EMS Safety: Take a time-out
This week is the 2009 Fire/EMS Safety, Health and Survival Week. Many fire and EMS agencies are taking a time-out from regular training activities to have a department safety stand down. My own department is substituting our monthly training meeting with a review of the International Seatbelt Pledge and a cook-out.
As you know, safety should not be isolated to a single training meeting, evening, day, or week. Safety is an integral component of all response and training activities. As you review safety procedures and practices this week, consider how EMS — like other healthcare providers — can more regularly add a "Time-out for Safety" to EMS calls and fire incident response.
My running and cycling partner is a general surgeon. At the start of every procedure, he leads his surgical team in a time-out for safety to confirm these important details:
- Correct patient identity
- Correct side and site
- Agreement on the procedure to be done
- Correct patient position
- Availability of correct implants and any special equipment or special requirements
A time-out for safety would be appropriate in many EMS calls and fire incidents. Checklists or confirmation criteria would make sense for:
- Patient extrication from motor vehicles, collapsed structures, and unstable surface
- Rapid sequence intubation to secure a patient airway
- Application of pharmacological restraint to excited delirium patients
- Transferring patient care to an air or ground ALS intercept crew
I would like to see a checklist like this before initiating code 3 — red lights and sirens — patient transport:
- Patient condition meets protocol indications for code 3 transport
- Patient secured to cot with lap, leg, and shoulder restraints
- All patient care providers wearing seatbelts
- Equipment — like cardiac monitor — secured with brackets, netting, buckles, or belts
- Experienced driver trained and authorized for code 3 transport
- Receiving hospital notified of code 3 transport and prepared to promptly receive patient
- Weather, road conditions, and other vehicle traffic suitable for code 3 transport
Does your EMS service use checklists before high-risk procedures? Please share links in the comments area.