Priority Traffic: To the Summit

Government & industry convene to address ambulance safety

• December 2009 JEMS Vol. 34 No. 12
• 2009 Dec 1

The daylong Ambulance Transport Safety Summit brought together, for the first time ever, dozens of government agencies and industry representation to share ideas surrounding the issues facing ambulance transport safety. 

The event was held Oct. 29, at the Transportation Research Board (TRB) of the National Academies, Keck Center, in Washington, D.C. 

"This brought a lot of people together that had not been in the same room before," says Nadine Levick, MD, MPH, chair and chief executive officer of Objective Safety, research director for the EMS Safety Foundation and coordinator for the conference. 

A comprehensive overview of EMS transport safety issues were addressed by a vast array of representatives, including the National Highway Traffic Safety Administration, the Bureau of Labor Statistics, the Department of Homeland Security, state EMS directors, EMS agencies, volunteer EMS, EMS physicians, and industry partners for EMS equipment and vehicles.

"The real goal was to have the National Academies hold an interdisciplinary platform for all the issues that pertain to the systematic approach to ambulance transports," Levick says. "It was a world-class event, with a very broad-based outreach. That range of people, from that range of backgrounds, has never been assembled anywhere in the world."

The summit, which was broadcast via webinar, covered transport systems safety engineering, occupant protection, ambulance fleet safety and operations management, vehicle safety assessment and design, clinical decision priorities and management, safety data and research priorities, among other things. 

According to presenter Gene Lukianov of Objective Safety, ambulances have a significant incidence of intersection collisions in urban areas, as well as loss of control and road departures in rural areas. Because of this, he says, ambulances can be made safer by addressing interior hard cabinets and hard edges that could potentially harm paramedics and patients during an unforeseen crash. Unbelted attendants could also potentially become projectiles during a collision, injuring patients, other attendants or themselves, so belting improvements need to be made. 

Chris Fitzgerald, from Risk and Energy Management Services, pointed out the need to prioritize the placement of equipment and resources around the critical seating positions of attendants. This includes forward facing seating designed to move forward and sideways for access to the patient and equipment and to improve clearance along the compartment wall. Rear-facing seating also needs to move forward for patient and equipment access. 

"The goal of the summit was to enhance ambulance transport safety through shared knowledge of technical data. Everyone wanted to bring forward the piece of the puzzle they had to augment the situation," Levick says.

She adds, "In the end, everyone knew what the issues were, and had a very good sense of how to move forward. ... I imagine what will come out of this in the long term will be a lot of time, effort and money saved by bringing all these people together and sharing their knowledge."

The webinar is archived and available free at www.objectivesafety.net/TRBSummit2009.htm. It’s expected that a TRB e-newsletter and a series of white papers will be produced to chronicle the summit content and activities.
Cynthia Kincaid

Agencies Address Regional Paramedic Shortages
The EMS Workforce for the 21st Century ,published in June 2008, stated, "There is no quantitative data indicating a national shortage of EMTs or paramedics."

NHTSA EMS specialist Gamunu Wijetunge, says, "The lack of consistent definitions hinders quantitative data." The definition of provider level is just one issue. The EMS Workforce report noted that "there may be as many as 48 levels of EMS practitioners."

However, as NHTSA EMS Director Drew Dawson points out, the lack of a national shortage doesn’t mean much to the areas that  are experiencing shortages of EMS personnel. But agencies like the Emergency Medical Services Authority (EMSA) of Tulsa, Okla., and MedStar of Fort Worth, Texas, have been proactively addressing shortages in their communities.

EMSA has experienced a paramedic shortage for a few years now, according to recruiter Chris Stevens. But a couple of years before the shortage was a reality, EMSA got a jump on what they saw coming.

They started offering fully paid paramedic training to their EMT-Bs who had completed the six-month probationary period. EMSA pays for the students’ uniforms, books, tuition and insurance during the paramedic training in exchange for a two-year employment commitment. Students work two days a week and attend classes at Tulsa Tech three days a week. Stevens says EMSA’s investment in each paramedic student is $15,000–$20,000. In addition to the education expenses, EMSA pays full-time wages to part-time workers.

MedStar also funds paramedic training for selected EMTs. The MedStar EMS Academy allows students to go to school full time, while still receiving their current rate of pay, and the company pays for tuition, books and fees. In exchange, MedStar students commit to three year’s work as a paramedic.

But NREMT Executive Director Bill Brown cautions, "The danger of training your own is that they go down the street for $2 an hour more." 

Stevens says EMSA has seen higher retention rates from their program graduates.

MedStar Associate Director of Operations Matt Zavadsky points out that effective retention is possible for agencies that create an atmosphere where employees feel wanted and cared for. "You have to have an organization that people want to come to and stay with," says Zavadsky. He describes such a place as having a balance of excitement, recognition, fun and autonomy.
Ann-Marie Lindstrom

For more on paramedic shortages, read the JEMS "Salary and Workplace Survey" and "200-City Survey" at jems.com/surveys .

Flu Absenteeism Might Predict Increase in Call Volume
A recent online survey of more than 1,800 public health employees in Minnesota, Ohio and West Virginia found that one in six said they wouldn’t report to work in the event of an influenza pandemic.

The survey, which was conducted from November 2006 to December 2007, found 16% of health workers unwilling to "respond to a pandemic flu emergency regardless of its severity."

"Employee response is a critical component of preparedness planning, yet it is often overlooked. Our study is an attempt to understand the underlying factors that determine an employee’s willingness to respond in an emergency," Daniel Barnett, lead author of the study and assistant professor in the Department of Environmental Health Sciences at the Bloomberg School told The Johns Hopkins University Gazette. 

The online study was funded by CDC’s Centers for Public Health Preparedness program and by CDC’s Preparedness and Emergency Response Research Centers program.

Glenn Leland, chief operating officer for the Emergency Medical Services Authority (EMSA) in Tulsa and Oklahoma City, Okla., has noted a rise in call volume that corresponds with a rise in absenteeism, although he cannot say if personnel are calling in for reasons other than being sick. Call volume statistics and absenteeism for the organization are monitored daily.

"We can definitely see reverberating effects of weather and flu in our EMS call volume, and we’ve been correlating that against absences in our workforce and seen some very interesting patterns," he says. "In this recent flu outbreak, the absences preceded the call volume increase by a couple of days. We had people calling out before people started calling 9-1-1, and we haven’t seen that before."

Leland believes the pattern may be due to H1N1 more severely hitting children—at least in the beginning of the outbreak. "When kids get sick, their parents stay home from work," he says. "People claim that they are sick or their kids are sick. We’ve taken absences without dissecting why."

EMSA is addressing some of its absenteeism issues by authorizing overtime and, in some cases, giving a bonus to those who work additional shifts. "We are fully staffed, but we’re using a lot of overtime to do it," Leland says. "We have also issued shift bonuses, so, in addition to the applicable overtime, they will get an additional $200 stipend for working an extra shift."

As far as the online study goes, Leland says he hasn’t heard of his EMS personnel calling in sick because of fears of working during a flu outbreak. 

"When I talk to paramedics, I don’t hear about any special concerns [surrounding H1N1] more than usual," he says. "We continue to plan and prepare for a pandemic and hope it doesn’t occur. It’s business as usual with a little more overtime." 
—CK

H1N1 Update
President Barack Obama declared H1N1 a national emergency in late October, but the pronouncement wasn’t in reaction to any recent events. Rather, it was a proactive decision that will allow his health chief to authorize moves of emergency departments to off-site locations. "The public ought to take some solace, some relief in this," P.J. Brennan, chief medical officer for the Penn Health System, told USA Today. "It’s not a suggestion that things have deteriorated in any way."

The Centers for Disease Control and Prevention and the Occupational Safety & Health Administration have released workplace H1N1 precaution fact sheets, including one for health-care workers. Of particular note for EMS providers are recommendations to transport H1N1 patients in ambulances with separate ventilation systems for the driver and patient compartments by operating the system in non-recirculation mode and to wear fit-tested N-95 (or better) masks whenever contacting or approaching the scene of a patient who has or may have H1N1. Access the fact sheet at  http://www.osha.gov/h1n1/protectyourself_healthcare.html.  

Pro Bono
We’re sometimes criticized for not doing enough live-action or experiential training in our EMS educational programs. Mock airliner crashes, simulated food poisoning events and other mass casualty incident (MCI) simulations are great ways to give EMS personnel "reality based" training. Training scenarios that are as true to life as possible are valuable tools for giving personnel the hands-on experience they may need when the "big one" hits. 

But organizers need to strike a careful balance between realism and incident safety, avoiding surprises that could be perceived as risking a catastrophe. EMS planners never want to put personnel or the public in harm’s way simply in the interest of conducting realistic training simulations. Good-intentioned live training has gone bad, and people were killed or severely injured. Just take a look at a few of the NIOSH reports involving live-fire burn training where accidents occurred that could have been prevented. To minimize the risk, consider these suggestions when conducting realistic MCI training:

Never trigger an emergency response. Don’t run lights and sirens or use other "emergency response" procedures during an MCI drill. We get enough of that experience every day, and studies show lights and sirens don’t make that much of a difference anyway, except in very extreme situations. So why risk a vehicle crash in response to a simulated incident, especially with the risk it poses the public? Keep emergency response mode for the real emergencies. 

Ensure total safety control. Make sure an adequate number of safety officers are in place to cover the key areas where injuries could occur. A senior safety officer should be involved in all aspects of the planning and execution. Other safety officers should be assigned to all high-risk areas of the drill. These personnel should focus solely on safety, and must act as the disinterested referees of the event. They must have the authority to stop an evolution in its tracks without question, pending safety review before the exercise is allowed to continue. 

Notify key officials. Make sure elected officials and other government agency heads know when the drill will take place, who will be involved and how it will be executed. They’re ultimately accountable to the public and they need to be prepared in advance, especially if something goes wrong. 

Tell all staff, "This is a drill." It’s critical to tell all responders a drill will occur and their role in the drill. It’s acceptable to not reveal the exact time the drill will commence. But once the drill is initiated, all participants must be told immediately and in no uncertain terms that it is, in fact, a drill, and not a real emergency incident. 

Don’t let moulage and acting go too far. Realistic "victims" are great, but don’t let the acting go too far. You certainly don’t want to let victims go to extremes (such as self-induced vomiting) that could confuse responders to the point that they wonder whether the incident has crossed the line and become a real emergency. Although it’s rare, sometimes actors posing as victims in a simulated MCI do experience a true medical crisis. Victims must be told to advise responders if they’re experiencing real symptoms. Consider using a universal code phrase or word, known to all involved, so that if it’s used by a "victim," the rescuer and other key officials will know the situation has become a real emergency. 

The overriding concern during MCI training must be safety. We have an ethical and legal obligation to not let things get out of hand and to ensure that the learning environment is safe for all concerned—the actors, the responders and the general public. Waking up the next day to a headline reporting that someone was killed or severely injured because of a mismanaged drill will not only damage your reputation but will likely bring on a multitude of lawsuits. Common sense in the execution of a drill can avoid these downfalls. 

Pro Bono is written by attorneys Doug Wolfberg and Steve Wirth of Page,Wolfberg & Wirth LLC, a national EMS-industry law firm. Visit the firm’s Web site at www.pwwemslaw.com for more EMS law information. 

Names in the News
JEMS editorial board member Richard Serino has formally taken over as deputy administrator of the Federal Emergency Management Agency. FEMA Administrator W. Craig Fugate, former director of the Florida Division of Emergency Management, swore in the former chief of Boston EMS on Oct. 19. The EMS concentration of these two top FEMA positions marks an unprecedented representation for the industry at the national level.

Quick Take
Study Finds EMS Job Satisfaction Low  
A study published in the fall issue of the Journal of Allied Health re-evaluated 2005 LEADS data and found EMT and paramedic job satisfaction to be extremely low. The authors report that among 11 factors of job satisfaction, just 67.8% of NREMT-Bs and 55.2% of NREMT-Ps are satisfied with pay, benefits and opportunity for advancement. Six percent of respondents indicated an intention to leave the profession in the next year.

Transatlantic Blog
In November, the popular EMS bloggers Medic999 and Happy Medic conducted a cross-Atlantic exchange program and chronicled their trips on JEMS’ new FireEMSBlogs.com. On Nov. 8, the U.K.’s Medic999 travelled to San Francisco to work with Happy Medic for seven days. "I got fantastic insight into the dual role of a paramedic/firefighter and the inherent difficulties that appear to come from working in emergency care in the U.S.," Medic999 says. Then on Nov. 19, Happy Medic landed in the U.K. to work alongside Medic999 and got a chance to experience the National Health System method of delivering prehospital care. The two bloggers hope their experiences lead to some change toward improving patient care on both sides of the Atlantic. "We intend this to be a timely review of two completely different methods of delivering quality prehospital care to our patients," explains Medic999. "At this time of socialized-versus-privatized health-care discussions in the States, it seems to be happening at a perfect time." JEMS

New tools to select alternate care facilities and transfer patients during disasters at www.ahrq.gov/prep/acfselection.

Collaborate and network with other health professionals at www.TheMedicalStop.com

Ohio H1N1 vaccination training module available at www.ems.ohio.gov  

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