10 Steps to Establish an EMS Risk Management Program

The time is now to embrace safety

Safety is getting a lot of attention in EMS lately. A number of federal and national initiatives are underway–from the National Fire Protection Association’s standard for ambulance safety, expected in June 2012, to the National EMS Culture of Safety Project.


“Every national organization that relates to what we do is on the same page,” says Chief Richard W. Patrick, MS, EMT-P, medical first responder coordination, Office of Health Affairs for the U.S. Department of Homeland Security. “There are not many other issues we can say that about.”


Until now, EMS has been slow to embrace safety and risk management concepts.” Shouldn’t it be unspoken that safety is something that we do automatically? Why do we let unsafe practices go?” asks Chief Learning Officer Jeffrey Lindsey, PhD, PM, CFOD, of the Health & Safety Institute. He points to a number of reasons, including liability concerns, HIPAA issues and the fear of showing weakness.


According to Lindsey, safety, whether it is provider safety, patient safety or system safety, is an internal belief system. “It doesn’t matter what anybody says or what SOP or SOGs are in place or what training you provide or what gadgets you provide if, at the end of the day, I choose not to use it. Therein lies the problem,” he says. “Safety has to be personal.”


Patrick suggests taking a page from high school anti-drunk driving programs. The message is most effective when it’s presented by other students–often peers who have been to jail or injured as the result of a drunk driving incident.


It may also be effective to remind personnel of their personal liability. Often someone doesn’t speak up when they have a safety concern because they aren’t in charge. Patrick notes that they can still be held legally responsible should someone be injured as the result of an accident, especially if it involves the public.


Leaders must also look at their role in creating an unsafe environment. “In many cases we are encouraging this [unsafe] behavior,” Lindsey says. By focusing on response times as a measure of success, personnel can get mixed messages.


Fortunately, there’s no need to reinvent the wheel when looking for ways to instill a culture of safety. Other industries have pioneered successful programs. “There’s so much data that’s applicable to EMS,” Patrick says.


One has to look no further than the fire service and its prevention programs. “Prevention is the foundation of the American fire service. If it’s predictable, it’s preventable,” Patrick says. Identifying and mitigating threats are the essence of risk management.


To establish an EMS safety and risk management program, Patrick and Lindsey recommend these 10 steps:

  1. Selec one person to be the risk manager for your organization. Provide them with the training and support necessary to get started with the process. Resources: NAEMT Health and Safety Task Group, IAFC Health and Safety, and insurance carriers.
  2. Identify the potential problem areas within your service. These may include exposures in a variety of areas, such as vehicle, facilities, medical malpractice, pollution or management.
  3. Share your organization’s loss history with your risk manager and explain why and how these losses affect the bottom line, as well as each employee. Job security depends on each member of the organization doing their part. The more losses, the higher the costs are to you and your bottom line.
  4. Appoint, or better yet, ask for volunteers within the organization to serve on a task force to identify problem areas and lend recommendations for correction. Caution: When selecing people to serve, set a couple of basic requirements for participation. If you have all new employees on the committee or if you have all members from one division of the organization, results may take much longer.
  5. Map out your plan of attack. Set reasonable goals for your target dates. Identify areas of greatest concern to all parties. Prioritize those concerns, and approach them one at a time. Start slowly, and watch the involvement grow.
  6. Ask your employees what kind of incentives they would want as rewards for meeting goals and objectives. Many dollars have been spent on items that didn’t mean a thing to the providers and, therefore, no incentive existed. What they would like to have may surprise you.
  7. Schedule review sessions with the committee to see where they are at and where they are supposed to be. Lend your support to them as they feel they need it. Encourage them to complete a certain project if it’s more urgent than other items being pursued. Mid-course correction is always necessary in any plan.
  8. Reward. Reward. Reward. Every dollar spent on prevention could cost you 10 to a hundred times more in claims. Constant acknowledgement from management is essential to any program’s success. Without it, the program merely exists without results.
  9. Evaluate the committee at least annually to ensure that equal representation exists as it compares to your organization’s growth. A committee that has unequal representation may have a greater task than necessary.
  10. Reward yourself! It’s a difficult task to delegate responsibility to someone else.

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