camts blog

Commission on Accreditation of Medical Transport Systems

Tag: covid19

Resilience During Times of Change

March 31,2020

by Eileen Frazer

reprinted from Air Medical Journal : http://www.airmedicaljournal.com/

In the Commission on Accreditation of Medical Transport Systems (CAMTS) 11th Edition Accreditation Standards, we included resilience training as part of stress management in the list of didactic education for managers and crewmembers, and we also included post−critical incident counseling in section 04.00.00 for communications specialists. In the current health care and economic change environments, care providers are not only challenged by adapting to change but also the “ordinary” stressors of dealing with emergency and life-critical situations.

It is more apparent than ever that managers (who also have to deal with a higher stress value) need to recognize and address employees who may not have resilience or the capability to “bounce back” after traumatic and tragic situations they deal with on a regular basis, often resulting in posttraumatic stress disorders.

In the CAMTS publication Safety and Quality in Medical Transport Systems: Creating an Effective Culture, the chapter entitled “Provider Resilience” was written by John Overton, MD, Laurie Shiparski, BSN, MS, and Philip Arthier, RN, MPH.1 The authors presented a self-assessment tool to identify the 10 symptoms of your capacity for resilience that is worth sharing.

Symptoms of low resilience Absent Present

  1. Forgetfulness and inability to access information you have
    learned to respond in the situation
  2. Inability to focus on individuals and the bigger picture of the situation
  3. Overwhelmed with emotion, uncontrollable crying, outbursts
    of anger, or frustration
  4. Complete sadness, sorrow, depression, despair
  5. Hopelessness, cynicism
  6. Inability to act on priorities
  7. Self-doubt about ability to impact the situation effectively
  8. All issues seem big and overwhelming
  9. Feeling alone and isolated Low energy, fatigue, exhaustion

According to the authors, if you answered “present” to any of the questions, it is time to focus on your resilience and stop any further progression of energy-draining behaviors.

In my opening paragraphs, I also talked about change. We know we do not function at our best when we are stressed and tired, and, on top of that, we are in the environment of constant change. When we consider the many changes we encounter, planned and unanticipated, it is even more critical to manage how we navigate through changes. The authors referenced earlier asked many health care providers how they effectively manage change in their personal and professional lives.

The following are the top responses they received that may sound familiar or interesting to our readers:

*I believe in myself and know I can handle any situation.
*The more I tap courage and act on it, the stronger I feel.
*I get enough rest and take care of myself.
*I find people I can talk to and find support.
*I recognize when I am feeling stressed & take a break, reassess, & adjust.
*I offer help to others and have an attitude of gratitude.
*I realize everything happens for a reason and I may not know why.
*I remind myself why I choose this profession & identify what brings joy.
*I know I make a difference in the lives of many with the work I do *Humor and fun help me get through tough times.
*I learn from every situation and seek challenges that grow me.
*When something feels overwhelming, I remind myself that I can break it
down into smaller manageable steps.
*I know time heals and sometimes I need to detach, think, and come back
to issues.
*I show up every day with all my talents and flaws, knowing it is all needed.
*I remember to have patience with myself and others as we adjust to new
things.
*I resist engaging in judgment and blame of myself and others.
*I notice now if I am in a downward spiral of negative thinking or being and remind myself to engage in energizing behaviors.

We are all called on to deal with stress and change. The Executive Staff of CAMTS recently recognized that we also need to be aware of site surveyors who may be asked to visit a program that experienced a recent fatal accident where interaction with management and staff can be very emotional. Having an open and caring culture is always our goal and we encourage surveyors to relate situations that dealt with difficult and
emotional situations. Storytelling is always a way to release stress.

Helicopters & Tents. DO NOT MIX!

Don’t set up Emergency COVID -19 Triage “Tents” Too Close To Your Heliport

March 27, 2020

by Rex Alexander

Helicopters produce a significant amount of downwash (rotor-wash) during takeoff, landing and hovering operations.  The velocity of this rotor-wash is directly proportional to a  helicopter’s size and weight.  Even a small helicopter’s rotor-wash can cause serious damage and inflict injury under the right circumstances. 

In 2018 at Fort Hunter Liggett, California the U.S. Army had 22 soldiers injured when a helicopter landed too close to the tent that they were occupying when it collapsed. 

Even when a tent stays in place, the laws of physics and aerodynamics are destined to displace every ounce of loose, unsecured and light to medium weight material located inside to the outside in a matter seconds. 

It is not just the location of the heliport in relationship to a tent that is of importance here.  The flight path of the helicopter must be taken into careful consideration as well.  As a helicopter is landing or taking off it is producing rotor-wash below it which can stay intact for up to a hundred feet or so.

Rotor wash is also greatly influenced by the wind and will travel in the direction the wind is blowing.  

The threat is two-fold:

  1. The helicopter can ingest loose items such as towels, blankets, trash bags, jackets and even the tent itself into the main and tail rotor systems with catastrophic consequences.
  • Individuals in and around the tent can be severely injured from the blowing debris or the collapsing of the tent itself, but if the helicopter crashes as in the scenario lives may be lost.

DO’S & DON’TS

Hospitals:

  • DO locate & set up any and all tents, storage areas, triage areas far away from any landing zone or heliport.
  • DO NOT assume your tent won’t be affected.
  • DO keep the area under the approach and departure paths clear of tents, storage areas, debris and triage areas.
  • DO secure any and all loose debris such as trash, dumpsters, tarps… near the heliport or landing area.
  • DO alert all Helicopter Air Ambulance Providers that you have a tent located on your campus and where it is.
  • DO mark the heliport with a large yellow X, signaling to pilots that it is closed for operations if you intend to close the heliport. 

HAA Providers

  • DO conduct a thorough reconnaissance of all landing sites prior to landing.
  • DO NOT attempt to land near any tent.
  • DO identify and use a safe alternative landing site when necessary.
  • DO NOT assume that materials near your landing area are secure.
  • DO alert other providers when you identify a new hazard
  • DO NOT hesitate to say NO when appropriate
  • DO Provide guidance and education on safe landing area operations  

CAMTS Open Letter to Accredited Services:

3/24/2020

We are receiving many calls and emails about our official position on transporting patients with suspected or diagnosed coronavirus.  First, it is NOT our position to dictate whether a patient with suspected or known coronavirus should be transported.  Medical transport is an important part of healthcare and transport is the conduit to get the patient to the most appropriate and definitive care.

Programs have unique opportunities to address the challenges of transporting patients while keeping staff healthy and able to function with diminishing resources and greater needs.

As accredited services, there may be times when you just cannot meet the Standards. Many professionals on the CAMTS Board of Directors are themselves involved in the same situations and realize these are extraordinary times. We will not penalize programs who need to make temporary changes to continue to provide a service. As best you can, continue to meet standards, especially as they pertain to quality and safety, but do what is right for your patients. As Winston Churchill once said: “It’s not enough that we do our best; sometimes we have to do what is required.” 

Over the past week, we sent out several blogs with ideas from various accredited services and helpful tips for pilots and mechanics.  If you have developed innovative  practices that have been effective and want to share – please pass them along and I will post them on our website.  We need to help each other and stay connected during these unpredictable times. 

Eileen Frazer, Executive Director

AMPA statement – Covid19

March 20, 2020

After careful monitoring of the rapidly changing situation related to COVID-19, understanding that concerns for health, safety, and the impact on meeting attendance, among other issues, are affecting our conference, the difficult decision has been made to cancel CCTMC for 2020.  We are committed to maintaining appropriate health and safety measures, and we encourage you to follow guidelines recommended by the Centers for Disease Control and Prevention and the World Health Organization.  CCTMC attendees and exhibitors will be issued a full refund or may choose to roll their registration to the 2021 conference.  Watch our websites, Facebook and www.CCTMC.net for details for 2021 as they become available in the near future. You won’t want to miss it!Best regards,AMPA, ASTNA, IAFCCP

AMPA Position Statement


AMPA is attentive to the concerns of its membership in addressing the challenges associated with the transport of patients with suspected or confirmed infection with SARS-CoV-2. Recommendations regarding the personal protective equipment required to care for these patients remain fluid, and AMPA recommends that its members remain familiar with the recommendations of the World Health Organization as well as those of their local, regional, and national health protection authorities.

• AMPA supports social distancing and recommends seeking alternatives to gatherings of greater than ten people.
• AMPA supports the WHO recommendation to employ standard, contact, and droplet precautions when caring for and transporting patients with suspected or confirmed infection with SARS-CoV-2.

⁃ AMPA recommends that patients with suspected or confirmed infection with SARS-CoV2 wear a surgical mask during care and transport.

• AMPA supports the WHO recommendation to employ standard, contact, and airborne precautions when caring for and transporting patients with suspected or confirmed infection with SARS-CoV-2 who are undergoing aerosol-generating procedures such as nebulization, mask oxygenation, high flow nasal cannula oxygenation, non-invasive positive pressure ventilation, endotracheal intubation, bag valve mask ventilation, cricothyrotomy, tracheostomy, and cardiopulmonary resuscitation.

⁃ AMPA further supports the WHO recommendation to attempt to avoid performing aerosol-generating procedures in confined spaces.
⁃ AMPA therefore cautions against transporting patients anticipated to require aerosolgenerating procedures during transport and suggests mitigating the need for aerosolgenerating procedures prior to transport.
⁃ AMPA recommends the use of a certified bacterial and viral filter in the ventilator circuit of mechanically ventilated patients but recommends airborne precautions during transport to safeguard against unanticipated aerosol-generating procedures.
⁃ AMPA further recommends the mitigating use of a certified bacterial and viral filter (1) between the bag and the endotracheal tube or between the bag and the face mask of manually ventilated patients, and (2) in the circuit of patients being provided noninvasive positive pressure ventilation, when feasible.
⁃ AMPA further acknowledges that local, regional, or national practice may be to employ airborne precautions on a broader population of patients with suspected or confirmed infection with SARS-CoV-2 and that these recommendations remain fluid.

• AMPA recommends that pilots and other vehicle operators employ droplet or airborne precautions as appropriate, utilizing appropriately fit-tested personal protective equipment, unless the cockpit and patient compartment are completely separated.
• AMPA cautions that using a particulate respirator mask while wearing a flight helmet may render the mask ineffective unless appropriate fit testing has been performed while wearing the helmet.
• AMPA acknowledges that SARS-CoV-2 may survive in the environment for extended periods of time and recommends decontamination of all surfaces and open air ventilation of the patient compartment following the transport of patients with suspected or confirmed infection with SARS-CoV-2.

AMPA acknowledges that our understanding of potential best practices remains fluid at this time and recommends careful consideration of current guidelines and continuous reassessment of the potential benefits and risks surrounding the transport of patients with suspected or confirmed infection with SARS-CoV-2. AMPA will continuously review these recommendations and provide interim guidance as necessary.

Info on Transport of Patients w/ COVID19

March 16, 2020

In these uncertain times, we wanted to get some information out regarding transport of patients who are diagnosed with coronavirus. There are many variables that could affect your decision whether to transport or not but here are some thoughts from our Board members who are actively involved in Rotorwing, Fixed Wing and Ground transport.

Response from Mike Brunko, MD, Flight for Life Medical Director (CAMTS Board Member)

Many programs, including mine, have halted transport of patients diagnosed with coronavirus by rotor, primarily because of inability to control and to be able to protect crew and pilots from patient contact (especially in helicopters where it is not possible to  physically separate the infected patient from the pilot) and/or the inability to get adequate N95 fitting with helmets. In our case, we have the added pressure of flying above 12000 feet, with oxygen on. It is difficult to decontaminate a helicopter as opposed to an airplane or ambulance and the air flow is not as easy to control. Right now, many busy academic programs are not transporting by rotor, but are by fixed wing or ground. Some are only doing intubated patients where we can control the filtration of inhalation and exhalation and lessen/prevent the aerosol exposure.

The AMPA Board Is actively discussing the literature, experience and their institutions’ recommendations. Most programs’ crews were fitted and tested for PAPR and N95s without helmets and likely didn’t consider the importance of separate testing (a standard we will need to address in the future). Today, I feel, ground and FW should be used and rotor CONSIDERED only for time sensitive critical ARDS patients where ECMO or ventilation strategies are necessary. This truly is a dynamic situation which may change tomorrow.

Webinar from Ashley Smith – NATA representative

Specific to fixed wing transports – please see the link on the www.camts.org website to the NATA webinar that our board member, Ashley Smith, made available last week.