2020 - Make it a new yearI have written several hundred of these articles. It is difficult to find new topics, because the issues that generate the need for safety newsletters remain constant. Rear-end collisions, backing into things, striking stationary objects, using lights and sirens inappropriately, and dropping patients continue to plague us. Stress, fatigue, pay issues, and the perception that we don't make a difference lead to burnout-induced attrition. The resultant staffing shortages have limited the number of units a service can place on the street. Obviously, remaining staff will have an increased workload. Maybe we can make 2020 a new year by looking at old issues in new ways.
The components of burnout are exhaustion, cynicism, and inefficacy. Those of you who do the real work of caring for patients have adequate experience with exhaustion. No explanation required. If you have any questions about cynicism listen to the jokes in the break room or garage. Inefficacy means we don't feel that what we do matters. We have had a tremendous impact on the mortality and morbidity associated with sudden cardiac arrest, ST-elevated myocardial infarction, trauma, and strokes - including those resulting from large vessel occlusion. We are increasingly becoming the early warning system for sepsis. Our non-emergency transports are equally important. People die without dialysis. They get sicker when non-urgent proactive assessments or intervention are delayed or missed. Our patients depend on us so much that 74% of people in a recent survey were concerned that burnout among healthcare providers could result in a public health crisis. The National Health Security and Preparedness Index rates states that are most prepared for medical emergencies. States were rated on the number of EMTs and paramedics per 100,000 people, the percent of the population within 50 miles of a trauma center, and the number of physicians and surgeons per 100,000 people. Without you how will people get to trauma centers and doctors? I vividly recall the days in my clinical practice in which unsuccessful resuscitations and ineffective clinical interventions seemed to occur more frequently than successes. The days of multiple back to back transports that required minimal use of clinical skills at times seemed too frequent. As you have similar experiences, remember that everything you do is important. The people you transport rely on you. That reliance is not misplaced. If you didn't care, you wouldn't do this work. You are important in your individual relationships with patients and as a crucial component of the healthcare system. Inefficacy? No way.
Crashes and patient drops continue to result in a significant number of patient injuries. These events do not always occur in emergency situations. The patients we transport non-emergently are fragile and susceptible to injury from forces of a much smaller magnitude than we might anticipate. Both the ambulance and the stretcher are patient movement devices. What's new? Maybe we should think of the ambulance as a big stretcher carrying a smaller one. Since the ACEP standard was published, universal spinal immobilization is evolving into spinal motion restriction. A recent study looked at head and neck kinematics during ambulance transport. Head and neck kinematics were assessed comparing spinal precautions during specific driving tasks. Angular displacement and linear acceleration outcomes were analyzed. A surprising result is that spine injured patients may be exposed to damaging forces without visible head motion. The highest vehicle accelerations, which generate potentially damaging forces, occurred during high speed turns, abrupt stops, and speed bumps. One conclusion from the study suggests that focusing on driver behavior may be a method to reduce harmful patient motion during transport.
I don't like committees. Some say a camel is a horse designed by a committee. My guess is the people on the committee had never ridden either creature. Maybe that's why OSHA has tips for starting a workplace safety and health program, not a committee. Make safety and health core values. Safety must be a daily part of interactions. Reporting mechanisms must be in place so injuries, illnesses, incidents, and near misses are discovered. Personnel must be educated in discovering issues and rewarded for reporting them. Management and field personnel must work together in creating a safety process, which chooses, develops and implements administrative, behavioral, and engineering controls. Realize that the process is ongoing, evolving, and never static.
Start your year by thinking about your decision-making when it comes to safety. New thoughts may give you novel options for a happier and safer 2020.
- Thezard F, McDonald N, et alia, “Effects of Immobilization and Spinal Motion Restriction on Head-Neck Kinematics During Ambulance Transport” Prehospital Emergency Care 2019;23:811-819.
- Kolb E, Sauter M, “States that are most prepared for medical emergencies” National Health Security and Health Index, Robert Wood Johnson Foundation, Philadelphia, Pennsylvania, June 2019
- “10 tips for starting a workplace safety and health program” Safety + Health, November, 2019, page 59.
- “People concerned about burnout among health care professionals, survey shows” Safety + Health, November 2019, page 25.
*Markel Specialty is a business division of Markel Service, Incorporated, the underwriting manager for the Markel affiliated insurance companies.