Month: October 2018

Dead Tired.

MedFlight participating in industrial field amputation training with the Kettering Health Network Surgical Emergency Response Team.

Dead Tired.
Amanda Osborne, MedFlight Outreach Coordinator

In my 18 years in EMS, I have never met a first responder who wasn’t unwaiveringly dedicated to their job and to serving others. Taking that extra 911 call, picking up that extra shift, waking up in the middle of the night when the tones drop, pouring that extra cup of coffee as to prepare for a long transport. I’ve been there myself. And I’ve come home to my family at the end of a long a strenuous shift, kissed my kids, and went to bed… exhausted.

Odd schedules, odd hours, odd circumstances innately lead to odd sleeping patterns. But what about fatigue? What is fatigue? “A subjective, unpleasant symptom, which incorporates total body feelings ranging from tiredness to exhaustion, creating an unrelenting overall condition which interferes with an individual’s ability to function to their normal capacity.” What this translates to: “You are so tired that you are not making great decisions.”

I had never heard of ‘fatigue management’ until I began my career in critical care transport 15 years ago. There were so many proactive measures and systems in place at MedFlight to respect and PREVENT fatigue that I lost count as I learned them all. Among those is a “Crew Rest” feature, where the team can take themselves out of service for a period of time to rest. We want healthy and alert clinicians taking care of the sick and injured. Listing every fatigue management system at MedFlight would make this article 4 pages long.

Let’s look at fatigue from a different angle:

A friend of mine, who does not work in this industry, just had his NORMAL work week increased to 72 hours a week, indefinitely. Six 12-hour shifts in a row, with one day off inbetween (and he is asked weekly to work that day as well). He works in an industrial setting working with very large machinery. As he talked about it, I found myself drawing a lot of parallels to OUR industry and how fatigue, burn out, and the drive to “get more done, place production over safety” can quickly threaten the well-being of medical transport crew members.

Talk with your teams: Could this lead to fatigued decision making? Could this lead to machinery failure? Could this lead to injury, or worse?

What would the potential risks be if we required our crews to work a similar schedule? What tools are in place at YOUR organization to mitigate against fatigue and burn-out? Which of those practices could proactively be placed in my friend’s work setting that would mitigate fatigue and potential errors?

Take time to review the safety measures at your organization that discuss fatigue and burn-out. In addition to having systems, practices, and beliefs in place that promote a safe working cultures, The Commission on Accreditation of Medical Transport Systems (CAMTS) recommends ongoing training on the topics of sleep deprivation, sleep inertia, circadian rhythms and recognizing signs of fatigue.

We work in an industry that needs us at our healthiest so we can help those who need us most. In addition to that, we have families at home who depend on us. Respect your fatigue level, and find a balance that maintains your health and well-being…it’s a matter of safety.

“Evidence-Based Guidelines for Combatting Fatigue in EMS”, Daniel Patterson, PhD, MPH, MS, NRP
“Fatigue: A concept analysis. Int J Nurs Stud.”, Ream E, Richardson
CAMTS Standards and Policies, 10th Edition.

After the Crash: Will You Survive?

by Shane Stull, Flight Paramedic, MedFlight

It’s 0800 hours… You are starting your shift on this cold, bitter morning.  You
call the Communications Center to let them know the crew is in for the day.
The communicator advised it looks like it is going to be a busy day.
After your morning brief, you and your crew head out the door for your first flight request. You quickly check the equipment, do your walk-around, and are on your way.

The day is very busy, and eventually, you find yourself on the way back to base after trip number seven.  And it’s only midnight.

Five minutes out from base, you hear the familiar voice on the radio with
another request, and off you go again. You look at your watch and notice that it’s
going on 0020;   This trip seems like it will take forever.  You look out your window,
and everything goes dark.

Wakening up covered with debris, still strapped to your seat, in the woods, darkness all around, silence surrounding you.  You don’t know where you are or how you got there. You check your body, luckily no major injuries. You look around trying to figure out what happened.  “Why am I in the middle of the woods sitting in a seat with no sign of anybody, just pieces of the wreckage?”  You call out, getting no response from anyone.
You start to panic, your breathing labored, trying to get up out of your seat, realizing that you’re still strapped in. You get unbuckled and crawl from the debris… Still trying to comprehend, asking the same question “What happened?!” over and over in your mind.

As you’re calling out for your crew, you notice the time:
0045. You need to get help and fast.  You try your cell phone, no service.  Radios are broken.  Twenty minutes goes by without word from your crew.  You are desperately trying to get help with no success.  “Boy it’s getting cold out here” you tell yourself while panicking and heart racing, still looking for your crew.  Is anyone coming?  Does anyone know where we are?  What happened?  Where is the survival pack?
This story has two endings, one with the program director telling your family
the bad news,  and one with a story of survival. You have the choice!

Let’s see what happens with the first ending.
You can’t find the survival pack or your crew.  You don’t carry anything in your pockets except medical equipment.  The sounds of a helicopter emerge overhead, but they are unable to see you.  Two days later,  you’re found frozen to death… fifty feet from your crew.   Days later, at your services, the person chosen to give your eulogy stands up and quotes a line from Prince:  “Dearly beloved, we are gathered here today to celebrate this thing called life.”  Not a very good outcome.
Let’s try the second ending and see what happens.

You reach into your pocket and pull out your personal survival kit, locating your flashlight and your crew.  Your crew is alive, but injured.  You are able to get a fire started with your fire starter to keep warm.   As you start walking around to gather more
firewood, you find the vehicle survival pack hanging in the trees.  Returning to build a shelter to protect yourself and your crew from the weather, you hear a helicopter emerge overhead.  It’s time to put your signaling skills to work.  As you make the fire bigger, your crew uses the flashlight to signal the aircraft.  Ten minutes later, rescue crews arrive to prepare you and your crew for transport to the ER for treatment.
Do these scenarios make you think?  It has all happened before, you know!
No one believes it will happen to them.  Do you carry a personal survival kit?  Do you know how to use it?  How about the vehicle survival kit, do you know what’s in it and how to use it?   What would happen if you crashed, do you have on your person what you need to survive?
Now is a good time to check your survival kit.  See what you have to work with, and be sure you check all the contents of the pack on a routine basis.  If it doesn’t work, it will not do you any good.  If you do not have a personal survival kit… then get one.  Only plan on what you have on your person to survive.
Well what do you think?   Are you prepared for a survival situation?   Will you