Why We Need Safety Training

When was the last time you took a class just for your own benefit?

Not your patient, not your employer, not your town/agency, not your regulatory agency—just you?

Well, now there is such a program. After 30 years in the field (during which time I’ve been assaulted, shot at, bounced around the “back of the bus,” broken a med box with my head and subjected to other assorted evils) I’m happy to say there’s now a program from the National Association of Emergency Medical Technicians (NAEMT) which addresses the issues that concern us—EMS providers, who are at least twice as likely to be injured doing our job than any other public safety provider.

The newly developed EMS Safety Course, developed by EMS providers for EMS providers, addresses the issues that directly affect us. The members of the developmental committee are experienced (let’s not say “old”) folks—they’ve been there, done that and “got the T-shirt.” They’re from every branch of the EMS family tree—fire, private, volunteer and third services—and they’re from all across the country.

The desire to prevent a new generation of providers from suffering through the same trials which befell us “oldsters” is not a single district problem. It pervades the entire industry, which is why NAEMT is the perfect organization to take on such a project. I wish I had been part of it.

The course addresses the following areas:

• Crew resource management
• Emergency vehicle safety
• Responsibilities in scene management
• Patient handling
• Patient, practitioner and bystander safety
• Personal health

And the EMS Safety Course could prove to be a game changer. It seeks to actively change the culture of accepting an inordinate amount of risk that permeates the industry.

When I started (in the days of the covered wagon), we never wore gloves, we performed mouth-to-mouth and we used DeLee suction devices that were powered by mouth.

We learned, we changed, we moved on—just not far enough.

Now it’s time for us to take the next step forward and not just protect our patients but also ourselves.

I still work for a fire-based regional paramedic unit, but my real love is being technical director for Massachusetts Institute of Technology EMS. These young folks are dynamic, exciting, energetic and filled with the enthusiasm we all once had (you do remember those days, don’t you?).

However, what keeps me up at night is not the occasional silliness that occurs on college campuses, not the possible missteps in treatment, nor the possible disagreements which occur with other agencies or people.

No, it’s that one-day I’ll have to talk to the parents of one of my charges to explain how they were injured while working on MIT’s ambulance. I would do anything to minimize this risk. So, when the EMS Safety Course became available I took advantage of it. The class was run as a continuing education program and was approved by the Massachusetts Department of Emergency Medical Services for continuing education credit. The course materials and cards were very reasonably priced and the costs associated with the class were covered under budget items. I believe that anyone could run the program for less than $50 per person. When we ran it, we offered Boston EMS some slots in the program and they had the foresight to send some of their senior staff, whose experience was greatly appreciated, to participate. I believe that they, too, will become early adopters of this new program “for the rest of us.”

There’s a lot EMS can learn from other industries. The airline industry is today among the highest reliability, lowest failure industries out there. It’s learned from its mistakes. One of the most prominent was Eastern Airlines Flight 401. This four-month-old Lockheed L-1011 Tristar 1 crashed into the Florida Everglades on Dec. 29, 1972. There were 101 fatalities and only 77 initial survivors.

The investigation pointed to the crew’s failure to recognize the deactivation of the autopilot during an attempt to troubleshoot a malfunction of the landing gear position indicator as the cause of the accident. At the time it was the deadliest crash in the United States.

The airline industry learned, it grew and changed. The industry developed crew resource management (taught in the first section of the EMS Safety Course). We have to do the same.

Through teaching the course I found that it, at least temporarily, changes the culture. Even though safety has always been encouraged, the age of the students and the influence of outside employment often were at odds with the procedures. With the addition of the EMS Safety Course (and input of senior personnel) we hope to instill more of the culture of safety that the program espouses. Using spotters while backing (although long a requirement of the service) seems to have increased in frequency. Rear-seat belt use has increased. And students’ attitudes have changed. “We (like to) think we’re safe all the time. This course changed my perspective,” says Dylan Soukup, an EMT with MIT-EMS.

I think the attitude shift stems from the nature of the program as a national, broad-based course that gives participants permission to shuck the testosterone-driven bravado that is endemic in some areas of the industry and focus on our true mission: good patient care provided by trained individuals who arrive safely and transport our patients’ appropriately.

I would encourage you to consider taking the NAEMT EMS Safety Course and urge others in the industry to do so as well. Taking care of ourselves needs to become an industry standard.

For more information on NAEMT's Safety Course, visit https://www.naemt.org/education/EMSSafety/EMSSafety.aspx.

Mark Forgues, MEd, EMT-P, has more than 30 years of EMS experience in municipal, hospital-based, volunteer, private, fixed-wing, collegiate and fire-based EMS agencies. He is director of Medical Resources Group, LLC, an education and consulting firm; technical director of the Massachusetts Institute of Technology Emergency Medical Services; and a per diem paramedic with Wayland (MA) Fire Department Advanced Life Support. He is also a national and internationally known speaker. Contact him at mforgues@mit.edu.