2022: a year of recovery for aeromedical accreditation

Spreading the word

As a truly global organisation, EURAMI was present at all major conferences and summits in 2022 – and will continue to do so in the upcoming year. Educating payers and providers on the importance of accreditation and standardisation of aeromedical transports, alongside the representation of our accredited members, is a key focus for the association, leading to a much wider recognition all over the globe. Furthermore, EURAMI’s efforts have already led to a reduction in additional audits by insurance and assistance companies, greatly reducing the workload for our members – one of the main missions of the association moving forward.

EURAMI has also launched several committees focusing on the development of governmental and military connections, further strengthening our position as a leader in accreditation, allowing members to work with a much broader clientele. The EURAMI membership will also see a new set of standards in the Commercial Airline Medical Escort and Rotary Wing categories, ensuring that all audited fields are up to the latest developments and guidelines.

They say time flies when you love what you do – for the team at EURAMI, the past 12 months certainly went by in the blink of an eye… and we already can’t wait for great things in 2023.

Eileen Frazer, Executive Director of the Commission on Accreditation of Medical Transport Systems (CAMTS)

Last year was busy, and seemed like a rebound from our semi-isolation during the pandemic precautions. We are conducting on-site visits again, although our surveyors are still expected to be tested prior to travel, exercising caution for their own protection and those of the healthcare professionals we visit. We completed about 60 site visits in 2022 for both CAMTS and CAMTS Global. The total number of ‘programmes’ we have accredited is over 200, including 238 fixed-wing and 898 rotor-wing aircraft. In our database, we also have 640 ambulances, one boat in Thailand, and a private car belonging to a physician responder in a remote part of Canada.

New direction

This year, we finalised the 12th Edition CAMTS Accreditation Standards and the 2nd Edition CAMTS Global Accreditation standards, available for free download or purchase on both websites. We also published Mobile Integrated Health (MIH) standards for both CAMTS and CAMTS Global. These are the first worldwide standards to address this emerging healthcare delivery model, which increases access to basic services by utilising specially trained emergency medical service (EMS) providers in an expanded role. Also called Community Paramedicine, but not exclusive to paramedic practice, MIH providers care for patients at home or in other non-urgent settings outside of a hospital, under the supervision of a physician or advanced practice provider. There are many studies that demonstrate MIH services reduce unnecessary trips to the emergency department, including readmissions, ultimately serving to limit overall healthcare costs.

 The Board of Directors was supportive of this new direction. Although it does not involve transport, it addresses care outside of the hospital. A select committee of MIH professionals met with CAMTS Executive Staff for over a year to develop and finalise the standards in July 2022. An MIH expert was added to the board in an ad hoc position to represent this new entity, and we have both the knowledge and infrastructure to make this a successful accreditation process. 

Last year ... seemed like a rebound from our semi-isolation during the pandemic precautions

Board of Directors

In October 2022, we honoured Jon Gryniuk for his many years of service on the CAMTS Board of Directors and the CAMTS Global Board, representing the International College of Advanced Practice Paramedics (ICAPP). He resigned due to a career change. ICAPP’s new representative is Ryan Gapinski – an Expatriate Flight Paramedic for Alpha Star in the Kingdom of Saudi Arabia. Alpha Star was accredited by CAMTS Global in 2021 and provides fixed-wing and rotor-wing services in Riyadh and NEOM.

Gapinski was introduced to the CAMTS Global Board members: Dr Stefan Becker, Head of Corporate Development for Rega in Zurich; Dr Vincent Feuillie, Medical Director for Air France; Dr Dhun Damrongsak, Medical Director for BDMS Emergency Services in Bangkok; and Dr Stephen Hancock, Consultant for Embrace Yorkshire & Humber Infant & Children’s Transport Service in South Yorkshire. Ashley Smith, the Treasurer for both CAMTS and CAMTS Global, serves on both Boards of Directors.  

This diversity of experience forms the foundation of the CAMTS Global Board of Directors, which approves the standards and policies and determine accreditation action and decisions. It is set up the same as the CAMTS Board of Directors to have highly qualified and experienced members who represent professional organisations – not a medical transport service. These representatives avoid conflicts of interest, so they are excused from any discussion that may involve an employer or competitor to a current employer. Specific forms must be signed by each member to declare potential conflicts prior to meetings.

Eileen Frazer and Dr Stefan Becker, CAMTS Global Founders, attended the International Travel and Health Insurance Conference (ITIC) in Athens in October 2022. They shared highlights of the 2nd Edition Accreditation Standards and answered questions at the exhibition booth. It was great to network with peers again – and we look forward to a happy and successful 2023. 

Amy Arndt, Operations Director at the National Accreditation Alliance of Medical Transport Applications (NAAMTA), talks about a focus on care and safety, a hugely successful expo and the development of new relationships

We appreciate this opportunity to update the medical transport industry on our activities in 2022 and projections for 2023. Taking time to review this year’s events, there are many accomplishments worth addressing.

Two Hoist Accreditation Programmes

NAAMTA’s Medical Transport Accreditation has been a requirement for government and military contracts since 2011. Over the past few years, we have seen an increase in the number of accredited members that provide services through government contracts.

As we audit these air ambulance service providers, we have identified distinct elements that would improve quality of care and safety; not only for the patient, but for the men and women fulfilling contract services. This leads us into the biggest achievement for 2022 – the development and release of two new accreditation programmes:

• Helicopter Hoist Medical Transport
• Helicopter Hoist.

In addition to the government contracts mentioned, these accreditation programmes target International Hoist Operators and US Part 133/135 Operators.

To develop them, we partnered with Pegasus Aero Services (aerospace and aviation consultants), and engaged an international development team of industry subject matter experts (SMEs), hoist professionals and training centres.

The successful development of these accreditations is a direct result of team members sharing their hoisting expertise in operational knowledge and criteria, with a focus on quality and safety for hoist medical transport and hoist external load services.

Additionally, this group has a solid foundation in regulatory requirements with Civil Aviation Authorities, the Federal Aviation Authority (FAA), European Aviation Safety Agency (EASA) and International Civil Aviation Organization (ICAO).

Our two accreditations include criteria that has the flexibility to meet US and international hoisting and hoist medical transport needs.

Hoisting standards rollout

In March 2022, at the HAI Heli-Expo in Dallas, we rolled out the two accreditation programmes and presented a plan for their implementation.

Attendees ranging from private organisations to branches of the military, including the US Coast Guard, commented on the improved operational safety that will result from implementing the accreditations.

We have had conversations with various members of the United Nations Procurement Department, Department of Defense, and the Air Mobility Command to demonstrate the alignment of the accreditation criteria with contract requirements.

We have been working on a project to assist our customers with turnkey solutions

Customer accreditations and continuous compliance

In the pandemic aftermath, the medical industry is recovering from such challenging times. We want to express our thanks and encouragement to so many areas that are growing strong through the winds of change. 

In 2022, NAAMTA feels honoured to have had an increase of new customers and renewals of accreditation. The concept of the NAAMTA Alliance and partnerships we develop has been an effective tool. We also want to congratulate our Alliance members, who demonstrated 90 per cent continuous compliance through the report process in the first three quarters of 2022. Our ISO auditor states that this is far above the norm – you are well deserved of recognition. 

Accrediting specialty transport

NAAMTA was approached this year to author an article regarding the accreditation of Specialty Care Transports. Nancy Purcell, NAAMTA Global Clinical Operations Director, provides insight into the intricacies of accrediting transport programs with a variety of specialty care patients. This includes patients requiring:

• Advanced Respiratory Support (i.e. complex ventilatory support, inhaled nitric oxide, Heliox, compressed medical air, liquid ventilation, etc)
• Complex Cardiac Circulatory Support (i.e. IABP, ventricular assist devices, ECMO, etc)
• Level III/IV High-Risk Maternal-Fetal Specialty Care
• Level III/IV High-Risk Neonatal Specialty Care.

Ambitions for 2023

We are looking forward to our ISO 9001:2015 Surveillance Audit. Here’s why:

• Although stressful, it keeps us in tune with our current and future customers’ comfort level for their accreditation audit
• An opportunity to learn from the auditor’s experiences
• Feedback teaches us our areas of weakness and provides opportunities for improvements
• Helps us recognise and celebrate our strengths, as we begin a new year of accreditation services.

We are also increasing our number of accredited members and look forward to these new relationships, while also working closer with military and government procurement entities – to assist in clarifying contract and accreditation requirements.

Finally, we have been working on a project to assist our customers with turnkey solutions that are now in a beta test phase. We hope to announce additional details by the end of the first quarter.

Jessica Peltz, owner of Medical Transport Accreditation and Compliance

While many medical transport programmes achieved accreditation in 2022, our primary focus was on quality and process improvement, which goes hand-in-hand with accreditation compliance.

Clinical quality improvement

Working with individual aeromedical providers to develop baseline quality benchmarks proved to be an engaging challenge. Establishing standards is only half the battle; changing the management of day-to-day team member operations is the other half. 

How are quality benchmarks determined for each unique transport programme? We begin by reviewing the scope of practice, along with clinical trends observed through chart audits and staff interviews. By evaluating knowledge and skills deficits, education and training is developed with clinical leadership to ensure all staff have the same knowledge base.

With custom quality measurement tools, it is easy to measure the effectiveness of education and training programmes. This closes the loop on the identified deficiency and offers your accrediting body documentation of your Quality Management Programme. Remember, measurable data allows for action!

Process changes

Depending on the individual aeromedical transport programme’s culture and size, changes to day-to-day operations can be accomplished very quickly and easily – or could take weeks or months to evaluate the proposal with a risk assessment.

Process improvement is a cyclical practice and following a streamlined method will simplify the project. It could be a complete overhaul of your operation centre’s Standard Operating Procedures. Or, at a granular level, a slight change in your internal file storage system.

The below process can be applied to many situations, such as clinical quality improvement (as described above) or a process change:

1. Identify opportunities for improvement
2. Determine how the problem can be improved
3. Implement the changes
4. Evaluate continuously.

The key to successful change is monitoring its effectiveness and making additional adaptations as needed. Failure to do so may lead to a reversion to old, inefficient processes.

Ongoing accreditation compliance

After obtaining accreditation, maintaining ongoing compliance is vital. This year, we worked with aeromedical providers to ensure they meet the rigorous standards of industry accrediting bodies.

Depending on the body, monthly, quarterly and/or annual reporting is necessary. This helps establish the regimen of compliance. If this type of expected reporting is not required, it is the responsibility of the transport programme to adhere to a schedule to maintain internal records of compliance. In working with providers this year, we learned that the simplest processes help maintain compliance:

• Quality management (QM) and safety
  • Using the abbreviated process described earlier, it is easy to document QM and safety findings
  • Determine how long to monitor – monthly, quarterly, annually.
• Meeting minutes
  • Prepare meeting agendas in advance
  • Document minutes on the agenda
  • Save in year’s folder > quarter’s folder.
• Staff training
  • Master documentation (spreadsheet or other tracking tool) for skills
  • Use of an LMS to track didactic completion dates
  • Quarterly training based on chart QA (this can easily be done at quarterly meetings!).
• Staff credentials
  • Many PCR systems include personnel management
  • Spreadsheet or other tracking tools can be easily implemented.

The months before reaccreditation are not the time to begin planning – planning begins in the immediate months after accreditation.

What’s next?

During Covid, providers honed their businesses and grew substantially. We look forward to dicussing their continued vision. While accreditation is a long-term goal, being prepared and already compliant makes the process much easier.