Creating a Culture of Safety: Colorado’s Story

For the past seven years, Colorado has supported training efforts to create a culture of safety among EMS agencies within Colorado and the surrounding states.  

These efforts have been supported by the Colorado Department of Public Health and Environment (CDPHE), Emergency Medical and Trauma Services Section (EMTS), State Emergency Medical and Trauma Advisory Council (SEMTAC) and the Mile-High Regional Emergency Medical and Trauma Advisory Council (Mile-High RETAC).

Each year, I have submitted a systems improvement grant to CDPHE. Dr. Charles Mains, Mile-High RETAC chairman, and the Mile-High RETAC Board of Directors, supported these efforts and provided scholarships and additional funding for the Mile-High RETAC Colorado Annual Safety Summit. The Mile-High RETAC Colorado 7th Annual Safety Summit is scheduled for October 21–24 at the Embassy Suites Hotel, Spa and Conference Center in Loveland, CO. This conference will address personal health issues, quality improvement scenarios, the role of the safety officer and situational awareness for EMS.

Why is this annual safety summit so important? The Strategy for a National EMS Culture of Safety document recognizes the difficult situations EMS providers work under, often with limited supervision. This three-year project was produced under a cooperative agreement between the National Highway Traffic Safety Administration (NHTSA), with support from the Health Resources and Services Administration’s (HRSA) EMS for Children (EMSC) Program and the American College of Emergency Physicians (ACEP). The document outlines the necessity for us to address EMS safety issues across all aspects of the job and states, “EMS safety is a problem that demands to be solved.”

Colorado began its journey in 2006 with the creation of The Safety Transportation Task Force after a series of ambulance crashes with major EMS agencies in the Denver metro area. The goal of this task force was to develop an EMS Safety Tool Kit that would consist of four modules: lights and sirens, safe driving, cab and patient compartment, and roadway safety.

The first Mile-High RETAC Colorado Safety Summit was held on October 3, 2008, with the focus on developing criteria for safety equipment required in ambulances purchased with CDPHE funds through the provider grant process. Six equipment items were identified: ambulance data recorder, child safety restraint systems, monitor brackets, radio headsets, traffic control devices and personnel restraint systems. Today, these guidelines remain, with the ambulance data recorder as a requirement when purchasing an ambulance using state funds. CDPHE awarded $260,000 to EMS agencies in Colorado for items in these six categories during the next grant cycle.

National statistics regarding crash frequency, ambulance safety as it relates to the rural communities, and the “hottest” new safety products available were discussed that first year. Black box training has become an annual presentation, teaching agencies how to collect data and use it for personnel training. Over the years the Mile-High RETAC Colorado Annual Safety Summit expanded its session offerings and brought in local, national and international faculty, including Dr. Douglas Kupas, Dr. Daniel Patterson, Dr. Jon Studnek, Dr. David Slattery, Nels Sanddal, Dr. Elizabeth Donnelly, Dr. David Ross and Randy Kuykendall. This annual conference has attempted to provide education to the EMS community not only with ambulance signage, but with personal healthcare issues as it relates to provider safety, patients and the community.

The second annual safety summit focused on driving behaviors. There was a presentation on the potential correlations in the individual risk-seeking tendencies in rural, volunteer EMS drivers and their history of citations when driving personally-owned vehicles, and EMS crash risks in rural ambulance drivers. Additional topics included ambulance crashes reported in the popular press, at-risk drivers in EMS, EVOC programs and addressing the issue of whether ambulances be emergency departments on wheels, and should CPR be performed in a moving ambulance.

The use of lights and sirens as a medical treatment was presented with the risks and benefits when deciding if this treatment is indicated.  

The helicopter deconfliction program addressed the needs of Colorado’s air medical community. This program included safety management systems, weather sharing and the use of night vision goggles with the aircraft.

John Killeen was an international speaker from Australia on vehicle visibility. He presented the global best practices in visibility and warning equipment, along with the various controversial issues related to markings and visibility.

The National Association of Emergency Medical Technicians (NAEMT) EMS Safety Course was beta tested in 2010. A small town display with miniature buildings, ambulances, autos and hospitals on a large table was used to create the educational scenarios. The American Traffic Safety Services Association (ATSSA) presented the Incident Traffic Control for Responders course. Additional topics included improving how EMS systems deal with sudden death, engineering science to improve ambulance safety, and strategies to keep crews belted in ambulances.

Pediatric transport in ambulances has become an annual presentation. Attendees are able to use various car seats and transportation devices in the back of ambulances for hands-on training.

Vendors are instrumental in supporting the Mile-High RETAC Colorado Annual Safety Summit. Various ambulance companies present their safety features along with other vendors that focused on safety equipment. Ambulances are on display during the safety summit.

Just Culture with Scott Griffith and Paul LeSage was a major focus of the Safety Summit in 2011. Since then, LeSage has become an annual speaker, presenting the Just Culture five essential elements and skills.

The Mile-High RETAC Colorado 5th Annual Safety Summit in 2012 featured “Escaping Violent Encounters,” providing healthcare providers with the tools to recognize, avoid and, if need be, defend against violent encounters. Other topics included predicting stress in EMS crews, managing stress in EMS, and the association between poor sleep, fatigue and safety in EMS. A panel discussion on transporting psychiatric patients brought many questions from the attendees. The updated NFPA Safety Guidelines were presented.

The Mile-High RETAC Colorado 6th Annual Safety Summit in 2013 was a Train-the-Trainer Course with tests and certifications. The NAEMT EMS Safety Course was presented with the attendees receiving a certificate after passing the test. Any agencies are limited in personnel and resources so the concept of a trainer returning to teach others in their agencies is a very attractive concept.

The content of the safety course included crew resource management, emergency vehicle safety, responsibilities in scene operations, patient handling, personal health and patient, practitioner and bystander safety. The attendees also received a certificate for the Coaching the Emergency Vehicle Operator (CEVO) training and ambulance maneuvering skills.

SEMTAC recognized safety as an important issue and has made the Safety Transportation Task Force a standing committee with SEMTAC, which has increased the importance of safety in Colorado. The Mile-High RETAC Safety Summit Planning Committee supports Colorado’s goal to provide premier education of EMS providers across Colorado and other states in the value of improved safety practices and to minimize accidents that result in harm to EMS personnel, patients and the community.

Some of the positive aspects of providing this Mile-High RETAC Colorado Annual Safety Summit training is that it began the dialogue of EMS safety issues in Colorado. The attendees have predominately come from the rural areas of Colorado and many of the attendees have participated each year. This annual safety summit has provided a high quality education from regional, national and international speakers. Due to the safety awareness efforts in Colorado, significant progress in aspects of EMS vehicle safety has occurred. The planning committee members for the annual safety summit have remained consistent over the past years.  

The annual safety summit evaluations indicate a continual need for learning skills in safety and to make it a priority for management. Each year this course has a new focus on safety. The culture of safety cannot be developed attending a one-time course. It is a continual effort that may take years to get the focus and attention it deserves.

Management and regulatory agencies should be held responsible for providing a structure and education to keep healthcare providers safe in all aspects of the job performance. Fatigue and stress lead to burnout and reduction of workforce. Recruitment and retention remain huge issues within the healthcare industry. Safety cannot become a culture by attending one safety summit. For safety to become a culture, it is an ongoing venture and must become a habit in the work environment. The daily risks that EMS providers encounter are not going away and must be addressed.

For more information on the annual safety summit, go to www.milehighretac.org. For questions regarding the annual safety summit, e-mail shirleyterry@comcast.net.

Shirley J. Terry, BSN, RN, is the executive director of the Mile-High RETAC.