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How EMS can improve operational safety through SMS and risk mitigation

A phased approach to adopting the four pillars of a successful safety management system leads to provider safety and a just culture


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This article originally appeared in the Sept. 5, 2019, issue of the Paramedic Chief Leadership Briefing, Understanding EMS assaults | Risk mitigation | Hurricane Dorian assistance. Have you subscribed to the Paramedic Chief eNewsletter? Manage your subscriptions today.

I recently attended the Association of Air Medical Services (AAMS) sponsored Safety Management Training Academy in Pittsburgh, Pennsylvania, as a year one student. I learned that implementing a successful safety management system (SMS) into an air or ground EMS transport system takes vision, discipline and patience. To be successful, it requires a commitment from the very top of an organization and must extend to the entire team.

SMS offers an organized and measurable format to grow your sustainable safety program with deep roots. Here’s a brief overview of the four pillars of SMS:

  1. Safety policy. Work with senior management to write a strong safety vision statement which becomes your organization’s guiding light. Establish senior management’s commitment to increased safety practices utilizing clear, unambiguous language (the least certified person in your organization should be able to understand it).
  2. Safety risk management. Implement new systems and revise existing systems. Develop operational procedures (e.g., scoring a daily risk assessment) and identify hazards or ineffective risk controls.
  3. Safety assurance. Evaluate the application of your SMS and determine whether expected progress toward effective risk management and improved safety performance is being achieved.
  4. Safety promotion. Build out safety culture through safety training and encouraging employees to share information. Identify “weak signals,” which occur when common practice drifts from policy and precipitates near misses. It’s been identified that the No. 1 cause of accidents is deviation of policy.

Evaluate your organization’s risk mitigation

Here are three questions you should ask yourself about your organization to increase your operational safety through SMS and risk mitigation:

  1. Is your safety committee diversified and educated? Form a safety committee with a task force approach. Select members with different backgrounds – for example, a paramedic, nurse, pilot, mechanic and a logistics officer. The variety will lend itself to unique safety perspectives. Send as many safety committee members as your budget will allow to formal SMS training. The structured learning and networking opportunities they gain will pay huge dividends to your safety culture. Hopefully, your organization understands that SMS and risk mitigation is a sound financial investment. Funding a robust SMS will significantly contribute to your organization’s bottom line with accident and incident reduction.
  2. Does your organization promote a punitive culture or just culture? Employees who comfortably self-report incidents are the secret sauce of safety promotion. This practice provides the fuel for data collection, which drives safety assurance. But it’s also the most difficult to capture. We are asking that employees self-report incidents and near misses that would potentially fly under the radar. A great question most employees will ask themselves is, “What incentive do I have to make myself look potentially incompetent in front of my peers?” The answer is to grow your organization’s just culture to allow employees to feel safe and accountable in sharing this extremely valuable information, which often leads to system improvements.
  3. How do you grow your just culture? We must all understand that perfection is unachievable. We will make mistakes, but will be held accountable. We will share and learn from our mistakes. And we will critically evaluate and design the systems which support our team before errors become critical. Create a learning culture by investing in your employees’ education. Be fair and just in the treatment of employees. Identify and create safety champions within your organization. Managers need to take steps to retain their best and brightest (be on the lookout to identify employees who grow excited when the subject of checklist utilization is broached).

At the SMTA, I was surprised to learn that, on average, it takes a mid-sized organization 7-10 years to effectively implement a safety culture. The key is utilizing a phased approach of the four pillars of SMS.

But for now, in the spirit of raising our risk reduction profile, let’s all ask ourselves, “what can I do today to make myself and my crews safer?” This information, gleaned from the top tier safety professionals who presented at the recent SMT, is just the tip of the iceberg. It’s my hope that sharing their perspectives may compel you to re-examine and seek improvement opportunities within your SMS.

About the author

Brent Tracy, BA, FP-C, is a flight paramedic with Humboldt General Hospital in Winnemucca, Nevada. He was recently awarded the Tim Hynes Foundation 2019 Safety Management Training Academy (SMTA) Scholarship.