Editor’s note: With this issue, we wrap up our Safety Leadership column. Many thanks to Michael Greene, Daniel Patterson and Blair Bigham for covering a vitally important issue in our industry.
Fourteen years ago, I learned a new concept: the statistical value of a life. From the first column in this series, you’ll recall that on Dec. 14, 1997, I also learned the heartbreak and pain of three lives tragically lost in the line of duty.
Very soon after this tragedy, I discovered that insurance settlers and workers’ compensation folks look at the loss of life in very analytical, actuarial terms: the value of a statistical life (VSL). At one point, the term VSL was actually uttered to a family member in the course of settling the loss of a loved one’s life. When the family member shared this with me, I was devastated, angry and speechless. How insensitive to treat a life, a lost life, a hero’s death as a formula, an exchange of monetary value to be quantified and “paid off.”
Since that time, I’ve learned the true meaning of VSL, developed by W. Kip Viscusi, a professor of economics at Vanderbilt University, but I have never accepted that a life, any life, is less than priceless. Like many of you, I’ve spent my life fighting death on behalf of fellow humankind, people who were total strangers prior to a 911 call.
Daniel Patterson, Blair Bigham and I have spent the past 12 months collaborating and sometimes conspiring for a change in the EMS approach to patient, caregiver and, yes, culture of safety. We have presented our evidence-based arguments, shared new assessment techniques, demonstrated examples of industry safety leaders, and provided a simple template for your organization to design and implement a safety management system (SMS). We now offer one final argument for engineering SMS into EMS.
The value of a life
Economists use the concept of VSL to look at the risks people are willing to take and how much they must be paid to take them. These studies, known as “revealed preferences studies,” look at a person’s actual choices in risk-taking from an economic perspective. A common source of such choices is the labor market, where jobs with a higher risk of death correlate with higher wages. For example, a company must pay lumberjacks an additional $1,000 a year to perform work that generally kills one in 1,000 workers. It follows that most Americans would forgo $1,000 a year to avoid that risk—and that 1,000 Americans will collectively forgo $1 million to avoid the same risk entirely. That number is said to be the “statistical value of life.”
Another method used to estimate the VSL is to ask people how much they are willing to pay for a reduction in the likelihood of dying.
So what is the value of a statistical life? $5 million? $7 million? According to Viscusi, it’s $8.7 million—the full range of figures used by the federal government in deciding which safety measures provide the greatest benefit. Feeling uncomfortable about this discussion yet?
“The reality is that politics frequently trumps economics,” said Robert Hahn, a leading scholar of the American regulatory process. Depending on the branch of government and the issue being decided, the VSL varies by $2 million to $3 million and some change. But Hahn said that putting a price tag on life still is worthwhile to help politicians choose among priorities and to shape the details of their proposals. “Even small changes,” he said, “can save billions of dollars.”
So where am I going with this discussion? We’ve said that EMS is not risk-free. And all of us know that our industry isn’t a cash cow. Budgets are being cut, EMS agencies are closing, reimbursement is declining, and expenses are increasing. You may be looking at SMS development and thinking, We can’t afford that.
OK, reality check here ... how much time, effort and cash have you invested in the SMS concept so far? The cost of your subscription, time spent reading and investigating the ideas we’ve offered—maybe you’ve even started to implement the SMS process at your organization. So far your SMS has cost nowhere near the millions of dollars of a VSL. Depending on the size of your organization, you’ll likely spend just hundreds. What are you willing to pay for a reduction in the likelihood of losing a crew member or patient in an accident? Safety management isn’t about how much you spend in dollars; it’s about how much you invest in safety leadership, culture and the commitment to high reliability. Said simply, spend a little on SMS, save millions on VSL! Even small changes can save a life. It’s about the people—and that, after all, is the business we’re in.
To restate our point, consider, if you will, dialogue from characters in the Disney animation Pocahontas:
Grandmother Willow: There’s something I want to show you. Look. (Dips a vine into the river, creating ripples.)
Pocahontas: The ripples.
John: What about them?
Grandmother Willow: So small at first, then look how they grow. But someone has to start them.
Safety glasses, $5; steel-toed work boots, $100; turnout gear, $500; computer aided dispatch, $50,000; ambulance, $100,000; salary expenses, $500,000; everyone home safely, priceless.
Take a dip in SMS. The ripple starts with you.
Michael Greene, R.N., MBA, MSHA, is a senior associate at Fitch & Associates (fitchassoc.com). He can be contacted via e-mail at mgreene@fitchassoc.com or by phone at 816-431-2600.
Daniel Patterson, Ph.D., MPH, EMT-B, is currently conducting new research on teamwork and conflict in EMS, sleep and fatigue. He regularly podcasts safety topics at EMSARN.org.
Blair Bigham, ACP, MS, EMT-P, is an associate scientist at St. Michael’s Hospital in Toronto and the principal author of Patient Safety in Emergency Medical Services: Advancing and Aligning the Culture of Patient Safety in EMS, published by the Canadian Patient Safety Institute in partnership with the EMS Chiefs of Canada and the Calgary EMS Foundation.