Are near-misses better than simulations?

What's a "near-miss?" The simplest definition is something bad almost happens, but doesn't. "Bad" refers to actual or potential illness, injury or damage, of course. Sometimes the bad things don't happen because we do something smart. Sometimes we are just plainly lucky. What are some general categories of events in which near-misses happen? Driving, Patient Handling and Clinical Errors from the big three.

Did you ever have a micro-sleep? A micro-sleep is a brief loss of attention characterized by a blank stare, head snapping and eye closure. It lasts a few seconds to a few minutes. I bet most of us can admit to having a micro-sleep while driving. We were lucky the head snapping woke us up, and we didn't hit anything. The unlucky one among us their passengers and perhaps people in other vehicles may have ended up severely injured or dead. If you're among the lucky, do you ever think about your micro-sleep as a near-miss? Do you wonder why your micro-sleep occurred? Do you ever think that you might need to do something about it? Do you ever wonder how many other folks at your service have near-misses while driving? Think about intersection management. Remember the time you almost didn't clear that traffic lane, but decided to stop and check anyway, just in time to watch a car zoom by? Remember how relieved you felt not to be killed? Would your coworkers learn from that experience if you share it? How will anybody ever learn about these dangers without mechanism for reporting, analyzing and mitigating near-miss experiences? Will anybody report anything unless management and employees buy into "Just Culture?" 

We seem to plan and communicate among ourselves better when dealing with large patients. Stop for a moment and recall as many instances as you can with patients whom size was not an issue. Some of them were almost dropped by you, or fell when the stretcher moved while you were trying to place them on it. Were there cases in which your partner did not move in sync with you, or slipped while moving a stretcher with a patient on it? confine your recollections to those near-miss events, do you have any insights that others could learn from? How will you share them?

People in medical transportation, doesn't matter at which level, all deal with the medical part every day. It's easy to think of mistakes we almost made that could have had a major, immediate, perhaps fatal impact. We have the responsibility to avoid developing habits that lead to negative mistakes like those. A Colleague shared a story. He was drawing up some medication from a vial at night. As he replaced the vial, it moved through an area with better lighting and he noticed  particulate matter in it. The medication from that vial wasn't given. The particulate matter would've put the patient at risk for clots and inflammation. This medic shared the information and reminded others to check the integrity of medications in well-lighted areas. Can you think of other examples?

Near-misses should be easy to report. Management needs to establish a culture that stresses the importance of identifying and controlling hazards. Employees should not fear punishment when reporting near-misses. Near-misses should be investigated to determine why the event happened and how its recurrence can be prevented. The results of the investigation should improve your service's safety system. According to the February, 2015 "Safety and Health" the National Council and OSHA recommend the following involvement:

  • Educate workers and all levels of management of the importance of near-miss reporting.
  • Ensure that everyone knows how to use the reporting process.
  • Keep the reporting process and communication loop simple.
  • Make sure that the near-miss reporting process is covered in new employee orientation.
  • Communicate the results of near-misses regularly and issue reminders of their importance.
  • Reinforce that the process is not punitive and show it by rewarding reports that help eliminate hazards.


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.

For safety or risk management questions or suggestions, please contact Markel.

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