A culture of safety

The Centers for Disease Control and Prevention (CDC) and the National Institute of Occupational Safety and Health (NIOSH) performed a four year study in which data was captured from emergency department records. It showed that more than 22,000 EMS workers are treated annually for work-related injuries. Most of those injured were full-time employees with less than 10 years’ experience. The majority of injuries were sprains and strains to the back and neck. Injuries happened during the care and transport of patients during 911 calls.

Body motion injuries as a result of excessive physical effort, awkward posture, or repetitive motion, resulted in 6,000 injuries per year. Exposure to harmful substances, such as blood or respiratory secretions, injured another 6,000. An area that we obviously do not give adequate attention to is the injury process related to slips, trips, and falls, which accounted for 4,000 injuries. Note that this is twice the number associated with motor vehicle incidents. Sudden stops, swerves, and crashes accounted for 2,000 injuries. Violence and assaults matched the annual frequency related to motor vehicle incidents of 2,000.

The CDC and NIOSH recommended that employers create a culture of safety. This is achieved by mandating practices that prevent injuries, maintaining a reporting system so that injury data is captured and monitored, and identifying near misses. A near miss is an event in which a negative outcome is narrowly avoided. On occasion, it is a matter of happenstance. A near miss may also occur as the result of a specific behavior. A good reporting mechanism creates the opportunity for near misses to validate safe behaviors. For example, years ago a driver called me to say that by following the lane clearing practice shown in “Arrive Alive Do No Harm”, she avoided a potentially fatal collision. When I asked her with whom she shared this information besides me, she said nobody. This was clearly a wasted opportunity.

Several recommendations were made for employers:

  • Protect workers and promote safety, health, and well-being through workplace policies, programs, and activities. Exercise, healthy diets, good sleep habits, and access to mental health support are pillars of this process.
  • Promote safe patient-handling techniques. Employees must be physically capable of performing the work, be given adequate training to lift properly, determine what is needed to perform the lift safely, and have immediate access to appropriate equipment.
  • Protect workers from exposure to blood, other potentially infectious body fluids, and environmental toxins. In addition to compliance with OSHA Bloodborne Pathogens Standards, employees must be informed of ever-changing hazards in the environment (e.g. carfentanyl) and be given the tools to recognize them and protect themselves.
  • Prevent slips, trips, and falls. Footwear should be considered personnel protective equipment. It must be durable, slip-resistant, cushioned, and provide adequate ankle support. Personnel must be trained to recognize hazards and reduce fall risks.
  • Improve motor vehicle safety. People must actually think about driving when the vehicle is in motion. Getting the vehicle safely from one location to another is the responsibility of everyone in the vehicle. Personnel and vehicle contents should be properly restrained.Texting, the use of cell phones (including hands-free), and manual data input must be prohibited while driving. Naturally, drivers should be trained and the effectiveness of the training should be documented by monitoring driver behaviors.
  • Prevent violence by patients. Policies, procedures, and training to prevent workplace violence are critical components of a culture of safety. Personnel must be given skills in recognizing dangerous situations, de-escalation, and self-defense.

    Although these are recommendations for employers, everybody has the responsibility to promote safety. Injury prevention will not occur unless those in harms way exercise vigilance and acquire the skills to protect themselves.


  • “Emergency Medical Services Workers: How Employers Can Prevent Injuries and Exposures.” https://www.cdc.gov/niosh/docs/2017-194/pdfs/2017-194.pdf
  • Reichard AA, Marsh SM, Tonozzi TR, Gormley MA.Occupational injuries and exposures among emergency service workers. Prehosp Emer Care 2017; 21 (4): 420-431

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