How to change bad behaviors in EMS

Past behavior can get in the way of common sense

One of the most amazing aspects of EMS is the seemingly endless array of tricks and pearls that are handed down from generation to generation. While many of these street skills are what make a responder a true professional and master of their trade, there is an equal number of these tricks that may actually contribute to their downfall.  

The examples below demonstrate both why it can be difficult to teach old EMS dogs new tricks, as well as a promising model for using new recruits to drive organizational change.

The Patient Lifting Problem
I recently taught a series of injury prevention classes for a very large EMS operation. One of the movements that consistently injures responders is loading and unloading the stretcher.

After an in-depth lecture complete with pictures and graphics on how and why injury occurs from improper lifting, we moved to the hands-on portion of the class. The medics all practiced and worked toward mastering safer and more effective ways to load and unload the stretcher, exploring different scenarios where they can apply these new techniques. Once the class was over and the responders had demonstrated proficiency in understanding their new ergonomic actions, they were ready to hit the street.

Now, one would think that if you have been shown a better and safer way to do your job, you would follow those directions. If you could reduce your chance of injury while at the same time reducing your exposure to liability, wouldn’t you do it? Unfortunately, the change has been much harder to effect.

The human psyche is a very interesting thing. We often do things that we know will cause injury, pain or even disease. Yet we do them every day. Take smoking as an example – we know what it will do to us, yet many of us still make the conscious choice to continue doing it.

We adopt behaviors such as outright poor nutrition, which we also know will contribute to obesity and disease rates. We simply accept this as part of the job. The amount of money that is spent on wellness initiatives and nutritional education is staggering, yet very few organizations can show behavior change and return on investment through these educational endeavors.

What makes humans and in this particular case public safety professionals so resistant to changing their underlying behaviors?

Solving the Problem
Another EMS service that I have worked with has taken a different approach to solving this problem. While considerable time is spent retraining, reeducating and reinforcing their incumbent employees’ underlying biomechanical behaviors, they are spending very little time re-training new employees.  This particular service gets most of their applicants from the local community college.

Working closely with the instructors at the community college, we developed a training curriculum that teaches real-world patient and equipment handling based on sound scientific principles. New responders enter the field with an already-established base of safe patient and equipment handling principles.

These new responders are shown simple and effective pre-shift and on duty injury prevention techniques such as pre shift stretching and simple exercises that further reduce their chance of injury.

Let’s go back to that first department where the incumbent employees were taught safer and more efficient ways to do their job. These responders have had a very hard time adopting these techniques into their everyday use. Here's why: by the time they were introduced to these new techniques, the old ones were so ingrained that it’s been difficult to change their behavior.

Do we expect to bring all responders into the fold? Yes, someday. Train the new responders so they in turn can help teach the incumbents. When a quarter of the employees change behavior, then half and over time, changes will occur. From there, an interesting phenomenon occurs. The rest of the employees, the resistant final quarter, will follow the crowd.

Training does change behavior, but we have to understand that there are multiple paths and methodologies that public safety departments must employ to get the desired result. We just have to better understand our workforce and adapt our approach to meet the educational and training needs of all our responders.

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