Safety Applies to EMS Crews & Patients

There’s a lot of talk about safety these days, Life-Saver; and finally, I think it’s not just a lot of fluff.

I remember, as an ambulance driver, studying for a history test during one of those rah-rah marathon safety appeals we’ve all endured. My agency at the time had just experienced a crash, and one of our supervisors talked my boss into bringing in some old truck driver to teach us the benefits of using backers–and how to drive like his grandma. I don’t much remember what he said, but he did bring donuts. (Safety food, right?)

I think the role of EMTs and paramedics is much more complex today than it once was, and plenty of people simply can’t put it all together. They’re tough, too. If you want to teach them something, as EMS educator Mike Smith says, “You gotta make their socks roll up and down.”

This is a tough job because if you want to make people safer, you need to change the way they think–make them see how valuable they are and how easy it would be to snuff them out. But you really have to mean it. (They’ll know if you do. And trust me; they’ll know if you don’t.)

Before you can change the way people think, you need to understand what it’s like to be them. EMTs and paramedics are typically taught, beginning on day one, that they’re not very valuable. Think about that: They typically earn their first rides by completing a highly abbreviated, barely medical, training program that doesn’t mention driving skills and omits the operation of an ambulance cot. Care to guess which two practices injure EMS providers more often than anything else? Yup, driving and cots. That’s probably not just a coincidence.

Once they’re hired, they quickly learn they’ll constantly be in harm’s way–a scant injury away from the ends of their careers (if not their lives). After they deal with scared, cranky, irritable patients, it doesn’t take them long to discover that some folks aren’t glad to see them. And soon enough, after their first payday, it dawns on them that, considering their responsibilities, their wages are pathetic.

If you read enough signals that say you’re not very valuable, pretty soon you start to believe it. I think that’s why so many of us under-prioritize our own safety. We don’t check our equipment. We don’t wear safety belts in the patient compartment. We drive way too fast. We respond emergently when we don’t need to. We bust intersections without coming to a stop. We lift poorly, and we lift when we don’t need to. So we get hurt.

I think biofeedback mechanisms (like black boxes) are nice. But I think it’s important to remember these are people we’re talking about.

In my opinion, the above leadership practices should come first.

These are just a few components of a culture of safety. But more than that, they’re aspects of an overall leadership strategy. EMS providers don’t do what they do for money, however much they deserve a decent living. They’re valuable. Important. And anything but inconsequential. They need to be reminded of that, often and consistently. JEMS

>> Teach leaders at all levels to keep themselves answerable to crews’ families. That means if you’re a leader, you should honestly like your crews, like the way they think and like the things they laugh about. You should constantly imagine yourself explaining to crews and their families why your daily decisions are the best thing you can think of to keep them safe. In fact, I think you need to honestly love them. If you can’t, you should do something else.
>> Involve crews in fleet maintenance. An ambulance can either earn us a living or kill us, any day. Crews should understand its anatomy and physiology at least as well as they understand the human body. And they should have the authority to take equipment out of service any time they note a critical finding, without anybody’s permission. What’s a critical finding? It’s something that can keep an ambulance from doing any of the things it has to do to keep you alive. (Like start, steer, stop and stay running.)
>> If you want crews to keep your vehicles looking sharp, do your share. When an ambulance goes in for service, pay attention to cosmetics, not just mechanics. Repair dings, paint scratches, dented dock bumpers, worn upholstery, scratched wheel covers and damaged windshields. Address safety issues, like seatbelt pretensioners. And take care of comfort issues, like seat cushions, AM/FM radios, worn-out air conditioning vents and so on. Before you return an ambulance to service, detail it. Make it look like you want it to look in public. Most importantly, expect vehicle techs to talk directly to crews–and listen to them.
>> Involve crews in the selection of their future colleagues. If they recommend you reject somebody, reject them. If they urge you to hire someone, hire them. And when you hire somebody, make a fuss. Like they’re … um, valuable.
>> Honor things that are important to people. This includes birthdays, anniversaries with your agency, graduations and the deaths of loved ones.
>> Teach safety constantly, and each time you do, remind people they’re valuable. Make safety a part of every educational event you sponsor. Sponsor plenty of those, and produce them like they’re important.
>> When somebody leaves your agency on good terms after a couple of years, make a fuss about that, too. Collect photos, and have a professional framer insert them into a framed matte that people can sign. They’re forever part of your agency’s name, and your agency is forever part of their life. (They’re also your future emissaries, by the way.)

This article originally appeared in October 2011 JEMS as “Keeping People Safe: Tell crews they’re valuable & mean it.”

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