One of the key components of safety espoused in the NAEMT Safety Course is maintenance of proficiency. For clinical activities, if we do something that a physician or nurse deems inappropriate there is no doubt we'll hear about it quickly. The didactic and psychomotor assessments inherent with ACLS, PHTLS, PALS and the like give objective evaluations of proficiencies. For a number of skills, we can estimate proficiency by immediate outcomes: we successfully perform endotracheal intubation or we don’t; we establish an IV or we don’t. What about non-clinical skills? There are two safety issues in medical transportation that have been described as “low hanging fruits”. They are driving and patient handling. When was the last time you honestly critiqued driving or patient handling skills? When was the last time a supervisor objectively critiqued driving or patient handling skills? If a supervisor did a critique, did the criteria employed match your perception of what was needed? The NAEMT Safety Course contains information that may serve as a basis for developing tool suitable for self-assessment or use by a manager.
Assessment of driving behaviors
Are vehicle inspection completed and documented properly? Are crews who perform mechanical inspections trained to do so in a uniform manner? Are seatbelts worn? Does co-driving occur? Are distractions minimized? Does the non-driver handle non-driving activities? Are Emergency Warning Systems activated and de-activated properly? Note the following:
- Is the speed of the vehicle appropriate for the road, environmental and traffic conditions?
- Are intersections cleared properly?
- Are other vehicles “pushed” into intersections?
- Are braking, turning, accelerating, decelerating and stopping done safely?
- Are a spotter and uniform hand signals used when backing?
Assessment of patient handling behaviors
At the beginning of the shift is all equipment inspected and tested for functionality? Does the crew practice loading the stretcher the stretcher at least twice while assessing the stretcher retention system? Are the following patient factors assessed as they relate to patient handling?
- Ability to provide assistance
- Ability to bear weight
- Upper extremity strength
- Ability and willingness to cooperate and follow instructions
- Height and weight
- Other conditions: amputations, spams, fractures, joint replacement, paralysis, cardio-respiratory compromise, edema, osteoporosis, pain, urinary or fecal catheter, very fragile skin
Are the following environmental factors assessed as they relate to patient handling?
- Presence of fixed physical obstructions
- Presence of removable physical obstructions
- Distance the patient must be lifted or carried
- Adequate lighting
- Freedom from bystander interference
- Factors that limit the use of engineering controls or good body mechanics
Does the crew use the information from the patient and environmental assessments to properly form, communicate, and execute a plan. Which minimizes lifting, shares the load, and involves the use of appropriate engineering controls and personnel?
Does the crew lift using the following techniques?
- Heads up and eyes looking into the partner's face
- Team members in position and acknowledge they are ready to lift
- All hands on the lifting equipment prior to lift
- Use the power grip with palms up
- Keep the feet apart and staggered at shoulder width
- Does not twist
- Bends at the knees
- Maintains balance
- Holds the load close to the body
- Performs a small test lift
- Rises slowly
As the stretcher is moved, the crew should use situational awareness, communicate and have full physical control of the stretcher at all times. The stretcher should be properly loaded or unloaded with the appropriate use of the stretcher retention system. If we think about driving or patient handling while performing them, we and our patients will be safer. We can also use these concepts as de-briefing assessment tools after an untoward event occurs. It's easier to fix mistakes if we know from where they come.
Szczygiel, M. (Ed.), EMS Safety, Burlington, MA, Jones and Bartlett Learning, 2017.
*Markel Specialty is a business division of Markel Service, Incorporated, the underwriting manager for the Markel affiliated insurance companies.