Executive Summary – Board of Directors Meeting  – October 27-28, 2013

The Board of Directors met in Virginia Beach on October 27-29, 2013. Board members present included:  Mr. Hickman, Dr. Conn, Dr. Stuhlmiller, Mr. Tangerose, Dr. Wedel, Dr. Brunko, Ms. Treadwell, Mr. Brown, Mr. Becker, Mr. Gryniuk, Mr. Sittig, Mr. A. Smith, Dr. Orr, Mr. Ragsdale, Dr. Rogers, Dr. Price-Douglas, Ms Holtschneider, Mr. Brisbois, Ms Palmer
Staff present: Ms. Frazer and Mr. D. Smith
Dr. Rogers presided. During the meeting, Mr. Howard Ragsdale was presented with a gift for his contributions and participation on the CAMTS Board for the past 5 years representing AMOA. Ms Kim Montgomery will be the new AMOA representative and Mr. Ragsdale will introduce and accompany her to the March 2014 Board meeting.
Treasurer’s Report
A quarterly report was distributed and Mr. A Smith pointed out that our legal costs for 2013 far exceeded budgeted numbers for the entire year.  A draft budget for 2014 was presented and approved unanimously with the condition that we would revisit legal costs, salaries and charges for site visits in January after we receive the year-end report.
Capital budget items were approved for 2014 to include $25,000 for revamping our database and developing web-based accreditation applications and an additional $2000 for replacement equipment.
Executive Directors’ Report           
Ms Frazer and Mr. D. Smith reported on activities since the July Meeting that included a report from the NASEMSO annual meeting. Ms Frazer and Mr. D. Smith provided a workshop to State EMS Directors. A recommendation by CAMTS was discussed - that States should provide Deemed Status to CAMTS accredited services instead of requiring by regulation that air medical services must be CAMTS accredited. Legal actions that have resulted from such regulations are becoming cost prohibitive to CAMTS. The States also expressed that they would like to provide feedback to CAMTS regarding programs that are going through a site visit. Several states have reported regulations that are not being followed by the CAMTS accredited services.  Ms Frazer will email a letter of inquiry to each State EMS agency as programs come up for accreditation and reaccreditation to keep lines of communication open.
Ms Frazer and Mr. D. Smith were also invited to the AAMS Safety Summit in Washington DC in early September. The CEOs and Safety Directors of the major 135 operators met to strategize how we can continue to improve safety and culture.  Feedback will be sent out regarding the outcomes and initiatives of this meeting that was well attended.
Ms Frazer also reported that she was asked to be on a panel discussion at the ITIC in Vienna November 4-7th along with EURAMI and IAAA representatives. The topic is transparency.  Following the conference, Ms Frazer will be the guest of Col Jay Neubauer, the Air Force commander in charge of moving injured and ill from the Middle East and Africa and tour the Ramstein AFB and hospital. Col Neubauer is very interested and supportive of the CAMTS standards and process. 
Guest Speaker
Mr. Kevin Gregory from Alertness Solutions was an invited guest speaker. Mr. Gregory spoke about his company’s efforts with AMOA to study pilot duty time with the purpose of developing fatigue management processes for EMS pilots.  His proposal is to do a similar study with medical personnel. The Board asked that a study design along with costs be provided to the CAMTS Board by January 2014. 
Airway Committee

Dr. David Stuhlmiller provided an update on the work done   by the Airway committee to develop airway management quality metrics in line  with current practice.  The intent is to define these and include as a reference tool and to further develop standard revisions for the 10th Edition.
Aviation Advisory Committee

The Aviation Advisory Committee reconvened and was attended by Mr. Chris       Eastlee, the AMOA Executive Director and several Board members and safety directors from 135 operators.  The initial meeting was basically to introduce the purpose and membership for future meetings. Mr. Ragsdale accepted the position of Interim Chair of this Committee and will solicit memberships and plan a meeting to coincide with the CAMTS Board meeting in March 2014.
Critical Elements Committee
Dr. Suzanne Wedel suggested at the last meeting that we create critical elements for 5 different medical protocols that we feel should be part of the protocols and acceptable as current practice.  The Committee has been working on this and met to further define critical elements that we will use starting January 2014 to determine that programs we are evaluating for accreditation over the next year have protocols consistent with current practice guidelines.  The protocols and critical elements will not be publicly disclosed since this is an internal process      and a way to assure consistency within our own review procedures.
Education and Marketing Committee        
The Education Committee introduced a revised instruction plan to submit simulations for approval in lieu of ongoing clinical experiences.  This will be made   available on the CAMTS website. 
Quality Management Committee
Denise Treadwell has accepted the Chair of the CAMTS Quality Management  Committee. Our goal is to redesign the CAMTS process to be in sync with the Malcolm Baldridge National Quality Award process since we intend to seek this award in the future.
CAMTS Workshops on Sunday, October 2013
We again presented Intro to Just Culture and Advanced Just Culture as well as Preparing for Accreditation. A new four - hour workshop entitled “Quality and Utilization Management” created by Dudley Smith was also provided. Pre-registration was disappointing for these workshops but we did have a better response on-site and evaluations were excellent.
Site Surveyor Luncheon - October 21, 2013
Heather McLellan was honored as the recipient of the Peggy Calhoun Memorial Award for her years of service and dedication as a CAMTS Site Surveyor. Heather is a Canadian and has been helping with the Education Committee and also the Quality Management Committee.  Each year the Board votes for an awardee and Heather was long past due for this award.  Congratulations Heather!
Executive Session - there were 14 accreditation decisions: 10 Full accreditations, 1 Provisional accreditation, 2 Deferred, and 1 Withhold.
Congratulations to the following services who were reaccredited:
            AeroCare – Lubbock, TX…………………………………….RW/FW
            AirEvac EMS Inc. -   O’Fallon, MO ……………………..RW/FW
            AirMed Utah – Salt Lake City …………………………………….RW/FW
            Alaska Regional Hospital Life Flight – Anchorage……………….FW
            LIFE STAR – Hartford, CT………...……………………………….RW
            LifeNet AZ – Tucson, AZ……………………………………………RW
            LifeNet of New York and Guthrie Air – Albany………………………………..RW
Congratulations to the following services who achieved accreditation for the first time!
            Good Samaritan AirCare – Kearney, NE…………………………………………..RW
            North Memorial AirCare – Brooklyn Center, MN…………………………….RW
            LifeMed Alaska – Anchorage…………………………………………………………..RW/FW/G

The next Board meeting will be in Austin, Texas March 27-29, 2014.

Executive Summary – Board of Directors Meeting – October 18 -20, 2012

The Board of Directors met in Seattle, WA, October 18-20, 2012 prior to AMTC.

Dr. Ralph Rogers, Chair, presided.

Treasurer’s Report was provided by Mr. Smith. The balance sheet was distributed for the July to October 1 time frame and presented the budget for calendar year 2013 which was approved.  A new .5 FTE position entitled Associate Director was approved with this budget.

Mr. Dudley Smith was willing to step down from the AAMS Board of Directors to accept the Associate Director position. AAMS will appoint a new CAMTS representative in the near future. Mr. Ashley Smith was nominated, accepted and approved for the Treasurer position on the CAMTS Executive Board.

Executive Director’s Report

Ms Frazer provided a report on the following issues:

  1.  Site Surveyor training – Planned for January 2013 in Dallas at the Bell Training Center. We have an interview team made up of Shirley Scholz and Charlann Staab (senior site surveyors) who will interview applicants during AMTC. Phone interviews will be conducted for those who are not in Seattle over the next few weeks.


  1. The book entitled “Safety and Quality in Medical Transport – Creating a Culture” will be published in December, 2012 by ASHGATE. We will have flyers and order forms available at the CAMTS booth during AMTC.  A poster of the book cover was shared with the Board.
  1.  A new Best Practice book is now available. We will be selling CDs at the Exhibit booth along with the 9th Edition Accreditation Standards, a copy provided to each of the Board members, mugs and other items.


  1.  Linda Meiner and Karen Rogers will continue to work on updating

The Standards Compliance Tool that will be part of the 9th Edition PIF.

  1.  Just Culture and Preparing for Accreditation workshops have record numbers of registrants and are being held in the hotel on Sunday, October 21.


  1. Ms Frazer was invited to speak at the International Travel Insurance Conference in Barcelona on October 30, 2012. She will then travel to London for the Military MedEvac Conference and meet with the ASHGATE publisher regarding final touches on the book.
  1. Peggy Calhoun Memorial Award LauraLee Demmons will be presented with this award during the Site Surveyor’s Luncheon on Monday October 22. Ms Demmons has also been the Standards Committee Chair for many years and instrumental in editing all of the standards but especially the Medical Escort Standards which are in current revision following the recent site visit conducted by Ms Demmons.


  1.  Site Surveyor’s luncheon will consist of review of QM issues that occurred in the previous site visits and update on the new standards. Each surveyor received a hard copy of the 9th Edition Accreditation Standards.

The Education and Marketing Committee met on Thursday evening and planned for future programs and discussed the process for approval of scenario based training.

Deliberation Rules, Mission, Vision and Values were reviewed by Dr. Orr prior to accreditation deliberations

Executive Session - there were 20 accreditation decisions: 16 Full Accreditations, 2 Probation, 1 Deferred, and 1 Withdraw decisions. Congratulations to the following services:


            Air Ambulance Specialists Inc.           FW                  Denver, CO
AirCare & Mobile                               RW/G              Cincinnati, OH           
Angel One                                           RW/FW/G       Little Rock, AR
Eagle Med                                           RW/FW           Wichita, KS
FlightCare                                           RW                  Saginaw, MI
Life Flight Network                            RW/FW/G       Portland, OR
Mayo Medical Transport                     RW/FW           Rochester, MN
Mercy Air                                            RW                  Rialto, CA
NorthFlite                                           RW/FW/G       Traverse City, MI
Panda Air                                            RW/FW/G       Portland , OR
Stat Flight                                           RW                  Indianapolis, IN
STAT Medevac                                   RW/G              Pittsburgh, PA
University MedEvac                           RW                  Cleveland, OH


New Accreditations:


            Bayflite                                               RW                  St Petersburg, FL
GHS Life Flight                                  RW                  Greenville, SC
Rescue Nurse                                      ME                  Denver, CO
1st accredited Medical Escort Service


The Meeting was adjourned on July 21, 2012. The next Board meeting will be in Seattle  on October 18, 19 and 20, 2012



Executive Summary – Board of Directors Meeting – March 29-31, 2012

The Board of Directors met in Nashville, TN for the Spring Board meeting.

Dr. Ralph Rogers presided and informed the Board that Mr. Stan Rose, HAI Safety Director, would be our guest later in the meeting.

Treasurer’s Report was provided by Mr. Smith. The balance sheet was distributed for the January – March 2012 time frame. Investment opportunities were discussed briefly and the Executive Board will review options and make a recommendation at the July meeting.

Executive Director’s Report

            Ms Frazer provided a report and discussion followed on each topic below:

The HAI HeliExpo was a great opportunity for networking. The Air Medical Committee was held on Sunday Feb. 12, 2012 and the Affiliate Members meeting was held on Tuesday, Feb. 14. Ms Frazer met with Stefan Becker, after that meeting to discuss EHAC and\or REGA joining CAMTS as a member organization. Mr. Becker would like to provide a presentation for membership at the July meeting. The Board was receptive to this and will welcome Mr. Becker in July.   

Ms Frazer also provided a presentation to the AMOA Board regarding the fatigue study CAMTS was proposing. AMOA would like to join forces and do fundraising for a fatigue research project. Details regarding the researchers and proposals are still in discussion.

Ms Frazer provided feedback on the joint ARGUS-CAMTS consult for International SOS. Mr. Coleman, who was sent as an observer and Ms Demmons who provided the medical consult provided reports and feedback. The 2 consults were held within a week in Santiago, Chile and Lime, Peru. After we have the full consult report, Ms Frazer and Mr. Smith will visit with ARGUS to discuss the challenges and future opportunities.

Mr. Smith provided an update on his comparative study of the CAMTS Standards and NAAMTA standards. Our corporate attorney is analyzing his analysis before they provide advice on how to proceed. 

Ms Frazer announced that the reference book “Safety and Quality in Medical Transport Systems: Creating a Culture” has been submitted to ASHGATE. The tentative publication date should be available by Summer of 2012.

Consults and upcoming site visits were discussed along with dates and site for future meetings. The Summer meeting will be held July 19-21 in Vancouver. Details about hotel room reservations will be emailed to the Board in a few weeks.

Annual dues letters were sent to each member organization along with an Annual Report.
Deliberation Rules, Mission, Vision and Values were reviewed by Mr. Smith prior to accreditation deliberations

Committee Reports

Ms Frazer reported on the following committees:

            Accreditation Standards Committee

            9th Edition Draft       
Ms Frazer suggested that we publish the 9th Edition in October 2012 with all the recommended changes and additions and then publish an Addendum regarding the Levels of Care in 2013 since that encompasses just one section of the standards.

The latest draft - #2- was discussed page by page – changes and draft 3 will be posted on the website and sent to each Board member to distribute to member organizations.

The discussion also continued on the Levels of Care. Postings and wide distribution of the Levels of Care will continue throughout 2012 and 2013 until we are comfortable with the end product and our constituents have played a major role in the definitions and descriptions.

Standards Interpretations and Questions from Site Surveyors

There was discussion about whether site surveyors should include areas that are corrected on site as areas of weakness or just note these in the Standards Compliance Tool.

Ms Rogers and Ms Frazer will solicit ideas from site surveyors as to which non compliant issues they think can be corrected on site without documenting in the ppt report as an area of weakness.

Interpretations of Standards

02.05.15 The interior of the aircraft must be climate controlled to avoid adverse effects on patients and personnel on board. (RW/FW) although G is not specifically mentioned here – we are looking at ground ambulances to comply as well.   

Interpretation: Measure cabin temperatures to get a baseline during start-up of the aircraft or ambulance and then again when patient is on board to get a baseline and another to see if temperature is maintained in the 50 to 95 degree F range. If temperatures are maintained in that range – there is no expectation to measure every 15 minutes unless something changes, such as the air conditioner stops working, for example. Document cabin temperatures on a QM form – along with measures taken to avoid adverse effects when temps are outside of those ranges.

01.02.02 Insurance

1. Hull insurance for each operating aircraft. Aircraft liability provides coverage with a single limit that must comply with the following minimums:

                        a.     Fixed Wing (U.S. dollars)
$5 million for twin engine aircraft
$25 million for turbo props and light jets*
$30million for heavy jets*
*(See Glossary for definitions of light jets and heavy jets)

                        b.    Rotorwing – $30 million (U.S. dollars)

Interpretation: These specific criteria in #1 above are a mandatory requirement to be eligible to apply for accreditation. Number #5 criterion listed below is not mandatory and is not being required as currently written.

5. Group life insurance or accidental death and disability at 3 times the crew member’s annual salary.

Interpretation: The Board is currently not requiring 3 times the crew member’s annual salary and this specific criterion is being revisited with insurance experts. Due to the many comments CAMTS received, we are considering the following questions before we revise this criterion such as: Is the company required to pay the entire premium or can they just offer the insurance to employees fees? What about per diem and on-call personnel?   How does workers’ comp insurance affect this criterion for Group Life or accidental death and disability insurance?
To be consistent – we said we were considering 2X salary as compliant whether paid by the employer in full or partially and offered additional to be paid by the employee.


04.02.02 Community Outreach Safety Program

  • b. Disaster response and/triage
  • FEMA and other Emergency Management classes for scene and disaster response.

Interpretation:  The FEMA courses listed in the References of the 8th Edition Accreditation Standards are IS-100a. and IS-200a that can be taken on-line at (http://training.fema.gov/IS/crslist.asp). This is an expectation for medical personnel only. Pilots may be required to be current in these courses if the service has a contract with FEMA for disaster response but this standard applies to medical personnel. 

QM/Site Surveyor Committee

Ms Rogers provided a report from the previous meeting and feedback from the site surveyor evaluations for this meeting.

Ms Rogers also asked Board members to provide her with names and contact information of potential site surveyors emphasizing that we need surveyors with aviation and fixed wing expertise.


Education Division

Ms Frazer reported that we canceled the Just Culture and Advanced Just Culture classes on April 1 because we had only 4 people registered.
Dr. Holleran is obtaining continuing education credits for these classes through our ASTNA affiliation.

There was discussion about the need to re-valuate the education we are offering and perhaps combine Team Steps and other offerings. Dr. Holleran suggested we develop education on QM and UR since that seems to be difficult for most programs. It was decided to hold an Education Committee meeting at the CAMTS office in June. Dates to be determined.

Process Committee

The subcommittee – made up of Karen Johnson, Linda Meiner and Sheila Calvert (Site Surveyors) continues to work to improve the Standards Compliance Tool.  We will incorporate the new standards as they are approved.

P.R. Committee

Ms Palmer gave a presentation on a Community Outreach Fund Raiser that is available for non profit organizations. Ms Palmer also re-designed the Café Press sale items and provided a ppt presentation of the sale items available from our website.


Deliberation Rules, Mission, Vision and Values were reviewed by Mr. Smith prior to accreditation deliberations

Executive Session - there were 22 accreditation decisions: 16 full accreditations, 1 Probation, 1 Intent to Suspend, 1 Deferred, 1 Preliminary Denial and 2 Withhold decisions. Congratulations to the following services:


Cal-Ore Life Flight                             FW                  Brookings, OR                       
Christiana Care LifeNet                      RW                  Wilmington, DE
EastCare                                            RW/G              Greenville, NC
Gallup Med Flight                               FW                  Gallup, NM
Guardian Air Transport                       RW/FW           Flagstaff, AZ
LifeEvac of Virginia                            RW                  Glen Allen, VA
LifeNet of Michigan                            RW                  Saginaw, MI
MedFlight of Ohio                              RW/G              Columbus, OH
MedSTAR Transport                         RW/G              Washington DC
Memorial Hermann Life Flight            RW/FW           Houston, TX              
ProMedica Transportation Network   RW/G              Toledo, OH
St John’s LifeLine Air Medical           RW                  Springfield, MO
TriState CareFlight                             RW/FW           Bullhead City, AZ
Vanderbilt Life Flight                          RW/FW           Nashville, TN

New Accreditations:

MedFlight of Oklahoma                     RW                  Oklahoma City, OK
SE Texas Air Rescue                         RW                  Beaumont, TX
Wyoming Life Flight                          RW/FW           Casper, WY


The Meeting was adjourned on March 31, 2012. The next Board meeting will be in Vancouver on July 19-21, 2012