camts blog

Commission on Accreditation of Medical Transport Systems

SHARING THE AIRSPACE

There was a discussion at the 2018 HeliExpo and at the recent CAMTS Board meeting regarding hospital helipads and Unmanned Aircraft Systems (UAS).  The development of UAS technology in the private sector and the FAA’s limitation in developing airspace regulations to ensure that they will not interfere with air medical operations is an issue of concern, especially with the number of private and business UAS increasing every day.

The FAA has Operational Limitations (PART 107) for UAS that limit the altitude to 400 feet AGL and operations around Class B, C, D, and E airspace with ATC permission. There are also Flight Restrictions over Sporting events with a seating capacity of 30,000 or more (FDC NOTAM 4/3621) but there is no FAA separation rule governing operations around a hospital helipad.

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One of the reasons is that the FAA’s database on the location of hospital helipads is probably, by their own estimation, only 50% accurate. Since hospital helipads are considered private and therefore subject only to Advisory Circulars, many hospitals do not register the “Airport Master Record” – FAA Form 5010-3 – in the first place – when it is built.   Most also do not turn in a Notice for Construction, Alteration, and Deactivation of airports FAA Form 7480-1 when the helipad is moved, deconstructed or altered. We all know that hospitals add, change and rebuild frequently.  The FAA puts out the location of hospital helipads to the public – but this information only has a 50% chance to be correct.

CAMTS site surveyors visit hospital helipads that are either in the control of the air medical service or if an independent service bases its aircraft on a hospital helipad. In these cases, the site surveyors are asking to see the FAA Form 5010 or Form 7480 to determine if this is current and accurate.  This is one way to assist the FAA with correct information so that as new regulations catch up to an exploding UAS population, we can help to stipulate airspace around hospital helipads.  This is one way to help improve the safety and protection of our airspace as the UAS technology and popularity continue to expand.

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Lift-off Time Clarification

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There has been a lot of misinterpretation about CAMTS’ position on lift-off times. Recently, we were told that CAMTS requires a 5-7 minute lift-off from the time of the request. This is not true!

Medical transport services are measured against the Accreditation Standards. There is no such standard, and there never will be such a specific number. The only reference to lift-off is listed as part of the performance metrics in Accreditation Standard 02.01.07  5. under “Communications.” This is a metric that programs are collecting, tracking and trending as part of the Quality Management process. It is the program’s responsibility to determine a range of acceptable lift-off times based on their specific scope of practice.

There are many variables that could affect setting a realistic lift-off time:

  • complexity of the aircraft, start and checklists
  • immediate request versus request from a stand-by
  • two stage dispatch under operational control
  • weather checks, route checks
  • IFR flight plan
  • etc., etc.

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Therefore, an acceptable range is set based on the program’s profile. If a specific request falls outside of that range and tracking reveals a trend, there may be a need to change policy, process or training practices. This is the intent of quality management.

The use of specified lift-off times to put pressure on crews and to use as a competitive tool should not be the intent and is highly discouraged.

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New “Best Practices” 6th issue

In this our 6th issue of “Best Practices”, published in July 2017, we have selected policies and practices that were acknowledged as excellent examples, and we also focus on the areas that are typically cited as deficiencies. This publication is not meant to endorse or recommend any particular policy or service – it is merely to be used as a resource document.

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The Board of Directors acknowledges the excellent programs and practices exemplified in the materials provided with much appreciation to the medical transport services, FAA Part 135 Operators, private agencies as well as organizations for their enthusiasm in sharing these proprietary materials. Each document listed in the index is identified by its title and by the contributor whose logo and name may appear on the documents.

We added a section in this edition called “Preparing for Accreditation” to assist new programs that are applying for accreditation. The process of applying for accreditation involves several steps, and the application materials may be time-consuming. However, services often acknowledge that they learned a lot about their programs by going through this application process, whether they achieve accreditation or not. Also, requesting materials prior to the site visit which are reviewed by the Executive Staff and site surveyors (more than 60 hours of review) results in a well-prepared, comprehensive audit.

Your copy of “Best Practices” 6th issue can be ordered on our website.

www.camts.org

CAMTS Awards Accreditation to Three Medical Transport Services

The Commission on Accreditation of Medical Transport Systems (CAMTS) proudly awarded accreditation to sixteen medical transport services at the CAMTS July board meeting in Weehawken, New Jersey.

Congratulations to the three new services as well as the services reaccrediting as follows:

New Accreditation

  •                 Sky Nurses, Delray Beach, FL
  •                 Memorial MedFlight, South Bend, IN
  •                 Medical Air Rescue, Rapid City, SD

Reaccreditations

  •                 Air Methods SouthEast Region, AL, FL, GA, SC
  •                 Air Methods Region 7, AR, IL,  MO
  •                 Children’s Medical Center, Dallas, TX
  •                 Life Force Air Medical, Chattanooga, TN
  •                 LifeEvac Virginia, Gasburg, VA
  •                 Med Flight Air Ambulance, Albuquerque, NM
  •                 Memorial Star Transport, Colorado Springs, CO
  •                 MONOC 1, Neptune, NJ
  •                 Nationwide Childrens, Columbus, OH
  •                 PHI Air Medical Kentucky, Lexington, KY
  •                 Sanford AirMed, Sioux Falls. SD
  •                 University of Iowa AirCare, Iowa City, IA
  •                 UMass Memorial Life Flight, Worcester, MA

 

The Board of Directors welcomed guest speaker Frédéric Bruder, Managing Director of ADAC Air Rescue in Germany as a lunchtime speaker during the Board meeting. Mr. Bruder provided a presentation on the ADAC service, the largest rotor wing air medical service in Germany.

 

Urgent Safety Notice – Lifeport Clip Decks

CAMTS has received several calls on this safety issue.  We have been made aware of incidents as a result of the LifePort Clip Decks.  We have been told that not all parties have received the following notice from LifePort.  Please heed this urgent warning!

Re: LifePort, Inc.’s Clip Decks – All Models/Part Numbers

It has recently come to our attention that Life port’s Clip Deck may be subject to misues in the field.  Our records show that you purchased, received through an intermediary, or may be in possession of a Life port Clip Deck.  Accordingly, this is to inform you that Life Port’s Clip Deck is designed and to be used for the purposes of non-vehicular ground transfers only.

LifePort’s Clip Deck is not designed, approved and should not be used, under any circumstances, to secure or retain an AeroSled during ground vehicle travel of any kind, including ambulance travel.  LifePort’s Clip Deck is not, and has never been, intended to be used in ambulances or any type of ground vehicles, under any circumstances.  Any such usage will expose all persons using the equipment, including but not limited to patients, passengers and medical professionals, to possible injury or death and therefore should be ceased immediately.

Please immediately contact LifePort’s Customer Service Department at 360 225-1212 or via email at customerservice@lifeport.com to arrange for shipment of warning placards for affixation on all Clip Decks consistent with the above.  LifePort will provide all placards free of cost, including affixation instructions.

Sincerely

Patrick Ogle

Customer Service Manager

LifePort

The following was received from a CAMTS accredited program:

On 6-5-17, while traveling in a ground ambulance, the LifePort sled came out of its base when going around a curve.  This is the third occurrence of a sled coming out of the base at our program.   When the second occurred in 2010, we took a harder look at the pins and receptacle holes they go into.  We found two design flaws:  1) the metal where the pin went into was made of a softer metal, aluminum, versus steel like the one in our aircraft base 2) the hole is drilled on the edge of a bevel, facilitating its wear.  When we contacted Lifeport at that time with our findings and looking for help, they offered no solutions nor assistance.  We fixed the problem ourselves with our mechanic replacing the receiving metal receptacles with steel ones in all our stretchers as are in our aircraft base.

The current clip deck involved in the incident 6-5-17 was received six months ago with our new isolette.   We knew we should replace the receiving metal parts and had begun the process but unfortunately it was not high priority as the prior clip decks had been used for ~ 10 years before the incidents occurred.  Apparently, an even inferior metal is being used in current production for the degradation seen in the images to have occurred so rapidly.    The hole is no longer round, but oblong and by its being in the bevel, you can see in image looking top down, this allows for a more rapid loss of integrity.

Our program has yet to receive the attached Lifeport notice.  We know of at least 2 others that have not received this notice; we are all current customers.    We learned of the warning via AAMS Critical Care Ground Special Interest Group who had a member receive this notice. 

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Inadvertent Instrument Meteorological Condition (IIMC) training

In keeping with CAMT’s values of continuously improving accreditation standards to improve patient care and safety of transport, the next revision to the CAMTS Standards will encourage additional helicopter Instrument Flight Rules (IFR) training requirements.  The draft of the recommendation, to be incorporated into the 11th Edition of the CAMTS Standards, will require quarterly Inadvertent Instrument Meteorological Condition (IIMC) training and demonstration of the pilot’s ability to safely maneuver the helicopter into visual meteorological conditions (VMC) following an inadvertent encounter with IMC and completion of an IFR approach.

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For instrument proficiency training in non-IFR-certified rotorcraft, the pilot should perform such maneuvers as are appropriate to the rotorcraft’s installed equipment, the certificate holder’s operations specifications, and the operating environment.

A recent analysis of fatal accidents over a five- year period, conducted by the U.S. Helicopter Safety Team, revealed that the Helicopter Air Ambulance industry had the second most fatal accidents, second only to Personal/Private operations.  Fifty-two percent (52%) of these accidents involved:

  • Inflight Loss of Control
  • Inadvertent IMC
  • Low Altitude Operations

Increasing IFR training requirements is an attempt to reduce the historical accident rate in our industry while focusing on data driven causal factors and is in keeping with the CAMTS mission to continuously improve transport safety.

This proposed future revision of the CAMTS Standards is being recommended by the CAMTS Aviation & Safety Advisory Committee, comprised of industry safety experts including non-CAMTS Board members. Final verbiage for the 11th Edition of the CAMTS Standards will be approved by the CAMTS Board of Directors prior to incorporation.

 

AIR EMS awarded Conditional Accreditation

 

The Commission on Accreditation of Medical Transport Systems (CAMTS) awarded Conditional Accreditation to Air EMS today for fixed wing and medical escort services.  Air EMS is the first to be awarded this accreditation and is supported by two very experienced FAA Part 135 operators who are able to provide aircraft for both national and international transports.

Conditional Accreditation was created to verify that a new service (in business for at least 4 months but less than 1 year) is able to demonstrate that policies, practices and training of aviation, surface and medical staff under a dedicated medical director meet accreditation standards based on the mission and scope of service as advertised. The aircraft and/or surface vehicle and medical equipment must also meet compliance with the standards and all legal regulations must be satisfied.

A service receiving Conditional Accreditation is permitted to advertise as conditionally accredited and will receive a letter of conditional status which can be provided to regulators and to contracting agencies that require accreditation. There is no minimal number of transports required but staff must be hired and trained and the medical director must have developed protocols. Although new programs may not have a mature Quality, Utilization and Safety Management System, those systems must be developed and organized according to the criteria in the standards.

The program may submit a PIF for full accreditation at its one-year anniversary or when the Conditional Accreditation expires.

CAMTS feels strongly that this process will provide a robust review for a new medical transport service that regulators and contracting agencies can support rather than requiring accreditation as soon as an aviation company decides to transport patients without proper preparation.

PIF Process – online format

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Dear CAMTS Accredited Services:

We are in the process of moving the entire PIF process to an online format – including attachments and all forms. We are anticipating it to be ready by January 1, 2017. In preparation for the new process and in recognizing the need to streamline the reaccreditation process, we need your help to identify the areas of completing the reaccreditation process that seem especially labor intensive with little benefit.

We are holding a Town Hall Meeting on September 25 from 2-4 at the Charlotte Westin Hotel in the Queens Room to meet with those who want to express their suggestions about the accreditation process and discuss where we have seen some inconsistencies. All are invited to attend even if you have completed this survey. Many of our Board members will be present to speak with you individually or as a group. The following survey will provide us with a starting place for those discussions.

Please complete this survey and return by September 9, 2016

StartSurvey_Button          SURVEY

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ANNOUNCING   

PRE-CONFERENCE EVENTS

SUNDAY, SEPTEMBER 25, 2016

At the Westin Hotel Charlotte, NC  in the QUEENS Meeting Room

 REGISTER   

 

8:00 TO NOON PREPARING FOR ACCREDITATION

This half day class will review the process, polices and Standards of CAMTS and provide excellent information for both programs seeking accreditation for the first time or for those approach a reaccreditation.  Learn about the more common areas cited as deficiencies and ask questions directly with the CAMTS Executive Director.

Register by visiting the CAMTS website at www.camts.org

There is a cost for this conference and each person receives a copy of the current 10th Edition Standards.

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1:00 to 2:00 PM  CAMTS Standards Committee

Each year at the Air Medical Transport Conference, the CAMTS Standard Committee meets to hear your comments and suggestions for improving the Standards. All are welcome. Please contact us through the CAMTS web site at www.camts.org.if you plan to attend.

*2:00 – 4:00 PM   

OPEN FORUM  

Streamlining the Reaccreditation Process

This session will focus on your suggestions for streamlining the CAMTS reaccreditation process.  We encourage all site surveyors, Board members, member organizations, aviation and medical operators and accredited programs to participate in guiding us to a process that makes reaccreditation less labor intensive and more consistent for programs and for CAMTS, while assuring substantial compliance with the Standards.

The session is FREE and no registration is required.

Each accredited program will receive a survey by email within a few days regarding the reaccreditation process – please take a few moments to fill this out and send it in so that we have a starting point for our  discussions and so that we have your input if you cannot make the meeting!

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Guidelines1

Interpretation Guidelines of the CAMTS Standards….
Issue: # 001
Date: July 22, 2016
Reference: 10th Edition Standards

Fire Extinguishers
It has come to our attention that the following standard has been interpreted to mean that the fire extinguishers in the Bell 407 and Agusta aircraft, for example, must be moved, or another fire extinguisher must be placed in the medical crew quarters. The standard, however, speaks to accessibility as follows:

“02.03.07 Safety and Environment
2. Equipment and Operations Around the Transport Vehicle
l. A fire extinguisher must be accessible to medical transport personnel and vehicle operator while in motion.”

The purpose of the standard is to assist in extinguishing a fire on board in the event the pilot is incapacitated or otherwise occupied. The problem is fire extinguishers are understandably designed to be within the pilot’s reach and are considered part of aircraft as listed on the certificate. Adding another fire extinguisher is not possible without getting either an STC or a FAA field approval (337). The CAMTS Board of Directors understands this and does not base an accreditation decision on this type of compliance issue with one specific standard. It may be and remain an outlier to the standard but in terms of interpreting this standard – Site Surveyors should be asking crew members how they would reach the fire extinguisher during flight in an emergency situation. If it is possible – even though it may not be readily accessible – it meets the standard.
If it is not at all possible, it may remain an outlier without negatively impacting accreditation. Remember accreditation is based on substantial compliance with the standards – not 100% compliance.

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