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
6. …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.
11. “…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.”
15. “This investigation
highlighted what is a
growing concern across
transportation – distraction
and the myth of
multi-tasking.”
NTSB Chairman Deborah A.P. Hersman.
19. “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.
28. It’s not you I worry
about. It’s the crazy
people out there.
29. “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…”
34. “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
36. “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
76. 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.”
77. Behavior Change Opportunities
• Behind the wheel
• In the classroom
• At the dinner table
• In the patient’s home
• During patient transport
78. Will you?
• Speak up
• Change processes
• Consider a pledge
• Practice focus and refocus
• Challenge exemptions
Editor's Notes
Distraction is a Real Issuehttp://www.ntsb.gov/news/2013/130409.htmlhttp://www.ntsb.gov/news/events/2013/mosby_mo/Abstract_Mosby_MO.pdf
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
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
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