Solutions to Provider Safety

This article appeared in the supplement Ambulance Safety Solutions sponsored by ZOLL Medical Corporation

Expert source: Alan Craig, MS, ACP, Deputy Chief Toronto EMS

   EMS rarely lacks for information. Every call brings a chief complaint, vital signs, assessment findings and a history. We differentiate among and intervene against endless combinations of illnesses, injuries and circumstances. Put it all together, and we have a whole lot to keep track of, at moments that aren't exactly tranquil.

   And just having that information is only the beginning of the job. What matters for patients--and ultimately for you--is what you do with it.

   "There's tons of information available in high-pressure environments like EMS," says Alan Craig, MS, ACP, deputy chief of Toronto EMS, Canada's largest municipal paramedic ambulance service. "There are different ways of making use of that information, and protecting both you and your patients by making sure you're properly processing the information available to you about their condition and the environment you're in."

   That's the concept of situational awareness, and it's important for everyone's well-being. And, luckily for everyone, advancing technology is going to make it much easier to keep a handle on.

Situational Awareness

   One leading conception of situational awareness breaks it down into three parts:

1. Perceiving critical elements in the environment;
2. Understanding the significance of available information;
3. Projecting what could happen next.

   If that sounds familiar, it's because it's precisely what EMS does.

   "When we have critical patients, we're not only aware, from our training and experience, of what's happening with them, but we understand why a change in blood pressure, for instance, or a drop in oxygen saturation is important," says Craig, who oversees Toronto EMS' service quality and program development. "Those are the pieces of information we use to make care decisions, and if any of that fails--if you fail to achieve that highest level of not only knowing what to do, but understanding what you're seeing and being able to project into the future--patients can get out from under you. You'll be surprised by what happens, and that can be lethal."

   Yet EMS is challenged to practice its situational awareness against the backdrop of uncontrolled environments: on the streets, in homes and businesses, surrounded by bystanders and distractions and dangers. That places a premium on excellent clinical skills--and having a little help, if you can get it.

   That's where new technologies come in. We need mechanisms to integrate, contextualize and filter the delivery of the torrent of data and facts coming at us--things that give us what we need to know, when we need it, without bogging down in ancillary details.

   "We want smart delivery of information," says Craig. "There's an enormous amount of information available now in the critical-care setting, and it can be overwhelming."

   Automation of the process should mitigate that. Through automation, our technologies should be able to package the obvious, display patient progressions, warn you if crisis looms, and promote compliance with protocols and procedures.

   Imagine tracking a vital sign over time. Easy enough to measure now, but in the hubbub of an emergency scene, what was it five minutes ago? How about 15? Can you rely on remembering accurately and instantaneously? Then, what's the trend, and what does it mean given your patient's presentation and your other findings?

   "Changes in something like a heart rate can tell us a lot about a patient's progression," says Craig. "If they become tachycardic, that's a clue about things. If they're bradycardic, if their blood pressure suddenly drops or increases, if their oxygen saturation drops or there's a change in their end-tidal CO₂ or ECG, that's a tremendous amount of information. So we really want to watch the things that are most predictive, that best describe transitions in the patient's condition. That needs a technology that looks at blocks of time, takes all of that information and then tells us specific things about what's going on, but not about things that are routine or normal."