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#1 Katie

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Posted 09 August 2011 - 02:20 AM

Working the possibility of starting a fixed wing neonatal transport team. Any protocol advice, even where to start, would be amazing and I would be grateful!
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#2 Mike Mims

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Posted 11 August 2011 - 02:21 AM

It took me a while to gather some information, but here are some things.
Here' what to do from start to finish..

- Is there a need?
There's gonna be a lot of financial and personal resources needed.
Competing programs, demographics, geography covered (fixed-wing vs Lear Jet)
- Proposed Budget.
Investors from private source or from a strong institution maybe a guide.
- Commitment.
From everyone involved, they should be fully aware what they are getting into.
- Looking for a Program Director.
Preferably someone with experience in Health Care, Air Medicine and Management.
- Medical Director.
Personality, along with the proper and required education and experience in the related field is a MUST. They will be key in writing your protocols, guideline and policies.
- Structure.
You have a some choices.
*Turn-key which the majority of the responsibilities are placed on a Vendor. They will also supply the aircraft, pilots, mechanics and maybe some medical personnel, but for a HEFTY price.
*Sponsored by an Institution, which can be cheaper, but you buy practically everything.
*Hybrid(self-managed) in which the Institution owns and manages the program, but a vendor will provide other components; pilot, maintenance, fuel etc.. This is the most popular
- RFP (Request for Proposal)
This are submitted by Vendors and should be specific. Example: If a fixed-wing is needed it should be specific.
- RFP reviewing
You should have a committee with members composed of, Admin, Medical Director, Program Director or anybody else that maybe involved decisions. Visit on-site each Vendor in the RFP and view what they are going to offer. Example: If you are requesting a Cessna Citation Jet, they should have one available WITH medical interior, so you can get the FULL picture.
- Making a Decision.
Are you going to use a Vendor or not.......
- Chief Flight Nurse
Flight experience is STRONGLY recommended. The CFN will have a multitude of responsibilities for day-to-day operations.
- Chief Pilot
They are involved with the aviation and acts as a link to the medical. They should have the experience in the type of Aircraft used and PIC.
They will be instrumental when apply for FAA certification process, which is in-depth process with but-load of paperwork, inspections, meetings etc...
1. Preapplication
2. Formal Application
3. Document Compliance
4. Certification
- Selecting and Ordering the Aircraft
Select the type that fits what type of service you are going to provide. If you plan to fly out-of-state a lot, than a Jet maybe a better fit than a turbo-prop
This is similar to building a house. The options and equipment must be agreed on by BOTH the buyer (which is you) and the manufacturer. Custom equipment may take a little longer to build. The medical interior is purchased separately, can cost hundreds of thousands of dollars, can take up to a year for completion and once the work is done, it's done.
- Your Base
Are you going to be located at the airport or off-site?
- Medical Equipment.
You should have everything that the NICU will use, but more compact. Also, ANY MOUNT has to be attached to the air-frame in such a way it doesn't become a projectile. The FAA requires any item be secure enough to withstand 8g's of force.
- Communications.
How, What, When, Where etc..... If the Communications is functioning INCORRECTLY you will loose business. Contracting with a service might be a good idea. Equipment can run in the tens-of-thousands range.
- Medical Crew
Somethings to look for: Education, Flight experience, Critical-Care experience in the related field, Specialty Certs, Personal and Professional skills, Physical well-being (height and weight)
- Pilots and Aviation Techs
This is where the Chief pilot can be VERY valuable when selecting pilots. Aviation Techs are the most important part of a flight program. I appreciate the role they play
- Orientation
Communications, Aviation, Safety, Medical
Comms: They need to attend classes with medical personnel and the pilots. Simulated flight following and problem solving, emergency drills for unscheduled landings or a crash. Courses for Comm personnel are strongly encouraged.
Aviation: Pilots and Techs become familiar with the aircraft, policies, procedures etc...
Pilots can begin learning the area, making contacts with local flight control and FAA personnel.
Safety: Procedures should be practiced in detail so once the aircraft is available they can be applied. Also, a safety committee is a common practice in programs. Personnel must feel that they can express ANY concern that they feel may not be safe and not fear any negative recourse.
Medical : The Medical Director will play a huge part with protocols/procrdures with medical personnel. Flight Physiology is a MUST for everyone!!!!!! Each crew member should show not only clinical competency, but didactic as well.
- On-site Aircraft Inspection
This is where the pilots and Medical crew need to be involved, as with others. Avoiding a surprise in the end will be less a factor if you perform frequent site inspections. Especially if it a custom, one-of-a-kind build. Do this as much as you can if you are having to "change" things around.
- Final Inspection and Acceptance of the Aircraft and Interior.
Once the aircraft and interior is complete, you should make the final inspection before accepting. NEVER SIGN ANYTHING UNTIL YOU ARE SATISFIED AND ANY DISCREPANCIES HAVE BEEN SOLVED. Once you sign the contract, you accepted it as is.....
- Flight training.
The medical crew must become accustomed to the aircraft, comms, equipment and operations. The medical crew should be aboard the aircraft as much as possible for any training flight.
Mock patient should be available for the crew to learn access points, equipment set-up, positioning etc...
Pilots need to become familiar with the aircraft before transporting patients. Also, becoming familiar with the crew and the medical environment. NOBODY, including the program director should pressure the pilots to learn "ASAP"!!!!
- Press Conference/Program Announcment.
If you can keep the program a little secret away from the public, it seems to produce a more attractive appeal. Local News media along with the internet can promote the service nation wide,
- Marketing/PR.
These can be incorporated in the flight training phase. Materials describing the benefits of your service will be beneficial.
- Program Operational.
Announced at a press conference. QA/QI needs to begin immediately following the announcement with the goal being to identify potential problems and correct them.
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Mike Mims

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#3 Jwade

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Posted 11 August 2011 - 03:42 PM

It took me a while to gather some information, but here are some things.
Here' what to do from start to finish..

- Is there a need?
There's gonna be a lot of financial and personal resources needed.
Competing programs, demographics, geography covered (fixed-wing vs Lear Jet)
- Proposed Budget.
Investors from private source or from a strong institution maybe a guide.
- Commitment.
From everyone involved, they should be fully aware what they are getting into.
- Looking for a Program Director.
Preferably someone with experience in Health Care, Air Medicine and Management.
- Medical Director.
Personality, along with the proper and required education and experience in the related field is a MUST. They will be key in writing your protocols, guideline and policies.
- Structure.
You have a some choices.
*Turn-key which the majority of the responsibilities are placed on a Vendor. They will also supply the aircraft, pilots, mechanics and maybe some medical personnel, but for a HEFTY price.
*Sponsored by an Institution, which can be cheaper, but you buy practically everything.
*Hybrid(self-managed) in which the Institution owns and manages the program, but a vendor will provide other components; pilot, maintenance, fuel etc.. This is the most popular
- RFP (Request for Proposal)
This are submitted by Vendors and should be specific. Example: If a fixed-wing is needed it should be specific.
- RFP reviewing
You should have a committee with members composed of, Admin, Medical Director, Program Director or anybody else that maybe involved decisions. Visit on-site each Vendor in the RFP and view what they are going to offer. Example: If you are requesting a Cessna Citation Jet, they should have one available WITH medical interior, so you can get the FULL picture.
- Making a Decision.
Are you going to use a Vendor or not.......
- Chief Flight Nurse
Flight experience is STRONGLY recommended. The CFN will have a multitude of responsibilities for day-to-day operations.
- Chief Pilot
They are involved with the aviation and acts as a link to the medical. They should have the experience in the type of Aircraft used and PIC.
They will be instrumental when apply for FAA certification process, which is in-depth process with but-load of paperwork, inspections, meetings etc...
1. Preapplication
2. Formal Application
3. Document Compliance
4. Certification
- Selecting and Ordering the Aircraft
Select the type that fits what type of service you are going to provide. If you plan to fly out-of-state a lot, than a Jet maybe a better fit than a turbo-prop
This is similar to building a house. The options and equipment must be agreed on by BOTH the buyer (which is you) and the manufacturer. Custom equipment may take a little longer to build. The medical interior is purchased separately, can cost hundreds of thousands of dollars, can take up to a year for completion and once the work is done, it's done.
- Your Base
Are you going to be located at the airport or off-site?
- Medical Equipment.
You should have everything that the NICU will use, but more compact. Also, ANY MOUNT has to be attached to the air-frame in such a way it doesn't become a projectile. The FAA requires any item be secure enough to withstand 8g's of force.
- Communications.
How, What, When, Where etc..... If the Communications is functioning INCORRECTLY you will loose business. Contracting with a service might be a good idea. Equipment can run in the tens-of-thousands range.
- Medical Crew
Somethings to look for: Education, Flight experience, Critical-Care experience in the related field, Specialty Certs, Personal and Professional skills, Physical well-being (height and weight)
- Pilots and Aviation Techs
This is where the Chief pilot can be VERY valuable when selecting pilots. Aviation Techs are the most important part of a flight program. I appreciate the role they play
- Orientation
Communications, Aviation, Safety, Medical
Comms: They need to attend classes with medical personnel and the pilots. Simulated flight following and problem solving, emergency drills for unscheduled landings or a crash. Courses for Comm personnel are strongly encouraged.
Aviation: Pilots and Techs become familiar with the aircraft, policies, procedures etc...
Pilots can begin learning the area, making contacts with local flight control and FAA personnel.
Safety: Procedures should be practiced in detail so once the aircraft is available they can be applied. Also, a safety committee is a common practice in programs. Personnel must feel that they can express ANY concern that they feel may not be safe and not fear any negative recourse.
Medical : The Medical Director will play a huge part with protocols/procrdures with medical personnel. Flight Physiology is a MUST for everyone!!!!!! Each crew member should show not only clinical competency, but didactic as well.
- On-site Aircraft Inspection
This is where the pilots and Medical crew need to be involved, as with others. Avoiding a surprise in the end will be less a factor if you perform frequent site inspections. Especially if it a custom, one-of-a-kind build. Do this as much as you can if you are having to "change" things around.
- Final Inspection and Acceptance of the Aircraft and Interior.
Once the aircraft and interior is complete, you should make the final inspection before accepting. NEVER SIGN ANYTHING UNTIL YOU ARE SATISFIED AND ANY DISCREPANCIES HAVE BEEN SOLVED. Once you sign the contract, you accepted it as is.....
- Flight training.
The medical crew must become accustomed to the aircraft, comms, equipment and operations. The medical crew should be aboard the aircraft as much as possible for any training flight.
Mock patient should be available for the crew to learn access points, equipment set-up, positioning etc...
Pilots need to become familiar with the aircraft before transporting patients. Also, becoming familiar with the crew and the medical environment. NOBODY, including the program director should pressure the pilots to learn "ASAP"!!!!
- Press Conference/Program Announcment.
If you can keep the program a little secret away from the public, it seems to produce a more attractive appeal. Local News media along with the internet can promote the service nation wide,
- Marketing/PR.
These can be incorporated in the flight training phase. Materials describing the benefits of your service will be beneficial.
- Program Operational.
Announced at a press conference. QA/QI needs to begin immediately following the announcement with the goal being to identify potential problems and correct them.



Katie,

Mike has given you a decent start with a few exceptions.

1. Everything he has just written above will have to be included in your business plan. Have you ever written a business plan?

2. The business plan financials are going to be your biggest challenge. You will need to Pro Forma out at a minimum of 5 years to show any Venture / Angel / Bank Investor how and when they will get their money back. This is something very few Medical people can do own their own so I suggest finding someone well educated in Finance. Preferably an MBA or CPA.

3. Any investor will want to see your Admin Team with very strong experience and FORMAL EDUCATION.......

4. I highly recommend AGAINST limiting yourself to a Chief Flight Nurse. There is absolutely NO REASON you must have a nurse in this position. For the company I just started, I am using a Director of Clinical Operations. This is a Masters Degree required position, preferably in business or healthcare management, and is open to any discipline. Medic / Nurse / RT IMO limiting yourself to NURSES ONLY for this position is very shortsighted and is a definitive cause to many management problems I encounter during my consulting. Usually, because they have no formal education in business / finance / healthcare admin.

5. As mike said, You are going to have to show a NEED for the NEO's......The NEO docs are very particular about who they send their babies with, and a new startup for NEO only is going to be fighting an uphill battle from the beginning to succeed.....

6. Do you have any hard numbers to support your premise of this program being needed?


Feel free to hit me up offline if you need some help or questions....The business plan for my Fixed Wing company is over 40 pages with the Financials being the biggest section. The investors are going to ask you some very hard questions, so preparation is going to be key for you. You MUST be able to speak the business side to them or have someone on your team who can.....If you don't, the chances for anyone investing are very slim....

Respectfully,
JW
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John Wade MBA, CCEMT-P, FP-C, RN

"Have the courage to follow your heart and intuition, they somehow already know what you truly want to become" Steve Jobs

#4 SerendepitySaki

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Posted 11 August 2011 - 05:10 PM

highly recommend the following software:

Business Plan Pro

http://www.businessplanpro.com/





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LET THE WILD RUMPUS BEGIN !!!!!!
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#5 SerendepitySaki

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Posted 11 August 2011 - 05:19 PM

on FaceBook here:


http://www.facebook.com/Bplans
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LET THE WILD RUMPUS BEGIN !!!!!!
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#6 FloridaMedic

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Posted 11 August 2011 - 05:20 PM

Do you already have helicopter and ground service? Adults? Peds? What is your current staffing? Private or hospital based?

What are the state statutes for neonatal transport? Florida is one state that is very specific for personnel, equipment and the medical director.
Are you familiar with a AAP guidelines? Will you be able to recruit nurses (and RTs) with no less than 5 years of active Level III experience and who will still have access to a NICU to maintain current competencies. The transport team must exhibit proficiency in all aspects of neonatal care continuously and the preferrable way to to be actively working in the NICU utilizing all skills on a daily basis.
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#7 Macgyver

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Posted 11 August 2011 - 06:19 PM

Do you already have helicopter and ground service? Adults? Peds? What is your current staffing? Private or hospital based?

What are the state statutes for neonatal transport? Florida is one state that is very specific for personnel, equipment and the medical director.
Are you familiar with a AAP guidelines? Will you be able to recruit nurses (and RTs) with no less than 5 years of active Level III experience and who will still have access to a NICU to maintain current competencies. The transport team must exhibit proficiency in all aspects of neonatal care continuously and the preferrable way to to be actively working in the NICU utilizing all skills on a daily basis.


Ditto - also how are you going to maintain clinical competency - especially in low birthweight neo's / high frequency / nitric? One 12 per week is easy if you are hospital (level 3) based but hard for a stand alone program. One 4 hr rotation a year nowhere near cuts it.
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Ken BHSc, RN, REMT-P

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Posted 12 August 2011 - 02:44 AM

Ditto - also how are you going to maintain clinical competency - especially in low birthweight neo's / high frequency / nitric? One 12 per week is easy if you are hospital (level 3) based but hard for a stand alone program. One 4 hr rotation a year nowhere near cuts it.


Out of 36 hours (3 - 12s) our team does 2 taking patients in the NICU and 1 dedicated to transport and assisting in the unit. We have another team that takes call for a backup on their off day 1 - 2 days per two weeks. I couldn't imagine not working with this stuff daily for cross training of skills and knowledge between the RNs and RRTs. It all has to be second nature. Nothing worst than someone fiddling with their equipment while the baby's HR drops to 10. Too many babies have been messed up and have died by lack of training/education, improper transport capability and ego. And, of course, bowing to the "out of my hospital now" pressure before properly stabilizing can play a huge factor especially if the team is inexperienced. You have to have enough experience to get past the adrenaline rush from "its a baby!"
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