EMS Insider, Expert Advice

Managing Risk

By Gordon Graham

I thought it was a bit odd when I first saw name of this publication: EMS Insider. I was wondering what A.J. Heightman was thinking when he asked an “outsider” (I have only been a recipient of EMS services, not a provider) to write something to be read by the “insiders.” But I do understand the way his mind works. Outsiders tend to look at things differently than insiders do and sometimes the outside perspective might make you think about things a little differently.


Over the years I have been accused of throwing around four-letter words, and that is true. In fact, here is a favorite four-letter word that many people do not think about often enough. Are you ready for it? Bias. Years ago I wrote a piece on this word with the kick off statement “everyone has a bias!”


Holy moly! (Two more four letter words). I get the occasional “nastygram” after I write things, but this particular article got me quite a few negative comments, including my favorite of the group, which read, “Dear Mr. Graham. How dare you say I have a bias? I can assure you that I do not have a biased bone in my body!”


So I typed a response, but I did not send it because these emails seem to have a life after initial transmission. But had I sent it, it would have read, “Not only are you biased—you’re stupid!”


Now before you send me a nastygram of your own regarding this comment, let me explain. If you salt your food before you eat it; that is a bias. If you prefer Ford over Chevy; that is a bias. If you prefer home fries over freedom fries; that is a bias. And there is nothing wrong with being biased, so long as that bias does not negatively impact anyone else.


The bias that I see almost daily involves another four-letter word: Risk. If you have been to any of my live programs over the last 35 years, you know I talk about risk (and specifically how to manage risk) a lot. The bias that many people have is that too many people think risk and risk management are solely related to “the safety stuff.”


To be fair and accurate, if you have this view you are partially right. Understanding the importance of safety and building control measures (policies) to keep people safe is part of an overall risk management strategy. But risk management is bigger than the safety stuff. It is bigger than the ergonomics stuff. It is bigger than the insurance stuff. It is bigger than the subrogation stuff.


Risk is ubiquitous. Everything you do in life, and everything you do in EMS operations, involves a level of risk. If you are hiring people, there is a level of risk involved. If you are firing people, there is a level of risk involved. If you are writing a report following a mass casualty incident, ambulance accident or patient transport, there is a level of risk involved. Even when you are driving an ambulance there is a level of risk involved.


So what can you do with all of these risks? You can eliminate some risks. You can share some risks. You can avoid some risks. And you can transfer some risks. When all of these are considered, you have a risk management program.


The one thing that I don’t want you to do is to run from risk. In the early ’80s, early on in my career as a young lawyer, I got into this discussion with some chiefs and sheriffs. There were two major lawyers who defended police agencies around California, and I wanted to get part of that market. So I sent out a flyer to a group of law enforcement executives to come to my program at a law enforcement conference where I promised I would should them how to eliminate police civil liability. They showed up and I told them the secret. If you don’t want to get sued, don’t do anything. Don’t answer the phone. Lock the front doors on your station. And whatever you do, don’t roll on any calls.


Some of them got the joke, some did not.


The point is we cannot eliminate risk. All jobs in public safety involve risk, but running from risk will cause your agency nothing but greater problems.


All of us in the high-risk profession of EMS response and public safety must understand the breadth and the depth of real risk management and recognize how much can be done to manage the real risks you face.


Here is a definition that I will be using in all future writings, and I hope you will use this in your high-risk job in EMS operations:


Risk management is any activity that involves the evaluation of or comparison of risks and the development, selection and implementation of control measures that change outcomes.


Or more simply stated: It all gets down to what I call “RPM.” You must be able to recognize the real risks you face, personally and professionally. After recognition, you need to be able to prioritize these risks in terms of frequency and potential severity. And then you must mobilize (act) to do something to address the given risk. It all gets down to RPM: Recognize, Prioritize, Mobilize.


Well, that wraps it up for this initial piece. I look forward to the next opportunity to give you some further thoughts on risk management. Until then, you can take a look at some of my Tips from Lexipol at www.Lexipol.com. Some of those might be of some value to you as an EMS Insider.

Gordon Graham is a 33-year police veteran and the president of Lexipol. He is a risk management expert and a practicing attorney. He is one of the most sought-after speakers in public safety and has presented a common sense approach to risk management to hundreds of thousands of law enforcement professionals around the world.