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Mercy Charity Flight Programs For Our Veterans: American Airlines & Robert Gates

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Defense Secretary Gates With Dr. Val

I recently wrote about the heroic efforts of volunteer pilots involved in Mercy Medical Airlift and Air Compassion for Veterans. I met Steve Craven on a shuttle to a Red Cross event with US Defense Secretary Robert Gates. Steve kindly explained a little bit about what some airlines are doing to contribute to our active duty and veterans’ medical transportation needs. I was soon contacted by American Airlines to help them with awareness efforts of their own veterans initiatives.

I interviewed Captain Steve Blankenship, the Managing Director of Veterans Initiatives at American Airlines. Feel free to listen to the podcast or read a summary of our discussion below.

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Dr. Val: Tell me a little bit about yourself, Captain.

Blankenship:  Being a veteran myself (20 years with the US Cost Guard) a count it a real privilege to serve our veterans. During my first 8 years with the Coast Guard I was a helicopter rescue crewman doing search and rescue based out of Miami, Florida. I eventually went to navy flight training and retired from the military in 1991 and was hired to fly for American Airlines for the next 14 years. In 2004 I helped to launch their Veterans Initiative.

Dr. Val: Tell me about Operation Iraqi Children and Snowball Express.

Blankenship:  There are so many children who have never been in uniform, but who have paid the ultimate price of losing a mom or a dad in war as they defend our freedoms.  American Airlines is particularly proud to be supporting childrens’ initiatives. The Snowball Express program involves private flights around the country to pick up kids and their surviving parent to take them on a fun-filled trip during the difficult winter holiday season.

Actor Gary Sinise helped to co-found Operation Iraqi Children where we shipped over 25 tons of toys and educational materials to Iraq. Our troops were able to give out 10,000 individually wrapped gifts to young children in Iraq.

Dr. Val: What about American Airlines’ support of the iBot Mobility System for wounded veterans?

Blankenship: The iBot is a special kind of wheelchair (designed by the guy who created the Segway) that allows its user to sit at an eye level with someone standing next to them.  They can also climb stairs. To date we’ve raised over $700,000 to buy these iBot Mobility devices for our wounded warriors.

Dr. Val: What else is American Airlines doing for veterans?

Blankenship: We fly wounded warriors and their families on charter flights from Brooks Army base to Disney World. We have three dedicated “yellow ribbon” airplanes that we use to fly recovering service men and women to events so they can get out of their rehab centers for a period of time and have fun with their families. This kind of charity comes naturally to us because American Airlines was founded by a military veteran and over 10% of our current staff are either active duty military personnel or veterans.

Every day we go to work, we recognize that the right and privilege we have to fly our airplanes and transport our passengers was paid for by the men and women who wear the cloth of our nation. American Airlines is continually looking for ways to thank them and support the efforts of our military.

Dr. Val: How do military and their families find out more about your programs and services?

Blankenship: They can send me an email directly and I’ll make sure they’re referred to the right place.

steve.blankenship@aa.com

US Airways: Unsung Corporate Hero?

usairwaysWhen it comes to facilitating transportation for wounded military personnel and their families, US Airways tops the generosity list, providing about $1 million in complimentary plane tickets/year. Steve Craven, a volunteer pilot with Mercy Medical Airlift, sat next to me en route to a recent Red Cross volunteer recognition ceremony at Walter Reed Army Medical Center. He told me about the great lengths that some airlines will go to to help military families in need. For example, United Airlines and Delta Airlines have both recently offered assistance with the transportation of military personnel to cancer centers of excellence. Sadly, American Airlines, Continental Airlines, and Southwest Airlines have repeatedly turned down requests for assistance.

According to Mr. Craven, his organization coordinates about 25,000 Angel Flights, 10,000 cancer-related flights, and 6,000 Iraq war veteran flights (via Air Compassion for Veterans) per year, with over 7,000 volunteer angel pilots nationwide. Mercy Medical Airlift also runs a National Patient Travel Center which acts as a clearing house/military travel agency for charitable ticket programs, air ambulance discounts, and special lift programs – including transportation to the NIH for clinical trials.

I asked Mr. Craven what sort of patients need the air ambulance service. He responded that often times elderly veterans or military personnel with terminal illnesses wish to die at home (rather than in a specialty hospital or facility) but are too sick to travel in a regular airplane. The air ambulance service allows them to fulfill their last wish and die with dignity.

Sometimes, military families have a very sick child and have exhausted their resources but need specialty treatment at an academic center. Mercy Medical Airlift makes sure they get where they need to go. Once there, the families often stay at Ronald McDonald House or Fisher House. We’re so grateful to our partner airlines who make it possible for military families to stay together in times of medical hardship.

I offer my thanks to US Airways for their generosity to military personnel and their families – as a rehab physician, I know how much it means to them to have their family with them in sickness and in health.

Secretary Robert Gates Addresses The Red Cross At Walter Reed

Secretary Robert Gates Addresses The Red Cross At Walter Reed

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Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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Click here for a musical take on over-testing.

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