Distraction is Deadly: Presentation to MN EMS Teaching and Learning Conference April 2014
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Distraction is Deadly: Presentation to MN EMS Teaching and Learning Conference April 2014. Presented by Greg Friese, MS, NRP
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Distraction is Deadly: Presentation to MN EMS Teaching and Learning Conference April 2014
- 2. Not Urgent Not Important Urgent Not Important Not Urgent Important Urgent Important
- 3. 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
- 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.”
- 16. Distraction Type
- 17. Texting
- 18. ON OFF TASK 1 TASK 2 ON OFF
- 19. “This investigation highlighted what is a growing concern across transportation – distraction and the myth of multi-tasking.” NTSB Chairman Deborah A.P. Hersman.
- 20. Multi-Tasking Lie Infographic • http://www.nsc.org/safety_road/Distra cted_Driving/Pages/The-Great- Multitasking-Lie.aspx
- 21. ON OFF TASK 1 TASK 2 ON OFF
- 22. ON OFF TASK 1 TASK 2 ON OFF
- 24. ON OFF TASK 1 TASK 2 TASK 3 ON OFF ON
- 25. “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.
- 26. New York Times Gauging Your Distraction http://nyti.ms/qgCETw
- 27. ON OFF Driving Train TASK 1 TASK 2 TASK 3 ON OFFUsing Phone ON OFFLooking at Paper
- 28. ON OFF Driving Squad TASK 1 TASK 2 TASK 3 ON OFFUsing Phone ON OFFLooking at MDT
- 29. We Know…
- 30. 91%
- 31. 5% 9%
- 32. 21%
- 33. 4x
- 34. 0.08
- 35. “…Secondary tasks requiring drivers to look away from the road ahead, such as dialing and texting, are significant risk factors for crashes and near crashes, particularly among novice drivers.” New England Journal of Medicine 2013
- 36. F.O.S
- 38. It’s not you I worry about. It’s the crazy people out there.
- 39. “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…”
- 42. Distraction
- 43. Patient Care
- 44. Self Partner Community Patient Response Assessment Treatment Transport Risk of Distraction?
- 45. “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
- 46. “Good person doing what they think is the right thing to do.”
- 47. “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
- 48. Draw up and administer…
- 49. 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
- 51. Culture: How we act in workspace
- 54. Can I bother you real quick?
- 56. “… up to a third of the mistakes were linked to distractions from avoidable interruptions.”
- 63. Checklist
- 66. “Checklists and signage can be used as reminders to reduce distractions, and are simple, inexpensive tools for medication safety.”
- 67. 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)
- 68. Listen close to what I am about to say... You need to know this… Standby for priority traffic…
- 69. I pledge to…
- 71. NO PHONE ZONE
- 73. ANSWER IGNORE
- 75. There’s an app…
- 78. Focus Time
- 88. 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.”
- 89. NO PHONE ZONE
- 90. Behavior Change Opportunities • Behind the wheel • In the classroom • At the dinner table • In the patient’s home • During transport
- 91. “But when we’re caring for their loved ones, they expect our competence, our undivided attention, our concern, our gentleness and our best efforts to keep them comfortable and as free of pain as we can.” People Care, 2nd edition. Thom Dick.
- 92. Will you? • Speak up • Change processes • Consider a pledge • Practice focus and refocus • Challenge exemptions
Editor's Notes
- Distraction is Deadly: Driving, Patient care, and Education Presented by Greg Friese, MS, NRP Director of Education and CommunicationCentreLearn Solutions, LLC[1 hour session 945 am to 1045am]
- Label each quadrant...hat tip to Steven CoveyImportant and urgentImportant and not urgentNot important and urgentNot important and not urgentPlace these things into each quadrantFacebook notifications – friend request, you were tagged in a postEmail about a sale at your favorite store (REI)Text message from your spouseText message from your childPhone call from friends and familyPhone call from a studentEmail from a studentEmail from a vendorEmail from employerOut of office replyDriving ambulance to cardiac arrestDriving ambulance for dialysis patient return to homeMild asthmaSevere asthma Discuss urgent, important Discuss types of calls and messages that are Important and urgentImportant and not urgentNot important and urgentNot important and not urgent(Estimate percentage of calls in each category)
- Experiential activity … flip the classroom … have them teach each otherDay 1 Class 1. Students need to learn how to Disable auditory, visual, and kinetic notificationsDisable auto refresh for social networks (Facebook, Twitter, Google+, Instagram, etc.)Put phone out of physical and visual reach
- Distraction is a Real Issuehttp://www.ntsb.gov/news/2013/130409.htmlhttp://www.ntsb.gov/news/events/2013/mosby_mo/Abstract_Mosby_MO.pdf
- Pilotwas sending TEXT messages …. Dozens and dozens during pre-flight. Messages sentwhile flying, while the helicopter was being prepared for return to service, and during his telephone call to the communication specialist when making his decision to continue the mission,
- There are 3 general types of distraction
- Manual or mechanical distraction – hands off the wheelAnythingthat takes hands off the wheel – eating, texting, tying boots, grooming, adjust radio – lights – sirens[this guy is doing both]
- Manual distraction solution…hands-free and voice to text devices are not safer.
- Hands free is not better. From http://tti.tamu.edu/2013/04/23/voice-to-text-apps-offer-no-driving-safety-benefit-as-with-manual-texting-reaction-times-double/Cognitive load is not changed
- Visual distraction - eyes of the roadSomething that causes you to look away from road, patient, vial, syringe, protocol … sending a text.
- Example of a visual distractionAmbulance then rear ended a truckSerious injuries to patienthttp://www.prnewswire.com/news-releases/louisiana-jury-awards-117-million-to-woman-injured-in-ambulance-accident-while-pregnant-164761026.html
- Cognitive or mental distraction – thinking of something else – mind off of drivingBrain not engaged in task of driving – we aren’t aware of time we spend cognitively distractedGet your head in the game. Explanation of cognitive distractionhttp://www.youtube.com/watch?v=Ae-mO8OxXFA&feature=share&list=PL337F74DED367FDE7“looking but not seeing”“Inattention blindness
- https://www.aaafoundation.org/sites/default/files/MeasuringCognitiveDistractions.pdf“AAA Foundation challenges the notion that drivers are safe and attentive as long as their eyes are on the road and their hands are on the wheel.”
- https://www.aaafoundation.org/sites/default/files/MeasuringCognitiveDistractionFS.pdf“study provides some of the strongest evidence yet that “hands-free” doesn’t mean risk free.”
- From 1953 National Safety Council Video on the importance of not being distracted. “Inside your head is the most difficult place in the world to get privacy”http://www.youtube.com/watch?v=D-qiQh4mrHA&list=PL337F74DED367FDE7&index=1
- When you read/hear about any type of collision try to understand the type or types of distraction that were contributing or causing factors:ManualVisualCognitive
- Texting … all three distraction types …. That is what makes it so dangerous. “texting while driving is especially dangerous because it combines all three types of distractions.”http://www.cdc.gov/features/dsDistractedDriving/
- Multi-tasking … not possible. Can’t be cognitively engaged in two simultaneous tasks.Multitasking is a MYTH!
- Online conversations – in the EMS space - about the helicopter accident had a lot of people arguing that text messaging had nothing to do with this, couldn’t be proved as the cause, etc.
- Learn more in this infographic:http://www.nsc.org/safety_road/Distracted_Driving/Pages/The-Great-Multitasking-Lie.aspx
- 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=PL337F74DED367FDE7This is reality … Listen to wife or read email.Listen to a presenter or read the newsBrowse Facebook newsfeed or play card game with kids
- Despite your desires, wishful thinking, or ongoing attempts at multi-tasking you can’t do both effectively. Drive or talk on telephone. Make a choice.
- Activity idea – recall of information while performing task of entering data into an ePCR.Patient care toggle tasking example … assessing patient while also navigating buttons/tabs of electronic patient care reportCognitive challenge … looking for button to click, dropdown, text field, etc while also listening to patient and 1 to 5 other people that might be giving you more information.
- You can’t do this either.
- Experiential activityGame measures how reaction time is affected by external distractions. http://www.nytimes.com/interactive/2009/07/19/technology/20090719-driving-game.html?ref=technology
- This is impossible, dangerous, and potentially fatal.“In the moments before the derailment, Garzon received a call on his work phone from Spain's national train company Renfe, court documents show. The call was to inform Francisco Garzon, 52, of the route that he needed to take. The court said Garzon was talking to train company personnel and based on black-box data recorders, appeared to be consulting a paper document at the time of the derailment. ”http://worldnews.nbcnews.com/_news/2013/07/30/19776780-investigators-driver-of-spanish-train-that-crashed-was-talking-on-phone
- Have you ever done this? Doing this without consequence doesn’t mean you have special skills. It means you have had a near failure. Near failures are strong predictors for actual failure.
- 91% or more 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.
- In 2012 from Driver Electronic Device Use in 2012. NHTSA February 2012Percent of drivers holding ears to their phones while driving660,000 vehicles driven per daylight moment * Estimate9% of vehicle drivers using phone to ear of hands-free device
- 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
- From Distracted Driving and Risk of Road Crashes among Novice and Experienced DriversSheila G. Klauer, Ph.D., Feng Guo, Ph.D., Bruce G. Simons-Morton, Ed.D., M.P.H., Marie Claude Ouimet, Ph.D., Suzanne E. Lee, Ph.D., and Thomas A. Dingus, Ph.D.N Engl J Med 2013;370:54-9.
- http://www.swnews4u.com/section/170/article/15514/Grant County deputies and the Platteville Fire Department and EMS responded to this crash on U.S. 151 at Southwest Road Monday around 11:35 a.m.The 2014 Ford Mustang owned by Avis Rent a Car and driven by Matthew Bruhn, 37, Jeffersron, rear-ended a tractor driven by Matthew Miller, 33, Platteville, pulling a trailer full of liquid manure.The sheriff’s department said Bruhn had been talking and texting on his cellphone when he hit the trailer.Bruhn was treated at Southwest Health Center in Platteville for a broken finger.U.S. 151 was blocked during manure cleanup.The state Department of Natural Resources
- Did your mom say this?
- http://theactivepursuit.com/texting-driver-convicted-of-homicide-in-crash-that-killed-bicyclist/
- View video “From One Second to the Next”Documentary directed by Werner Herzog. Available on YouTube.
- http://www.kbtx.com/home/headlines/Distracted-Driver-Causes-Minor-Crash-with-Ambulance--202222151.htmlAmbulances hit by distracted driversResponders on the roadway hit by distracted drivers
- Connected topicsJust cultureCRMPatient SafetyWe are going to continue to dig on distraction …
- Activity idea … [From Strategy for National EMS Culture of Safety]What is the risk of distraction during patient response, assessment, treatment, and transport? Understanding, reducing, eliminating distraction will have an impact on all community groups. to self, partner, community (bystanders), and patientSelf – needle stick, lifting injuryPartner – lifting, slips, and falls, scanning for cross traffic (driver licking massive ice cream cone as driving through major intersection with red lights and sirensPatient – medication administration errorCommunity – vehicle collision
- 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
- Draw up and administer …. What are distractions and disruptions that happen when you are asked to administer medications … list several. Back of the ambulance can become many of these things … Med room had plenty of opportunities for visual, manual, and cognitive distraction. But also lots of chances for disruption and interruption. Share my experience with the Emergency Department “Med Room” was also … Shared by urgent care staff and suppliesStorage area for lots of other suppliesBuffet and eating area for staffGathering spot for informal conversationCommunication and sign-ups
- 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
- Culture … how we act in the workspace
- NAME 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.
- Experiential activity …That is the script I use to call out distraction that puts me at risk.We should all have scripts that …Label the distractionRemind of the consequencesAsk for a behavior changePromise a willing partner
- Decreasing Disruptions Reduces Error http://www.nursezone.com/Nursing-News-Events/more-news.aspx?ID=18693Disruptions and interruptions… take lots of forms … Disruptive student behaviors (see Rom’s presentation on dealing with difficult student behaviors)Activities outside of or adjacent to classroomNovel situation – dog in the classroomSomething more desirable … pizza delivery next store. Another person in the ambulance
- Observation of behaviorCount interruptions for different tasksTimes kids interrupt conversation between me an my wife :)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.
- Preventing disruptions and interruptionsWe could adapt the sign for paramedics. Hang on the window of the ambulance … use in the lab. Limit the number of people that can be in the ambulance or inside the no interruption zone
- 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.shortNo Interruption Zone Where? How to identify? When? What would you put in the no interruption zone?Paramedic doing drug calculationsCardiac arrest pit crew. Other ideasSide tracks on the safety express. Interruptions lead to errors and unfinished… Wait, what was I doing?http://www.ismp.org/newsletters/acutecare/showarticle.asp?id=37
- Put the code team in the no interruption zone …From Johnson County Med ActCardiac Arrest Check List and Pit Crew Procedure
- How do you stay on the road or after an interruption … how do you get back on track?Ask the class for ideas … In the classroom as an instructorIn the classroom as a studentIn the ambulance as a paramedic or a paramedic preceptor
- Checklists … From Johnson County Med ActCardiac Arrest Check List and Pit Crew Procedure
- Job Aids and 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.”What are the opportunities in class to add in “read backs”Homework assignmentsQuiz/test instructionsScenariosSkill sessionsSedgwick County EMSMedication Administration Cross-Check© User Manual
- Draw attention to …Poor communicationInterruptionsPreoccupation Task Saturation
- Innovative approaches to reducing nurses' distractions during medication administration.http://www.ncbi.nlm.nih.gov/pubmed/16022030
- Being clear on when and how devices can be used can help students stay on track
- Cue students of important information … before giving the important instructionsAssignment instructionsTest instructionsOther critical information
- http://www.everyonegoeshome.com/seatbelts/International First Responder Seatbelt PledgeOften have associated education activities
- 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.
- Engineering Controls … app … needs to be turned onAT&T Driver Modehttps://play.google.com/store/apps/details?id=com.drivemode
- Experiential activity … focus time, time on task, time trackingApp or stop watch or egg timer or phone or Google search (set timer 2 minutes)… progressively lengthen time you stay focused. But also acknowledge we can’t maintain heightened awareness/attentiveness for an unlimited period of time.
- 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
- Plan and deliver an injury prevention program … Distracted DrivingLearning facts about distracted may change student’s attitudes (about risk) and behavior (texting). Deliver to different audiences … teens, civic groups, professional driversInjury Prevention – poster – develop and distribute. Utilize other campaigns and distribute with other student groups in college
- 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=279Featuring EMS personnel
- An audience could be other EMS practitioners.
- Citizen injury prevention campaign from Sunstar Paramedicshttp://www.sunstarems.com/dont-be-a-distracted-driver/
- Confrontation of distraction starts with looking at our own behaviors … from a March 2010 article in New York Times. Part of a prize winning series of articles on “Driven to Distraction” New York Times, March 2010http://www.nytimes.com/2010/03/11/technology/11distracted.html?pagewanted=allArticle raises issue of state laws that ban texting while driving but exempt emergency responders
- “VFIS wants you to know the facts when it comes to distracted driving while operating an emergency service vehicle.”View, download, or embed full infographic at http://www.vfis.com/free-infographic-firefighter-EMS-distracted-driving.htm
- 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.aspxLots of flaws … similar statues in other statesNo person may operate a motor vehicle while using a wireless communications device to compose, read, or send an electronic message, when the vehicle is in motion or a part of traffic.Subd. 3.Exceptions. This section does not apply if a wireless communications device is used:(1) solely in a voice-activated or other hands-free mode;(2) for making a cellular phone call;(3) for obtaining emergency assistance to (i) report a traffic accident, medical emergency, or serious traffic hazard, or (ii) prevent a crime about to be committed;(4) in the reasonable belief that a person's life or safety is in immediate danger; or(5) in an authorized emergency vehicle while in the performance of official duties.
- From“Minnesota Cell phone use is totally banned for school bus drivers.”
- Last sentence of chapter 1 of People Care, 2nd edition by Thom Dick.