- An EMS culture that encourages drivers to push past their limits to serve those in need
- A volume-driven business model looking to squeeze out every last penny.
Godfrey, an experienced transport nurse, said that smaller private ambulance providers rely on volume. “Private ambulance services are unique because its volume-driven and the profit margins are narrow. If you have a handful of ambulances and you’re getting reimbursed for each transport, say Medicaid is paying $150 a trip, you’re going to put them in the lowest cost operating ambulance and you’ll hire the least expensive person.”
That often translates to hiring younger, inexperienced drivers more willing to take chances. Godfrey said, “I don’t know of any 22-year-old that would say I’m kind of tired and impaired and I shouldn’t drive anymore.”
However, this safety expert said that type of thinking could end up costing companies money. “If they are volume-driven, you can see how they are going to say ‘don’t take breaks, keep on going.’ It’s really rather short-sighted.
Getting the maximum amount of work out of employees every shift seems like it would increase profit. Jonathan Godfrey warned that exactly the opposite can happen, “A serious safety event is going to cost you far more by death or serious injury. It will impact all the way across your business, your call volume, and your insurance rates to operate vehicles. You could end up closing up your doors.”
He said some businesses are tempted to skimp on equipment in the name of saving money. “If you’re just doing it for the money, instead of giving them a 2-year-old monitor, you’ll get by with giving them one that is 25 years old.”
Accidents And Errors
Godfrey said that fatigued employees make mistakes. “Medical errors, driving errors, and documentation errors go through the roof when fatigued.
In fact, studies show that being awake for 24 hours had similar effects to a blood alcohol level of .10%. The legal limit is .08%. Another study from the American Journal of Industrial Medicine showed that even a 12-hour shift increased the chance of error by 28%.
High Tech Solutions
Godfrey was in charge of setting up the safety management system for a large metropolitan hospital. “Instead of saying, ‘okay everybody, drive safe,’ we set up policies, procedures, and a whole living, breathing system that monitors it.”
His plan included outfitting ambulances with the latest technology to monitor drivers. “We have six identical ambulances and drivers have to fob in with their own little key. It tracks everything they do: how it moves, lights, and sirens. If any of the parameters are exceeded, it activates an automatic recording system inside and outside the ambulance.”
In the next round of upgrades, he plans to install sophisticated equipment capable of detecting driver fatigue. “If they get droopy-eyed, nodding, weaving in their lane a little. We’re trying to be proactive. All of that data is fed into a system that’s figures out what they were doing on that trip on that time and their overall driving behavior. Those scores are benchmarked against our standards and other drivers. They are evaluated in real-time and it sends out a message when problems happen. You can actually radio them and tell them to slow down etc…”
The Wild West
Godfrey said areas like Scioto County are more likely to have problems. “Private ambulance businesses are kind of the wild, wild West. The places where you find the most errors are small municipalities or small ambulance operators. They don’t realize the benefit or they choose not to invest in the time equipment and the training.”
Ideally, he said that equipment monitoring driver fatigue would be standard equipment in every EMS vehicle. Every agency should also have a real fatigue policy that’s applied to every run.
He also said that it’s time to change the culture of safety in EMS services. Godfrey feels that while police and firefighters have done a lot to increase safety recently, EMS hadn’t been brought to that level.
Okay To Say No
Godfrey said it’s important that bosses monitor the fatigue level of employees. But it’s also important that the boss not penalize employees for admitting they are too tired to roll.
He implemented rules that allowed EMS personnel to pass on calls without fear of punishment. “Anyone at any time can go and say, “No, I don’t feel comfortable doing this for any reason.’ People thought I was crazy when I talked about it.”
Godfrey said many voiced concerns about people crying wolf and skipping calls out of laziness. “If we go and transport 6,000 patients successfully with no injuries no deaths no wrecks, we lose a dozen transports because someone doesn’t want to go. Which is better? Lose a few transports or have an ambulance rollover?”
He said that if a boss suspects that someone is abusing the policy, the person should be dealt with on an individual basis. “You need to drill down an manage the people better. That’s truly the way that you can prevent accidents and save lives.”