Editor’s Note: In recognition of National Safety Month, JEMS.com presents you with an article on the Culture of Safety and a review of the third Transportation Research Board EMS Systems, Safety Strategies & Solutions Summit in Washington, D.C. The summit offers 10 tips you can do to improve EMS safety right now, as well as long-term strategies and solutions to make safety part of the culture of EMS.
The attendees of the third Transportation Research Board (TRB) “EMS Systems, Safety Strategies and Solutions Summit in Washington, D.C., answered a challenge from the presenters: “What 10 things would you do right now to improve EMS safety?” Here are their responses:
1. Eliminate the bench seat in all ambulances. All seats should face forward or rearward;
2. Ensure all equipment is secure and within reach without having to be unbelted;
3. Eliminate protruding surfaces. Recess certain structures, such as the grab bar in the roof of the ambulance, so that it isn’t a strike hazard;
4. Provide better (more “real-world”) training for drivers;
5. Reduce the amount of equipment EMTs and paramedics have to carry;
6. Design stretchers and ambulances for easier loading and unloading;
7. Mandate wearing of seat belts by providers in the patient compartment unless patient care requires being unbelted. This would include the requirement that drivers be notified when anyone is unbelted in the rear, and either stop or adjust driving appropriately;
8. Prioritize items that can be retrofitted to improve safety;
9. Enhance crew and vehicle visibility;
10. And perhaps the best suggestion of all: Include field medics, along with ergonomists and automotive engineers, in the design of ambulances.
The Safety Proponents
Who were the people who came up with these tips, you may ask? Forty-four EMS safety proponents who ranged from field providers, EMS managers and government officials to automotive engineers, ergonomists and ambulance manufactures, gathered in Washington, D.C., on Feb. 29 for the third TRB summit. They were joined via webinar by another 45 like-minded individuals and others through a live link to the EMS Today Conference & Exposition in Baltimore. The meeting provided information on the status of EMS safety and what changes may be coming.
Click here for the TRB 2012 EMS Safety Systems Strategies and Solutions Summit Multimedia document.
Creating a Culture of Safety
Several notable projects that are under way have the goal of making sure safety considerations are included in every aspect of EMS. The third draft of the EMS Culture of Safety project’s Strategy for a National EMS Culture of Safety Project was released earlier this year, and a large number of EMS organizations and individuals provided comments. The document includes the concept of a “just culture,” where field providers are encouraged to report problems and near misses without fear of reprisals or retribution in an effort to better identify and deal with safety issues on a systemic rather than individual level.
The document can be accessed at www.emscultureofsafety.org. Crew resource management, pioneered by the airline industry, is being applied to the EMS environment, offering an approach that providers can use to create an environment of safety in every aspect of an ambulance call. The NAEMT EMS Safety: Taking Safety to the Streets course, which includes information on crew resource management, has reached more than 1,500 EMS providers during its first year.
A Better Ambulance by Design
Another item on the groups’ agenda was the current lack of safety design standards for ambulance design and the efforts of the NFPA 1917 project. Ergonomist Chris Fitzgerald discussed efforts to assess the physical aspects of providing emergency care in an ambulance and use the information to design a more user-friendly environment that would reduce the number of injuries (primarily back and shoulder) suffered by EMS providers.
Automotive Engineer Gene Lukianov also described design considerations that can create a safer and more crash-worthy environment. Examples include elimination of the bench seat in favor of front-facing seats, better stretcher retention mechanisms and environmental controls that can be reached without requiring providers to leave their seats.
Jim Swartz, director of Careflite EMS in Dallas, described the ambulance his service has designed with input from providers as well as ergonomists and auto engineers. The steps used to design the interior of the vehicle are the same as those used to design today’s automobiles—keeping the occupants from being hurt by the vehicle itself. Even the loading height is lower, which helps reduce the chance of back injury when loading and unloading the patient. The design ensures providers are in the safest possible position within the ambulance and that everything, including the occupants, is secured when the vehicle is in motion.
Fleet Management Strategies
In addition, the group reviewed studies that indicate EMS workers are among the most sleep-deprived in the country. It pointed out that the effects of sleep deprivation can mirror that of a person driving with a 0.08 blood alcohol level. There are several fleet safety systems that monitor driver performance, providing real-time feedback to the driver and information to the fleet manager that can literally save lives.
The group was introduced to new technology solutions and telematics, including the status of the Next Generation 9-1-1 project and “Rescu.me,” a site which provides motorists with a notification when they’re being approached by an emergency vehicle.
In his closing remarks, Arthur Cooper, MD, suggested that Hippocrates’ statement: “First do no harm” was only the first line. The second line would have been, “Then DO some good.” We don’t have all the information, but we have enough that we can start doing something right now to make our people safer.