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Everyday EMS
by Greg Friese

Take a Time-out for Safety

This week is 2009 Fire/EMS Safety, Health and Survival Week. Many fire and EMS agencies are taking a time-out from regular training activities to have a department safety stand down. My own department is substituting our monthly training meeting with a review of the International Seatbelt Pledge and a cook-out.

As you know, safety should not be isolated to a single training meeting, evening, day, or week. Safety is an integral component of all response and training activities. As you review safety procedures and practices this week, consider how EMS — like other healthcare providers — can more regularly add a "Time-out for Safety" to EMS calls and fire incident response.

My running and cycling partner is a general surgeon. At the start of every procedure, he leads his surgical team in a time-out for safety to confirm these important details:

      • Correct patient identity
      • Correct side and site
      • Agreement on the procedure to be done
      • Correct patient position
      • Availability of correct implants and any special equipment or special requirements

A time-out for safety would be appropriate in many EMS calls and fire incidents. Checklists or confirmation criteria would make sense for:

      1) Patient extrication from motor vehicles, collapsed structures, and unstable surface
      2) Rapid sequence intubation to secure a patient airway
      3) Application of pharmacological restraint to excited delirium patients
      4) Transferring patient care to an air or ground ALS intercept crew

I would like to see a checklist like this before initiating code 3 — red lights and sirens — patient transport:

      1) Patient condition meets protocol indications for code 3 transport
      2) Patient secured to cot with lap, leg, and shoulder restraints
      3) All patient care providers wearing seatbelts
      4) Equipment — like cardiac monitor — secured with brackets, netting, buckles, or belts
      5) Experienced driver trained and authorized for code 3 transport
      6) Receiving hospital notified of code 3 transport and prepared to promptly receive patient
      7) Weather, road conditions, and other vehicle traffic suitable for code 3 transport

Does your EMS service use checklists before high-risk procedures? Please share links in the comments area. Also see an additional post at for Safety, Health, and Survival Week.

About the author

Greg Friese is Editor-in-Chief of He is an educator, author, paramedic, and marathon runner. Ask questions or submit tip ideas to Greg by e-mailing him at

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