“One engine responded to a new residence for a medical call and report of a patient who had fallen with a possible head injury. The patient had fallen and was confused with an altered LOC. There was nothing to indicate it was anything other than a fall with head injury as dispatched. After the patient was loaded into the ambulance for transport (after about 20 minutes on scene and as the engine company was leaving) the spouse mentioned to the law enforcement officer on scene (a firefighter with a different department) that he also felt ill. The officer/neighboring firefighter became suspicious and asked personnel to test for carbon monoxide. The meter pegged at 999 ppm (its highest available reading) almost immediately. Personnel immediately evacuated the spouse and four sleeping children. All had neurological signs and symptoms once they were awake.
(To read the entire report, enter report #08-066 in the “Search Reports” section of the website).
This report emphasizes the importance of situational awareness. When we let our guard down on those “routine” calls, it sets us up for potentially dangerous consequences. According to the CDC, approximately 500 lives are lost each year due to carbon monoxide (CO) exposure and many more experience symptoms ranging from headaches, dizziness, loss of mental alertness, and nausea, to permanent heart, brain, and nervous system damage. It is unknown how many more thousands of these cases go unreported due to inadequate medical history and lack of awareness.
The carbon monoxide molecule attaches to red blood cells in our bodies 230 times easier than an oxygen molecule, increasing the ease in which this dangerous gas is absorbed. CO exposure is a product of incomplete combustion. It can enter living spaces in numerous ways, including improperly vented natural gas, kerosene and oil burning appliances such as space heaters, water heaters, stoves and furnaces. It can also occur due to cars and generators idling in garages, malfunctioning fireplace chimneys, and the use of charcoal to heat or cook inside the home. Incidents increase in winter, when these appliances are used more frequently and windows are frequently closed.
How Can We Learn From Near-Misses?
Is the above report something that could have happened to you? Have you experienced a similar incident? If so, did you pass it along, keep it to yourself, or maybe just share the experience with your partner or co-workers? The idea behind the Near-Miss Reporting System is to share our experiences with others, as well as to learn from the experiences of our peers, both positive, and negative. By logging on to www.EMSnearmiss.com we are able to take the concept of a “kitchen table” discussion with our crew, and share it with emergency responders around the country. The commercial airline industry, the military, and the medical field have already benefited from analyzing near-miss reports. The program is funded by the U.S. Department of Homeland Security’s Assistance to Firefighters Grant Program and is managed by the International Association of Fire Chiefs.
How Can You Use
The foundation of the system is the database of reports that are submitted by emergency responders around the country. File a report so others can learn from your experiences. The event may have been one where something went wrong that could have been done differently, or perhaps it was an event where everything went well and others can learn from your successful handling of a dangerous incident. It can be something that happened yesterday, or even something that occurred 30 years ago. The incident can be one in which you were directly involved, one you witnessed, or even one you heard about from someone else.
Besides submitting reports, you can also use the database to read the reports of others. One way to do this is to sign up for the free Report of the Week (ROTW). By clicking on a link on the right side of the home page, you can sign up by entering your email address. These reports are carefully selected to highlight a multitude of different themes that you can use to share with your crews. In addition to the carbon monoxide reports mentioned earlier, other EMS themes have included combative patients, needlesticks, and vehicle accident scenes. The weekly reports can be placed on bulletin boards, used for informal training sessions, and incorporated into class curriculum.
Another tool available to website visitors is the “Search Report” feature. Reports can be searched by report number, incident type, region of the country, and many other categories. One of the most useful ways to access reports is through the keyword search. By typing in a keyword, you will be able to access reports falling into the category of the keyword, enabling you to zero in on specific report categories. As an example, when searching for carbon monoxide reports, I was able to find 11 reports by typing in “carbon monoxide” 46 by entering “CO,” and eight by entering “CO exposure.” Typing in “EMS” yielded 185 reports. Try a few different words or combinations of words to expand the number of reports you can find in the topic you may be interested in. You may want to try “needlestick,” oxygen cylinder,” “ambulance,” and “combative patient” for starters.
In addition to reading individual reports, there are many other valuable resources on the website. By accessing the “resources” tab, you will find a vast array of other useful tools. There are presentations, videos and pictures, department policies, emergency vehicle driving programs, annual reports, reports grouped by categories, Near-Miss calendars, training tools, and a continually growing wealth of other information.
How Can You Participate?
Submit a report! Tell your story. By adding the www.EMSnearmiss.com link we are challenging the EMS community to add to the growing number of EMS reports in the database. Encourage your coworkers to do the same. Near-Miss training sessions are scheduled at various conferences and training sites around the country. If you would like to find out about scheduling a trainer to visit your organization, please contact us via the website.