Are we doing enough to protect us from ourselves?

By Joe Coons

EMS has made large strides in provider safety since I started in this industry in 1992. Ambulance manufacturers now design vehicles with provider and patient safety in mind. Crumple zones, limited head strike components and vastly improved restraint systems are helping keep crews and patients safe in the event of an accident. Safety improvements in equipment haven’t stopped there – take, for example the powered apparatuses cot manufacturers have designed to help decrease provider lifting injuries and reduce dropped patients.

Even with these great strides in equipment design, the industry has a lot of work to do to create a prevalent culture of safety. According to the CDC, more than 22,000 EMS providers visited an emergency room for work-related injuries each year during a 4-year study. Providers and patients are injured or killed due to improper or omitted use of those improved restraint systems. Additionally, we’re still experiencing lifting injuries, as well as bio-hazard exposures; and slips, trips and falls. Include the violence committed against us by those we are providing care to, and we have a lot of room for improvement when it comes to safety.

With the added stressors of the pandemic, errors involving human factors are sure to happen. If a root cause analysis were done in each instance, it would be revealed that poor decision-making is almost always involved in an injury. Choices such as not wearing seat belts in the back while transporting, or not wearing eye protection during trauma care are things that should easily be corrected.

COVID has pushed providers to the limit with longer transport distances due to the need to find available beds. As a result, fatigue has squarely secured its place among factors impacting decision-making and increasing the chance for errors and injuries. When errors occur, we can find ourselves in one or more of the following states:

• Rushed
• Frustrated
• Fatigued
• Complacent

These can all result in us not staying on task, having loss of situational awareness, loss of balance or traction of footing or finding ourselves unintentionally in harm’s way of outside forces, like traffic during a highway scene. These four states are easily found in EMS operations and are all ways we can get ourselves into a position of being injured.

• Rushing to complete something due to patient condition
• Frustration when things are not going our way during a significant incident
• Fatigued from working too many days in a row
• Complacency when lifting equipment or during other mundane processes

We work in an extremely dynamic environment in EMS. To say there is a one-size-fits-all strategy would be woefully inaccurate. Managing human factors falls on the shoulder of both the organizations and the individuals. For instance, organizations should evaluate their scheduling pattern against their workload to ensure ambulance crews are not overly fatigued on a regular basis. In turn, the individual crew member should consciously prepare themselves to be fit-for-duty by getting enough sleep prior to their shift. Employers need to make it easier for staff to report near misses without the fear of reprisal to learn about the gaps in their organizational safety measures. Creating a just culture is one of the few things that every organization can implement to improve safety within its own walls. It can really help design processes to mitigate the four states of error and help prevent negative consequences.

Let’s take an instance where a medic draws up the wrong medication because it is similar in design to another vial in the same bag. They do not deliver the medication to the patient because they catch their mistake before any consequences are realized. If there is a mechanism in place to report it without punishment, a change can be made before someone else makes the same mistake resulting in harm to a patient.

The same processes can be utilized for employee safety. Having a non-punitive way to point out a shortcoming in safety processes (e.g., utilization of lights and sirens while responding to 911 calls) can help improve our policies, procedures and processes. Caregivers can and should hold one another accountable for using vehicle restraints properly and ensuring good lifting techniques. Here are four other pieces of low-hanging fruit that can improve industry safety for our patients and EMS crews alike:

1. Be in the moment during critical tasks. A critical task can be defined as anything that if done incorrectly will cause harm. Staying focused is paramount as many mistakes occur when we get distracted during periods of input overload.
2. Use checklists to make sure no steps are missed. Checklists to ensure equipment is ready at the beginning of shift, during drug administration and other tasks will help head off unwanted events.
3. Have a plan. This applies to organizations and individuals alike. Having a plan on how to recover from a negative event can help minimize the consequences when things don’t go as planned. This should include a structured process like root cause analysis to find out why things happened the way they did.
4. Physical fitness. Having strength and good mobility are ways to help us overcome some of the awkward positions our bodies get into while moving people for a living. It also helps us combat fatigue, enhances our ability to stay focused on any given task and remain resilient to high periods of emotional stress.

EMS has moved forward so much in my 29 years in this industry. I’m excited to see where we go in the next 20-plus years as our culture continues to evolve. If there’s one thing about EMS, it’s the fact we’re adaptable. One of the most important things we can do is continue to make a deliberate effort to protect us from ourselves.

About the author

Joe Coons is director of safety, LifeFlight Eagle.

This article was originally posted Dec. 7, 2021. It has been updated.