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Studies Report on Stretcher Errors & Rate Protective Gear

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In the coming years, as the culture of safety in EMS project continues, we hope to hear much more about patient and provider safety initiatives, and more routine reporting of errors, adverse events and near misses in all areas of EMS. This Oklahoma-based study helps remind us how simple research can be, and how important it is that all EMS agencies participate in it and then report their findings in a peer-reviewed scientific publication.

Stretcher Errors
Goodloe J, Crowder C, Arthur A, et al. EMS stretcher “misadventures” in a large, urban EMS system: A descriptive analysis of contributing factors and resultant injuries. Emerg Med Int. 2012;2012:745706.

This retrospective analysis of quality improvement data in a single Oklahoma-based ambulance service covering two cities (Tulsa and Oklahoma City), the Emergency Medical Services Authority (EMSA), reports a low incidence of adverse stretcher events: 23 events in a one-year period when this urban EMS system transported more than 129,000 patients. The authors randomly selected a year to review and analyzed data with their existing error reporting system. The primary reason for adverse events was a failure of the stretcher to “catch” on the hook in the process of unloading a patient. No patients were injured from stretcher errors during this time period.The intent of the project was to establish a good baseline, and I think this study will help accomplish this for Oklahoma.

However, I’m not sure how generalizable these results are to other services. Many factors contribute to accurate reporting and a low instance of errors. The authors discuss that a culture of safety and method of tracking errors already existed in this system. Kudos to them for already implementing these practices.

Although we have no reason to doubt their reporting, and this safety record should be commended, I find myself wondering if all near-misses were actually documented. I hope they continue on this great path of safety, documentation and publication of research so we can all learn more. Who will join them in a prospective multi-center study?

Protective Clothing?
Bourlai T, Pryor R, Suyama J, et al. Use of thermal imagery for estimation of core body temperature during precooling, exertion and recovery in wildland firefighter protective clothing. Prehosp Emerg Care. 2012;16(3):390–399.

Accurately measuring core body temperature in EMS is one of our industry’s most challenging present day enigmas. As we progress in our knowledge and treatment of sepsis, therapeutic hypothermia and other temperature-related conditions, determining core temperatures has become essential.

In this project, the authors report on a tightly controlled, experimental project with high-sensitivity thermal imaging machines.
Although this study was small (six wildland firefighters in turnout gear), it took extra care to avoid some of the common problems associated with temperature research. The subjects ingested a pill with a radio transmitter to accurately measure core temperature, and they had skin sensors placed around their faces and other locations. They were pre-tested for fitness ability, and their diets were controlled during the day before the test. They were also pre-cooled by drinking ice-cold slushies (my kind of research). In full turnout gear, the subjects walked at 4 mph for 45 minutes.
The authors found a high correlation between thermal imaging temperature readings from the face and core temperatures during active exercise. The study discussed the theory that the temperature of blood passing along the facial arteries fed by the carotid artery in close proximity of the aorta appear to mirror core temperatures.

However, before you run out and borrow a thermal imaging unit from the fire engine in the station, beware: The facial temperatures while at rest and during recovery were not a good match. The units used in the study were the highest sensitivity possible (older units may not be as sensitive). This study had only six subjects and was conducted indoors. I completely agree with the authors when they suggest that larger studies, under more realistic environments (outdoors), are needed before we can render judgment on this technique.

If this method of temperature measurement were to work, the potential applications at large sporting events and other mass gatherings, as well as for patients with other illnesses, could be useful. I know someone reading this will be inspired to try it, so be sure to get institutional review board approval and make it an official study you can publish. We want to know what you find.

Watch Box

Fernandez A, Crawford J, Studnek J, et al. An investigation of the association between extended shift lengths, sleepiness, and occupational injury and illness among nationally certified EMS professionals. 2012 SAEM Abstracts;S66.

Stay tuned for the full paper from Fernandez and the co-authors. This abstract was presented at the recent Society for Academic Emergency Medicine meeting. The authors used the National Registry of EMTs Longitudinal EMT Attributes and Demographics Study to see if there is a link between extended shift lengths, sleepiness and occupational injury. Answer: Yes. In this large survey that included the Epwroth Sleepiness Scale (ESS), ambulance crashes, missed work due to occupational injury or illness and needle sticks, it appears that 17.5% of respondents (186 out of 1,078 surveyed) experienced an occupational injury or illness within the past year. Working less than or equal to 24-hour shifts was more than one and a half (odd radio of 1.72) times likely to be associated with injury or illness. Sleepiness was also a factor. Does this mean the death of the 24-hour shift? I'll wait for the full paper to draw any dramatic conclusions, but this should cause all of us to give serious thought to how much rest we get and how many hours we work in a row.
 

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