There are some of us who say they work in emergency medical services. They don’t like to think of themselves as merely “ambulance drivers” working in medical transportation. Others say that they provide Advanced Life Support, as they perceive Basic Life Support is provided by less skilled individuals with less sophisticated certifications. Then we have the wheelchair/paratransit personnel who have no plans to perform ANY clinical interventions. What’s wrong with this artificial hierarchy?
Independently of the levels of clinical service provided, clients/patients must be moved without injury. We must murder the concepts of “granny calls” and “routine transfers.” No, this article is not about driving. It’s about patient handling: loading /unloading patients, and moving them on stretchers and/or wheelchairs. Some of you might be thinking “this is a no brainer.” You are correct. It is apparent that many people load, unload and move patients without using their brains. Why? They have become complacent.
Those who are complacent are by definition self-satisfied or unconcerned. A great definition of complacency is “self-satisfaction accompanied by unawareness of actual dangers or deficiencies.” When somebody is acutely ill or injured, or in an obviously hazardous environment, we use situational awareness to perceive and mitigate dangers to ourselves and patients. The failure to use this level of awareness on less dramatic transports is common, and has resulted some "common errors":
- We weren’t paying attention and hit a rough patch, the stretcher tipped-over. The patient stayed on the cot, but hit her head on the curb.
- The pavement was slick. I slipped and let go of the stretcher.
- My partner looked away and didn’t see that the cot didn’t connect to the bracket.
- I forgot to secure the rear of the wheelchair and it tipped over.
- My partner raised his side faster than I did. The stretcher tilted and the patient almost slipped out.
- I don’t like to use the shoulder straps on the cot. It’s too much trouble.
- There was a crack in the pavement I didn’t see. It’s not my fault the stretcher tipped over.
Any of these sound familiar? It’s not surprising that nationally, clients/patients injury from drops and other handling mishaps is huge in numbers. Should we be concerned when we transport people non-urgently for interventions or assessment of chronic conditions, we too frequently hurt them? Clients become patients. Non-acute patients become emergency cases.
How many times do you transport a non-emergency patient without evaluating them or the environment? One might think, why evaluate them when there's nothing needed to be done? But the evaluation is important to determine what you need to do to transport them safely. No matter how simple, you need to make a plan. Branch Rickey said, “Where risk arises, it is simply the residue of bad planning.”
No, this does not need to be a complex process with protocols, algorithms and multiple layers of administration. Just take the time to think about a few things.
- Know you patient. Does his/her mind and body work? How do I protect him/her?
- Know your terrain. What do I need to do to get from where I am to where I need to be safely?
- Decide if you have the right resources in terms of equipment and people to move the patient safely.
- Formulate a plan. Communicate it with your team and the patient.
- Constantly be alert to what is going on with your patient and in the environment.
- Communicate with your team and the patient as needed.
- Do this on every transport. Pasteur said, “When it comes to observation, chance favors only the prepared mind.”
*Markel Specialty is a business division of Markel Service, Incorporated, the underwriting manager for the Markel affiliated insurance companies.