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Distraction is Deadly in EMS Education, Driving, and Patient Care

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Distraction is Deadly in EMS Education, Driving, and Patient Care presented by Greg Friese, MS, NREMT-P at National Association of EMS Educators Symposium in Washington DC. August 2013

Distraction is Deadly in EMS Education, Driving, and Patient Care presented by Greg Friese, MS, NREMT-P at National Association of EMS Educators Symposium in Washington DC. August 2013


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  • Distraction is a Real Issuehttp://www.ntsb.gov/news/2013/130409.htmlhttp://www.ntsb.gov/news/events/2013/mosby_mo/Abstract_Mosby_MO.pdf
  • http://tti.tamu.edu/2013/04/23/voice-to-text-apps-offer-no-driving-safety-benefit-as-with-manual-texting-reaction-times-double/
  • http://www.prnewswire.com/news-releases/louisiana-jury-awards-117-million-to-woman-injured-in-ambulance-accident-while-pregnant-164761026.html
  • Explanation of cognitive distractionhttp://www.youtube.com/watch?v=Ae-mO8OxXFA&feature=share&list=PL337F74DED367FDE7
  • “texting while driving is especially dangerous because it combines all three types of distractions.”http://www.cdc.gov/features/dsDistractedDriving/
  • Toggle TaskingMulti-tasking doesn’t workBrain chooses one or the other “Toggle Tasking”http://www.youtube.com/watch?v=L_Kzq2x-z7Y&feature=share&list=PL337F74DED367FDE7
  • http://www.nytimes.com/interactive/2009/07/19/technology/20090719-driving-game.html?ref=technology
  • http://worldnews.nbcnews.com/_news/2013/07/30/19776780-investigators-driver-of-spanish-train-that-crashed-was-talking-on-phone
  • 91% of US adults own a mobile phone. (Pew Internet Research project)In 2011 CDC research … in the last 30 days (http://www.cdc.gov/features/dsDistractedDriving/)Almost 70% of drivers reported talking on phone regularly, fairly often, and at least once.About 31% reported reading or sending text messages or emails regularly, fairly often, and at least once.
  • 21% of all crashes involve people talking on cell phoneshttp://www.nsc.org/safety_road/Distracted_Driving/Pages/The-Great-Multitasking-Lie.aspxAnother source, NSC video 15-25% of crashes, even while the total $ of crashes is decreasing http://www.youtube.com/watch?v=3QJ26OYVfXI&feature=share&list=PL337F74DED367FDE7
  • Drivers on phone – handheld or handsfree – 4x as likely to be involved in a crashhttp://www.nsc.org/safety_road/Distracted_Driving/Pages/The-Great-Multitasking-Lie.aspx
  • Drivers on phone – in a simulator – had reaction times slower than drivers with blood alcohol content of 0.08http://www.nsc.org/safety_road/Distracted_Driving/Pages/The-Great-Multitasking-Lie.aspxCouple that with what we know about the impact of fatigue. 18 hours without sleep can be enough to have this equivalent BAC
  • Did your mom say this?
  • http://theactivepursuit.com/texting-driver-convicted-of-homicide-in-crash-that-killed-bicyclist/
  • http://www.kbtx.com/home/headlines/Distracted-Driver-Causes-Minor-Crash-with-Ambulance--202222151.html
  • What is a medical error?National Coordinating Council for Medication Error and Prevention (NCCMERP) has approved the following as its working definition of medication error: “... any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems including: prescribing; order communication; product labeling, packaging and nomenclature;compounding; dispensing; distribution; administration; education; monitoring; and use”http://amcp.org/WorkArea/DownloadAsset.aspx?id=9300
  • “Good person doing what they think is the right thing to do.”Paul MisasiSedgewick County EMSListen to Part 1 http://www.emseducast.com/archives/1166Listen to Part 2 http://www.emseducast.com/archives/1179
  • Medication errors aren’t the fault of an individual forgetting or not using the 5 Rights, 6 Rights, or 10 Golden Rules of Medication administrationAnd the prominent Institute ofMedicine report To Err Is Human: Building a Safer Healthcare System notes:“The majority of medical errors do not result from individual recklessness or the actions of a particular group—this is not a ‘bad apple’ problem. More commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them.”26
  • Lecture 1 System Analysis Slide – in a discussion of 10 key elements of the medication system from the Learning Aids: Medication Errors, 2nd EditionFrom the American Pharmacists Associationhttp://www.pharmacist.com/learning-aids-medication-errors-2nd-editionKeep in mind that is mostly aimed at pharmacists, nurses, etc.
  • There are a lot of things that contribute to distraction … Fatigue StressHungerEnvironmentCulture – how we act in workspace
  • My ScriptNAME of Partner… Please put down the phone and focus on driving. Our patient is expecting us to arrive ready and able to care for their emergency. My kids are counting on me getting home safely at the end of this shift. To meet their expectations I need your help. I also promise that I will do everything I can to make sure you get home safely from this shift.
  • Decreasing Disruptions Reduces Error http://www.nursezone.com/Nursing-News-Events/more-news.aspx?ID=18693Disruptions and interruptions… take lots of forms …
  • http://www.marylandpatientsafety.org/html/education/solutions/2010/documents/communication/Medication_Interruptions_and_Distractions.pdfDistraction – diverts attentionInterruption – causes stop and restart
  • From http://www.grhosp.on.ca/epulseaugust2012 “While managing the care for high volumes of patients, staff on the bustling unit identified that nursing staff dealt with multiple interactions at the same time as they’re entering medication orders or getting medication ready for patients.Staff analyzed total medication errors over a three month period on the surgical inpatient unit. The study revealed that up to a third of the mistakes were linked to distractions from avoidable interruptions.Staff members have created a “No Interruption” policy, that uses signs and special uniforms to identify areas in which staff are not to be interrupted while doing certain work.”
  • Grand River Hospital has implemented http://www.grhosp.on.ca/epulseaugust2012SignsSpecial uniformsTo notify other staff to not interrupt nurses preparing and administering medications.
  • The following Patient Safety event was entered into the EVENT system today, August 1, 2013, at 5:28pm CDT. The record may have been altered to remove identifiers or for other administrative purposes.Description: Close-Call.  While preparing two medications for patient administration, the medic preparing them started drawing one from a vial of Adenocard, 6 mg/2 mL when they intended to prepare Zofran, 4 mg/2 mL.  The other medic caught the mistake while it was being withdrawn from vial.   No patient harm.Cause: Crew reviewed and believes that the primary contributor was multiple distractions from too many 1st responders & their wanting to converse while medic was working on preparing multiple syringes.  Both correct med. syringes were then properly labeled & medication check procedures completed before administration.  Confused vials were also the same physical size.
  • No Interruptions Please: Impact of a No Interruption Zone on Medication Safety in Intensive Care Unitshttp://ccn.aacnjournals.org/content/30/3/21.short
  • From Johnson County Med ActCardiac Arrest Check List and Pit Crew Procedure
  • From Johnson County Med ActCardiac Arrest Check List and Pit Crew Procedure
  • From Johnson County Med ActCardiac Arrest Check List and Pit Crew Procedure
  • Processes help get you back on track, as well as signaling a no interruption zone – time and place. Conversations that are scripted/organized need to be practiced and consistently used. http://www.kagoon.com/journal-of-emergency-primary-health-care-jephc-vol-7-issue-3-2009-article-990374/main“The  „crosschecking‟ measure  is  also  viewed  by  Jenson  et  al  as  the  most  effective  single  measure to  reduce medication error.”
  • Draw attention to …Poor communicationInterruptionsPreoccupation Task Saturation
  • Innovative approaches to reducing nurses' distractions during medication administration.http://www.ncbi.nlm.nih.gov/pubmed/16022030
  • http://www.everyonegoeshome.com/seatbelts/International First Responder Seatbelt Pledge
  • http://www.everyonegoeshome.com/seatbelts/International First Responder Seatbelt Pledge
  • Reviewing and taking pledge could be a class activityNo texting and driving pledgesItCanWait.comhttp://www.itcanwait.com/?WT.srch=1&wtPaidSearchTerm=don%27t+text+and+drive+pledgeNoPhoneZonePledge.comhttp://nophonezonepledge.org/Focus Driven – advocates for cell-free drivinghttp://www.focusdriven.org/
  • Digital Paramedic – Distraction TriageJob Action SheetEssential ResponsibilitiesSilence phoneTurn off notificationsReduce inputs Prioritize incoming transmissions – with rules and filters
  • TeXTe - Emergency SMSAnyone with the “code” word can get a text message to you … even when phone is on silent. https://play.google.com/store/apps/details?id=ravid.dev.esms
  • Stop receiving emailsLook for “Unsubscribe” in the fine print.
  • … app … needs to be turned onAT&T Driver Modehttps://play.google.com/store/apps/details?id=com.drivemode
  • Time to be able to check a pulse, count breaths, listen to heart sounds, listen to lung sounds
  • Collect a SAMPLE history, perform a head to toe exam, start an IV, review a protocol and calculate a medical dosage
  • Read a book chapterResearch and write a portion of a presentationListen to a lecture
  • Create distractions for driverManual – ask driver to open map bookCognitive – driver to recall and explain a driving near miss or accident Visual – Point to a location on a mapCombination – read and reply to a text message
  • Plan and deliver an injury prevention program … Distracted Driving
  • Injury prevention efforts … EMS involvement with anti-distracted driving campaignshttp://news.vanderbilt.edu/2013/05/vanderbilt-county-superstar-tim-mcgraw-share-important-message-regarding-dangers-of-distracted-driving/Highway Don’t Care Music Videohttp://www.youtube.com/watch?v=KmxaY_OVvWA#at=279
  • NewYork Times, March 2010http://www.nytimes.com/2010/03/11/technology/11distracted.html?pagewanted=all
  • In Minnesota … as is the case with many other states … “It is illegal for drivers to read/compose/send text messages and emails, or access the Internet using a wireless device while the vehicle is in motion or a part of traffic —including stopped in traffic or at a traffic light.”https://dps.mn.gov/divisions/ots/distracted-driving/Pages/default.aspx
  • Transcript

    • 1. Distraction is Deadly
    • 2. Slideshare.net/gfriese http://goo.gl/mCCUg1
    • 3. Not Urgent Not Important Urgent Not Important Not Urgent Important Urgent Important
    • 4. Disable Notifications Friend Request Tagged in a Photo Comment on Post Added/Removed New Follower X X X X X
    • 5. …pilot had made and received multiple personal calls and text messages…while the helicopter was being inspected and prepared for flight, during the flight, on the helipad…making mission-critical decisions about continuing or delaying due to fuel situation, and during the accident flight.
    • 6. Types of Distraction 1. Manual 2. Visual 3. Cognitive
    • 7. Manual Distraction
    • 8. Voice to Text
    • 9. Visual Distraction
    • 10. “…ambulance driver … became distracted when he took his eyes off the road while reaching for a company-issued tracking device that fell to the floor.”
    • 11. Cognitive Distraction
    • 12. Texting
    • 13. ON OFF TASK 1 TASK 2 ON OFF
    • 14. “This investigation highlighted what is a growing concern across transportation – distraction and the myth of multi-tasking.” NTSB Chairman Deborah A.P. Hersman.
    • 15. ON OFF TASK 1 TASK 2 ON OFF
    • 16. Incident Patient Assessment Narrative Signatures Billing Vital Signs Cardiac Monitoring AVPU Pulse RR SpO2 EtCO2 BG GCS Temp Pain
    • 17. ON OFF TASK 1 TASK 2 TASK 3 ON OFF ON
    • 18. “When operating heavy machinery, whether it's a personal vehicle or an emergency medical services helicopter, the focus must be on the task at hand: safe transportation.” NTSB Chairman Deborah A.P. Hersman.
    • 19. New York Times Gauging Your Distraction http://nyti.ms/qgCETw
    • 20. ON OFF Driving Train TASK 1 TASK 2 TASK 3 ON OFFUsing Phone ON OFFLooking at Paper
    • 21. ON OFF Driving Squad TASK 1 TASK 2 TASK 3 ON OFFUsing Phone ON OFFLooking at MDT
    • 22. We Know…
    • 23. 91%
    • 24. 21%
    • 25. 4x
    • 26. 0.08
    • 27. It’s not you I worry about. It’s the crazy people out there.
    • 28. “A 20-year-old woman who exchanged a series of text messages then crashed into a bicyclist… convicted of homicide by negligent operation of a vehicle…”
    • 29. Distraction
    • 30. Patient Care
    • 31. Self Partner Community Patient Response Assessment Treatment Transport Risk of Distraction?
    • 32. “Medical error is... any preventable event that may cause or lead to inappropriate medication use or patient harm” National Coordinating Council for Medication Error and Prevention
    • 33. “Good person doing what they think is the right thing to do.”
    • 34. “More commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them.” To Err Is Human: Building a Safer Healthcare System
    • 35. Draw up and administer…
    • 36. Problems With Environmental Factors and Staffing Patterns • Lack of space, crowded and disorganized storage • Poor lighting, excessive noise • High patient acuity • Deficient staffing, excessive workloads
    • 37. Culture: How we act in workspace
    • 38. Can I bother you real quick?
    • 39. Task Interruptions 1. 2. 3. 4. 5. Distraction
    • 40. “… up to a third of the mistakes were linked to distractions from avoidable interruptions.”
    • 41. Medication Safety Zone DO NOT DISTURB
    • 42. Close Call Reported 8/1/2013
    • 43. Paramedic Doing Math
    • 44. No Interruption Zone Med Cart?
    • 45. Checklist
    • 46. Checklist
    • 47. “Checklists and signage can be used as reminders to reduce distractions, and are simple, inexpensive tools for medication safety.”
    • 48. Daily EMT-P Class Schedule Ride Along Review (device free) Cardiac Lecture (Shared Google Doc notes) **Break** (Ins, Outs, and Inbox) Cardiac Meds (Drug Guide app) Simulation (Code app)
    • 49. Listen close to what I am about to say...
    • 50. I pledge to…
    • 51. NO PHONE ZONE
    • 52. DISTRACTION
    • 53. ANSWER IGNORE
    • 54. Important? Urgent?
    • 55. There’s an app…
    • 56. Unsubscribe g***@centrelearn.com
    • 57. There’s another app…
    • 58. Time Tracking
    • 59. Driving Simulator Manual Distraction Visual Distraction Cognitive Distraction
    • 60. Injury Prevention Group Project
    • 61. Emergency Responder Exemption • WI Distracted Driving Law ??? • MN Distracted Driving Law – https://www.revisor.leg.state.mn.us/statut es/?id=169.475 – “(5) in an authorized emergency vehicle while in the performance of official duties.”
    • 62. Behavior Change Opportunities • Behind the wheel • In the classroom • At the dinner table • In the patient’s home • During patient transport
    • 63. Will you? • Speak up • Change processes • Consider a pledge • Practice focus and refocus • Challenge exemptions