A Culture of Safety Saving Ourselves First

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A Culture of SafetySaving Ourselves First

• for
• Hudson Valley
• Leading EMS Providers
• Craig van Roekens MD MBA MPH FACEP
• Chair HVREMAC ViceChair of HVRTAC
• Director of Emergency Services at VBMC

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Municipal, Volunteer and Commercial EMS workers

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The Reality of EMS

• Underpaid
• Overworked
• Unrealistic Expectations
• Hazardous Situations without Hazard Pay

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Occupational Risks

• Violence
• HazMat CBRNE Issues
• Infectious Issues (Blood/Airborne/Contact)
• Circadian Sleep Issues
• Stress/Random
• Lifting/Back Issues
• Transportation Risks

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Occupational Fatalities
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EMS Legend/Lore

• We raise the dead
• The Golden Hour Exists
• Lights and Sirens Save Lives
• 8 minute response time saves lives
• Helicopters save lives
• Bryan Bledsoe

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EMS CultureHero Complex

• We do need safety devices
• We do not need masks
• We do not need seat belts
• We do not need to obey traffic rules
• We do not need helmets/reflective gear
• We do not need sleep
• We do not need to take care of ourselves
• We want to be heroes

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ED experience

• Flu/Pneumonia shots
• Mask, gown and glove usage
• Tetanus current
• Hand washing
• Lifting
• Seat belt usage
• Work hours

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Culture
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Structure/Process/Outcomes

• Training/Education/Safety Officer
• Equipment/Vehicles/Design
• Policies/Procedures/Manuals/Certificates/Skills
• Measurements/Tracking/Trending

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Scene Safety

• Others are paid more and have the right equipment
  and the right policies

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Not standard EMS gear

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Also unfortunately not standard EMS gear

• Every patient, every time?

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Also not standard gearsafety reflective uniforms

• Every roadside stop?

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Violence
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Perhaps someone else can be doing the knocking
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Challenges of 24/7/365

• Increased stress
• seconds of shear terror, hours of utter boredom
• Increased obesity
• Increased diabetes
• Increased atherosclerosis
• Increased cancer
• Increased depression, alcoholism and substance
  abuse

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Policies on Work Hours on Wellness?

• What about all those other jobs?
• Overtime?
• Continuous, consecutive, cumulative hours?
• Mandatory physicals, screening for blood
  pressure, cholesterol, diet, cancer, stress
  tests, exercise facilities.
• CISD teams or process?
• On education on safety issues?

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Remember how to lift?
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Our aching backs

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Butthe real problem

• Transportation---¾ EMS deaths
• Aeromedical and Ground
• Exemptions from FAA, NHTSA, FMVSS
• No requirements for EMS drivers
• WE EMPHASIZE RESPONSE TIMES

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Daily Challenges

• CPR done in moving vehicle
• IV sticks/intubations in moving vehicle
• Lights and Sirens
• Combative patients who may be altered by
  substance abuse and/or withdrawal as well as
  psychiatric issues

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Q What do these two Ambulances have in common?

• A They are both manufactured using plywood

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• I DONT NEED NO
• SAFETY RESTRAINT
• SYSTEM
• WHEN I'M IN THE
• PATIENT COMPARTMENT

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ITS NOT IMPORTANT TO DO ADAILY VEHICLE CHECK
OUT

• CAUSATION NO DAILY CHECK OUT
• NO RECORDED TIRE PRESSURE
• NO USE OF OVER THE SHOULDER
• SAFETY RESTRAINT SYSTEM
• IMPROPER INSTALLATION OF THE
• STRETCHER SECURING SYSTEM

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• Built for SPEED

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Crashes are predictable

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Novel ideaprotect the brain

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Fleet inspections/maintenance

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Intersections

• Hazard by Design

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Who is Driving?

• NATIONAL STATISTICS SHOW THAT
• 10 20 OF ALL COMMERCIAL
• DRIVERS
• CAUSE
• 80 90 OF THE ACCIDENTS

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(No Transcript)
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Road Safety, Inc.Driving Simulator
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Who is flying and loading?
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FDNYEMS Academy
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Army and Marine CorpsDriving Simulators
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Marketing for your competition
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One Crash will change lives

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Imagine this.
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2008 Fire/EMS Safety, Health and Survival Week
June 22-28, 2008

• 1. Initiate an emergency vehicle policy, to
  include
• Always buckle up.
• Always stop at red lights and stop signs.
• Always drive at speed limits and defensively.

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2008 Fire/EMS Safety, Health and Survival Week
June 22-28, 2008

• 2. Fully implement the Wellness-Fitness
  Initiative
• Provide annual medical and physical
  evaluations.
• Provide equipment and time for exercise.
• Provide nutrition information.

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2008 Fire/EMS Safety, Health and Survival Week
June 22-28, 2008

• 3. Fully implement NFPA 1500, especially
  sections addressing PPE
• Provide compliant PPE.
• Train and enforce use of PPE, including
  respiratory protection.

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Needle less almost

• Most Agencies

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Safer medication routes?

• Intranasal Route (Alamo initiative)

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Safer medication routes?

• Nitrous self administration (Arlington)

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Safer Noninvasive Respiratory Support

• CPAP devices (MLSS and RPS)

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Do we really need to do CPR en route?

• LAGRANGE initiative

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Hands Free?

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Event Recorders

• Film, audio, speed, acceleration, GPS

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Too little too late

• The auto industry has less than 10 years to
  protect my kids

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Develop a Culture of Safety

• Important for your agency
• Important for your county, region, state
• Important for yourselves

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Structure, Process, Outcomes

• Have a Safety Officer
• Have a Safety/Wellness Plan
• violence/infectious/HAZMAT issues
• sleep/work/rest/overall health
• Vehicle/Operator inspections/training/monitoring
  
• Provide training, support, policies, manuals,
  equipment
• Track/Trend/Benchmark

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Take care of yourself
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Promote a safer culture
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Credits to

• www.objectivesafety.com
• www.thomcosafetynet.com
• www.firefighternation.com
• Cms.firehouse.com
• And others