A few years ago, when AMR Corporate Medical Director Dr. David McKenas was presenting a paper at a professional conference, he said to those gathered, "Aviation medicine involves not only dealing with the health concerns of people but the unusual environments in which those people go."

He should know. McKenas — or "Dr. Dave" to the many employees who know him and have read his "How the Health Are You?" columns in Flagship News, Connections and here on Jetnet — has spent the better part of his career dealing with medical issues that are up in the air. Literally.

Dr. David McKenas

He's been with American for a decade, overseeing passenger health, employee health awareness, government compliance and medical services; before that, he was a United States Air Force Flight Surgeon and served as chief of medical operations in support of 21 space shuttle missions.

But now McKenas is moving on to join a major health management firm in order to pursue his interest in developing integrated health management tools for companies. His final day with American will be this Friday, November 15.

Awards Come Through Teamwork
McKenas has been recognized with numerous awards, both individually and on behalf of American. For instance, he's earned the Julian E. Ward Memorial Award for superior performance in aerospace medicine during residency, and earlier this year on behalf of AA received the Admiral Zumwalt Corporate Excellence Award presented by the National Marrow Donor Program to a corporation supporting the organization's programs, services and mission.

But McKenas is a true renaissance man as his accomplishments have ranged from medical to musical; he also once captured the Francis Hopkinson Memorial Medallion in a piano concerto competition while performing with the Garden State Philharmonic Orchestra.

It's no wonder, then, that Sue Oliver, senior vice president, human resources, expressed great regret that McKenas will be moving on.

"He will be greatly missed," said Oliver. He is known as a pioneer throughout the industry. He and his team were the impetus to start [many] important programs. Under his leadership, these efforts positioned American Airlines as a leader in providing innovative medical programs and life-saving technology for our customers."

If you asked McKenas to pick the key word out of Oliver's glowing review, there's no question he'd focus on "team." Of his decade with AMR, he said, "I am most proud of working with a team of Medical Department and Integrated Health professionals that could make things happen."

"Tracy Nelson, an effective administrator and clinical nurse — an incredible asset to the airline. Barbara Rice, ever-optimistic, tirelessly energetic. People look up to her and seek her guidance. Virginia Nisbet, who manages Group Health, is one of the best in the United States. Analytic and wise beyond all belief. Bettye Harris had the biggest job of all — managing me. Astute, savvy, in-tune. Judy Berger has been with AMR for 30 years and knows so much it's scary. She tells it exactly as she sees it, and we need more of that."

"They understood the vision and helped save literally hundreds of lives — so far! — nationwide, because they took the innovative chance," said McKenas. "Without them, our team could not have accomplished the great things that served as a catalyst to the airline industry to boost onboard medical safety."

Performance Review: Visionary
"He's been a great boss," said Rice, the R.N who oversees the Employee Assistance Program and corporate drug testing, as well as other areas. "He really is a visionary in every sense of the word. We at American were incredibly fortunate to have had him on our team."

McKenas intuitively understood how to manage his team, added Rice. "He could track everything he asked us to do and follow up in the nicest way to make sure it was done," she said. "But we had all the autonomy and support we needed."

Nelson, the lead nurse for AMR Medical, echoed Rice's evaluation. "Dr. McKenas has an extraordinary ability to mentor and is very visionary. These two attributes," said Nelson, "have afforded many fortunate folks who worked closely with him boundless opportunities to achieve."

Unlike the airline industry as a whole, where achievement is measured in whole numbers like passenger seat miles and load factors, in the medical arena, success measurements can be a bit more elusive.

"I'm proud of finding the fine line between employee and company issues, and serving as an advocate for both," said McKenas. "I have often said to our unions that health care is not an adversarial issue — we all want the best, and want valued workers back to work."

The Bottom Line: Saving Lives
The most publicized innovation of the McKenas era at AMR was the January 2001 announcement of the SKYCAARE program, which offered passengers an alternative to costly air ambulance services by providing discounted seat rates for accompanying nurses. As always, McKenas deflected most of the credit for SKYCAARE to RN Linda Campbell, who he called "the dynamo that made all of these aeromedical programs work."

Truth be told, innovation in onboard medicine has often originated from the AMR Medical Director's office. For instance, McKenas — acting on information gathered from marketing surveys that there are doctors on board American flights 85 percent of the time -— led the effort to place a "mini-emergency room" kit on board all flights.

In doing so, American was the first airline to give onboard physicians the ability to treat life-threatening illnesses in customers. These Emergency Medical Kits, or EMKs, subsequently led the FAA to mandate similar upgrades throughout the industry. The kit now found on virtually all domestic commerical air carriers is the same model developed by American.

However, McKenas is quick to sing the praises the AMR Corporate leadership, particularly Bob Crandall, Don Carty and Bob Baker for being willing to support a program that had no financially measurable return on investment: "They saw the wisdom of supporting a program that might simply save the lives of about 40 people each year," he said.

Also under McKenas' watch, the AMR Medical team established what he called "one of the most expert and effective EAP programs that I am aware of in the United States," as well as "Hope Clinics," placing high quality treatment facilities where the employees live and work at DFW, LAX and AFW — again, so far.

It's Not a Holographic Doctor, but ...
American was also the first airline to conduct successful inflight medical telemetry by using seatback phones to download images and medical data to ground physicians who could then advise the captain as to whether or not a medical diversion was necessary. "This is technology that I fully expect to evolve in the aircraft of the future," said McKenas.

Always looking forward, McKenas also believes the future of the airline industry will include larger aircrafts flying transpolar routes. "Communications can be tenuous over the poles," he noted. "I see a need for some sort of onboard artificial medical intelligence system, to direct personnel on what to administer if a person takes ill."

If that sounds like something out of Star Trek: Voyager, well, the technology is already being developed — and remember, the good doctor knows a little something about spaceflight.

When he served as CMO for Space Shuttle Operations, McKenas worked directly with the astronauts on emergency exit exercises, among many other things. "Part of my job was to be at the console, and to take over medical operations if the shuttle had a catastrophe, such as an abort landing," he recalled.

He was also involved in development of the Assured Crew Return Vehicle, a pod-like apparatus designed to affix to a space station that would safely return an ill crewmember to earth. The ACRV pod is still part of the active designs for future space stations.

In recognition of his contributions, he received the "Silver Snoopy" — an award presented by the astronauts for outstanding performance contributing to flight safety and mission success. But he just missed out on an even greater honor — the year he was the USAF's top astronaut candidate for mission specialist, the Navy candidate was selected. "That was about 80 pounds ago, anyway!," joked McKenas.

"Looking at the total health picture"
So now it's on to another challenge, one McKenas says he'd like to take a leadership role in solving. "Just as 'managed care' was an innovation many years ago," he says, "integrated health management — balancing costs with employee productivity and lost time — is the next wave, which I would like to help create." "Integrated health management means looking at the total health picture," he explained. "Group health, workers' compensation, EAP, lost time, drug rehabilitation and prevention programs — all to maximize an employee's presence in the workplace, for the lowest possible total cost." Fortunately, the first steps toward integrated health management have already been taken at AMR Medical.

Upon the conclusion of McKenas' tenure with American, Dr. Thomas Bettes, who currently leads the AA Clinical Services group, will assume an expanded role with oversight for all AA Medical Services. McKenas departs knowing AA Medical is in good hands.

"Tom and I joined the company at about the same time," McKenas said. "He's a 'clinician's clinician' and knows his medicine cold. He's steadfast and diligent at his work, and I am proud that he is picking up the reins."

In these difficult times for the airline industry, McKenas noted, it's also important that Bettes is "a wizard at understanding and implementing the human resources-related laws that have medical impact, such as the Americans With Disabilities Act, Workers' Compensation and Family Medical Leave." That's high praise coming from McKenas, who has served as chairman of the Medical Advisory Committee (MAC) for the Texas Workers' Compensation Committee.

That's Not All, Folks
McKenas has plans for additional ways to keep busy as he moves on professionally.

"Well, for one, I believe the public needs to be better informed about the medical safety of air travel. There are so many myths that need to be debunked regarding cabin air quality, ozone, radiation, economy class syndrome — the public needs to be educated. I may write a book."

Like another long-ago doctor-turned-author named Luke, McKenas is also drawn to missionary outreach. "I'm not one to flaunt my faith," he says, "But I am a Christian, and the new job will permit me more time to do short-term medical mission trips, which is evolving into a great love of mine. I am looking at some Amazon and Russian opportunities in the near future."

Above and beyond all of those possibilities, though, Dr. Dave is most interested in expanding the time he puts into his roles as husband to his "wonderful and very wise" wife Laurie and father to their two children, Erin and Catherine. "And innumerable pets," he adds. "Cats, rats, gerbils, fish, hermit crabs ..."

A Final Diagnosis
"Clearly, AMR is at a crossroads, concludes McKenas. "So to the AMR family, I would simply paraphrase words from the Book of Joshua when Moses died, and Joshua was just about to lead his people into what is now known as Israel. 'Do not be afraid; do not be terrified. Neither look to the left nor the right, but look forward. Do not be discouraged, but be courageous.'" "Be very courageous."