On Thursday, April 28, at JEMS Con/FDIC International 2022’s Opening Ceremony Day 2, featured speaker David Page, director of the Prehospital Care Research Forum at UCLA, addressed the audience on “Bringing Light to the Dark”:
“It is Chief Brunacini’s three tenets—safety, service, and smiles–that I would like to talk with you about today. Safety first, of course. If we can’t make it home from our shifts–and not just physically but also psychologically in one piece–then we are no good to our patients, our families, or ourselves. So I’m on a quest to make safety less fuddy duddy and more sexy! If safety were sexy, I think more of us would think of it–in fact, some of my partners would not stop thinking of it.
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“If safety were sexy, more of us might practice it, study it, maybe even get good at it. In 2012, the National Highway Traffic Safety Administration, in a report led by Dr. Sabina Braithwaite, rolled out a Culture of Safety Strategy. It has been a decade–a decade–check this document out if you have not, the basic tenets of crew resource management and evidence-based practices, focusing on a systematic approach to:
- Closed loop communication
- Teamwork
- Blameless error and near-miss reporting
- Humility
- Situational awareness
- Human factors engineering
- Enlisting patients as a partner in their own care
- Personal and shared responsibility
- ACCOUNTABILITY and follow through
- Connecting leaders and personnel at all levels
“By all metrics, health care–EMS included–could be responsible for as many as 100,000 to 200,000 preventable deaths each year (IOM report). In several studies, EMS has error rates, just on medication administration, of near 50%. This is unacceptable.
“Now look at aviation. Aviation, using crew resource management and a culture of safety, created an industry that is one of the most error-free industries in the world. EMS and Fire need to embrace this culture and CRM.
“We need to:
Report near misses and errors in a way that is nonpunitive
Research root causes
Measure and remeasure
Make systematic changes based on evidence so the error does not reoccur.
“Let’s talk about service. For too long, service = sacrifice, sacrificing our health, especially mental health, racing to “save” others. But Brunacini’s version of service was about building reliability and trust that a community could depend on its public servants, no matter what.
Emergency medical services are not all about lights and sirens but about serving all our communities, no matter the need. We love our traumas and delight in the cardiac arrest saves, and yet too long have we seen inequities of service for underrepresented, underserved, and underfunded populations. We must do better.
“It is time that we admit that 90% of our job is NOT saving lives! It is serving the community, alleviating pain, and helping people get care.
“Finally, smiles. We relish in our stories of glory, right? But, and this is sometimes a little bit twisted, we also tend to have a great sense of humor. It is this ability for us to find the good in a bad situation, to help a child forget an open fracture, or to help a grandma with dementia feel safe again. Our smiles bring hope. After all, we are the brokers of a promise, a promise that if the community trusts us, calls on us, we will do the best we can. This is hope. Nothing is more powerful than hope. It is the fuel that a sick or injured soul needs to power itself to well-being.
We are its agent, its sales force. It is with polite civility that we can defuse anger and restore dignity. So smile. Remember how powerful and infectious that smile becomes when it inspires others.
“Safety, service, and smiles.
“When science showed us tourniquets saved lives, EMS ADAPTED and adopted.
When science showed us oxygen wasn’t all good all the time, EMS ADAPTED and adopted.
When science is showing us we are making errors, EMS MUST ADAPT in a culture of safety.
When science is showing us providers are burning out and killing themselves, EMS MUST ADAPT and adopt a new mindset.
“And, most important of all, when no one is looking,
When no one is MEASURING,
When no one is using EVIDENCE-BASED scientific practices,
WE, EMS folk, we must take control of our own destiny and do the research that will improve our profession, our patient care, and our self-care!”
