By Shawn Henners, Safety Officer, Montgomery County Hospital District
Montgomery County Hospital District (MCHD) provides indigent care, 911 EMS service, and public health for a county of about 500,000 residents, the 13th fastest growing county in the nation. On the EMS side, we have about 200 EMS field personnel, and in 2015 we ran just shy of 60,000 calls.
In 2014, the Safety Committee noted that the number of reported employee injuries caused by “combative patients” was starting to rise. That year, 14 of our 44 (32%) employee injury reports identified “combative patient” as the immediate cause. One of those incidents aggravated a pre-existing back problem, effectively ending the career of one of our paramedics and costing over $100,000 in workers’ comp claims. 2015 was not very different – 12 of 52 (23%) employee injury reports identified “combative patient” as the immediate cause, including a concussion caused when a paramedic’s head was slammed against a cement floor. Thankfully, that employee recovered quickly and fully.
In May 2015, the Safety Committee considered several training solutions on the market, both nationally and locally. In the end, we chose DT4EMS (Defensive Tactics 4 Escaping Mitigating Surviving). We chose this particular solution because it was designed for EMS/fire, and includes training on the legal and ethical responsibilities to our patients (and how to recognize an attacker vs. a patient), how to de-escalate a situation by providing great customer service (a high value at MCHD), and finally, how to physically defend yourself from an attack while minimizing liability to the organization or individual. The class is a perfect combination of lecture & practical skills – it seems like you’re never in your seat for more than 30 minutes at a time.
We hosted a train-the-trainer in October 2015 and trained nine employees (plus one local firefighter). After a few months of planning and looking at policies and SOGs that might need to change to better align with the training, our in-house trainers trained EMS command staff and some of our training department in January 2016. Although some of them were rather skeptical at first of the need for training, by the end of the 16-hour class, they were 100% behind it. We will begin training our field crews in March, integrate the class as part of our new employee training plan in May, and plan to extend the training to our call-takers and dispatchers as soon as possible.
Future expansion also includes training other first responder organizations in our region, and providing an 8-hour class to all of our non-EMS staff. We will be tracking our injury rate as we roll this training out, and we expect to see a significant decrease in the number of injuries caused by aggressive patients. And although our customer satisfaction scores are consistently very high, we expect to see those improve, too. Our employees will have the training they need to stay safe, we will make better use of taxpayer money as our workers comp insurance premiums go down, and our patients and their families will receive the best pre-hospital care possible. It really is a win-win.
Since January 1, 2012, the most common causes of injury among Emergency Services Organization Safety Group members have been strains, slips, trips, and falls, miscellaneous causes, industrial hygiene incidents, and being struck by objects.
During this time period, the causes of injury with the highest average claim costs were motor vehicle collisions, strains, slips, trips, and falls, being caught in, under, or between objects, and being struck by objects.
Common Industry Hazards:
A list of activities or situations that contributed to the safety group’s injuries is provided below in order to raise awareness of common hazards within the industry. After reviewing this list, download the Common Control Strategies document from the Texasmutual.com Safety Resource Center to learn how to protect your employees from these hazards.
Slips, Trips, And Falls:
Being Struck by Objects:
Among Emergency Services Organization Safety Group members, the three most common causes of injury are strains, slips, trips, and falls, and miscellaneous causes. The three causes of injury with the highest average claim costs are motor vehicle collisions, strains, and slips, trips, and falls.
Texas Mutual recommends that you implement control strategies to protect your employees from these causes of injury. You can use the free safety resources available through the texasmutual.com Safety Resource Center to implement new company policies, train employees, and document your safety activities.
Slips, Trips, And Falls:
Control Strategies for Additional Common Industry Hazards:
Being Struck by Objects:
When the Zika virus began making headlines, the message was that Americans were relatively safe unless they travelled internationally. But new information about the virus has emerged at a dizzying pace. It seems the only thing we know for certain about Zika is that we don’t fully understand it or its potential impact.
That’s why it is critical that you comply with 29 CFR 1910.1030, OSHA’s bloodborne pathogen standard. The standard protects workers who can reasonably be anticipated to come into contact with blood or other potentially infectious materials (OPIM) as a result of doing their jobs. Here are a few highlights from the standard.
Use universal precautions. In layman’s terms, treat all human blood and OPIM as if it is infectious for bloodborne pathogens.
Documentation is key. Put your bloodborne pathogen program in writing. Update it annually, and document that you have considered and begun using appropriate, commercially-available effective safer medical devices designed to eliminate or minimize occupational exposure.
Train employees on the program. Training is a core element of any successful injury and illness prevention program. OSHA requires you to train your employees on your bloodborne pathogen program on initial assignment, at least annually thereafter, and when new or modified tasks or procedures affect a worker’s occupational exposure. Again, remember to document that you provided the training.
Engineering controls are still king. Engineering controls are the best way to protect employees from any hazard, including bloodborne pathogens. Engineering controls remove the hazard at its source. Examples include providing needless systems, sharps disposal containers and self-sheathing needles. The second-most effective hazard control strategy is to change the way employees do the job. Finally, personal protective equipment, such as gloves, gowns and masks, are the least-effective protection against hazards. They should always be your last line of defense.
Make post-exposure evaluation available. Evaluation and follow-up must be at no cost to the worker. The health care professional will provide a limited written opinion to the employer, and all diagnoses must remain confidential.
More information For more information, refer to OSHA’s bloodborne pathogen Web page, and download a sample bloodborne pathogen program.
Over the holiday weekend, 11 tornadoes swept the Dallas area, prompting Gov. Gregg Abbott to declare a state of emergency across much of North Texas. State and federal agencies are working alongside volunteers to assess and reverse the damage. If your business participates in recovery efforts, the Occupational Safety and Health Administration encourages you to educate your employees about the hazards they might encounter and teach them how to protect themselves.
For tips on weathering tornadoes and the hazards that often accompany them, visit Texas Mutual’s blog post titled “Lessons from the Field: Tornadoes Carve Path of Destruction Across North Texas.”
For information on preparing your home and your business for an emergency, leverage these free tools:
WOW, family life, work life, food choices, stress, this fast-paced world and still thinking of ourselves as losers, we just can’t live up to everyone’s expectations. Time, time, and more time is what the demand is today. In the 1920’s and 1930’s society was overworked so employees took action and the government reduced and made regulations to help give us personal and/or relaxation time. Today, we are reliving history by being connected to our work environment and the emergency response processes 24/7. Face it, let’s put it on the table, we are overweight, getting older, and exercise and proper eating becomes quite difficult as a worker and a community driven individual. It is TIME to take time for YOURSELF. However, can we even live up to our own expectations? The BIGGEST LOSER campus in Niagara Falls, NY last spring taught me how and I wish to share an experience that can benefit you.
The biggest and most important lesson was spend time with those whom matter most, YOU being first on the list, because without you there is no need to worry about the rest. Most expert suggest picking the time of day you can focus on you. For example, I start my day around 4 a.m. each morning, having a cup of coffee, no cream and sugar. Is it good for you if you enjoy it? Let’s face reality, most everything we consume is not good for us in one way or another. Those of you that have to have that morning soda, keep in mind the ingredients are full of bad stuff, visit “Hunger for Change” on the internet to learn more. If you have to have a soda do something to counter the reactions. For example, if you drink all the bad stuff, exercise.
Exercise comes in many forms and programs, again our focus was “giving us choices”. On the average BIGGEST LOSER made us workout 5 ½ hours a day for a week. While this is not realistic, they were giving us choices in our workout plans. One workout day at BIGGEST LOSER was equivalent to one workout week back at home. You need to do the type of exercise you enjoy involving some kind of cardio and muscle strengthening. I have been very confused with this because I like running. As I get older it becomes more difficult, but trying is the key. Please don’t listen to others as they try to discourage you from doing what you like, most likely they really wish they could do it and they could if they make it a priority. We are not telling you to run, the best form of exercise is doing some type of outdoor activity you enjoy, anything from working in the yard to riding a bike 150 miles. Three very important rules, even I have a problem maintaining are: stretching your body before you take on the activity, drinking 100 ounces of water a day or ½ your body weight in ounces of water a day, and take small steps toward your goals. Stretching, has been echoed from the experts throughout my life. Looking back at my injuries during my career in the emergency services, if I would have stretched in the morning it would have prevented most of those injuries. At the BIGGEST LOSER we had a choice to get up early or sleep in, we took an hour of stretching to soft music every morning, remember this is a form of exercise. A recommended app is SWorkit. This app shows you how to stretch and gives you choices on what to stretch and has a timer, with music to relax you. Small steps toward your goals can be rewarding because you see the results and before you know it you will be setting bigger goals. Listen to your body, if something is hurting or not feeling right during the exercise STOP. Take time to examine the problem. Don’t confuse this with regular workout pain, our body is aging and undergoing a change so there will be some discomfort.
At BIGGEST LOSER we ate healthy and felt full all day long and I still lost 10 pounds during that week. Throw away the scale, you are trying to loss body fat, not regular scale weight; this is the term I use. One goal was to lose 1 pound of body fat a month. Yes it becomes difficult but it is one that sticks in our mind. If we are exercising and eating right you could actually gain weight not lose it because you are building muscle mass. BIGGEST LOSER encourages you to eat 45 minutes after you wake up or 45 minutes after your morning exercise, I prefer after morning exercises. They also recommend no food consumption 2 hours before bedtime.
Knowing your Basal Metabolic Rate (BMR) also helps you understand yourself. The BMR is the minimum number of calories your body needs to function when completely at rest, these calories are what you need to survive the day. Are you eating over this rate? If so, counter balance with more physical activity. Equally as important is if you become more active and exercising more during the day then your calorie intake may have to increase. BIGGEST LOSER recommends you should consume half of your BMR for the day after you have eaten lunch. People will approach you and ask what type of diet you are on. If you are on a diet you could be depriving the body of nutrients to help your physical condition. Eat small portions, about five times a day. Another app I would suggest is Fooducate. This app recommends alternative healthy products to what you may already like.
Lastly, BIGGEST LOSER was the best medical treatment I have ever received. The experience will never be forgotten, relaxing, peaceful, and getting to know yourself. I will return. Take the TIME and go, call them first and they will be glad to help you through the process. Become that loser of weight, gain time for yourself, and maintain a happy life style.
By Roy Mercer, VFIS of Texas Director of Safety, Training & Education
Recently the State Fire Marshals’ Office had a conference in Hurst Texas to bring in some well-known speakers from across the nation to address the subject of Line of Duty Deaths. The conference was a successful learning experience to assist fire departments with changing some strategies and tactics to lower the risk of having a serious injury or death in your fire department.
The conference addressed multiple subjects that need to be touched upon in order to attack the problem of firefighter injuries and deaths. Topics such as SOGs, Maydays, Firefighter Health, Accountability, and multi-firefighter death incidents were all covered to give attendees a starting point to be able to do something within their department to lower the risk.
Every time there is an LODD in Texas, the State Fire Marshal’s Office is required by law to investigate the circumstances surrounding the death and provide recommendations, policies and national standards that might help a fire department to avoid an LODD. At the end of each fiscal year, the SFMO is also responsible for putting a summary of all the LODDs for that year along with the common recommendations and policies that fire departments should make sure they are following.
If you don’t read any of the individual LODD reports, PLEASE read the summary of all the LODD’s for the year which can be found at www.tdi.texas.gov/fire/fmloddannuals.
Since 2001, the reports have been done by SFMO, have they made a difference? I believe so! If you look at how many LODDs Texas was having on an annual basis compared with how many we see now on an annual basis I think you will see a general downward trend of LODDs over the last several years. Of course there are several incidents within this time period in which one incident accounted for multiple LODDs, however, if you factor those incidents out the general trend has been down.
While it is extremely important to recognize and continue to work with all of the Texas fire service stakeholders, agencies, and fire departments to identify the trends in LODDs and injuries, we must also recognize that as a profession in Texas, we have been doing a better job training, learning from the recommendations from the LODD reports, and being safer while on the fire ground. Good Job! Let’s continue to put out our best effort in making sure we utilize the tools and information out there to keep our firefighters safe!
By Chris Barron, Fire Chief Manchaca Fire Department
2014 IAFC Volunteer Fire Chief of the Year
2016 HB 3667 Grant: Workers' Compensation, Death, and/or Disability coverage - The 77th Texas Legislature (HB3667) created the Rural VFD Insurance Program and is funded by a 2% sales tax on the sale of fireworks. The program provides reimbursement grants for Texas firefighters to obtain workers compensation, death and disability insurance from private insurance companies. Each year more than 400 fire departments and 11,000 firefighters take advantage of the grant offering.
Who is eligible?
Any chartered, non-profit volunteer or part-paid/volunteer fire department is eligible, provided the number of paid members is 20 or less. All qualified departments must participate in a firefighter certification program administered under Section 419.071 of the Texas Government Code (Texas Commission on Fire Protection), or by the State Firemen’s and Fire Marshal’s Association of Texas (SFFMA), or by the National Wildfire Coordinating Group (NWCG).
What is eligible?
Any combination of compensation insurance for firefighters (workers' compensation, death, and/or disability insurance) is eligible. The insurance coverage must include a workers' compensation or similar benefit, and a death benefit. Departments may enter into agreements with cities or counties in order to qualify for coverage and/or special premiums.
How much will it pay...
The program will reimburse 100% of the actual cost of eligible insurance coverage, up to a maximum of $125.00 per fire department member covered in the calendar year 2016.
How to apply...
It's easy, simply read the Application Procedure, complete the following forms and submit via fax, email or mail. Please submit these forms only once during the enrollment period of Dec. 1, 2015 thru Aug. 31, 2016.
Fax: (979) 845-6160
Call: (979) 458-6505
Texas A&M Forest Service
Capacity Building Department
200 Technology Way, Suite 1162
College Station, TX 77845-3424
Emergency vehicle drivers have in their care, custody and control most of the major assets possessed by your organization (the vehicle, portable equipment, and personnel). Emergency vehicle drivers should also make every attempt possible to provide due regard for the safety of others. The safe operation of these vehicles, particularly during emergency response, depends greatly on the ability and skills of the driver.
VFIS recommends the following Emergency Vehicle Driver/Operator Requirements be adopted by your organization to reduce the exposure presented by the operation of your emergency vehicles.
Texas Mutual also offers a Sample Distracted Driving Policy. It is your responsibility to get yourself and others to where you are going safely. Avoid activities that will distract you from this responsibility.
With so much, literally riding in the driver's hands, your organization should select drivers based on specific benchmarked criteria. Selecting, training and maintaining good, safe drivers should not be left to chance. Your organization can maximize the good qualities of a driver and minimize any negative aspects, by proactively addressing the key issues of emergency driving and by following the prescribed guidelines provided in the above resources.
RULES AND OPERATING PROCEDURE: SEAT BELTS AND PERSONAL PROTECTIVE EQUIPMENT
It is apparent that not all staff understands the importance and necessity of wearing seat belts and protective clothing while responding to emergencies. All staff will adhere to and enforce this procedure immediately.
ALL AGENCY OWNED EQUIPMENT DRIVEN ON PUBLIC ROADWAYS
All passengers must be seated and belted whenever the vehicle is in motion. The only exception to this rule is during slow speeds (less than 10mph) such as parades and other similar events. Apparatus seat belt warning systems shall not be modified or disabled in any way.
Seat belts may be removed after setting the parking brake or by direct order of the right seat officer upon arrival of an emergency scene. This specifically refers to arrival at an emergency where one or more personnel are ordered to depart the vehicle for a specific assignment and the vehicle is being positioned elsewhere.
Failure to adhere to this rule will result in the senior officer and/or right seat officer’s suspension from active duty for a minimum of seven (7) days, or increased by the Fire Chief. In addition, the non-complying individual(s) will receive the same reprimand as the officer. The Fire Chief reserves the right to provide one (1) written reprimand that will be placed in the respective personal file.
PERSONAL PROTECTIVE CLOTHING (ALL FIRE DISPATCHES - INCLUDING VEHICLE FIRES AND RESCUES)
All personnel riding in agency vehicles must don the minimum of pants, suspenders and boots prior to boarding the vehicle (except for pickup/SUV vehicles). Personnel are encouraged to don the coat prior to boarding. All personnel MUST remain seat belted at all times while the vehicle is in motion.
The vehicle driver is exempt from wearing PPE during the response; however the driver is encouraged to wear a minimum of PPE pants, suspenders and boots. The driver must don pants, boots and helmet as soon as possible after arrival at fires and rescues.
ALL OTHER DISPATCHES All personnel must be appropriately attired. This specifically means that agency outerwear must be worn. If agency outerwear is not available at the time of the response, the minimum attire is pants, suspenders and boots.
ESO WC GROUP
VFIS of Texas