EMS is a dangerous profession, dangerous for EMS providers, patients and, at times, the public. The safety of patients, EMS providers and the public is a responsibility that we all own and it will take leaders and working in teams with EMS providers to maximize safety for all these groups.
Kevin Seaman‘s session at EMS Today 2016 presented background on national efforts to move to an EMS Culture of Safety. Using case examples, both near misses and mishaps were reviewed with a perspective of learning all safety opportunities for improvement possible. The perspective that, “To err is human,” led to discussion of the concept of a Just Culture, in which, EMS workers feel comfortable sharing near misses and mishaps in a non-judgmental that work environment, encourages broadly sharing lessons learned.
Borrowing from the aviation industry, the concepts of the use of checklists and implementation of crew resource management (CRM) were introduced. Examples of EMS implementation of checklists and CRM were shared. The example of a healthcare systems implementation of a program to eliminate central line infections through the use of checklists to change culture was explored. The power of leadership to foster culture change for safety was emphasized.
An ambulance mishap was reviewed using a Human Factors Analysis approach to tease out factors that contributed to the mishap. Examples of how these factors can be shared broadly throughout an EMS organization or industry to educate and prevent the next mishap were provided. Examples of EMS programs that used checklists, crew resource management and a feedback loop were presented.
The path forward requires all EMS team members to work with each other to transition from a culture of “blame and shame” to a just culture which, once implemented, will optimize patient, provider and public safety.
Take Home Points from the presentation include:
- Humans make errors; improve EMS processes to minimize human error and maximize safety
- Checklists create consistency and help EMS providers ensure all essential steps are complete
- Process analysis — steps to an EMS mishap are like links in a chain; break one link to prevent harm
- Non-punitive reporting with loop closure leads to culture change
- An EMS “Just Culture” embodies a living organization with a shared mission to maximize safety for patients, EMS providers and the public in our industry