New perspectives for the new year, part 2

In this article we will continue the discussion on the most common categories of EMS professional injuries.

Slips, trips, and falls are loss of balance injuries. They occurred at a rate of 1.4 per 100 FTEs. These injuries were the result of falls which happened on the same level, changing surface conditions, and stairs. Rushing and moving while carrying a load may decrease environmental awareness. Administrative controls, in addition to proper policies and procedures, should include systematic, recorded direct observation of personnel’s patient handling behaviors. Engineering controls include proper preparation of workplace surfaces. Footwear should increase traction, provide adequate ankle support, provide protection to the toes and dorsum, and give adequate cushioning. Behavioral control includes enhanced situational awareness and the recognition of footwear as personal protective equipment.

Motor vehicle incidents are a surprising number four at 0.8 motor vehicle events per 100 FTEs compared to 0.04 per 100 FTEs for other workers. Crashes remain the greatest cause of line of duty deaths. The likelihood of being killed in an ambulance is 2.5 times that of a general vehicle. T-bone events and intersection crashes are most common. A NHTSA investigation of 48 ambulance crashes showed that 84% of EMS workers were unrestrained in the patient compartment at the time of the crash.

Administrative controls are extensive. In addition to the usual policies and procedures, they extend into system design. Systems should be structured to minimize the number of lights and siren responses. The efficacy of a service should be based on clinical outcomes, not response times. Dispatchers must screen calls to activate the appropriate level of response. Lights and sirens responses should be reviewed in the same fashion as high risk clinical interventions. A recent NHTSA publication states that the goals of using lights and sirens on less than 50% of primary responses and 5% of scene to hospital responses are necessary to ensure safety. Systematic direct and recorded observation of driving behaviors is critical. Engineering tools such as GPS and onboard monitoring are used to enhance operational efficiencies, monitor driver behavior, and collect data for trend analysis. Vehicle design modifications are intended to provide safer work environment by enhancing external and internal protective features. Behavioral controls require the training and re-training of drivers. It must be understood that everyone in the vehicle has the responsibility for safety. Due regard mandates the use of constant scene size up. There should be no risk taking.

Violence and assaults occur at a rate of 0.6 per 100 FTEs. Forty-three percent of assaulted workers had less than 4 years’ experience. Half of the assaulters were under the influence of drugs or alcohol. There was no law enforcement presence during 62% of assaults. Police reports were made in 42%, but were more likely to occur when police were present at the time of the assault. Risk of assault for EMS workers is twice that of private industry. Sixty-seven percent of assaults were verbal and 44% had a physical component. Less than half the victims sought care. Administrative controls should show management support, create a reporting process and ensure that follow-up is guaranteed. There must be no fear of repercussion. Assault should, by policy, not be viewed as “part of the job.” It is not acceptable for those who report assault to be perceived as someone “who can’t take it”. Engineering controls include personal protective equipment. Behavioral controls require an awareness of the “violence footprint” of the service area. Situational awareness for recognition is critical. De-escalation and self-defense training can be used to enhance safety and professional confidence.

Think about how this article relates to your personal experiences. The operative word is think. Do you actually learn from what you endure? Or do you just react?


References

  • Bledsoe, BE, Sweeney RJ, Berkeley RP, Korey CT, Forred WJ, Johnson LD. “EMS provider compliance with infection control mechanisms is suboptimal.” Prehosp Emerg Care. 2014; 18:290-4.
  • Department of Health and Human Service, “The Opioid Epidemic in the US” www.hhs.gov accessed July 7, 2017
  • Drug Enforcement Agency, “Fentanyl: A Briefing Guide for First Responders”, www.dea.gov accessed June 23, 2017
  • Kupas DF, “lights and Sirens Use by emergency Medical Services: Above All Do No Harm.” Submitted by Maryn Consulting, Inc. for NHTSA Contract DTNH22-14-F-00578, May , 2017.
  • Reichard AA, Maarsh SM, Tonozzi TR, Konda S, Gormley MA. “Occupational injuries and exposures among emergency medical services workers. Prehosp Emerg Care. 2017;21(4); 420-431.
  • Wadman M, “Biased opioids could yield safer pain relief.” Science, 2017;358: 63655; 847-8.
The information provided in this article is intended for general informational purposes only and should not be considered as all encompassing, or suitable for all situations, conditions, and environments. Please contact us or your attorney if you have any questions.