Columns, Trauma

How to Lower Risk

It was a late fall evening in northern Wisconsin when we finally found the fisherman. He barely had the energy to keep his head above water. He was wearing boots, heavy clothing and no life jacket when he fell out of his boat. The water was cold, and he’d been treading water for more than an hour. It was probably minutes before hypothermia and fatigue would have caused a loss of consciousness, and he would’ve drowned.

Risk of injury or even death is inherent in any outdoor task, activity or event. The magnitude or severity of risk is a function of the probability times the consequence. Perception of risk is determined by experience, knowledge, skills and judgment. But oftentimes, the actual risk is different than the perceived risk.

Actual risk vs. perceived risk
Many people have a fear of flying and perceive the risk of flying as great. The actual risk of commercial flight is low, especially compared to the actual risk of driving to the airport. In this case, the perceived risk doesn’t equal the actual risk.

Each summer, I read reports of recreational boaters who drown after taking a canoe, rowboat, raft or inner tube over a low-head dam adjacent to a park or picnic area. The victim perceived the risk of a plunge of a meter or less in a slow-moving river as minimal. Unfortunately, the actual risk from the re-circulating water hydraulic is enormous. Once capsized, the victim is unable to swim clear of the hydraulic and drowns. Even more tragically, many bystanders and professional rescuers fail to recognize the risk and become trapped while attempting to rescue the victim.

Accept a level of risk and understand the consequences
For many people, risk is desirable. A certain level of risk is why many of us have chosen to work in EMS and to participate in outdoor activities. Accepting risk also entails understanding consequences. When hunting, I’m at risk of falling. The consequence of falling after tripping over a tree root is much different than falling from my tree stand. This simple analysis can be applied to virtually any EMS activity. Change the probability, the severity of the consequence or both to lowerthe risk.

Change the probability
Short of living in a bubble, it’s nearly impossible to reduce the probability of an unwelcome event to zero. However, you can reduce it. Some simple things I do to minimize the probability of injury or illness on a camping trip include:

  • Having adequate shelter, water and food for the activity, location and season;
  • Frequently washing my hands;
  • Bringing appropriate equipment, clothing and footwear for the activity, location and season;
  • Carefully planning the route;
  • Traveling with others, and
  • Acquiring basic knowledge about local climate, flora and fauna;

Most backcountry emergencies are minor musculoskeletal problems, simple wounds and burns, and hot or cold exposure. Careful planning and robust prevention efforts reduce the probability of these problems. Surprisingly, it’s the mundane category of gastrointestinal illness that has the highest probability of occurrence. Frequently washing hands significantly reduces the probability.

Change the consequence
My heart was pounding as I watched a rock climber reach for his next hold. He was already dangling in the air by just his right arm. My breath stopped when he missed the hold, momentarily froze in the air and began to fall. At the same moment, his belayer ensured that the rope was in a “brake position.” The climber fell just a few feet before friction and well-placed protection arrested his fall.

The climber and his partner had taken steps to change the consequence of falling. Without a belayer, he would have fallen 15 meters and been severely injured. Instead he was winded, embarrassed, angry and eager to make the move on his next attempt.

The risk of such unwelcome events as falls or crashes exists. Since the risk exists, many steps can be taken to reduce the consequences of the untoward event. Some of those things include:

  • Wearing a lifejacket when canoeing or kayaking;
  • Wearing a helmet for skiing, snowboarding, climbing, cycling and whitewater boating;
  • Wearing and/or using other protective equipment, and
  • Intervening before an injury or illness worsens

EMS is not without risk
I believe the actual risk of working in EMS is much greater than many of us perceive. For example, I rarely see co-workers use a seatbelt in the patient-care compartment. The actual risk of a motor vehicle collision — red lights or not — is much greater than the perceived risk.

This past month, one of my fellow instructors at Wilderness Medical Associates (who was also a flight paramedic) was killed in a helicopter crash. A different helicopter crash this past month injured a former co-worker of mine. In the past two years, I’ve known three EMTs who’ve been riding in ambulances that crashed and were totaled. I know many EMTs and paramedics who have sustained back injuries or needlesticks, and others who’ve been assaulted by patients.

I have good friends who’ve recently started jobs as flight medics. This is a case where I perceive the risk to be greater than the actual risk. But, is the actual risk of a crash any greater in a helicopter than a ground ambulance? According to Rocco Altobelli, a flight medic in north-central Montana, “The probability of a helicopter accident is lower than an ambulance, but the consequences to the crew are higher.”

Remember, in all settings risk equals probability times consequence. Unless you take action to lower the probability or consequence, the risk of serious injury exists every time you start the ambulance, board the helicopter or head outdoors for fun and adventure.