You are treating an elderly patient with nausea and ask your partner to draw up some ondansetron, you take the syringe from him and deliver what you believe to be 4 mg. While cleaning up your ambulance after the call you realize that what you actually pushed was 50 mg of diphenhydramine. And just like that a medication error has been committed.
If you’ve been in EMS for any length of time you no doubt have had a conversation with somebody about response times. Perhaps you are a field provider who was spoken to about your extended response time, or as a manager you discussed your systems average response time with a town manager. It’s a metric we all live by and it’s a number we are all familiar with, but should this be a key indicator for our systems success?
Safety has become a continued focus in EMS, especially as it revolves around communication. The techniques found in Crew Resource Management (CRM) have helped develop a framework to improve safety through effective communication. The term Crew Resource Management was coined in the late 70s by the airline industry and was developed as a solution to a series of preventable incidents.
New York City had an ambulance service for sick horses, in 1867, two years before there was an ambulance service for people. The American Society for the Prevention of Cruelty to Animals decided that ambulances were needed for horses, two years before Bellevue Hospital decided the same thing. (Needless to say, neither horses nor humans were offered a patient satisfaction survey.)
Astonishingly, even after many cities and towns had ambulance services, there were few federal laws regulating them until the 1970s.
When we think we have it bad today it is good to remember how ambulances were called for and dispatched when they were first invented. When Manhattan’s Bellevue Hospital began its ambulance service in 1869, the second in the country (after Cincinnati), they were impeded by the absence of telephones, which hadn’t been invented yet. Calling an ambulance in New York City worked like this: A patrolman would discover someone who is ill or injured and use a public telegraph station (itself a recent innovation) to contact his precinct, which would send out policemen with a stretcher.
During the Napoleonic wars at the turn of the 18th century, Surgeon Dominique-Jean Larrey developed new emergency procedures, many of them still in use today in modernized forms. Not only did he create “flying ambulances” that brought immediate and well-provisioned aid to the battlefield, but he also imposed order on the treatment that was taking place in the most disorderly of environments.
Modern emergency medicine began on the battlefields of the Napoleon wars in the late 1700s. Physician Dominique-Jean Larrey was dismayed at the practices of the time, which left wounded soldiers on the field until the battle was over. By this time the danger to those who would pick them up lessened. Unfortunately, by this time many of the wounded were already dead.
Employee engagement is one of those buzzwords we love to use but have a difficult time defining. When we talk about employee engagement we are referring to our employees’ commitment toward our organization, and more importantly to our patients. There are a variety of ways to measure employee engagement; through surveys, through discussions with current employees, or simply through the judgment of leadership.
It seems like just a few years ago pain management became a key issue that we were working on in out-of-hospital patient care. The National Association of EMS physicians published its position paper 15 years ago suggesting we better identify and treat pain in the field. There was an epidemic of untreated pain, and opioids were the solution.
Pro EMS has been using Feedback Innovations for several years to improve patient satisfaction, operations, and employee engagement. Feedback Innovation’s patient satisfaction tools are used internally to improve operations. Pro EMS sends patient satisfaction surveys to all patients, regardless of their transport disposition, which ties directly into our patient centered culture. Feedback innovations’ reports with aggregated data and run specific comments are then sent to our providers so they can see directly the many great comments we receive on behalf of their great work.