How EMS Can Reduce Job-Related Risk - Administration and Leadership - @

How EMS Can Reduce Job-Related Risk

Better driving & lifting practices are just some of the ways to increase your chances of a good shift



W. Ann "Winnie" Maggiore, JD, NREMT-P | | Tuesday, December 13, 2011

What are the real risks in our EMS practice? A look at the areas of physical danger, as well as those with the highest liability risk, is in order. Risk is defined in Black's Law Dictionary as "a degree of hazard; a specified contingency or peril; exposure to loss, injury, disadvantage or destruction; and the element of uncertainty in an undertaking." This article will explore the different types of risks—physical and legal—that EMS personnel face, and it will provide tips to lower the uncertainty.

The Leading Cause of Risk
EMS vehicle crashes remain the most prevalent cause of morbidity and mortality for our patients as well as for EMS responders. They also cause the most expensive claims and lawsuits. A look at the EMS list servers will find almost daily references to serious EMS vehicle accidents.

In 2009, 207 serious accidents were reported to the EMS Network. In those crashes, 191 EMS providers were injured and five were killed, while 39 patients were injured and nine killed. In other vehicles involved in these crashes, 119 people were injured and 20 were killed. Driver-related factors contributing to these devastating accidents include fatigue, straying out of the lane and excessive speed. Failure to wear restraints while working in the patient compartment both contribute to the severity of injury, as does the design of ambulances that ultimately cause injury.

The tireless work of Nadine Levick, MD, MPH, to improve the safety features of ambulances keeps trying to push the industry towards safer vehicles. Risk management tools include having priority dispatch systems reduce unnecessary Code 3 responses, being well rested, keeping speed down, implementing better vehicle design and paying attention to the road.

Air ambulance transportation fares even worse. "EMS helicopters have the worst fatal crash record in aviation, and it is the setting in which EMS crews are most likely to die on the job," said Ira Blumen, program director for the University of Chicago Aeromedical Network, in a hearing before the National Transportation Safety Board. Interestingly, in Canada, where two pilots are required, and there are much more rigorous standards for flying in inclement weather than in the US, there were almost no crashes. Overuse of helicopter transport is currently being closely examined by leaders in the EMS and aviation industry to reduce the risk of flying.

Patient Handling Incidents
Patient handling incidents also rank high on the list of risks. According to VFIS Education Specialist David Bradley, BS, NREMT-P, patient handling incidents are the most common injury claims from patients as well as the most common cause of disability for prehospital healthcare providers under the age of 45. Strains and sprains of the back, knee and shoulder are extremely common, and Worker’s Compensation claims place a burden on the EMS agency.

Risk management tools include staying in good physical condition, training in equipment use and good body mechanics, having impeccable maintenance of equipment and providing solid documentation if a patient handling mishap occurs. Use additional personnel when needed to lift extremely heavy patients or to move patients from difficult locations. It's also critically important for EMTs to be focused on the task of moving a patient and to be aware of hazards, such as lawn sprinklers, uneven pavement, small rugs and weather-related issues.

Legal Liabilities
As for legal risks, patient refusals and "no loads" are a high-risk activity. A lack of understanding by EMTs of the informed consent/informed refusal process has led to numerous lawsuits by patients who deteriorated after being examined by EMS and left behind. Over-reliance on refusal forms, "EMS initiated refusals" and end-of-shift fatigue lead to failures to transport patients who should be transported. It is important for EMTs to remember that a family member cannot consent or refuse transport for their loved one, and that a person who is impaired by drugs, alcohol, trauma or illness may lack decisional capacity to refuse transport.

Today's EMTs have tools to assess a patient's decisional capacity, such as pulse oximetry and glucometry, but the best tool in the box is still the ability to talk to our patients and documenting how they process information. Risk management tools include a thorough patient assessment, evauation of a patient’s mental status and decisional capacity, following protocols including contact with on-line medical control, and careful documentation. Courts have upheld patient refusals even when the patient goes downhill after refusing transport if EMS has carefully documented efforts to transport the patient. These calls can be frustrating and can take a lot of time, but the best patient care results from taking the time to do the proper assessments.

Worth a mention—yet not in the highest liability category—is clinical error. Such airway issues as misplaced endotracheal tubes remain a quality assurance concern. An incomplete or poorly performed patient assessment can lead to cavalier attitudes and the failure to discover subtle signs that a patient is heading for trouble.

EMS is a risky business, but the risks of our profession can be reduced by using tools that are available to us as providers as well as managers. Education is our best defense to the uncertainty we face daily in our work. Keeping physically and mentally healthy can greatly reduce stress, exhaustion and lack of focus, thus reducing errors.

Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Administration and Leadership, Legal and Ethical, W. Ann Maggiore, JD, NREMT-P, level of risk, ambulance crashes, EMS provider injuries, patient-handling injuries, patient lifting injuries, EMS vehicle accidents, seatbelt use in the back compartment of an ambulance, Nadine Levick, VFIS Education Specialist David Bradley, BS, patient refusals, no loads, informed consent/informed refusal process, refusal forms, non-transports, clinical errors, field clinical errors

Author Thumb

W. Ann "Winnie" Maggiore, JD, NREMT-PWinnie Maggiore is an attorney and paramedic in Albuquerque. She is a shareholder at the law firm of Butt, Thornton & Baehr, PC where she defends physicians, dentists, oral surgeons, nurses, paramedics and other health care providers, as well as law enforcement officers, against lawsuits and administrative enforcement actions. She is an author of many EMS legal publications, a member of the JEMS editorial board, and holds a volunteer faculty position in the Department of Emergency Medicine at the University of New Mexico.


What's Your Take? Comment Now ...

Buyer's Guide Featured Companies

Featured Careers & Jobs in EMS

FEBRUARY 25-28, 2015

Baltimore Convention Center
Baltimore, Maryland USA






Get JEMS in Your Inbox


Fire EMS Blogs

Blogger Browser

Today's Featured Posts


EMS Airway Clinic

Innovation & Advancement

This is the seventh year of the EMS 10 Innovators in EMS program, jointly sponsored by Physio-Control and JEMS.
More >

Multimedia Thumb

Wesleyan Students Hospitalized for Overdose

11 students transported to local hospitals.
Watch It >

Multimedia Thumb

Denver Medic's Family Says Job Stress Contributed to Suicide

Veteran of over 25 years took her own life after a call.
Watch It >

Multimedia Thumb

Denver First Responders Join to Remember Paramedic

Veteran medic took her own life after fatal accident.
Watch It >

Multimedia Thumb

Rigs Going in Service from EMS Today 2015

Snap shot of some of the vehicles at EMS Today that will be on the streets soon
More >

Multimedia Thumb

Florida Hospital Fire

Fire halts construction project at Tampa cancer center.
More >

Multimedia Thumb

The AmbuBus®, Bus Stretcher Conversion Kit - EMS Today 2013

AmbuBus®, Bus Stretcher all-hazards preparedness & response tool
Watch It >

Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >

Multimedia Thumb

VividTrac offered by Vivid Medical - EMS Today 2013

VividTrac, affordable high performance video intubation device.
Watch It >

Multimedia Thumb

Braun Ambulances' EZ Door Forward

Helps to create a safer ambulance module.
Watch It >

More Product Videos >