Creating a "culture of safety" in the EMS community

Hate is a strong word.

I HATE hearing about medics getting injured, disabled, killed in the line of duty.

Since I play the bagpipes and I'm a public safety guy, I go to more than my fair share of public safety funerals. It is distressing to see the impact of these mostly-unnecessary, mostly-preventable deaths on friends, families, agencies, and communities. It's hardened me a good bit over the years - to the point where I don't feel at all bad about dropping the disciplinary hammer on a medic that I catch in an unsafe act.

But....there will never be enough supervisors to "catch" all the unsafe behavior - nor should there be. There has to be a better way.

A great lecturer from California, Gordon Graham, teaches about risk management and public safety. He knows - he was a captain in the CHP, a lawyer, and a risk manager. He says, many times, "If it's predictable, its preventable."

Ok - so I can predict that within the next year, several of my medics will injure their backs. Several others, knees, shoulders, etc. Several will tip over the stretcher with the patient on it. Several more will crash trucks. Others will drive down the street, talking on the cell phone, texting on their blackberries, etc. Many will remain physically un-fit - overweight, inflexible, without the strength to carry their gear and their patients.

How do we change this? How do we prevent the waste, pain, suffering? How do we create a culture where partners and co-workers educate, and use peer pressure, to eliminate unsafe behavior? How do we get medics to care enough about themselves to be smart about their actions? It's not hard to don a reflective vest when you get out of an ambulance.

My worst professional nightmare - a line of duty death of one of my own. I want badly to prevent ever having to deal with that, having seen how hard it is on other heads of departments when it happens to them.

Give me some ideas, ladies and gentlemen. Please.

Thank you.


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Comment by Skip Kirkwood on March 25, 2009 at 7:18am
Another idea, which I offer to the EMS community, is to provide paramedics with the same training that law enforcment "Crisis Intervention Team" members receive, which is great for dealing with patients suffering from mental illness. We introduced this program to our advanced practice paramedics, and we found two benefits. First, they are better able to deal with mentally ill patients, including getting them to the right place (the crisis assessment center instead of the ED), and their on-scene partnerships with the CIT officers and deputies seems to work just great - the medical and helping hand approach of the paramedics, coupled with the legal commitment authority and more empathetic approach of these specially trained LEOs. It was a 40 hour course, put on primarily by county mental health professionals.

Comment by Lisa Fields on March 25, 2009 at 2:30am

Thank you both for this post and also for using Gordon Graham’s quote.

"If it's predictable, its preventable."

I have taken a number of OSHA classes simply as a means of adding value for all my customers. An additional beneift has been I've become more aware of situations waiting to happen in my own home as well as the enviroments in whick I train.

In North Carolina we have one of the best trainers I’ve even seen working for OSHA. Bob O’Neil is such a remarkable trainer I sent a letter to our Department of Labor Commissioner Sherie Barry highlighting his work. As a Keynote Speaker/Trainer I have high standards and Bob has proven worthy of my praise. I don’t know if you could ever have him present.

It's important for all EMS professionals, Pre-hospital Care Staff, 911 operators, those within all medical facilities, etc to have a solid understanding of mental illness and how a chemical imbalance within the brain can impact a call.

I have developed a presentation I’ve used with 911 Operators to help them gain additional empathy and understanding of Mental Illness. This can also be presented to all those within the EMS Field. The Operators and their “official leaders” have reported this presentation has given them the results they were seeking.

As the economy continues to challenge all of us, the number of people who cannot afford their medication/mental health services will be further impacted. The manner in which professionals assist people in fragile mental conditions can impact the results for the patient but can also have a direct impact the personal safety of EMS professionals.

I appreciate the hard work you all provide on a daily basis.

Comment by Skip Kirkwood on March 4, 2009 at 6:22pm
Hi Kristen,

It is surely a complex environment out there.

One of the challenges about being part of a larger entity like county government is that there are some challenges with "getting benefits" for EMS folks that are not provided to the rest of the county's employees. For that to happen, the busiess case needs to be really strong. Until recently, there has not been data that showed that EMS folk are different (ergonomically and injury-wise) than the rest of the workforce.

What is interesting is the question of motivation. A year or so ago, some employees asked about working out at work. At our headquarters station, we cleaned out a good-sized storeroom, and a bunch of fitness equipment went it. Some supervsiors made money contributions, and some really nice stuff was purchased. Now....rarely used. Rather watch TV, nap, read. The employer can do whatever they want; if the employees aren't motivated it will take a lot more effort.

You'll be happy to know that we have trained everybody in scene safety. And we work with our co-responders to use blocking vehicles at almost every highway scene. Those 40,000 fire trucks make great safety barriers at accident scenes. We spend a lot of money on flashing lights, and the rear of all vehicles purchased the last 3 years have contrasting hi-viz chevrons to enhance safety.

That's a shame about the firefighter who got crushed from behind. The same thing happened to a Charlotte (MEDIC) paramedic a few years ago.

Comment by kristen on March 4, 2009 at 11:31am
Skip, its been about 18years ago now, but I once approched some of your predecessors about starting a health and fitness training program with your agency. at the time I was a personal trainer and taught cardiac rehab and group fitness at several local hospitals. I was told thanks but no thanks, patted on my head and sent away. It amuses me now to see all of the EMS work force studies about injuries and lack of fitness. It has taken almost 20 years for it to finally catch up to EMS, despite fire depts. that have mandated time for exercise as part of the job expectation for many years. part of my hospital required training is ergonomics, something that EMS doesn't offer as part of the mandated orientation, also health and fitness safety checks. as part of my application process at the hospital that I work at, I was given a physical, provided with free dietary information, as well as yearly health screenings. we also have a "wellness"center and can receive discounts at local fitness centers. oh, and the monthly wellness newsletter keeps us up to date on anything new being offered, as well as tips and advice on exercise and nutrition. It is not that expensive to begin with education. That can be said for any safety program. You have monthly con-ed and I believe that safety, both physical and emotional, starts with education. Also, don't know if you had heard that one of the volunteers in our state lost his legs at a scene yesterday, he was putting on his turnout gear while standing at the back of his vehicle on the road shoulder and was struck by an oncoming car, pinning both legs, causing them to be amputated. When we discuss and teach scene safety we need to talk about these kinds of issues to demonstrate what can occur. I, myself came across a scene last week in my area. Early in the morning on a country back road. down a hill and into a blind curve on a bridge I suddenly came upon a wreck scene. Thankfully, I was using caution as I know that there is a scoolbus stop at the base of the hill going out of the blind curve, so I was able to stop in time to avoid hitting the EMT and Firefighter standing in the road conversing, with the lights off on both vehicles. In fact, it was the flashing yellow lights of the school bus that first caught my attention. Had I not seen the bus, I could have very well been involved in this MVC myself. the ambulance was on one side of the road, no lights, and the firetruck was on the other, no lights, no cones, no flares, no warning of any kind. Thank goodness the school bus driver had more sense and seemingly, more training. Why is it that school bus drivers are recieving more training than our emergency response personnel? Perhaps we should look at sending EMS responders through bus safety training?
Comment by Simon Bowthorpe on February 18, 2009 at 7:36pm
Training, training and more training. I think most of you have covered that. One other aspect is that EMS personnel get enough rest, do no work shifts whose length can provoke mistakes through tiredness. We should encourage fitness, diet (meaning nutrition and hydration), weigt loss when necessary and giving upany unhealthy habits. You have to know your people and keep an eye on personal situations that may result in a misjudgement while on the job.

One last word about fitness... someone mentioned time and money to go to the gym every day... we probably have time but not the money. Best fitness program I know is run, half an hour, everyday, come rain or shine.
Comment by Janet Smith on February 15, 2009 at 6:41pm
The tactic of rewarding good or safe behaviors is to reward often and as a surprise. And, these safety incentives or rewards are only one type of strategy for developing the overall "culture of safety" for EMS. And so getting back to tactics, and in comment to your question Lisa, I believe it's the regularly occurring , "employee of the month" kinds of reward initiatives that make the least amount of impact. So, while the $5 for wearing a seatbelt will get attention, it isn't necessary or even advised to repeat that tactic but maybe once a year. Instead, it's necessary to get creative with incentives, rewards and recognition. And, they don't have to be expensive.

I also think that many EMS safety officers are unsuccessful because they are not fully empowered or recognized for their contributions to the organization. There is a current disconnect in that being a safe EMS employee doesn't equate with being a "professional". When that does happen in an organization, the culture shift begins. It just has to become "cool, repected and rewarded to be considered a safe "professional". Not a simple task by a long shot, but doable.
Comment by Duncan Hitchcock on February 12, 2009 at 7:25pm
One of the biggest programs that both the IAFF and the IAFC have backed is the Wellness initiative for firefighters. We are in the process of creating a multi-year AFG for initiation of this project in our department. We are working closely with our union to develope a five year implementation program.

Are there others that are moving in this direction?
Comment by Duncan Hitchcock on February 12, 2009 at 6:07am
The addition of a bargaining unit can either benefit or deter the discipline process when necessity requires its application. By its nature, the union is in place to insure that due process is followed. In Florida we have a Firefighter's Bill of Rights that also aids in insuring due process.

The problem arises when the issue of quality of patient care is convoluted into a debate of a right to work issue. The focus of the actual problem is diverted from the patient's right and an expectation to a standard and quality of care to an individual employee's right to continue in a capacity that directly obstructs the agency's and its Medical Director's maintenance of that statndard.

The questions becomes for all invloved, "Do you want this person touching and treating you or your family?" "The decisions made and actions taken have placed management, the Medical Director and union in a position of great liability. Are you willing to accept that responsibility?"

Taking action as an employer is a long and labor intensive process. But that is the responsibility that comes with the job. Just as it is the responsibility of the employee to provide every patient with the best possible care. The responsibility for allowing an incompetent EMT or Paramedic to continue to function in the field is shared by the union. To turn a blind eye or to fight to maintain the the patient care capacity of a proven incompetent Paramedic incurs the responsibility for liability for their actions.

But when it boils down to the bare bones, if the Medical Director has lost faith in the individual's abilities to function, make decisions and provide care to the standards established, the dude or dudette doesn't play here any more.
Comment by Tracey Baker on February 11, 2009 at 6:34pm
Especially if they are UNION!
Comment by Lane Doby on February 11, 2009 at 2:46am
Dumb can be weeded out, but some employers simply won't take the time to do so.
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