Expert Opinions: Safety Advances
EMS World surveyed the members of its editorial advisory board about the most important prehospital EMS safety advances of the last few years. Here are some of their responses.
Ambulances are notoriously easy to flip, and there are still too many ways for patients and attendants to be injured during an accident. The changes in attendant seats and implementation of hydraulic stretchers and loading platforms are huge improvements, but more must be done for stability.
—Gene Gandy, JD, LP, EMS Educator/Consultant
Automatic driving recording cameras really change providers’ behavior and make them drive more slowly and safely.
—Sean Kivlehan, MD, NREMT-P,
Emergency Medicine Resident, UCSF
Research into the need for use of lights and siren, thus priority dispatching and reduced emphasis on fast responses for all calls.
—Vince Robbins, President/CEO, MONOC (NJ)
Wider utilization and/or implementation of termination-of-resuscitation protocols that prevent the unnecessary lights-and-sirens transport of futile patients.
—David Wampler, PhD, LP, Assistant Professor, University of Texas Health Science Center at San Antonio
The NFPA 1710 ambulance design specs are goofy in many ways; however, the interior design process had a great start, involving automotive and ergonomic engineers who actually solicited and listened to the few field providers who responded. They analyzed the seating positions in the ambulance as “work stations” (what a concept!) and concluded an ambulance needs to be designed so it’s physically possible for a field provider to remain restrained in a forward-facing seat and take care of a single patient, and systems need to be designed so that happens routinely.
—Thom Dick, Quality Care Coordinator, Platte Valley Ambulance (Colo.)
The holistic advance is the acknowledgement and embrace of the requirement to develop a ‘just’ culture and an EMS culture of safety. The fact that a medic a week seems to perish or suffer injuries in a vehicle-related incident is attracting attention. That there are now devices in the market to aid safe lifting and handling of patients that make patients safer and also protect our most expensive assets—our staff—is a great step in the right direction.
—Rob Lawrence, COO, Richmond Ambulance Authority (Va.)
The most important safety issue is related to transport. First, the number of emergent transports should significantly decrease as we identify patients who can and cannot benefit from saving a few minutes. Decrease in the number of air medical transports may correspond as states start to look at the issue from a safety and cost standpoint. Second, the configuration of the standard ambulance should change to a more European model with appropriate seating and recognition that treatment en route should be the exception and not the rule.
—Ken Lavelle, MD, NREMT-P, Attending Physician, Thomas Jefferson University Hospital (Penn.)
There is a growing (and hopefully sustainable) interest in preventing violence against EMTs and paramedics. The recent attention of NEMSMA on this issue is critical. When EMS managers cooperate with local law enforcement and prosecutors to ensure that violence against EMTs is taken just as seriously as violence against police, we will have made significant progress.
—Greg Friese, NREMT-P, Director of Education, CentreLearn
I think the most important EMS safety changes are coming out of the “Hartford Consensus” (see www.naemt.org/education/TCCC/tccc.aspx) and tactical training for EMS providers. Training and education in tactical emergencies are essential in our new reality, and we can prioritize providers’ safety in these events and do more to save more lives in active-shooter situations.
—Will Chapleau, RN, EMT-P, Manager, ATLS Program, American College of Surgeons
