How ems can improve with newest patient safety recommendation

1. How EMS Can Improve Care With
Newest Patient Safety
Recommendations
Dr. Soumar Dutta.
Consultant and Coordinator- Emergency Medicine
Patient Safety Officer
Narayana Superspeciality Hospital, Guwahati

2. EMS – Emergency Medical Service
To providing out-of-hospital acute medical care, transport to definitive
care of patients with illnesses and injuries

3. EMS
Fire
Fighters
EMTs
Paramedics
Nurses
EPs
– Emergency Medical Service

4. Terminologies in EMS
“Patient” is used to describe the casualty, victim, caller, or ill or
injured person to whom EMS personnel responds and no age is
excluded.
Patient safety is defined as the reduction and mitigation of unsafe
acts within the healthcare system.
Excluded from this definition are discussions of best practices for
specific diseases.

5. It’s a Tough Job…

6. Introduction
There is inadequate information about the scope and character of
adverse events in prehospital care.
Patient safety issues in pre-hospital care are poorly investigated
Most patient safety studies have been conducted in relation to
the hospital rather than the prehospital setting.

7. Errors in healthcare
Healthcare is not as safe as it should be.
Evidences points to medical errors as a leading cause of death
and injury.
Two large studies done in US: Deaths due to preventable
adverse events exceed the deaths attributable to motor vehicle
accidents, breast cancer or AIDS.

8. First report on patient safety norms
November 1999

9. Types of Error
Error or delay in diagnosis.
Failure to employ indicated tests.
Use of outmoded tests or therapy.
Failure to act on results of monitoring or testing.
Diagnosis
Error in the performance of an operation, procedure, or test.
Error in administering the treatment.
Error in the dose or method of using a drug.
Avoidable delay in treatment or in responding to an abnormal test
Inappropriate (not indicated) care.
Treatment

10. Types of Error
Failure to provide prophylactic treatment.
Inadequate monitoring or follow-up of treatment.
Preventive
Failure of communication.
Equipment failure.
Other system failure.
Others

11. Second report on patient safety norms
years after …..
To Err is Human
15

13. Recommendations

14. Recommendations

15. Recommendations

17. Haddon matrix framework
Developed by William Haddon in 1970, The Haddon Matrix is the most
commonly used paradigm in the injury prevention field.

18. Paradigm shift
“Scoop and Run” and not to “Stay and Play”
A critical injured patient cannot be stabilized in field

19. Haddon matrix framework
HOST
AGENT
PHYSICAL
ENVIRONMENT
SOCIAL
ENVIRONMENT

20. Host
• Patient
• EMT
• Locomotive
operator
Agent
• Energy during
injury.
• Unrestrained
equipment
inside
ambulance
Physical
Environment
• Roadway
• Design of
ambulance
Social
Environment
• Social
• Legal
• Cultural norms
Haddon matrix framework

21. Haddon matrix framework
Post
event
During
event
Pre
event
Timing of factors also plays a role in the event occurrence

22. Host
• Conceptualizing the EMS professional as the host in Haddon matrix
Health & Fitness
Alertness at work
Education
Knowledge
Skill
Capability

23. Host factor solutions
Although high rate of occupational injury among EMS provider, but lacks
standard reporting methods of such injuries.
Non sharing of data outside a single agency/jurisdiction.
Decisions made by local groups no centralized organization and national
leadership.
EMS provider injury can be reduced through focused and creative efforts,
rigorous scientific testing to develop ergonomic equipment specifically
designed to meet the challenges of providing patient care in the pre hospital
environment

24. Host factor solutions
Technology making significant in roads assistance to drivers.
Driver monitoring and feedback systems to help change dangerous driving
behavior.
Patient’s comorbid and acute medical conditions also makes the patient
susceptible to injury or decline in health status as a result of ambulance
transport or a crash.

25. Agent
Energy exerted
during the course of
an injury
Unrestrained
equipment
Ambulance design and maintenance are of primary consideration
Audible and visual warning signs

26. Agent factor solution
Newer design
ambulance rear
compartment
Advance
technology of
patient care
Restraint of both provider and patient for maximum safety.
If EMS professionals were able to remain in a stable, seated position for
longer periods of time, this intervention could cut the risk of falls and
subsequent injury significantly.

27. Physical environment

28. Physical environment solutions
Policy to enforce speed limits
Situational awareness at the scene of an EMS response
Develop hands-free devices to provide patient care and for communication
while maintaining seated and restrained position.

29. Social environment
Vehicle Use
Personal
management
Behavioral
response
Response time
Light & Siren use
Call prioritization
Seat belt usage
Driver training
Notion of speed at all cost
Personal accountability
Error recognition
Self reporting

30. Social environment solution
The reliance on response time should be considered as a
performance indicator rather than the speed of the vehicle.
“Safety dispatch” – information - accurate & informative.
Acceptable use of light and siren.
Call prioritization will help replace of “rush” culture of EMS and
will provide a safe culture of transport/care
VehicleUse

31. Social environment solution
Develop and provide ergonomically effective seating positions
within the ambulance that allow EMS professionals full access
to the patient and allow the providers to care for the patient
while seated and restrained.
Screening of drivers at entry level, retraining and evaluation.
PersonalManagement

32. Social environment solution
BehavioralResponse
Situational awareness: recognizing hazard, decision making
Develop a culture of self-reporting
Discourage the “blame and shame” paradigm of criticizing or
punishing professionals who disclose adverse events.

33. Haddon Matrix

34. Conclusion
Regulations are needed for a uniform and centralized national reporting
network for all minor and major safety related issues.
Ambulance design – safety measures, patient, EMT & equipment restraints
Innovative equipment designed to meet the challenges during pre hospital
patient care

35. Conclusion
Real-time driver monitoring and feedback systems and event data recorders
(EDRs)
Research projects in pre hospital safety
Rigorous standards for EMT & driver recruitment. Reference from past
employees.

36. THANK YOU
www.narayanahealth.org