Paramedics and EMTs have one of the most dangerous of occupations. In addition to the regular news of tragic line of duty deaths, research shows EMS providers are:
- 2.5 times more likely to be killed on the job than the average worker.
- 5 times more likely to be killed in a transportation incident.
- 6 times greater illness and injury rate than the national average.
- 30 times higher risk of a transportation related injury than the national average.
Unfortunately, paramedics and EMTs often prioritize personal comfort and cool factor over safety. When I started my career in paramedicine 20 years ago, there were paramedics who were still getting used to gloves. Many of them would tear off the index finger of the glove so they could feel the vein for IV starts. This was unnecessary and negated any value of wearing the glove.
In the early 2000s, DOT standards mandated donning of high visibility vests and coats while working on federal highways. The first paramedics and EMTs who bought the high-visibility jackets were teased as “bumblebees” by their peers and veteran medics were adamant that they had the right not to be seen if they were not on a call. These attitudes still prevail today and more often than not, high visibility PPE is taken off at the first excuse, if it is even worn at all.
It takes leadership and determination to create a culture of safety that will effectively reduce on-the-job injury and increase use of PPE. Continuous repetition of safe practices is needed to develop and ingrain good habits, and habits are what ultimately provide comfort with the culture and the equipment of safety.
Paramedicine must develop a culture of safety where important PPE is worn every time on every call. Here are six PPE items that we should be wearing, but aren’t.
1. Eye protection
An injured eye often results in permanent irreversible blindness. Eye protection should be worn on every encounter. A simple pair of safety glasses can protect your eyes from ultraviolet radiation, flying particles, sparks, patient assaults and biohazard splatter.
The use of “eye-pro” is getting somewhat better overall. Some major services are even making it mandatory; but, like gloves, it has a long way to go until it is ingrained into paramedicine safety culture.
2. Knee protection
I had not seen regular use of knee protection until I began instructing at the U.S. Air Force Pararescue Paramedic program. All PJ trainees were required to wear knee protection in every lab and in field clinicals.
Knee protection can protect providers from hot asphalt, cold icy roads and biohazards. It can also cushion the knee from the repeated weight of your body and the body you are lifting. This is a smart addition that I do not see paramedics wearing. Knee protection, whether integrated into pants, or as separate articles of PPE, is good practice.
3. Isolation PPE
If you have ever transported a patient on isolation precautions, there is a very good chance that the hospital required you to put on a disposable gown and mask when transferring the patient to the stretcher. But how many of you kept the gown and mask on during the entire transport? Or, did you take it off once you left the ward?
There is a reason a patient is on isolation precautions and the same precautions used in the hospital should be continued in the ambulance. Are you familiar with your department’s procedures for PPE for isolation patients? Does the driver remember to take off the gown when driving and put on a new one at the destination? Recent events, such as the Ebola scare, and the potential for bioterrorism demonstrate that these are questions that every paramedic and EMT should have the answers to.
4. Body armor
Violence against EMTs and paramedics has been occurring since the beginning of paramedicine. This is nothing new. “Mother, Juggs and Speed,” a movie from the 1970s included scenes where paramedics were shot. However, 40 years later, the vast majority of EMTs and paramedics are still not provided body armor. Those who are provided armor are probably not wearing the vests on most calls.
Body armor can not only provide protection against firearms and knives, but can also provide significant protection during motor vehicle collisions. Soft body armor can be worn under a uniform like police officers or a body armor vest that can be easily taken off between calls. Modern armor allows for considerable comfort and movement but there are still issues depending on the type worn. Care must be made in the selection and fitting of body armor.
5. Seat belts
A major issue with paramedic safety is proper seat belts or safety restraints for everyone in the ambulance. Many EMTs and paramedics actively resist properly buckling the patient with all three sets of belt restraints and the shoulder harness. Even worse, some services remove the shoulder harness or tuck them behind the cushion.
Some of my students initially resisted untucking the harness straps from under the cot cushion and actually use them in simulation. A 20-year NHSTA study discovered that only one-third of ambulance patients in serious crashes were secured with both shoulder and lap restraints and 44 percent were ejected from their cots.
EMTs and paramedics are also very bad at wearing seat belts. The same NHTSA study found that 84 percent of EMS providers in the patient compartments of ambulances that crashed were not using safety restraints. Many refuse out of the need to work on patients. Many simply don’t like them. In an accident, they become projectiles and end up suffering serious or fatal injuries.
6. Helmets
Whenever race car drivers get in their vehicles, they do so with a helmet. Whenever police ride a motorcycle, they wear a helmet. When the fire department works on a roadway scene, they do so with helmets. All fans of “Emergency!” know that Johnny and Roy put their helmets on every time they were driving with lights and sirens. Did they know something we don’t?
Although we don’t have good data yet, I believe that head injuries are at the top of the list as the primary cause of serious and fatal injuries to paramedics. I believe this is true both inside and outside the ambulance.
Unfortunately, most EMTs and paramedics are not issued custom fitted helmets that are designed for prehospital tasks. If they have access to a helmet, it is usually issued to the truck and not the person. The truck issued helmet is either a one-size-fits all hard hat designed for construction workers or a one-size-fits-all firefighter helmet. These helmets are not able to provide the same protection as helmets designed for vehicles traveling at high speeds.
Paramedics and EMTs need a helmet that is designed for the work of paramedicine and not firefighting. It must be custom fitted and rated for motor vehicles at speed because on the road is where paramedics get serious head injuries. Paramedics and EMTs need a helmet when they ride a bicycle or ATV to a patient, when they work an accident scene, on all potentially violent scenes and every time they are in the back of a moving ambulance.
We owe it to ourselves and our families to come home every night safe and sound. We owe it to ourselves to stay healthy so we can enjoy our lives and more importantly, our golden years. We must develop and ingrain a culture of safety that protects us. Wearing the proper PPE each and every time is the first critical step to mitigating the hazards of the profession.
