January - February - March 2004

Chair & Editor
Steven E. Sittig, RRT
Mayo Med Air
AL-G 403
Mayo Clinic
200 SW 1st
Rochester, MN 55905
(507) 255-5696
sittig.steven@mayo.edu

CAMTS Representative
Thomas J. Cahill, RCP, RRT, EMT-P
Shriners Hospital for Children-Cincinnati
3229 Burnet Ave.
Cincinnati, OH 45229-3095
(513) 872-6191
tcahill@shrinenet.org

by Steven E. Sittig, RRT

As I sit down to write my first chair notes of 2004, I have just returned from the 49th AARC International Respiratory Congress in Las Vegas, NV. The Congress set records for attendance, and excellent lectures were presented throughout the four-day meeting. The AARC Board of Directors was most impressed with all of our actions to turn section membership around in 2003, and, as you most likely have heard by now, we have been given another year to attain the 350-member level needed to maintain our status as a stand-alone specialty section. I want to thank all of you for your efforts in recruiting and maintaining membership in this important facet of respiratory care, and I look forward to working with you again this year as we continue to build membership for the section.

I attended several meetings with other section chairs and the AARC leadership on the Sunday prior the beginning of the conference. One issue of discussion was the AARC's decision to go to the electronic format for all the section Bulletins, beginning with this issue. The Education and Management Sections transitioned to the electronic Bulletin last year with much success.

The fact that some employers are now limiting access to the Internet at work was discussed as a potential issue for many staff therapists, but the benefits of the electronic format were deemed to outweigh any disadvantages. Specifically, the conversion will save the AARC money in printing and mailing costs, thus reducing the overall cost of running the sections. One suggestion for those who do have limited access to the Internet at work - and no access at home - is to approach department management and ask that information services remove the block to the AARC web site. That way, you can access and print the Bulletin to read at a later time. As you can see, the format is a lot friendlier to printing than the previous PDF format.

A benefit of the conversion to the electronic format is that the lower cost of running a section is also spurring a new analysis of what is needed to maintain a section. That issue will be evaluated by the Board at its next meeting. I'll keep you posted on the developments.

In addition to the electronic Bulletin, the Section's web site will also undergo a makeover this year to enhance its usefulness to members. The goal is to develop the web site into something more than just a library of past Bulletins. I would very much like to hear your ideas for what should be added to the new site. Ideas mentioned in Las Vegas included having a photo library of RTs in transport and programs' ground rigs and aircraft. The AARC wants each section to personalize its web site according to its needs, so it's up to us to decide what types of features the site should contain. I encourage you all to think about what you would like to see on the site and e-mail me or Kris Williams at the AARC office with your ideas.

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The opening day of the AARC Congress saw our first-ever Transport Uniform Day and Recruitment Booth, complete with transport team members from around the country dressed in transport scrubs and flight suits. The booth was located in the AARC Central area of the exhibit hall, and the interest generated for the section was evident, in the first hour nearly a dozen therapists came by, asking how to join or for more information about the section. I had figured most people would simply be running around picking up all their free goodies so soon after the hall opened, and thus not paying that much attention to our display. Instead, we gave out more than 80 two-page information handouts on the section, along with individual business cards for later contact information.

The recruitment effort also featured our first-ever Transport Section poster, featuring pictures of RTs in transport settings ranging from ground ambulances to varied aircraft, along with some of the smallest patients we serve. I am hoping we can make this poster available so that members may use it during state meetings and other events where we might recruit new members for the section or want to showcase our role in transport. Please e-mail me if you'd like to have a copy for such purposes.

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The first shipment of Transport Section lapel pins has now been distributed. However, new members need not worry! The AARC is re-ordering the pins, and will be distributing them as soon as they arrive in the Executive Office. If you are already a member but have not yet received your pin, please contact either Steve Sittig, Pat Lee or Kris Williams. They'll make sure you get one ASAP.

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Transport RTs were well-represented at the 2003 Air Medical Transport Conference (AMTC) held in Reno, NV, November 4-6. About 30 therapists were in attendance at the meeting. This was my first time at the conference, and it was an eye opener, as there were nine medically configured helicopters in the exhibit hall!

On the day preceding the opening of the conference three medically configured fixed wing aircraft were also towed the mile-and-a-half distance from the airport and placed on static display in the parking lot at the Reno Hilton, which was our host hotel. The interstate that runs past the airport and hotel was shut down on one side at 4 a.m. to facilitate the trek. The medically configured Army Black Hawk pictured here was also on static display.

A Transport RT meeting was held over the lunch hour during one day of the meeting and attended by 24 therapists. A number of subjects were discussed relating to the specialty and our need for growth on a national level.

The Transport Section was also well represented at the conference, as two of our members presented excellent lectures on transport safety issues. Sherry McCool, from Mercy Children's Hospital in Kansas City, MO, presented a lecture on safety and the specialty team. Wes Ware from Arkansas Children's Hospital followed with a talk covering specialty gas safety on transport, along with ECMO transport. It was great to see RTs presenting in this major national transport forum. This is something we, as a profession, should do more often to help promote the role and value of the transport RT.

One tradition from the AMTC that we are going to try to adopt at the AARC Congress is setting aside one day when everyone involved in transport wears his or her transport uniform. This was a great success on a limited basis in Las Vegas (see article in this issue), and we believe that expanding it to include all transport RTs in attendance will further boost section membership. Whether you wear scrubs on transport or a flight suit, coming to the meeting in your "work clothes" will help illustrate to our peers the unique environment in which we practice.

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At the request of neonatologists and nurse practitioners, the RT staff at Children's Hospitals and Clinics in Minneapolis, MN, will be participating on neonate transport on a more regular basis. Prior to this request, RTs only accompanied the team on nitric oxide transports. This is a huge opportunity for this busy department and the transport RT specialty.

The decision to add RTs to the team came from medical directors at the hospital. The NICU staff now attends high-risk deliveries at Children's, and medical direction wanted to provide the same service to their outlying referral hospitals. The transport RT will be added to the team by either the neonatologist or the nurse practitioner, depending on the anticipated needs of the patient. Previously, the team was composed of a nurse practitioner and a NICU registered nurse.

In preparation for this expansion of service, a core group of NICU RTs and their department director traveled the short distance to the Mayo Eugenio Litta Children's Hospital in Rochester, MN, where they spent the afternoon with Grant Wilson, RRT-NPS, supervisor of the neonatal/pediatric RT transport group and an AARC Transport Section member. The meeting covered issues involving training, competencies, scheduling, and scope of practice.

According to the department director at Children's Hospitals and Clinics, Denise Johnson, RRT, the addition of the RT to the area of high risk delivery opened the door for this opportunity on transport. "The neonatologists and nurse practitioners were very impressed with our skills and what we could contribute to the care of newborns, therefore they wanted our services on transport."
It is anticipated that 14 RTs will be trained to staff this expanded service. They expect to be up and running sometime in early February.

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The Ultimate Game Plan: Preparing for Critical Care Transports from Referring Hospital to a Tertiary Hospital. Presented by Jen Chahanovich, RRT, FAARC, and James Calhoun, RRT-NPS, Kapi'olani Medical Center for Women and Children, Honolulu, HI.

In this lecture, Jen and James described the transport process from a management perspective, outlining clinical requirements and team member training. Orientation of new team members is always a hard process to define, especially when it comes to determining when a new member is "ready" to be dispatched on his or her own with a nurse. A system requiring all new team members to attain a certain number of points to complete their orientation was presented. Specific areas, such the need for intubation and high oxygen requirements, were given higher point values. The new team member must complete a number of high-value transports with a mentor before receiving clearance to complete transports with nurses. If you'd like more information on how this system works, e-mail me at sittig.steven@mayo.edu and I'll forward your request to Jen.

Management of Neonate Patients During Transport Through the Use of Protocols. Presented by Dr. Kenneth Ash, neonatologist at Kapi'olani Medical Center for Women and Children, Honolulu, HI.

Dr. Ash covered the use of protocols for critical care transport of the critically ill newborn. The Kapiolani team is based on the RN/RRT model, and their protocols must address such challenging issues as long flights over the Pacific basin and flights to the mainland with congenital heart patients.

Troubleshooting and What If Scenarios in Transport. Presented by Wayne Takenaka, RRT-NPS, and James Calhoun, RRT-NPS, Kapi'olani Medical Center for Women and Children, Honolulu, HI.

This lecture covered issues involing troubleshooting of equipment, along with situations encountered by all of us who complete patient transport. Presented in the format of a David Letterman Top Ten List, the talk zeroed in on scenarios common to the transport setting. As Wayne and James covered these top ten items you could see the entire audience shaking their heads in agreement and laughing as they recalled similar scenarios during their transport careers.

Critical Care Air Transport Teams (An Air Force Perspective). Presented by Major Deborah Milkowski, MD, David Grant Air Force Medical Center, Travis Air Force Base, California.

This lecture covered the military's changing paradigm for treating and transfering critically ill military and civilian patients to the specialized care facilities they need using the Air Force's Critical Care Air Transport Teams (CCATT), which include RTs. Dr. Milkowski covered the logistics involved in these flights, which are occurring more frequently all over the world. These teams may be airborne for 16 hours and refuel in mid air in order to complete their missions. (And we thought we sometimes had long days!)

Advanced Practice and Improving Service in the Pediatric Intensive Care Unit. Presented by Dr. Greg Schears, Mayo Clinic, Rochester, MN.

Dr. Schears presented a model of advanced practice for transport RTs that demonstrates how these advanced practice team members can help improve patient care in the ICU setting and on transports. A system was also presented that helped decrease ICU-based pediatric specialty team response at Mayo from 25-30 minutes to 5 minutes, allowing for the expansion of inter-hospital pediatric trauma service by the RN/RRT specialty team.

High Frequency Ventilation in Transport. Presented by David Blackney, RRT, Sutter Children's Hospital, Sacramento, CA.

David described his facility's use of the Bronchotron High Frequency Ventilator, which is also capable of conventional ventilation, and can be used with transport nitric systems to provide a one-ventilator system that supplies vent support to the sickest of newborns.

Continuous Quality Improvement to Improve Transport Services. Presented by Dawn Filippa, RRT, from Life Star Flight in Hartford, CT.

Dawn covered this important aspect of transport, which strives to improve service to the patient and to the systems with which we all interact on a daily basis. From referral facility staff to patient family members and EMS crews, a systematic approach, she says, is essential to thoroughly evaluate your service and how to improve it. Systems should not point fingers at team members, but should instead promote team-building. These systems are needed to help teams meet EMTALA guidelines.

ACLS and the Critical High Risk OB Transport. Presented by Ami Metts, RN, RNC, from Memorial Hospital in Colorado Springs, CO.

This lecture covered subject matter of which those of us who are members of neonate transport teams must be aware in order to help anticipate maternal issues that may seriously affect the newborn patient. This progressive, high-risk maternal team incorporates an RN/RRT configuration. I found it very interesting that RTs are branching out into nontraditional areas of transport. It shows that we are a very valuable and flexible profession that can serve many types of critical patients.