Editor’s note: Safety has emerged as a national EMS priority, as marked by the “Changing the Culture of Safety” initiative recommended by the National EMS Advisory Council and sponsored by the U.S. Department of Transportation. With this issue, BP begins a series of 12 articles exploring the topic from a variety of perspectives. The lead author is noted safety expert Michael Greene, R.N., MBA/MSHA, a senior associate at Fitch & Associates. He has served in numerous front-line and leadership positions throughout his career, working in volunteer and paid search and rescue, and as a paramedic, a county EMS director and an air medical/critical care transport director. He is also the author of numerous articles and chapters on EMS and air medical transport topics.
Our peers in helicopter emergency medical services (HEMS) have been catching a lot of flack in the media recently, due to several high-profile incidents and government investigations. Maybe you’ve been thinking, Thank goodness it’s them, not us. But what are you doing to achieve the safest environment for your staff and patients?
You may find my opinion harsh or even critical, but I don’t see much activity at the grassroots level in making ground EMS operations safer. There seems to be an intense focus on “the box,” meaning the area behind the ambulance cab, but not much activity out of (and beyond) the box. Where are the vision, the commitment, the tools and the passion to meet our guiding mission, “First do no harm”?
Did I catch you stifling a yawn? Yes, I’m talking about day-in, day-out safety manuals; policies and procedures; documentation; reporting; risk management; hazard identification; and continual improvement. Do you delegate these tasks to others, place them on your management agenda once a month or once a quarter, and recite the mantra “safety first” but shudder when you wake to the phone ringing at night? If so, you’re not alone.
Bringing a painful lesson home
I was yawning the night of Sunday, Dec. 14, 1997, after a long day of skiing with friends and enjoying a rare evening at home alone, with my wife and kids visiting out-of-town relatives. I was just getting into bed when the phone rang at 9:31. On the other end of the line was my communications specialist, who, voice wavering, said, “We have a helicopter down.” Tragically, EMS helicopter N771AL struck wires on takeoff from a multi-casualty accident scene in Littleton, Colo., impacting the frozen ground upside-down at an estimated 23 G. Two medical crew members, flight nurses Leslie Feldmann and Beth Barber, along with pilot Pete Albplanalp and a critically injured patient, died instantly. In the blink of an eye, lives were lost, and lives changed.
While most were celebrating the holidays that December, AIR LIFE Denver, along with an outpouring of the EMS community, wept publicly, attended funerals, consoled grief-stricken family members and privately wondered, Are we safe? My own river of tears carried the crushing weight of responsibility for lives lost on my watch. Had I put safety first? Could I have done something differently? Concern for the safety of my program and team became overwhelming. Could I face a wife, husband, parent, child or the community at large and say I had done everything in my power as the steward of the service to develop, maintain, promote and ensure the safety of the lives entrusted to me? Had I been honest that the baseline risk in EMS transportation isn’t zero? (Emphasis added.) Thus began my quest for answers to these difficult yet imperative questions.
Think it only happens to the other guys?
Do you think this can’t happen to you, your service or your community? Do you assume this is a HEMS issue only? Do you believe ground EMS is safer? I think not. Even a cursory review of recent news headlines would suggest otherwise:
- Ambulance involved in fatal accident”: CBS Philadelphia, Oct. 10, 2010.
- Police say ambulance driver fell asleep before head-on crash”: Floyd County, Ga. (WRCB), Oct. 14, 2010.
- Ambulance carrying accident victim hit on I-95”: Greenwichtime.com, Oct. 17, 2010.
- Massachusetts ambulance, vehicle crash left Taunton man dead: 3 hurt”: Justicenewsflash.com, Oct. 27, 2010.
In fact, according to a 2002 report in Annals of Emergency Medicine, the transportation fatality rate for EMS workers is nearly five times that of other U.S. workers. That same report found that in the 10-year period from 1988 to 1997, there were more than 350 fatalities and 23,000 injuries to people involved in ground ambulance crashes. And a Canadian study concluded that the fatality rate in ground EMS was 1.7 per million ground miles traveled, higher than HEMS at 0.4 per million air miles traveled. Enough said?
The Association of Air Medical Services (AAMS) has developed a goal of “zero errors of consequence” in air medical transport, coined Vision Zero. A worthy vision no doubt, but how does that translate to the everyday, sometimes mundane safety activities at our organizations? How does the “vision” allay the fears of a family member when his or her loved one leaves for work each day?
Enter the concept of a high reliability organization (HRO). An HRO is an organization that has succeeded in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity. In other words, an HRO is an organization that conducts relatively error-free operations, over a long period of time, making consistently good decisions, resulting in high-quality, reliable operations.
Sound too good to be true? Well, if the goal is a high reliability organization, then the “how” is through the development of a safety management system (SMS). In the toolbox of the HRO, an SMS is a coordinated, comprehensive set of processes designed to direct and control resources to optimally manage safety, which takes unrelated processes and integrates them into one coherent system, facilitating proactive hazard identification, promoting a safety culture (attitudes, behavior, ownership), and providing a systematic way to control risk and to provide assurance that the risk controls are effective.
Thanks to the foresight of publisher Keith Griffiths, Best Practices will be publishing a series of safety columns during the next year, written by myself and safety experts Daniel Patterson, Ph.D., assistant professor in the Department of Emergency Medicine at the University of Pittsburgh School of Medicine; and Blair Bigham, MS, a Toronto ground and air paramedic and an internationally recognized investigator/researcher for the University of Toronto who has been involved with a variety of safety-based studies.
Specifically, this series will help you transform your organization into an HRO through SMS development. Each month, we will help you build your own SMS, pillar by pillar, starting with a solid foundation and ending with a roof to weather the safety storms.
Got your attention? Then stay tuned!
