EMS Safety & Awareness - Spooky Scenarios

As an EMS provider, you’re bound to encounter some spooky calls during your time on the truck during Halloween.

That's why Limmer Education has put together some Hammer House of Horror-inspired emergency scenarios!

Treating Werewolf Attack Lacerations – Treat deep cuts and lacerations like a pro.

The Mummy's Guide To Proper Bandaging Techniques – Learn proper bandaging techniques for real emergencies (no mummification required!)

Handling Toxic Slime & Chemical Burn Care – Learn the essentials of chemical burn care, inspired by alien slime!

Treating Impaled Objects – How to handle that stake-through-the-heart call safely.

How To Treat Rabies Bites – Handle rabid bites with the right care.

What spooky EMS scenarios have you encountered?

All image credits belong to Limmer Education.

EMS Legal Matters - Emergency Medical Treatment and Labor Act (1986)

EMS Providers should be familiar with the Emergency Medical Treatment and Labor Act (EMTALA), as it impacts their responsibilities when transporting patients to hospitals. 

Here are some things EMS providers should know about EMTALA:

Purpose of EMTALA:

EMTALA is a federal law that ensures an individual's access to emergency services regardless of a patient's ability to pay.

The primary purpose of EMTALA is to prevent 'patient dumping', where hospitals refuse to treat or transfer patients with emergency medical conditions because of their inability to pay or lack of insurance.

Key Provisions:

EMTALA requires hospitals that participate in Medicare (virtually all hospitals) to provide a medical screening examination (MSE) to anyone who comes to the emergency department seeking treatment, regardless of their ability to pay.

If an emergency medical condition is identified during the MSE, the hospital must stabilize the patient's condition or transfer them to another facility that can provide appropriate treatment. 

A hospital must provide all necessary treatments within its capabilities to stabilize the patient before transfer.

Hospitals must accept transfers of patients in unstable conditions if they have the appropriate resources and capability to treat the patient's condition.

Impact on EMS Providers:

EMS providers play a crucial role in the initial assessment and stabilization of patients before they arrive at the hospital.

EMS providers must perform an initial assessment and provide necessary interventions to stabilize a patient's condition to the best of their ability within their scope of practice.

EMS providers should transport patients to the nearest appropriate facility capable of providing the necessary level of care based on the patient's condition, even if the patient lacks insurance or ability to pay.

Documentation and Communication:

Documentation of the patient's condition, interventions provided, and the decision-making process regarding transport destination is crucial.

EMS providers should communicate effectively with receiving facilities regarding the patient's condition, anticipated needs, and reason for transport to facilitate continuity of care.

Penalties for Non-Compliance:

Hospitals found in violation of EMTALA may face civil monetary penalties, exclusion from the Medicare program, and potential lawsuits.

EMS providers may face liability if they knowingly transport a patient to a facility that does not have the capability to provide appropriate care for the patient's condition.

In summary, EMS providers must understand their role in EMTALA compliance, which includes providing appropriate medical care and transport to patients regardless of their ability to pay. 

Effective communication, documentation, and adherence to protocols are essential to ensure compliance with EMTALA regulations and provide quality emergency medical care.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Brown, J. F. (1999) Ethics, Emergency Medical Services, and Patient Rights: System and Patient Considerations. Topics in Emergency Medicine 21 (1): 49-57 Accessed April 1, 2024

Harris, D. (2014) Contemporary Issues in Healthcare Law and Ethics (4th Ed). Illinois: Health Administration Press.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

EMS Discussion - Use of Lights & Sirens

EMS Providers should be aware of the ongoing discussion surrounding the use of lights and sirens during emergency calls. There is a growing concern about the risks associated with their use, such as an increased likelihood of accidents and harm to patients.

EMS Providers should stay updated on local and national guidelines regarding when to use lights and sirens to ensure the safety of both themselves and the public.

Those operating emergency vehicles must consider alarming statistics showing that ambulance crashes significantly impact clinicians, patients, and the public, with the risk of a crash increasing by over 50% when lights and sirens are activated.

It is crucial for EMS Leaders to implement well-researched guidelines supporting the restricted use of lights and sirens to enhance the safety of all individuals involved in emergency responses.

In an outstanding demonstration of collaboration on provider, patient, and community safety, 13 national and international associations have partnered on the release of a Joint Statement on Lights and Siren Vehicle Operations in Emergency Medical Services (EMS) Responses (NAEMT, 2022).

The statement articulates principles guiding the use of lights and sirens during emergency vehicle responses to medical calls and initiatives to decrease their use safely. EMS vehicle operations using lights and sirens pose significant risks to both providers and the public. Therefore, their use should be limited to situations where time saved is expected to be clinically important to a patient’s outcome (Merill, 2022).

Communication centers should utilize structured call triage and categorization to identify subsets of calls based on the response resources needed and medical urgency. Physician oversight is crucial in developing response configurations and modes for these protocols.

Agency Leadership should monitor the rates of lights and sirens use, appropriateness, compliance, and outcomes related to their use. Municipal Leaders should be aware of the increased crash risks, and quality care metrics should drive contract agreements.

States and provinces should monitor and report on emergency vehicle crashes to better understand the risks associated with lights and sirens use.

Collaboration between EMS and Fire Agency Leaders is essential in understanding public perceptions and improving education about the risks associated with lights and sirens to create safer expectations.

According to a recent presentation by NEMSQA, 87% of EMS responses were made with the use of lights & sirens, while transports nationally used them 51% of the time. The time savings averaged 102-216 seconds during a response and between 42-228 seconds for transports (from multiple recent studies); yet life-saving interventions are being done in only 6.9% of responses (according to an ESO study of 7.5M records).

At the same time, our odds of being involved in an accident increase by 53% in responses and 184% during transports (not to mention accidents in our wake that do not involve an EMS unit). Furthermore, litigations that involve ambulance incidents are 86% when using L&S.

The data presented highlights concerning statistics surrounding the use of lights and sirens in EMS responses and transports. While time savings are evident, life-saving interventions are performed in only a small percentage of responses.

The increased risk of accidents during both responses and transports underscores the need for a shift towards safer practices. Litigations involving ambulance incidents predominantly occur when lights and sirens are used.

It is crucial to view the use of lights and sirens as a clinical treatment and to follow the guidance to "use only as needed" to ensure the safety of patients, the community, and EMS providers. Prioritizing safe ambulance operations is vital for everyone's well-being and to ensure a safe return home after each shift.

Further Reading:

Merrill, L. (2022) 14 Groups Issue Joint Statement on EMS Use Of lights, Sirens https://www.ems1.com/ambulance-safety/articles/14-groups-issue-joint-statement-on-ems-use-of-lights-sirens-AAfswfKx2gaog3dy/ Accessed February 28, 2024

National Association of Emergency Medical Technicians (2022) Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses https://naemt.org/docs/default-source/advocacy-documents/positions/joint-statement-on-red-light-and-siren-operations-with-logos---final.pdf?sfvrsn=e586e893_4 Accessed February 28, 2024

National EMS Quality Alliance (2024) Improving Safety in EMS: Reducing the Use of Lights and Siren https://nemsqa.memberclicks.net/assets/LSChangePackage/Improving%20Safety%20in%20EMS%20Reducing%20the%20Use%20of%20Lights%20and%20Siren.pdf Accessed February 28, 2024

Zavadsky, M. (2023) Culture Shift: Reducing Lights and Siren Vehicle Operation https://www.ems1.com/safe-transport-point-b/articles/culture-shift-reducing-lights-and-siren-vehicle-operation-XDonsygscixIghQT/ Accessed February 28, 2024