I have a friend who worked his way through college by being a paramedic. I’ll call him Steve.
To get more information on the National Strategy for Creating a Culture of Safety in EMS initiative, visit emscultureofsafety.org. |
Steve told me once how he worked at the same time for two different organizations providing EMS in nearby cities. On the final day of his comprehensive, six-week orientation at ABC Ambulance, the owner of the company took him aside and said, “You are important to us. You’re about to go out there and represent our organization in everything you do, from the way you drive the ambulance to the way you deal with the most difficult customers. We are here to support you and keep you safe.” Hearing this, Steve thought about what he’d observed during his orientation, including the company’s considerable investment in training, equipment and customer service. It was more than just talk—this owner meant it, and it showed in the organization’s priorities.
On his first day at XYZ Ambulance, there was no orientation. Without even meeting the higher-ups, Steve was immediately out on his first call—in a dirty, badly stocked and poorly maintained ambulance and with a partner who smoked in the cab, with an unstated but clear message: His work and patient interactions were only of interest in terms of how quickly he could clear calls and avoid doing anything that created work for management. Safety was not part of the conversation, much less a priority.
“The interesting thing,” Steve told me, “was how I could literally put on the same uniform with the only change being the patch on my shoulder, and how vastly different my attitudes and actions were from shift to shift, city to city.”
The culture of one organization fostered Steve’s best instincts; the culture of the other, his worst. Taking a cue from leadership, the peer pressure at ABC was all about doing what was right, including being safe. The peer pressure at XYZ was to hotdog and take risks. Much to his chagrin, Steve found himself submitting to that pressure on the job at XYZ, even to the point of not wearing his seatbelt, because nobody else did.
By the time you read this, some 100 stakeholders representing every aspect of emergency care will have gathered near Washington, D.C., with the formidable task of providing input on a national strategy to create a “culture of safety” in EMS. The initiative is part of a three-year cooperative agreement between the National Highway Traffic Safety Administration, with support from the Health Resources and Services Administration’s EMS for Children Program and the American College of Emergency Physicians. Safety experts from other industries—including hospitals, the airlines and FedEx—were brought in to share their experience with the challenges they faced, and overcame, to institutionalize safety within their respective cultures. “Culture” is a complex thing, but in this context it is generally defined as the shared beliefs, customs, attitudes and behaviors of a particular group. The fundamental questions EMS stakeholders need to answer are: What is the culture of EMS, where are we headed, and how can safety fit in?
Whatever comes out of this initiative, Steve’s experience demonstrates a fundamental truth: A national safety strategy will have to be implemented locally, by EMS leaders who share that vision. And, unfortunately, by others who currently do not.
Keith Griffiths can be reached at editorinchief@emergencybestpractices.com.
