Halbrook Associates.com

Is Air Ambulance Safety in a tail spin??

During the Korean and Vietnam wars the ides of evacuating casualties by aircraft became practical. As the countries Emergency Medical Services system grew and evolved the use of aircraft became an integral part of treating the most seriously sick or injured among us.

As the system evolved many flight programs entered the arena. These programs have provided years of safe and reliable service to those in need. Unfortunately the past several years have brought safety concerns to the forefront of the industry. In august of 2005 the NTSB published a report highlighting air medical safety concerns. In this report 55 accidents were analyzed. These 55 accidents occurred from January 2002 until January 2005, and several lessons learned were published. The report established the following recommendations.

All Air Medical Flights should be conducted under FAR part 135

Aviation flight risk evaluation programs should be implemented

Consistent coordinated flight dispatch program including aviation weather capabilities should be utilized

Use of technologies such as terrain awareness, and warning systems should be adopted.

Since this 2005 report was filed no formal implementation of these recommendations has been required. With no change in policy, mindset, or culture accidents continue to happen. In the last 11 months there have been nine more fatal air medical accidents. As a result of these accidents 35 pilots, patients, and health care providers have lost their lives. Since these accidents have all occurred this year we are still waiting for formal NTSB accident reports to roll out. Even with out the final reports in hand the NTSB has just raised the stakes. On October 28th 2008 the NTSB published its “Most Wanted List” This list prioritizes its concerns, and begins to use its influence to make changes. I’ll give you one guess as to which topic was the #1 priority for the NTSB.

You guessed it the air medical industry is their concern, and they are looking back to their 2005 report for the fixes. It appears that the FAA is listening. They are currently floating a draft of rule changes. These changes are being reviewed by the industry before they get implemented early next year.

We are all well aware that there are no “Silver bullets” when it comes to aviation safety. The only way to make long lasting improvements is to change the culture. No longer can flight safety programs sit back and point fingers at other services. This is no longer a VFR vs. IFR issue. This is not a small vs. large service issue, and it is certainly not a hospital vs. stand alone service issue. This is an issue of such broad reaching importance that congress itself has returned its attention. Republican leaders have called for hearings to address air medical safety, and federal legislation has been enacted to try to force changes .

We recognize that a safety culture is not developed overnight, but it is out hope that leaders in the industry will work together with legislators, and standards bearers to instill a safety culture into the air medical industry.

The old coast guard adage of "We must go out, but we don't have to come back" no longer applies to any of the rescue fields.

How the current economic crisis affects public safety

     With the recent turmoil of the economic crisis it is no surprise that the housing market is slipping. This slip is affecting almost everyone. As the assessed value of homes drop many property owners are losing equity. This loss of equity in return equates to a lower taxable property. This tax break may be a blessing to the property owner, but it could be detrimental to the public safety agencies that protect that same home. With money slipping it would not be a surprise if a local suburban city made an announcement to all department heads that they had to approach budgets differently this year.

 

In years past this city’s departments presented a budget based upon the previous year’s expenditures. They added for appropriate cost increases and submitted for the next fiscal year. This year the budget is tight.

 

With a significant decrease in tax base that same city might tell each city department to submit a 90% budget. That means that a fire department/ EMS service with a total operating cost of $1,000,000.00 would lose $100,000.00. 10% doesn’t seam like a lot, but let’s take a look at where a typical fire department’s costs lie, and where we can make cuts.

 

Building: A fire department has to operate out of a building. Most fire stations are decades old, and have fixed operating costs associated with them. Heat, electricity, water, etc are not items that you can easily cut in a budget. Certainly a chief could elect to not upgrade, or remodel, the station, but those types of projects are generally so extensive that they are bonded referendums, and as such would not be a part of a typical budget. There is not much we can cut here, so lets keep looking.

 

Apparatus: A dept could put off purchasing a new ambulance, or fire engine, but again those purchases are bonded, and not a part of the regular department budget. There is little a service can do to limit its apparatus costs. When a piece of equipment breaks it needs to be fixed. If budgets are real tight you could start to park apparatus until more money is available.

 

Fuel: Everyone knows the impact that fuel prices have made to budgets this year. Thankfully here in my neighborhood I just saw 1.99 a gallon gas. It has been a long time since gas has been that cheap, but fuel costs are another area with limited opportunity for cost cuts.

 

Staffing: Unfortunately staffing is the only area that a public safety agency can make a drastic cut. With fire fighters making roughly $30,000 per year you would need to lay off two fire fighters to make up that 10% loss.

 

If a fire department relies on paid on call or volunteer fire fighters to cover calls, and supplements these volunteers with a minimum full timer staff, the loss of two full time fire fighters could be significant.

 

As you hear talk of lower property taxes please make sure that you understand where those taxes go, and what they support.

 

In a day and age of city cuts it is important for the tax payers to decide what services are important for the city to provide. In lean times the choice is often made between parks, roads, and emergency services.  Please do not let another water park open while a fire station sits empty.

“I’m just a volunteer” an excuse, or a standard

The vast majority of emergency responders in this country are “volunteers”. These volunteers serve their communities in many forms. Some train and adhere to the highest professional standards for their discipline, while others adopt varying levels of training and certification.

Some volunteers staff and augment full timers within their industry while others respond from home to serve their community; still others spend their time providing different types of support to these response organizations.

As we look at the concept of volunteerism it is interesting to see how little payment plays into volunteer operations. Although the classic volunteer is an individual who does not receive an hourly wage for their services many volunteers take home some form of compensation for their efforts. Some are reimbursed for their expenses while others are paid for facilities that they bring to the table. Still others receive an hourly compensation for their time served. These compensations may or may not be the same as full timers in the same industry.

Looking at the classic Tennessee volunteers brings this truth home. The fact is that General Andrew Jackson paid his “Volunteers”

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So, volunteers come in many different shapes, sizes, and disciplines. What does that mean for the emergency response industry? My belief is that the person who calls for help does not care weather the responders who assist them are paid or not. They also don’t care if you have a “real job”. What the victims care about is that the responders who assist them are capable, competent, and available when tasked.

So, if you are a volunteer organization that is attempting to build, or rebuild credibility within an emergency response industry you really need to stay away from the “I’m just a volunteer mentality”. The simple truth is that no one cares. Either you are capable of the public trust that has been placed upon you, or you are not.

If you are building or working towards a professional responsibility you need to determine what your entity is capable of. It is not until you determine and commit to a level of service that you can be taken seriously within your chosen industry.

Happy Independence Day

Fire Department Pancake Breakfast

This weekend the Community of Johnston Iowa celebrated its annual spring festival. "Green Days" is a broad community event with a parade, a carnival, fun run's, a variety of shows, and plenty of opportunities to socialize. The Johnston Fire Department plays an active role in the planning, and execution of Green Days. Johnston's Fire Fighters staff an ambulance to stand by at many of the gatherings, and they place several apparatus in the parade. These are all fun and exciting, but the largest event for the fire department is the annual pancake breakfast. This event brings the Johnston Community together to see, and learn about the FD. In order to maximize the potential of this event the Johnston crew has brought in Criss Cakes to cook the pancakes. This high speed pancake cooker ensures that lines do not get to long, and he even entertains the crowd while he is cooking. The Kiwanis group in Johnston is also present to provide free bike helmets to the kids who attend. With these two groups supporting the breakfast fire fighters are free to clean, seat, and great the residents of their community. This year as the Line grew a group of fire fighters conducted gear and equipment demonstrations. These guys raced each other, in donning protective equipment. They also provided hands on experiences for the kids to become comfortable with the fire fighters.

The proceeds from this event go to support the Johnston Fire Fighters Association. We have found that an organization that is funded, and supported by tax dollars, and bills for service has a tough time raising funds from community based fund raisers. Unless you have a consistent standardized approach to justify the need for traditional funds, and a plan for their use the tax payers of your community will not understand, or support your efforts.

this year the JFD had an excellent event. Feel free to stop by next year.

On the job injuries

America relies very heavily upon volunteer emergency responders. As responders we spend most of our time thinking about our victims, and not enough time about our own wellbeing. If you are employed full time you are often covered by workers compensation, employer provided health insurance, and disability coverage. Unfortunately many volunteer based rescue services have dramatically different insurance, and protection programs. Some of our least formal volunteer entities actually provide no coverage to their members, while others actually have excellent support. Recently I received an on the job injury at my volunteer rescue service. The injury is not serious, or debilitation, and it is most certainly not heroic, or noble. As I have worked my way through the formal steps I began to think about my family, and how they would be impacted if something were to happen during a search. As I worked through the different services that I support I was amazed to find that each one of them has different coverage. One group has no coverage. Another will cover medical expenses, and lost wages (from that entity) which means that I would be compensated the missed $5 per call, but luckily I was hurt serving the service that has staff who work very hard for its employees. The insurance provider has offered to pay my full time employment wage for any time that I have missed from my full time work. Honestly when I heard this I was shocked. I am lucky to be employed by this entity. One argument that career emergency response entities have against moonlighting is the fact that as an individual you may not receive protection during an injury. This post is by no means intended to dissuade you from volunteering for an emergency response entity. It is intended to make you aware of the issues associated with on the job injuries. Also, as you manage and utilize resources consider their well being.

3 Signs of a Miserable Job

Recently while traveling I had the opportunity to read an interesting new book.  This modern day fable of business leadership has three simple principles.  The Idea is that if you can connect a person to their work, and its impact on others their jobs will be viewed as positive and rewarding.  The Principles are simple, yet the book does an amazing job of conveying how these principles can be put to use in any work environment.  Within the Emergency Services burn out is high, and our leaders are often not given the tools to be successful. 

I know its simple, but take a look.

1.  Anonymity.  Under this concept an employee needs to feel like an important link in the system.  They should feel like they are a valuable part of the organization.

2. Immeasurment.  Good employees have a continuous desire to meet, and exceed expectations.  If you don't give an employee the opportunity to subjectively measure their performance they will be miserable.  Imagine playing an entire baseball game, at the end of 9 innings a supervisor arrives and tells you who they think won.

3.  Irrelevance.  Every good employee has a desire to have an impact on other people.  They want to better themselves, and others.   As a supervisor do your employees know how important they are to they are. 

People are driven by simple motivations.  Is it that hard to believe that these easy concepts could be the key to successful and healthy employees. 

The Table Group (The books web site)