1265 or
colin.henry@healthnetcct.com
304-610-3666 or
jeff.white@healthnetcct.com
304-653-4025 or
nick.cooper@healthnetcct.com
Intranet Website Resources:
TAMMA –
The link is found on HealthNet WorkPlace under Flight
Team/Communicators tab.
The link is found on HealthNet WorkPlace under Flight
Team/Communicators tab.
SafetyMatters
America’s Medical Transportation Safety Newsletter
Do you have any ideas for SafetyMatters?
Let us know by emailing colin.henry@healthnetcct.com or chenry@medflight.com