Safety and Quality in Medical Transport Systems

Creating an Effective Culture

Safety and Quality in Medical Transport Systems LOOK INSIDE
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  • Edited by John W. Overton, Jr. and Eileen Frazer, Commission on Accreditation of Medical Transport Systems, USA
  • The Commission on Accreditation of Medical Transport Systems (CAMTS) has been accrediting air and ground transport services since 1991. One of the most significant needs the Commission has recognized is to assist transport services in creating a culture that supports safety and quality for both crews and patients. Most of the helicopter EMS (emergency medical service) accidents and many ground ambulance accidents can be attributed to human factors and systems designs that lead to poor decision-making. Management commitment is vital to create and maintain a culture that supports risk assessment, accountability, professionalism and organizational dynamics. This reference book has been created by CAMTS to address this need directly and comprehensively.

    It offers a groundbreaking collection of expert insights and practical solutions that can be used by EMS, Fire and Rescue, public and private services, and professional emergency and transport professionals worldwide. Quoting from the foreword written by the late Robert L. Helmreich, Professor Emeritus of Psychology at The University of Texas Human Factors Research Project, 'This is an important book which should be required reading for everyone involved in patient transport, from managers and dispatchers to those at the sharp end… The experienced and able authors and editors of this work use culture as the overarching concept needed to maximize safety while delivering patients expeditiously.'
  • Contents: Foreword; A tribute to Robert L. Helmreich PhD; Preface; Section I The Foundations of Organizational Culture: A brief overview of the foundations of organizational culture, Ralph N. Rogers; Achieving optimal outcomes through just culture, K. Scott Griffith; Safety climate and safety culture, Terry L. von Thaden; The financial perspective of safety, Clive Adams. Section II The Current Medical Transport Environment: The current status of air medical transport, Terry L. von Thaden; The current status of ground medical transport, Nadine Levick. Section III Safety and Risk Management: An overview of the risk-management process, Kimberly Turner; Safety management systems, Kimberly Turner; Operations safety: developing, executing and upgrading the operations plan, Bruce A. Tesmer; Improving communications to improve safety, Robin Graham; Training to improve operational safety, Terry Palmer; Operational safety training: learning from the mistakes of others, Roger Coleman; Adjuncts to safety in ground medical transport, Nadine Levick; Medical error - recognition, reporting, managing response, and limiting harm, Gregory H. Botz and John W. Crommett; Fatigue challenges in emergency medical services operations, Melissa M. Mallis; Individual provider wellness and self-care, John W. Overton Jr, Laurie Shiparski and Philip D. Authier; Post traumatic stress disorder in emergency medical services, Eileen Frazer. Section IV Methods and Tools for Improvement: Measurement and data, Donna York Clark, Kate Moore and David F.E. Stuhlmiller; Essentials of learning and improvement, Donna York Clark, Jacqueline Stocking and David F.E. Stuhlmiller; Practical applications of methodologies: LEAN, Jennifer Hardcastle, Six Sigma™, Sandra Kinkade Hutton; Teamwork and integration, Patricia Corbett. Section V Workforce Challenges: Organizational challenges within medical transport services, Eileen Frazer; The role of associations in safety and quality, Dawn M. Mancuso; Safety and war-fighting: taking action to shape the safety culture of naval aviation, Kenneth P. Neubauer; Ethical challenges, David P. Thomson. A postscript: the next steps, Eileen Frazer; Index.
  • About the Editor: John W. Overton, Jr. earned a Bachelor of Science degree from Virginia Polytechnic Institute and State University and his Medical Doctor degree from the University of Virginia.

    After initial years in residency training, followed by six years of full-time inner-city emergency medicine that fostered interest in trauma care, Dr. Overton returned to residency training, completing general and cardiothoracic surgical residencies. His interests in trauma consulting and improving trauma care have continued throughout his career. He was one of the earliest adopters of a regional trauma database in the 1980s and contributed to the development of the National Cardiac Surgical Database in the late 1980s and early 1990s.

    Over a two-year period in the late 1990s Dr. Overton led a team that focused on reducing mortality following cardiac surgery in conjunction with the Institute for Healthcare Improvement. Significant and sustained process improvement and reduction in post-operative cardiac surgical death followed completion of the team endeavor.

    Dr. Overton’s surgical career has been influenced by his life-long interest in aviation and safety, employing aviation safety principles he learned as a pilot to improve surgical care. He has been a general aviation pilot for over three decades. Following his retirement from clinical surgery, Dr. Overton remains an active pilot and teaches medical and surgical colleagues principles of safety and risk management.

    He is a former member of the board of directors for the Commission on Accreditation of Medical Transport Systems, and in 2011 he was appointed to serve as the interim medical officer for the National Transportation Safety Board. He is a proponent of a just culture and teaches the subjects of Just Culture and Threat and Error Management to medical, surgical and transport teams.

    Eileen Frazer, R.N., Certified Medical Transport Executive; former chief flight nurse, chairperson for the Association of Air Medical Services’ (AAMS) Safety Committee that worked jointly in 1988 with the Helicopter Association International, the National Transportation Safety Board and the Federal Aviation Administration to develop a feasibility study that led to the development of the Commission on Accreditation of Medical Transport Systems (CAMTS) in 1990; executive director of CAMTS since its inception.

    Throughout her career, Ms Frazer has consulted with major hospitals and university centers regarding the training of air medical personnel in air medical safety and preparation of patients for air transport. Active in the State of Pennsylvania, she assisted in writing the rules and regulations for Air Ambulance (EMS - Act 45) for the state of Pennsylvania and served on the State of PA Nursing Advisory Board from 1985-1990.

    In 1991, Ms Frazer was the recipient of the Jim Charlson Award for significant contribution to air medical safety by the Association of Air Medical Services and sponsored by the Aerospatiale Helicopter Company. In year 2000, she received the Marriot-Carlson Award for outstanding contributions to the air medical transport community from the Association of Air Medical Services and the Bell Helicopter Corporation.

    After the alarming helicopter accident rate raised alarm by the public in 2008, Ms Frazer testified at the NTSB HEMS (Helicopter EMS) Hearings - February 2009 and at the Congressional Hearings on Air Ambulances - March 2009. In April 2009, Ms Frazer received the FAA Safety Team (Central Region) Education Outreach Award for developing the 'Hazards of Helicopter Shopping' education video for pre hospital and emergency department personnel.

    In February 2010, Ms Frazer was certified as a Just Culture Instructor after participating in the first certification instructor course by Outcome Engineering.

    Currently, as executive director of CAMTS, Ms Frazer continues to author policies and standards that guide the CAMTS accreditation process and has a regular feature in the Air Medical Journal and continues to publish and speak on medical transport quality, safety, and just culture.
  • Reviews: ‘essential to all of us involved in patient care … provides robust insight … both a textbook and an excellent reference that will guide and facilitate organizations as they strive to improve all layers of their medical enterprise-definitely not restricted only to the transportation of patients.’
    Aviation, Space and Environmental Medicine, Volume 84, Number 12, December 2013