Developing a Safety Culture

This article is from the supplement Ambulance Safety Solutions sponsored by ZOLL Medical Corporation

Expert source: Tim Egan, Chief and Director of Information Technology, Rockland Paramedic Services, Nanuet, NY.

   Rockland Paramedic Services (RPS) is a not-for-profit advanced life support first response agency covering Rockland County, about 30 miles northwest of New York City. With 220 employees running more than 40,000 transport and 9-1-1 calls a year, the odds are that bad things will happen to good people.

   Going back over its records, RPS administrators found an upward trend in collisions, employee injuries, insurance costs, workers' compensation costs and out-of-pocket expenses being borne by the company.

   A review of incidents in 2008 revealed:

• 12 vehicle collisions--8 chargeable, 4 non-chargeable;
• $39,000 in damages, not including a totaled ambulance or multiple replacement rear step bumpers;
• 33 on-the-job injuries;
• and one "shock loss," an insurance term for a major loss event.

   Injury and accident-related expenses were increasing each year even as Rockland tried to contain costs. Physician bills for minor injuries were paid by Rockland rather than file workers' compensation claims. Damage to vehicles that was close to or just over the deductible was paid for rather than filing insurance claims.

   A catastrophic ambulance collision in April 2008 that seriously injured two employees shook Rockland to its core. The agency took a hard look at itself and put steps in motion to embrace a culture of safety throughout the organization.

   Did Rockland have some issues? Sure, along with the one catastrophic collision, there were a host of other events, but they were mostly minor. Were they out of control? Not by a long shot. Twelve accidents and 33 on-the-job injuries out of 40,000+ runs certainly looks like an enviable safety record. Then why spend the time and money?

   Chief Tim Egan, Rockland's director of information technology, puts it in simple terms: "Even though most of the collisions were avoidable nickel and dime stuff, it just didn't seem right that we weren't doing anything about it."

   Despite what they thought they were doing, they weren't as safe as they could have been. Each year they were spending more and more on injuries and vehicle damage. What if they spent some of that money on prevention instead?

Creating a Culture of Safety

   Early questions asked were: "How many unnecessary injuries are we experiencing?" and "What could we do to prevent another tragedy?" By their definition, "unnecessary" and "preventable" were interchangeable words.

   Looking at prevention, they found a 2008 survey of 468 EMS providers conducted by the New York State Safety Technical Advisory Group, of which only 86% reported seat belt use in the cab. More than half--55%-- reported never wearing a seat belt in the back of an ambulance.

   Making staff commit to taking the National Fire Service and EMS Seat Belt Pledge offered a no-cost solution: To honor those who have been injured or killed in the line of duty, we will wear our seat belts at all times while riding in the front of this vehicle. We will also ensure all our passengers and equipment are properly restrained. Because it is the right thing to do!

   Two 2008 collisions occurred while backing up and 12 rear bumpers were replaced at $600 each due to "unknown" damage. Mandating rear spotters during all backing movement offered another no-cost solution to a recurring problem.

   All new drivers are required to take a full Coaching the Emergency Vehicle Operator (CEVO) course with driving component during orientation. Remedial training can be ordered after an incident, or on the recommendation of a supervisor who has witnessed less-than-professional driving behavior.

   Visibility of the ambulances has been improved with mandatory 24-hour headlight use. In addition, new, higher-visibility graphics modeled on the NFPA 1901 Standard for fire apparatus have been added to ambulances and other fleet vehicles.

   DriveCam driver risk management products and software have been installed in all vehicles to decrease collisions, injuries, maintenance and insurance costs. Drivers know that any risky driving will be captured, which encourages them to drive professionally and safely. Supervisors can review triggered events or general driving data to determine what, if any, remedial training is called for.

   Purchase of a fully outfitted bariatric ambulance with a winch, 1,200-pound capacity ramps, and power stretcher with a 1,000-pound folded limit has reduced personnel injuries due to moving bariatric patients.

   Non-driving safety measures have included:

• Safety briefings at every staff meeting and CME training session
• Back screenings and lifting instructions during pre-employment physicals
• High-visibility vests for roadway use and upgraded uniform jackets with reflective materials.

Results Prove Safety Works

   Since the introduction of the first new safety culture measures, the same numbers that had been trending up have reversed dramatically:

   With the mind-set that stopping just one collision or injury is worth the effort, these numbers clearly show that Rockland's culture of safety has been a resounding success.

What's Next?

    Rules and systems that are working are vigorously enforced. At the same time, new ideas are continually evaluated. One idea being pursued for its crew safety features as well as patient care efficacy is ZOLL's AutoPulse automated chest compression device.

    Rockland likes the AutoPulse primarily as a safety device, but also as a tool with which to perform significantly better CPR.

    Studies show the AutoPulse moves more blood, more consistently than is possible with human hands. Easy to use and battery operated, its load-distributing LifeBand squeezes the entire chest. As a result, victims receive more consistent, high-quality compressions than those delivered by responders in the back of a moving vehicle.

    The AutoPulse also improves EMS crew safety in two main ways. First, it serves as an extra patient care provider doing compressions, reducing the number of responders riding in the dangerous rear compartment. Second, with the AutoPulse performing compressions, the EMS crew members can remain seated and belted in safer positions while performing their all-important lifesaving work.

    Rockland is always on the lookout for safer ways to provide exceptional patient care. As Chief Egan says, "We've created a whole new workplace culture. Everything we do now revolves around safety."

About Rockland

   Rockland Paramedic Services is a 501(c)3 not-for-profit corporation headquartered in Nanuet, NY. It operates 14 ALS first-response paramedics 24/7 in eight vehicles. Formed in 1992, Rockland provides first response service for all of Rockland County. Rockland Mobile Care is the company's ambulance division, fielding 18 ambulances. Started in 1999, it serves Rockland County with interfacility transfers and backs up the 9-1-1 system with paramedic services and patient transportation.

Ed Mund began his fire and EMS career in 1989. He currently serves with Riverside Fire Authority, a fire-based ALS agency in Centralia, WA. His writing and photos have been published in several industry publications. Contact him at ems@emedstrat.com.