Ch 9 Flashcards
One of the key goals of EMS Agenda 2050 is EMS systems that are designed to minimize exposure to injury, infections, illness, or stress.
• A culture of safety includes:
• Data collection
° Just culture
• Coordinated support and resources
• EMS education initiatives
• EMS safety standards
• Reporting and investigation of errors and near misses
• Just culture is an approach to leadership that balances fairness and accountability and encourages people to report errors and near misses by focusing on risk management.
Behaviors associated with error or risk are categorized as:
• Human error
• The reasons for the error are investigated and the individual who committed the error is counseled or educated
• At-risk behavior
• At-risk behavior is when an EMT actively makes a choice to take a risk, believing that the potential adverse outcome is insignificant or that it was justified in the moment.
• This situation typically requires coaching and increased awareness.
• Reckless behavior
• Reckless behavior involves a conscious disregard for a significant and unjustified risk, and it usually results in disciplinary action.
Just culture
The concept of consistent patient care across the entire health care team from first patient contact to patient discharge; working together with a unified goal results in improved individual and team performance, better patient and provider safety, and improved patient outcome.
Continuum of care
Previous models of emergency care often consisted of providers who worked separately, passing the patient from one individual or group to the next.
• Gradually, emergency health care providers recognized that by working as a unified team from first patient contact to patient discharge, it was possible to improve individual and team performance, patient and provider safety, and ultimately, patient outcome.
• This concept is known as the__
continuum of care.
• Community paramedicine and mobile integrated healthcare (MIH) teams may be the best example of the team concept of__
• In the MIH model, health care is provided within the community rather than at a physician’s office or hospital.
• The success of MIH programs has shown that EMS providers, working as a unified team with in-hospital and other community health care providers, can improve patient outcomes, increase patient satisfaction, and reduce health care costs.
continuum of care.
A health care model in which experienced paramedics receive advanced training to equip them to provide additional services in the prehospital environment, such as health evaluations, monitoring of chronic illnesses or conditions, and patient advocacy.
Community paramedicine
A method of delivering health care that involves providing health care within the community rather than at a physicians office or hospital
Mobile integrated healthcare (MIH)
EMTs consistently interact with the same partner or team and often become familiar with the other emergency health care providers and hospital staff with whom they frequently interact.
• Regular teams often train together.
• Team members who frequently train and work together are more likely to move smoothly from one step in the procedure to the next, performing as one seamless unit.
• Team members who train and work together less often may need more explicit verbal direction to accomplish their tasks, potentially leading to patient care delays.
Regular teams
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EMTs work with providers with whom they do not regularly interact or may not even know.
Providers must work within an environment that supports and promotes collaboration rather than competition.
It is crucial to have a clear understanding of the roles, responsibilities, and capabilities of each team member.
• One of the best ways to accomplish this is to train together when possible.
Temporary teams
• Some EMS systems form special teams whose members have particular knowledge, skills, abilities, equipment, and/or training to serve a specialized role within the larger emergency health care team.
• Examples include:
• Fire team
• Rescue teams
• Hazardous materials (hazmat) team
• Tactical EMS team
• Special event EMS team
• EMS bike team
• In-hospital patient care technicians
• MIH technicians
Special teams
The National Incident Management System (NIMS) defines a__ as “The organizational level that divides the incident according to functional levels of operation.
Groups perform special functions, often across geographic boundaries.”
• In the context of EMS, a group consists of individual health care providers working independently to help the patient.
• Some examples of EMS groups are triage, treatment, and transport groups at a mass-casualty incident.
group
A __ consists of a group of health care providers who are assigned specific roles and are working interdependently in a coordinated manner under a designated leader.
Team
In 1945, the__ first defined the five essential elements of a group that people must share. These elements include:
• A common goal
• An image of themselves as “a group”
• A sense of continuity of the group (an understanding that the group may work together more than once, even in a slightly different configuration)
• A set of shared values (how the group wants to get things done) |
• Different roles within the group (often self-assigned)
• Once a group has formed, the ability to function as a true emergency response team depends on the way in which its members work together.
Research Center for Group Dynamics
• In dependent groups, each individual is told what to do, and often how to do it, by his or her supervisor or group leader.
• Group members rely on the group leader for task assignments, troubleshooting, and virtually all decisions, thus limiting the group’s ability to adapt and deliver critical medical care in an uncontrolled field environment.
Dependent teams
• In independent groups, each individual is responsible for his or her own area (either a physical space or set of tasks).
• Members of an independent group may receive support and guidance from a supervisor or group leader but do not have to wait for an assignment before taking action as they would in a dependent group.
• Although independent group members may work on the same patient, each person is focused on individual goals (starting an IV line, splinting an arm, etc.), rather than on working together to achieve a unified goal.
Independent teams
EMTs and other health care providers who work interdependently are functioning as a true team.
Although each provider may still be assigned to a particular area or task, everyone in an interdependent group works together with shared responsibilities, accountability, and a common goal (the best possible patient outcome), as opposed to focusing on the goals of their own individual areas.
Interdependent
When you believe there is an immediate or potential problem that must be brought to the attention of the team leader,__ recommends use of the PACE mnemonic:
• P Probe.
• Look or ask to confirm the problem.
• A Alert.
• Communicate the problem to the team leader.
• C Challenge
• If the issue is not corrected, then clearly challenge the team’s present course of action that is leading to the problem. For example,
“Lieutenant, I think this additional action should be taken. Do you agree?”
• E Emergency.
• If the problem is clear and critical (such as an immediate safety issue), then immediately communicate the emergency to the entire team.
Crew resource management (CRM)
In __each member is responsible for maintaining awareness of the current patient situation and sharing any critical information with the team leader.
° The team leader is responsible for listening to any critical information provided by you or other team members, and incorporating it into his or her decision making.
•__ empowers people to speak clearly and concisely when they detect a problem or potential problem.
crew resource management (CRM)
A set of procedures for use in
environments where human error can have disastrous consequences. It empowers people within a team to communicate effectively with one another with a goal of improving team situational awareness, patient and crew safety, and overall communication.
Crew resource management (CRM)
• Knowing the nature of the emergency, especially when the call is low frequency and high risk, can help you prepare before arriving on the scene.
• En route to the call, mentally rehearse the steps in the care that may be needed.
• Designate a leader.
• Crew members should discuss:
• Their roles
• What additional help may be needed
• What equipment should be taken in
• What transport destination should be considered
Pre arrival
Provide the scene size-up and request additional resources as soon as possible.
Position equipment in a standard location so others can anticipate where to find supplies.
Assess and intervene for life threats immediately.
When given information about the patient, first rule out the worst-case scenario.
• The mnemonic ROWS (rule out worst-case scenario) can be used to remember this step.
Arrival
During the call
The strategies the team leader uses to make decisions depend on the nature of the situation.
The team leader must:
• Gather data. This begins with the dispatch information and continues when the EMT gathers the patient history and completes the physical examination.
• Interpret that data. What do the data mean? Is there a clear pattern? Is more information needed?
• Develop a plan. The EMT determines what treatment is needed based on the information at hand.
• Communicate the plan to the team and implement it. During this time, the team leader reflects on whether it is the right choice and invites feedback from the team
• Evaluate the effect of the decision. During this phase, the patient and situation are reassessed. Based on this reevaluation, the team either continues with the plan or adjusts it.
During the call
• After a stressful or complicated call, it’s important to debrief and talk about what happened.
• If the team consists of you and your partner, that discussion can be informal and happen during the cleanup after the call (back-step debrief).
• For complex calls, a department may assemble the entire team to talk about the call.
• Formal debriefings may include personnel from other departments. These should be structured to help everyone gain an understanding of:
• What happened on the call
• What went well|
• What opportunities exist for improvement
Listen to the feedback with an open mind.
After the call
Traps that frequently lead to decision making errors are
Bias, anchoring, overconfidence
It can be harmful when you remain locked into the bias and consider only one possible idea, ignoring or not seeking other data
Bias
Occurs when you settle on one possible cause of the patients problems early (sometimes before the call) and fail to consider other options
Anchoring
Occurs when you overestimate your ability. Overconfidence may cause you to ignore others when they disagree with a decision,resulting in actions that harm either the patient,the crew,or the public
Overconfidence
Involves repeating the message back to the speaker to help confirm that you heard and understood the message and will act on it
Closed loop communication
