Oct 23, 2009

CAMTS Accreditation - Blessing or Curse?

NOTE: This is my commentary/response to the original article which appears at:

VerticleOnline and published Oct 21, 2009


CAMTS accreditation has become double edged sword.

On one hand your HEMS program may not be able to live without it (either by regulatory requirement of your state, OR by lost revenue via third party insurers who require accreditation), but on the other it may be hard to live WITH it too! -recurring site visits, 3 year applications for reverification, continually updating standards etc.

One of the big problems with CAMTS accreditation is that in some circles it is legislatively mandated (see the 8 states that require it) and by definition, accreditation conflicts with "mandatory" -- so which is it? Mandatory or voluntary???

Personally I believe the original intent of CAMTS was good for the following reasons:

1) It's not governmental: for those of us who dislike big brother running everything. (This is a HUGE plus in my book)

2) Technically, it's still voluntary (debatable)

3) Nursing/carregivers: involvement with heavy focus on requirements for the medical crews, in my opinion, is good. I believe the industry is moving towards recognizing the medical crews as AIRCREWS. I think there will be needed discussion when/if this happens (I hope it does) because then there is more FAA oversight in that aspect.

4) CAMTS uses widespread representation. Argue if you like about how the pilots are not as strongly represented, but there are a few other "non-specific" seats on the CAMTS board of directors which could be occupied by qualified pilots as well.
---->NOTE: if the HEMS pilots do not feel they are represented adequately by CAMTS, then they should lobby their professional organizations to develop some type of accreditation program as well, OR, get their representative body to work more collaboratively and intertwined with CAMTS
5) In my personal opinion, in what I have read and researched over the years, I feel CAMTS strives to stay "ahead of the curve" in as much as incorporating or leaning towards industry leading "best practices" as well as those practices which may be recommendations by federal investigative/review committees. I have always felt that CAMTS was dynamic and responsive to the HEMS community.

I realize there are more problems and concerns with CAMTS which I have not listed here; I will look for part two of this article to help stimulate more discussion.

My bottom line however, is directed towards the skeptics and nay-sayers.. and I say to those that are (1) unhappy, (2) dis-enfranchised or (3) mis-represented by CAMTS - "sorry", CAMTS has ONLY become so influential and powerful by the VOLUNTARY submission to it's program requirements and accreditation processes by programs across the US... The more programs that seek the CAMTS "Merit Badge", give the CAMTS machine more influence, power and presence....

Oct 12, 2009

National Emergency Nurses Week Oct 11-17, 2009

Emergency Nurses "Prepared for the Unexpected"

Emergency nurses across the US will be celebrating Emergency Nurses Week, Oct. 11-17, and Emergency Nurses Day on Oct. 14. This year’s theme is "Prepared for the Unexpected," a perfect theme as every day brings the unexpected. There is no "usual" or "typical" day in an emergency department.

Emergency patients are just that — emergencies requiring acute, episodic care. We care for patients across the lifespan, with a vast range of problems. It is not uncommon to care for a two-year-old boy with a fever, a 75-year-old woman with a fractured hip and a 22-year-old man involved in a car crash, all in the same hour.

We are frontline health care providers, often a person’s first and only interaction with the health care system. Every day, we interact with other disciplines — including physicians, paramedics, respiratory therapists and police officers. We do not work alone, but as part of the health care team, relying on each other’s skill and expertise. Each day, we touch people’s lives, from providing CPR, to explaining the signs of infection to a mother whose child just received stitches for the first time. We are there for our patients and families during happy and sad times — we are also there for each other.

We need to acknowledge the great work done by all our emergency nurses across the US. We are truly a unique specialty, caring for a multitude of diseases and injuries from infancy to adulthood. Every day, we are faced with increased demands, from violent patients, short staffing to overcrowding, but we do our best to provide safe and competent care.

Since 1989, the Emergency Nurses Association has celebrated the second Wednesday in October as Emergency Nurses Day, a day set aside to honor emergency nurses for their commitment to patient care. Starting in 2001, ENA expanded the celebration to devote an entire week to honoring emergency nurses, because it was felt that one day was not enough to recognize all contributions made my emergency nurses.

ENA is the only professional nursing association dedicated to defining the future of emergency nursing and emergency care through advocacy, expertise, innovation, and leadership. Founded in 1970, ENA serves as the voice of more than 36,000 members and their patients through research, publications, professional development, injury prevention and patient education.

Oct 8, 2009

ENA General Assembly Day #1 - Town Hall Report

Day #1 of the ENA General Assembly (GA) finished up with a Town Hall style meeting. This is an activity which has been done at the last several ENA GAs and has continued since. It is an opportunity for members to meet in a collegial and informal setting and ask quetions and engage in an "open forum" with the ENA leadership. This provides an opportunity for members to directly ask questions or discuss ideas with the leaders in a setting in which they might not otherwise be able to so easily. Each town hall meeting has several ENA leaders and members of the board present.

The town hall meeting Wednesday evening went quite well. Participation was good and there were approximately 40-50 members present to share.

Some of the topics/items shared are presented here...

One member brought up discussion that they were having a hard time getting "buy in" on TNCC education at her small community hospital because they aren't a "trauma" center and apparently the adminstration felt that they didn't need "trauma" education.

The presenter aknowledged that TNCC was an outstanding course that taught good ED nursing skills as far as patient assessment. Members of the ENA board and those involved with TNCC development responded. They said they understood the point and suggested that this person try to promote TNCC education from the standpoint that a lot of trauma doens't come into the ED by EMS/prehospital, but also by private vehicle or "walk in". As such, it seems that "trauma" education even in the non-trauma centers is definitely of benefit. There was no indication that the naming of the TNCC product was going to be changed, but that maybe a strategy for marketing it differently to address the broader needs of all EDs.

Another question was presented regarding the newest BCEN certification, the CPEN (Certified Pediatric Emergency Nurse). It was pointed out that the CPEN is the only BCEN credential which includes a clinical practice requirement in order to sit for the exam. Currently the other BCEN credentials do not have this (CEN, CTRN, CFRN). The question was asked as to why this practice requirement was made and if in the future, the other credentials would move to include a clinical requirement also.

The response was that the CPEN was developed in conjunction with the Pediatric Nursing Certification Board (PNCB). The joint venture was necessary to establish core content and competencies and as such necessitated the CPEN mirror the pre-existing clinical practice requirement of the PNCB.

So basically the CPEN is a "joint-certification" and shares similarity with PNCB. The other BCEN credentials (CEN, CFRN, CTRN) are unique to BCEN and share no joint development with other certifying boards.

Finally a member from California ENA brought up for discussion that in her state they were having a new mandate from their state legislation. AB 911 mandates that the EDs use a matematical formula to calculate how "full" or "busy" they are with high acuity patients. The presenter discussed how they are not sure how these numbers are going to be used but they are having to dedicate resources to fulfilling this obligation. There was also concern that this mandated a certain softward package or method to do this. Another speaker, also from California, stated that she felt it was a useful tool because part of the calculation was taking into account some patient/system acuity beyond just the ED as it includes numbers of ventilators available etc.

The ENA town hall board responded that they were not as familiar with this recent legislative madate, but would keep their eyes on it in the future. It was stressed to the attendees that this was an example of needing to keep active on the legisltative forefront via our ENA's support structure.

The town hall meeting ran up until the end of time and probably would have gone on longer if there was not a time constraint.

This author has attended the GA Town Hall meeting for th past 4 GAs. I have always appreciated the venue and felt that it was beneficial. It's a nice forum to get a "direct line" to the people with answers or to get referred to those who may be able to help more. It has always been open, informal and a good use of time.

I'm going to suggest to the ENA conference committe that we continue this forum, maybe even to have it repeated on one of the days of the "reguular" conference too, or to extend the time to 90 minutes or so because there has always seemed to be more topics pending that people wanted to discuss.

Oct 7, 2009

ENA Conference/General Assembly Opening in Baltimore

Wednesday October 7.

ENA president Bill Briggs called the General Assembly to order for 2010 here in Baltimore MD.
Many new and interesting things were on tap for starters.

One of the first "improvements" was the installation of a new method for registering keypads for the delegates to vote with. Previous years had seen difficulties with delegate registration, missing keypads, DUPLICATE keypads, keypads being "swapped" etc. So it was with a bit of trepidation that we installed a new vendor/service for this and a new process for registering keypads. Overall it seems to be like a good system and some inefficiencies since last year have been improved upon... so far. ...we'll see!

The second part of the morning session saw some emotional debate and speaking regarding one of the new proposed bylaws which is going to effectively "cap" the number of delegates to the general assembly.

This had been proposed by ENA leadership for several reasons, one of which was a financial concern in that larger and larger delegate assemblies was becoming a logistical chore, as well as expenses to the organization were increasing as well. The ENA leadership had proposed a fixed number of delegates and each state would be awarded a respective percentage based upon their annual membership.

Good --- Bad???

Much discourse was had throughout the assembly, many people voiced their opinions both for and against. Some of the larger states voiced concerns that their representation might be diluted by the smaller states getting their "guaranteed" delegates based on small ENA member rolls. Other speakers voiced concerns about the principles of "grassroots", "membership driven" as their speaking points and they advocated for the current method using arbitrary ratios, such as is the current case.

The discussion went on and nearly ran into lunch time and discussion had to be halted temporarily.

As for this author, I am not completely convinced on my own stance on this. I understand the need to limit some of the expenses and the ever increasing logistical burden, however I also understand that, as a "pure" representative organization that is growing, a stable delegate:member ratio, despite increasing numbers, has it's benefits also.

Will be interesting to see how this one pans out.