SAFETY

[Emt_Sparky]

There are many things out there that are unsafe for us as EMT / PARAMEDICS... tell me what you want to see safer, and HOW if you have an idea....

[weasel 108]

There are many things out there that are unsafe for us as EMT / PARAMEDICS... tell me what you want to see safer, and HOW if you have an idea....

Are you talking as far as apparatus safety? :?

[Ridryder 911]

Albeit, there are probably many devices, procedures, and actions that are unsafe daily however; there are many we do daily that we should not do.

First thing I would eliminate is personal cell phones! Sorry, I am so tired of phones ringing (or should say those damn hip hop or humorous cartoon sound bites... nothing like Pdiddy going off, while attempting to listen for heart sounds) during an assessment. Worse is those that attempt to drive and talk while driving! I do make allowances to talk to dispatch, business (med control, etc.) but there is rarely any thing that can't wait for 30 minutes!

Improper staging of vehicles, from Police, FD, etc.. apparently this is no longer taught! Everyone wants to go immediately to the area and leave EMS unprotected with EMT's exposed to traffic and unsafe areas.... Yes, we loose several EMS personnel every year from this.

There are others, I will have to think of.

R/r 911

[Emt_Sparky]

I guess I mostly care about EMS transport safety. Things like strapping down equipment, safety belt use, safer ambulances. Better practices. Things like that.

[Ridryder 911]

Check out this month's JEM'S it has a whole article on it!... as well as new EMS truck designs!

R/r 911

[dahlio]

I think the biggest concern is personal saftey. How many people honestly strap themselves in during a transport? And even if you had them on, how could you work on a patient. This might sound over the top, and it probably is since I'm saying it. What if we wore harnesses around our waist, and it attached to the roof of the ambulance, so that you can stand up if you had to, and that way you're still strapped in. (yes, its a bit extreme, but i am extreme)

[Dale]

The strap/harness idea has been tried before. Some fellows from Phoenix offered a harness system with retractors. The problem is getting someone to walk-around in it all day (or worse, an entire 24 hour shift.) One of the seating manufacturers has once again resurrected the idea and a few departments are buying it in the name of "safety." Time will tell if the crews continue to use that item a year from now. There are some other seating/restraint ideas that have merit but as long as folks won't even use the existing seat belts in the cab, what personal incentive will they have to use them in the back.

Some of the problem stems from those good old Federal Ambulance Specifications that pretty much mandated interior design for decades. The lack of adequate seating to allow for easy reach of patients during transport has contributed to injuries and deaths since it is impossible to sit on the bench while sitting correctly and wearing the seatbelt snugly as designed. The more innovative agencies have adopted sliding high-back seats that will permit someone to "slide" towards a patient for easier access while wearing a seatbelt securely. This is a common feature in most European ambulances for years but only slowly being adopted in the US. The new ambulance specification revisions expected later this year will finally address the idea of having more secure seating and actually only requiring the capability to transport one supine patient on a primary litter. No more squad bench (or even the streetside "CPR" seat) will be required but it can still be a customer-selected "option" if required for local circumstances.

Amubulance cots are supplied with shoulder-style restraints to keep patients from sliding off the head end of the cot during a rapid deceleration. Accident investigaions have revealed this problem to be a cause of injury/death to patients. The cot manufacturers strongly urge users to fasten these straps on patients. But you would be surprised as to the number of cots I see where they have either been removed (sometimes for cleaning and never replaced) or the crew thinks they are cumbersome and either removes them from the cot frame or tucks them under the mattress.

Another issue has to do with loose items placed in the patient compartment. Keep everything enclosed with crash-worthy brackets (not some flimsy piece of velcro straping or jury-rigged strapping created at your station) or contained within cabinets with good latches. Imagine sitting in the pt. compartment and having it rotate 360 degrees (on its long axis.) Now imagine what happens to all of the items that are sitting exposed and depending upon gravity to keep them in place. Next imagine what happens during a violent impact with a car, tree, building, ditch, etc.? That deceleration creates instant missiles out of those same items (med kits, oxygen bottles, defibrillators, pulse oximeters, etc.) I had a friend killed over 3 decades ago by a small oxygen cylinder that literally "flew" from its horizontal mounting bracket in the patient compartment and hit him in the head while sitting in the driver's seat when they were in a head-on collision.

Check out your own rig to see if you have kits lying loose on top of the cot or squad bench. Is there an oxygen cylinder lying behind the squad bench cushions? Is the defib unit sitting unrestrained on the floor or countertop?

Driver training is another area that probably doesn't get the attention it deserves. This is especially true for those that don't have the opportunities to drive the ambulance on a daily basis and respect its handling characteristics (like in a volunteer rescue squad.) Even the career folks can run into problems if they are using a variety of vehicles instead of standardizing by only driving one kind of vehicle (i.e. a van versus a modular.) Each kind of vehicle has significant differences in turning, braking, center of gravity, etc. It is no different in some fire departments where their accident rate seems to be higher where a crew is operating a spare rig that is radically different than their normally assigned vehicle.

Crew visibility at the scene is also important. In many countries, high-visibility clothing seems to be the norm but we still see many agencies here in the US that adopt darker clothing that can make crew members virtually invisible during low light conditions. And flashing lights really don't offer you much protection when there are a multitude of vehicles sitting at a scene. Approaching drivers are distracted by all of the different flashing lights and may not pay attention to the person actually standing in the roadway. I believe there are some new hi-viz clothing standards being adopted soon that should apply to construction workers and others that actually have to operate on roadways. You may want to do some research on these items. In my former department, we wore those hi-viz vests routinely at scenes that were not a "house call." And this was over 15 years ago!

[Emt_Sparky]

Dale and everyone else,

I hear you. I have been in EMS for almost 20 years now, and everything that you said is very true.

Safety is a challenge, form the individual to the Politicians. Laws and standards NEED to change. The US is FAR behind other places like Australia, and Europe.

I am working with a non profit organization whose entire purpose is to prevent transport injuries. Feel fee to check out these links.

http://www.objectivesafety.net/

and

http://www.globalemsforum.org/

There was a very informative webinar on April 25th. A recorded version of this presentation is posted there.

The Mission statement of the GLOBAL EMS FORUM is:

"The Global EMS Forum is a gathering together of like-minded health care professionals and providers caring for patients in the fields of pre-hospital, out-of-hospital, ambulance and Emergency Medical Services (EMS) from diverse environments who believe that the interests of these patients are best served by shared experience, knowledge and practice between providers from different systems globally. The aim of this collaboration is to improve the care that can be provided to save life and prevent further injury or illness, and caring for those who are in urgent need.”

Come check us out. Please feel free to send me a message if you want more info.

[CBEMT]

I think the biggest concern is personal saftey. How many people honestly strap themselves in during a transport? And even if you had them on, how could you work on a patient. This might sound over the top, and it probably is since I'm saying it. What if we wore harnesses around our waist, and it attached to the roof of the ambulance, so that you can stand up if you had to, and that way you're still strapped in. (yes, its a bit extreme, but i am extreme)

Simple physics should tell you that this is a bad, bad idea.

Adjustable bucket seats with 4-point harnesses. Anything less is gambling with your life.

Ditto to what Dale said about shoulder straps on the patient and unsecured equipment. Guess what a portable O2 bottle does to the human head at highway speeds?

[Dale]

We have been installing 3-and 4-pt. harness systems along with adjustable high-back seats for at least 15 years. Unfortunately, many clients do not appreciate the value of such safety items and will focus more attention on how many warning lights they want instead of occupant protection. And even some of those agencies that do offer an upgraded level of protection still have issues with getting their staff to consistently use these items on a routine basis. Old habits die hard and you can't be everyone's mother all of the time.

We also see EMS providers installing little "cups" on their own in the floor or stepwell of ambulances to "hold" portable oxygen cylinders. Those tanks are held in by gravity and single thumbscrew! Very dangerous! I wonder why the manufacturers of those products still sell those items when they are not compliant with any existing standard. I know of only one manufacturer that makes a "compliant" crash-worthy portable cylinder restraint system.

The new KKK "F" standard coming out will adopt by reference the newly revised AMD (Ambulance Manufacturing Division) testing standards that will require, for the first time, actual performance standards for small cylinder mounting systems and safety nets, just to name a couple of new items. There have been a lot of "questionable" things done for years by some builders that will finally have a "quantifiable" standard applied so such items are supposedly meeting minimum requirements. Of course, customers must depend on the honesty of a vendor to ensure that what they had "tested" to meet these new standards is actually what gets installed on each vehicle.