Promoting a Culture of Safety

When it comes to emergency medical service, there's a lot more to developing a culture of safety in the workplace, according to the president-elect of the National Association of Emergency Medical Technicians (NAEMT).

"Safety is not a class," said Don Lundy, NREMT-P and Charleston County (SC) Emergency Medical Service Director. "It's not a piece of equipment, it’s a culture and it has to be from the top down."

Lundy was a guest lecturer at the EMS World Expo 2011 held in Las Vegas in August. His lecture, titled "Culture of Safety," focused on how to reduce worker compensation costs and reduce provider injuries.

Lundy said it's important for ambulance service and EMS provider agencies to realize "the most expensive thing is walking around in your bays," and that is personnel.

"We must take care of our people," he said.

He focused on an initiative he implemented in Charleston that reduced workers' compensation premiums by $1 million and virtually eliminated back injuries. He started a program of power lift stretchers that dramatically reduced back injuries in his service. That program was also augmented with tracked stair chairs with the same goal—reducing lifting-related injuries suffered by providers.

"It used to be that back injuries were the No. 1 injury in EMS," Lundy said. "It's not that way any longer." He explained that driving a 27,000-pound ambulance too fast or recklessly, is one of the most dangerous operations in all of EMS.

"Sometimes, there's not much you can do, especially if they woke up in the morning and drank eight ounces of bonehead," Lundy said.

Nevertheless, there are ways organizations can minimize injury and losses, not only of revenue and premiums, but of the human resources which are, by far, the most valuable assets.

Driver training goes a long way toward teaching EMS personnel what they can and cannot do with ambulances and reduces injures and collisions, Lundy said, noting that's an illustration of a safety directive that comes from the top down. Most EMTs and medics are not going to seek driver training on their own, yet it's critically important to the provider mission.

Lundy said he's an advocate of a program known as Coaching the Emergency Vehicle Operator (CEVO), which is designed to improve operators' abilities to read traffic conditions and act accordingly with a goal of preventing collisions.

In conjunction with appropriate equipment, training and protocols, Lundy said it's just as important that employees take care of themselves physically. Being an EMS provider is a physically demanding job and employees and employers need to do what they can to promote fitness, he said.

An incentive to stop smoking is one way an employer can help improve the health of providers. Identifying and providing solutions to repetitive movement injuries is another, Lundy said, which is why he invested thousands of dollars into power lift stretchers and stair chairs.

"You have to identify the problem and find the solutions, a new way to do it," Lundy said.

Keeping fit by encouraging providers to participate in bowling leagues, baseball and basketball games and hockey is a good idea as well, Lundy said, noting he's not sure why some organizations have banned organized sports as on-duty activities for providers. Yes, people do sustain sports-related injuries on duty sometimes, but the benefits of being physically fit far exceed the risk of injury from a game.

Part of being ready to work is to make sure providers are well rested he said, which is why he's an advocate of 12-hour shifts. He predicts that 24-hour shifts are on the way out, especially when one considers that many providers work at other agencies on their off day.

"Do you want to be the patient when the paramedic is finishing up 48 hours straight?" Lundy asked rhetorically. "I don't."

Acknowledging that injuries and illnesses are part of any work place, Lundy said agencies must be willing to allow employees to recover and get well when they are hurt and sick.

"I love loyalty, but I don't love blood on the desk because you're hurt, but you want to make sure you get the report done," Lundy said. He recommends that sick employees stay home and those who are injured stay out until they are healed.

A back injury on average costs in excess of $26,000 factoring in lost wages, medical care and therapy, Lundy said. Severe injuries, however they are inflicted, can end careers.

"What a shame to have a good EMT or medic not return to work," Lundy said. "If you're old like me, it's not such a big deal, but if you're 22 or 24 and you can't do your job anymore because of an injury, that's devastating."

That's why he said all provider organizations must focus on a culture of safety. Problems must be identified and everyone from the top to the bottom must recognize the problem and embrace the solution for it to be effective, Lundy said.

Employers will want to see cost savings, whether is town officials looking to reduce taxes, or a private provider who wants to see changes in profit and losses, Lundy said. And, employees must "take the project seriously" and understand the benefit not only to the agency, but to themselves as well.

When changes are implemented, they should be reviewed after the first 30 days, and again at 90 days and then at six months.

"If there's no improvement, you're going to have to try something else," Lundy said. "There's no point in trading one problem for another."

Ed Ballam is a staff writer for the EMS World news team.