Overton John W. - Safety and quality in medical transport systems: creating an effective culture

SAFETY AND QUALITY IN MEDICAL TRANSPORT SYSTEMS

Creating an Effective Culture

Edited by

JOHN W. OVERTON, JR.

and

EILEEN FRAZER

Commission on Accreditation of Medical Transport Systems, USA

ASHGATE

John W. Overton, Jr. and Eileen Frazer 2012

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission of the publisher.

John W. Overton, Jr. and Eileen Frazer have asserted their moral right under the Copyright, Designs and Patents Act, 1988, to be identified as the editors of this work.

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Ashgate Publishing Limited
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Ashgate Publishing Company
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British Library Cataloguing in Publication Data

Safety and quality in medical transport systems : creating an effective culture.

1. Transport of sick and wounded--Risk assessment.

2. Transport of sick and wounded--Safety measures.

I. Overton, Jr. John W. II. Frazer, Eileen.

362.1880684-dc23

ISBN: 978-1-4094-3540-2 (hbk)
ISBN: 978-1-4094-3541-9 (ebk-PDF)
ISBN: 978-1-4094-7198-1 (ebk-ePUB)

Library of Congress Cataloging-in-Publication Data

Safety and quality in medical transport systems : creating an effective culture / [edited] by John W. Overton, Jr. and Eileen Frazer.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-4094-3540-2 (hbk) -- ISBN 978-1-4094-3541-9 (ebk)

I. Overton, Jr., John W. (John W.) II. Frazer, Eileen.

[DNLM: 1. Safety Management -- organization & administration. 2. Transportation of Patients-organization & administration. 3. Ambulances. 4. Emergency Medical Services -- organization & administration. WX 216]

362.1880289--dc23

Priented and bound in Great Britain by the MPG Books Group, UK

Ralph N. Rogers

K. Scott Griffith

Terry L. von Thaden

Clive Adams

Terry L. von Thaden

Nadine Levick

Kimberley Turner

Kimberley Turner

Bruce A. Tesmer

Robin Graham

Terry Palmer

Roger Coleman

Nadine Levick

Gregory H. Botz and John W. Crommett

Melissa M. Mallis

John W. Overton, Jr., Laurie Shiparski and Philip D. Authier

Eileen Frazer

Donna York Clark, Kate Moore and David F.E. Stuhlmiller

Donna York Clark, Jacqueline Stocking and David F.E. Stuhlmiller

LEAN: Jennifer Hardcastle
Six Sigma: Sandra Kinkade Hutton

Patricia Corbett

Eileen Frazer

Dawn M. Mancuso

Kenneth P. Neubauer

David P. Thomson

Eileen Frazer

Figures

JOHN W. OVERTON, JR., M.D.

Dr. John Overton earned a B.S. degree from Virginia Polytechnic Institute and State University and his M.D. 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 postoperative cardiac surgical death followed completion of the team endeavor.

Dr. Overtons surgical career has been influenced by his lifelong 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 until 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 the 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 high helicopter accident rate raised alarm among the public in 2008, Ms. Frazer testified at the NTSB HEMS (Helicopter Emergency Medical Services) Hearings -February 2009 and at the Congressional Hearings on Air Ambulances March 2009.

In April 2009, Ms. Frazer received the Federal Aviation Administration 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, has a regular feature in the Air Medical Journal