A best practice can be defined as a technique, method, process, activity, incentive or reward that's more effective at delivering a particular outcome than other techniques, methods, processes, etc. By using proper processes, checks and testing, the thinking goes, projects can be rolled out and completed with fewer problems and unforeseen complications.
Best practices do not commit people or companies to inflexible, unchanging traditions. Instead, the best practices approach is a philosophical model centering around continuous learning and improvement based on evaluating current processes and breaking down what's worked, how and why. By understanding this, these methods and systems can then be shared elsewhere without a need to replicate them exactly.
Unfortunately, in today's clinical, training/education or even operational realms, there are precious few tested best practices and little way to adequately share them with the EMS community at large. In this article, we highlight several initiatives and practices that are being successfully implemented by EMS organizations in the U.S.
EMS systems are in a constant state of flux, with issues and directives constantly evolving and re-evolving. These include training programs, federal and state laws and guidelines, day-to-day operational realities and more. One way EMS managers can ease this burden is by sharing best practices. While resources and personnel differ from system to system, best practices should serve as inspiration, providing a framework for improvement, but being as modifiable as required by local circumstances. The challenge, for EMS agencies brave enough to break old patterns to gain needed improvement, is to make these proven ideas even more relevant by implementing them in our own backyards.
Black Box Technology
One of the most dangerous tasks undertaken in EMS is driving an emergency vehicle. An operator has to concentrate on traffic flow, emergency radio transmissions, geography and updates on patients' conditions. Inherent distractions like these make risk reduction and management-that is, improving safety and performance while reducing accidents and operating costs-difficult at best.
Ambulance crashes are usually about the drivers. In 2001, researchers conducted a retrospective analysis of all fatal ambulance crashes reported to NHTSA's Fatality Analysis Reporting System (FARS) from 1987-97. During this 10-year period, 339 ambulance crashes caused 405 fatalities and 838 injuries. Sixteen percent of ambulance operators in the study results were cited, of whom 41% had poor driving records.1 As well, a review of fatal ambulance crashes occurring between 1991-2002 that appeared in the CDC's Morbidity and Mortality Weekly Report in 2003 found that driver-related factors, like driving too fast or in the wrong lane, seemed to have a greater impact than weather and road conditions.2 Poor driving histories by vehicle operators were also shown to be significant predictors for fatal crashes, both overall and among EMS workers specifically. Almost 50% of crash-involved ambulance drivers had some kind of collision or moving violation in the three years before their fatal event, and a special group had more than one offense listed in the FARS database.
So what's an EMS agency to do? Other than patient care, the major responsibility of EMS providers is transportation of the sick and injured. It would seem obvious that such transportation is expected to occur in a safe and prudent manner. So, just as a responsible EMS agency conducts routine quality improvement and assurance reviews of the patient care rendered by its personnel, why shouldn't those same administrators review driving habits? The answer from most EMS leadership would be that they can't monitor every driver every minute they have an ambulance out on the road.