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Improve EMS Patient Safety with Recommendations
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
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.
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.
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
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.
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.
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.
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.
An adverse event is an injury caused by medical management rather than the underlying condition of the patient. An adverse event attributable to error
is a “preventable adverse event