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Sharpening the Focus on Safety


View a video interview with Daniel Patterson below this article.

Many may see Daniel Patterson, PhD, MPH, EMT-B, as a professor with emergency medicine ties, but in truth, he’s a detective. Although this EMT with a doctorate doesn’t carry a badge, he does have an instinct for following clues and posing questions that yield, sometimes, surprising results.

Patterson is a kind of research detective, and his methodologies have had fundamental effects on EMS. His most recent project, The EMS Agency Research Network for Quality and Safety Improvement, is just the latest in a long line of research initiatives he’s developed that have had tremendous influence within the EMS community.

“My uncle was a paramedic for a long time, and his stories captured my imagination and desire to do something about the challenges he described to me in EMS,” says Patterson. “I discovered there was a huge gap in knowledge on safety and quality.”

Focusing on the Methodology
Patterson, who’s an assistant professor at the University of Pittsburgh, School of Medicine, Department of Emergency Medicine, and director of research for the Center for Emergency Medicine of Western Pennsylvania, was awarded a Society for Academic Emergency Patient Safety Fellowship shortly after arriving at the university. The fellowship sharpened his desire to focus on quality and safety within EMS.

In fact, Patterson’s professional goal has been centered on becoming a stellar research methodologist, particularly where EMS is concerned. “If I had to be characterized by a phrase, I would want people to say, ‘He’s the guy that wants to make sure it’s EMS tested and EMS approved,’” he says. “I want to make sure that everything we use as a measurement or indicator of safety, quality or performance has gone through sufficient rigor, so that we can say, ‘Yes, we are confident that works for EMS.’”

Patterson’s research has focused on partnerships within EMS, specifically the working relationships where providers are required to depend on each other in stressful situations. Patterson is familiar with EMS partnerships because he also works in the field as an EMT one day a week. “Partnerships have been studied intensely, and with great rigor, in the military and aviation fields, but EMS has been overlooked,” he says. “The dynamic between you and your partner has a huge impact on how you behave, how you approach patients and how you approach your safety and your partner’s safety.”

The Effect of Teamwork and Sleep Deprivation
To collect the most effective data, Patterson has concentrated on coming up with rigorous measurement tools for evaluating teamwork within EMS. He hopes to provide the industry, managers and shift supervisors with the ability to diagnose, detect and evaluate partnerships that actually improve safety and care, reduce conflict and prevent injury to EMS providers.

“If you’re not on the same page as your partner, you have conflict, don’t trust one another or come into the shift not even knowing who your partner is because it’s your first time working together, then that opens a can of worms that no one has looked at,” he says. “I think it’s time we evaluate how we can prevent injury, and maximize performance and satisfaction on the job by putting people together who will work well together.”

Patterson has also fixed his attention on the effects that disrupted sleep patterns and fatigue have on EMS providers.

“If you feel fatigued, your cognition is not at its best,” he says. “Many of the shifts in EMS are 12–24 hours, and there’s no doubt that sometime during that shift you are tired. When you’re at greater risk of being tired, you’re a little more complacent, which can threaten both you and your patient’s safety.”

Patterson has discovered that many EMS providers have poor sleep quality. This may not seem surprising, but he notes that the findings are concerning. “A large portion of those we sampled reported severe fatigue at work,” he says. “We knew the problem was there, but we’ve never really measured it with reliable, valid tools.”

To underscore the severity, and possible repercussions, of sleep deprivation on EMS workers, Patterson highlights a recent call he and his partner were dispatched to that involved a suicidal young man.

“He was nice enough, but if I [had not been] of sound mind and cognition, I could have missed something very important, some subtle signs that he was showing me that could have put me and my partner at risk,” Patterson says. “I could have done a poor assessment or overlooked places where he might have been hiding something that could have injured him or us.”

Collecting Data from the Source
Much of Patterson’s research is based on information collected via cross-sectional survey methods. “A lot of this is perception, and you can’t lab test a perception,” he says. “You have to use surveys to capture this stuff, but not just any survey. We want to make sure that the tools not only measure, say, trust in your partner, but do it every time we use that tool so that it’s reliable. We fully test the tools’ properties, so we’re confident that we actually measure what we intend to measure.”

Perhaps surprisingly, Patterson isn’t so much interested in how a culture of safety is defined or improved, but in how it’s measured.

“I’m not interested in how you go about trying to improve your culture of safety, because every agency is different; you do what works best for you,” he says. “What I care about is that you are given a tool that actually measures what you think you are measuring. If it doesn’t, you are potentially wasting your money and time and going down the wrong path. And that’s not OK.”

As an example, he points to the ED, a closely related sector to EMS, yet with disparate requirements.

“The ED is not mobile, not in the out-of-hospital environment, not in a patient’s bedroom, and not on the side of the street with traffic running by,” he says. “What may measure fatigue in the ED is probably not going to work 100% of the time in an EMS setting because it’s a different world. We can’t simply adopt a tool off the shelf. The context is different. The items are slightly different. We really have to think about measurement carefully.”

Publishing the Findings
For the past few years, Patterson has been working on developing methodologies to study workplace safety culture. His first study, which was published in the American Journal of Medical Quality in 2010, was focused on testing the reliability and validity—the psychometric properties—of the EMS Safety Attitudes Questionnaire (EMS-SAQ) before widescale dissemination. “In this study, we confirmed that we had a good tool,” says Patterson.

Patterson’s second study, “Variation in Emergency Medical Services Workplace Safety Culture,” published in 2010, aimed at developing workplace safety benchmarks in EMS agencies. The tool allowed agencies to compare themselves to a national benchmark with accompanying data. “We found wide variations in which agencies had a positive perception of the different components of workplace safety culture,” he says. “Not every EMS agency has a positive workplace safety culture. We all had assumptions, but now we have the data that says it’s true.”

Although Patterson doesn’t think those in EMS are surprised by his research findings, he does acknowledge that some of the results are eye opening. “We knew some of these negative perceptions of workplace safety culture were there,” he says. “It’s important for the industry that we now have some data to support our assumptions.”

Ultimately, Patterson’s goal is to give EMS the rigorous research methodologies that will lead to improvements and solutions that only come through a thorough understanding—and measurement—of the problems faced by EMS providers and their patients every day.

“My concern for all the research that I do is giving EMS managers confidence. They don’t have time to be wrong, and I want all EMS managers to have the tools they need, free, so they can concentrate on improvement, whether it be performance, safety or quality,” he says.

Patterson also reminds us of what is at stake: “EMS is probably the most overlooked profession where we impact people’s lives, and people don’t realize it,” he says. “I think it’s a great profession, and my aim is to give EMS the respect it deserves through my research.”

Please view the interview with Daniel Patterson that took place at EMS Today.


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