AMPA
Corona Fatigue Syndrome
Situational awareness is intrinsic to the practice of critical care transport medicine. Our community's culture of safety often describes the importance of vigilance in maintaining situational awareness and combating complacency — a carefree sense of security borne from ignorance or overconfidence. We educate against ignorance, we warn that familiarity can lead to overconfidence, and we encourage constant vigilance to identify and mitigate threats to ourselves, our teams, and our patients. We recognize that fatigue erodes vigilance, and we generally structure our operations to reduce acute fatigue as best we can.
In the July-August issue, I explored some of the challenges we have faced and some of the opportunities we have been afforded because of the coronavirus pandemic. At the time, my corner of the world was dealing with its first surge of patients, and while there was much uncertainty about what lay ahead, there was still hope that we had exercised some epidemiological control over the situation. CCTMC had to be canceled, but there was still hope that AMPS and the AMPA Core Curriculum might yet be held. These hopes have unfortunately since been dashed, and now it seems likely that most of 2020 will ultimately be canceled.
As many AMPA members rightly anticipated, this has not turned out to be a short journey, and SARS-CoV-2 has offered us another challenge — chronic vigilance fatigue. Our vigilance isn't just being threatened by long hours, cognitive overload, or environmental stress; it's being threatened by our intellectual endurance to maintain it. It's not that we don't appreciate the need for continued vigilance; it's that our motivation to maintain it has eroded over time. In moving past our fears, we require new motivation in order to maintain vigilance.
Any disaster response requires an extra level of vigilance compared to standard operations, and prolongation of that disaster results in gradual erosion of that vigilance due to habituation to the threats involved. But because these threats exist outside the set of standard operational threats, complacency regarding them is more challenging to manage through simple self-awareness. Because they require “extra” vigilance on top of our “normal” vigilance load, it is more exhausting to remain vigilant, and so our vigilance fatigues. Normalization of these extranormal threats may help combat chronic vigilance fatigue, but this is complicated by the changing nature of the threats and our reluctance to accept them as part of a new normal.
Brendan Berry, President
ASTNA
Staying Resilient in the Face of Adversity
In an unprecedented year, we've faced a global pandemic, civil unrest, and continued uncertainty as to what the future holds. Like many of you, life has been altered in a way that has greatly impacted our day to day lives, and this “new normal” could endure for an unforeseen amount of time. Regardless of how 2020 has impacted us, one overarching theme has been ever-present in my mind; self-care. No matter what your role may be in transport medicine, we are all susceptible to burnout and fatigue, especially in our current climate. Consciously take time for yourself, your families, and those closest to you. As we continue to endure what the rest of 2020 has in store for us, actively taking part in self-care can help retain some sort of normalcy in our lives. We owe it to ourselves and those whom we care for.
The #ASTNACARES campaign was a huge hit! Thank you for all of your wonderful nominations and participation to help us spread a little light and love to those on the frontlines. The wellness of our members and those in the industry is important to us, and we appreciate all that you do.
As I write this article, AMTC 2020 is still on course to occur in Nashville, TN. While working with individuals from our partner organizations on the AMTC education committee, we have been fortunate to see so much interest in presenting education topics. Never before have we seen such diverse, creative, and informative sessions presented. Although we anticipate and look forward to seeing you all in Nashville, 2020 may have other plans for us. AAMS is diligently working to create alternatives so that we may still take part in the education we look forward to each year.
Make sure that you take part in the ASTNA Annual Membership Meeting on November 3, 2020; more information on that to come. I truly hope to see you all in person this year!
In an effort to provide the highest quality education for our members and colleagues in the industry, ASTNA is proud to continue offering Online TPATC. This CAMTS-accepted course allows providers the opportunity for over 16 hours of continuing education that can be accessed anytime, anywhere. ASTNA is developing the Online Pediatric Advanced Transport Course (PATC), which we plan to release before the end of 2020.
No matter where 2020 may take us, keep up your dedication and hard work that truly benefits the communities we serve. Stay safe!
Josh Walls, President
IAFCCP
Rising to the Challenges
The past few months have brought many new considerations to the forefront in how the IAFCCP continues to do business. At our core, our mission is to serve advanced practice paramedics with education, advocacy, and leadership. Some examples of this support are education offerings at conferences, advocacy through a robust delegate and GCAC program, and leadership through various project and position offerings. Navigating a purely virtual environment for a prolonged period was never a consideration. To that end, I am seeing our organization adapt and overcome, and despite a myriad of distractions, work to remain forward leaning into what a vision of our footprint into the future should look like.
Over the past couple of months, we have worked with ASTNA and AMPA to lay the structure and support for CCTMC to be the standard for national HEMS conferences. We have also begun work on a project of updating our critical care exam, prep book, led by Jason Bazelow. Additionally, the project of the next revision of the Core Curriculum is well underway with paramedic representation at nearly all levels of the effort. Finally, the IAFCCP recently completed an external audit of the organization's operations. We were found to be in high standing, special thanks to Monica Newman, our executive director.
Closing this update out, the value of diversity has come to the forefront of our conversations. Here at the IAFCCP, we are committed to negotiating this charge without preference to creed, color, or gender. We acknowledge the need for change in our world. We will learn how we can do better, and we will do our part to affect positive change. Lives depend on it.
We invite you to think about our future, remember our past, and most importantly, move forward with conviction and inclusiveness.
Ryan Walter, President
NEMSPA
Subtle Disciplines of Leadership
Drastic changes have occurred across our country and the industry since our last article. Not only the COVID-19 pandemic but changes to the economy, impacting many industries to include aeromedical transport/HAA. The last few years have seen a large number of pilots leaving the military to pursue new career options. Groups, include Helicopter Association International (HAI) and Rotary to Airline Group (RTAG), have done a tremendous job helping service members transition into the civilian job market. Various reasons exist and each individual who has chosen to transition has done so for their own reasons, but 1 common theme cited is leadership. Air medical transport cannot operate safely or effectively with compromised leadership in our transport teams.
Leadership is vitally important in our industry, just as it is in all facets of life. The challenge we face as air medical transport pilots is leading and building cohesive teams. I have seen this especially in my transition into the HAA industry as a part-time or flex pilot in the program I operate while continuing my full-time military career. Not unlike other pilots within the industry, I find myself often going months between shifts at a given base and frequently on shift with new crewmembers. Personnel turnover is and will continue to be a factor in HAA operations.
As regional airlines close or significantly scale back operations, many pilots are looking to HAA and air medical transport as a viable career option, and those who join our programs will need to adjust and gain experience in the industry and in their new role. It is an adjustment many of you have experienced and is very rewarding but not without the challenges that accompany any change. Adding to the normal challenges has been the dynamic environment we have operated in during the pandemic, with rapidly changing policies and procedures occurring daily and sometimes hourly. All these factors and more will continue to challenge us as we work to provide quality care to the communities we work and serve in with our programs and partner health care systems.
To mitigate these challenges, we as leaders in our flight crews need to practice what one of my instructors called “subtle disciplines.” Below are 3 “subtle disciplines” offered as suggestions to ensure we are leading by example and deserving of the trust placed in us by the fantastic medical crews we're able to work with.
1. Do the first things first: Our number one priority is safe operations. Take care of the critical tasks first. Be deliberate and follow a process. We use checklists in the aircraft and many programs have checklists and briefs for shift change. Be deliberate and prioritize those tasks that are critical to safe flight. Pre-flight, weather, weight and balance, NOTAMs, etc. When you use checklists and established processes, you demonstrate and gain trust. Someone important is always watching, and it's not management. Medical crews want and deserve to be able to trust their pilots.
2. Communicate continuously (early and often): Air medical resource management begins outside the cockpit. It begins when you walk in the door for your shift. It's simple, but greet you crew with a positive attitude. From the start all should communicate expectations.
While accomplishing their critical tasks, such as finishing charts and checking medical equipment, let your crew know what you are accomplishing and when you will be ready to conduct a crew brief. Conduct crew briefs with specificity when able or especially when working with new crew. Address emergency actions, roles, and responsibilities and ask what you can do to help the team.
Periodic updates to weather situation, especially on marginal days, reduce ambiguity/uncertainty and keep medical crews engaged in the decision process while conveying that they are important and valued member of the team. Many crewmembers have expressed they appreciate verbal articulation of what I am doing. It allows the crew to know where we are in a process and what our plan of action is for landings, takeoff, or deviations to the briefed route. Communicating effectively allows for the team to work towards the common goals from the same perspective and for the pilot to gain and or maintain the trust of the medial crew.
Solicit input when needed during a flight but especially after a flight. Postflight debriefs can be critical for identifying areas for improvement, air medical resource management processes, and individual application of skills. (See FAA Advisory Circular for Air Medical Resource Management at https://www.faa.gov/regulations_policies/advisory_circulars/index.cfm/go/document.information/documentID/22500.)
3. Make the decision: We are expected to make the tough call. While most programs have embraced policies such as “3 to Go, 1 to say No,” we often have the ability to significantly influence the perceptions medical crew have regarding flights. Many transitioning military pilots are used to constant pressure to accomplish missions in less than ideal conditions and increasingly utilizing automation and mission equipment to mitigate risks of weather. As inclusion of Autopilot, Radar, TWAS, and NVG systems, as well as proliferation of mission planning tools such as Foreflight, increase awareness and the information available, we need to ensure we are diligent and focus on sound aeronautical decision making, both before takeoff and during the execution portion of accepted flights.
Ensuring there is a reasonable expectation of having and maintaining both legal and individual weather minimums should be critical in our decision to accept flights. Mentorship through discussions among pilots and shared knowledge of local weather patterns and trends will be of immense value to pilots new to programs and geographic areas. Strong training programs and peer mentors will help aid in making those tough calls on dynamic or marginal weather days. Ensuring use of En-route Decision Points (EDPs) and detailing those criteria during crew briefings let crews know you have a plan and that you are prepared. When your decisions are based on sound aeronautical decision-making principles, you communicate them, and you stick by them, teams will begin to value your decisions moving forward, with increased trust in your abilities.
Leading to accomplish the great work that air medical transport teams do takes constant work and diligent attention to subtle details that easily fall victim to familiarity and complacency. As emergency medical services pilots, we are more than just the driver. Subtle disciplines allow us to execute our duties while building and maintaining the trust of our medical crews, the programs, and communities we serve. That trust is vital to the health of our programs and industry. Most importantly, it is vitally important to those who deserve to be able to place their trust in us at the beginning of every shift when we walk in the door.
Assess your own cockpit, commit to improve personally and professionally, and dedicate to subtle disciplines to help ensure #EVERYONEGOESHOME.
Christopher A. Henson, Secretary