2010 safety summit saturday september 18, 2010 mcconnell ... safety conference 2010.pdf ·...

2010 Safety Summit2010 Safety SummitSaturday September 18, 2010Saturday September 18, 2010

McConnell Heart Conference CenterMcConnell Heart Conference CenterColumbus, OhioColumbus, Ohio

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2010 2010 Safety Safety

SummitSummit

Ohio Association of Critical Care Transport

PresidentThomas E. Allenstein, RN, CMTE.Chief Clinical Officer – MedFlight

Vice-PresidentWayne A. Fleck, RN, BSN, BA, CMTE.

Business Manager – University Hospital’s MedEvac

Secretary/TreasurerTeresa Merk, RN, BSN, MBA, CMTE.

Clinical Director - Cincinnati Children’s Transport Team.

Conference ChairRuda Jenkins, RN, BSN, MBA, CFRN, CMTE.Clinical Manager – Air Care & Mobile Care.

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2010 2010 Safety Safety

SummitSummit

Saturday, September 18, 2010

7:00 – 8:00 am Registration / Breakfast8:00 – 8:10 am Welcome and Introductions

Ruda Jenkins, RN, BSN, MBA, Conference ChairAir Care and Mobile Care, Cincinnati OH

8:10 – 9:15 am Keynote AddressEnhancing Workplace Safety, Organizations That Get It

Jonathan Godfrey

9:15 – 9:30 am Break9:30 – 10:30 am A. Ambulance Safety

Mark Collins, BSBA, PMP.Director of Operations, MedFlight.

B. Flying in the Wired Obstructive EnvironmentRobert A. Feerst

10:30 – 11:00 am Vendor Break

11:00 am – 12:00 pm Weapons of Mass Destruction (WMD)Steve Saltzman

12:00 – 1:00 pm Lunch / Vendor1:00 – 2:00 pm A. Helicopter Safety for First Responders

Stan KocolSafety Manager, St. Vincent/UTMC/St. Rita’s LifeFlight

B. Inadvertent IMC for Medical Crews and Control FlightInto TerrainColin Henry

Director of Safety, MedFlight.Jeff Schorsch

Check Airman, St. Vincent/UTMC/St. Rita’s LifeFlight

2:00 – 2:30 pm Break / Vendor

2:30 – 3:30 pm Sleep Deprivation/Human FactorsChristopher A. Goliver, M.D.

Medical Director, St. Vincent/UTMC/St. Rita’s LifeFlight

3:45 – 4:30 pm OACCT Landing Zone SafetyBryan L. Spangler, BA, EMT-P, EMSI, CMTE.

Outreach Coordinator, MedFlight.

4:30 pm Evaluation and CEUs

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Major Education Sponsor: $1500

Program Sponsors: $1000

Sponsors: $500

Vendors:

$200 - Kalitta - Xtreme ALSE, LLC - Zoll Data - PharMedCorp - The Center for Medical Transport Research - Physio MedTronics -PraxAir - Phillips - ResponseSoft

Table of Contents

Enhance Workplace Safety, Organizations That Get It ...................................................................5

Ambulance Safety............................................................................................................................6

Flying in the Wired Obstructive Environment...............................................................................21

Weapons of Mass Destruction .......................................................................................................22

Helicopter Safety for First Responders..........................................................................................23

Inadvertent IMC for Medical Crews and Control Flight Into Terrain ...........................................25

Sleep Deprivation/Human Factors.................................................................................................33

OACCT Landing Zone Safety .......................................................................................................46

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8:10 – 9:15 am Keynote Address Enhancing Workplace Safety, Organizations

That Get It Jonathan Godfrey

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9:30 – 10:30 am Breakout Session A Ambulance Safety

Mark Collins, BSBA, PMP. Director of Operations, MedFlight.

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Ambulances Safety

Comprehensive Approach

Mark Collins BSBA, PMP, CM

Objectives

• Understand what causes of accidents.

• Understand Behavior Bases Safety Programs

• Become interested in making a positive contribution to your safety program when you return home.

U.S. Ambulance StatisticNumber of Ambulance Services 15,276

Number of Ground Ambulance Vehicles 48,384

Number of EMS Personnel 840,669

Volunteer Personnel 22%

Percent EMT-B (Workforce Certification) 53%

Percent EMT-I & P (Workforce Certification) 50%

Percent Registered Nurses (Workforce Certification) 8%

Percent First Responders 11%

Percent FD with cross trained EMS (Operator) 38%

Percent FD with Separate EMS (Operator) 4%

Government or Third Service (Operator) 23%

Private company (Operator) 13%

Hospital Based Service (Operator) 7%

Public Utility (Operator) 2%

Other (Operator) 12%AAA 2007 Annual Fact Sheet

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What Causes Accidents?

• Unsafe Conditions, OSHA Violations, dangerous equipment. Year in and Year out it is 4% to 15%

• Unsafe actions, at risk behavior, poor decisions. Year in and Year out it is 85% to 96%

Ohio BWC Statistics

RW accidents 1987-2000

66 of 87, or 76% of total accidents were caused by Human Factors

RW Fatal accidents 1987-2000

84% of Fatal Accidents were caused by Human Factors

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National Highway Traffic Safety Administration

1. Do not track Ambulance Accidents as a category.

2. Ambulances are in there with all vans, and light, and medium duty trucks; the data must be manually collated.

3. Sometimes you have to make assumptions to build logic.

Statistics Assumptions

1. AAA in 2004 estimated 10,000 ambulance crashes nationally each year.

2. National Safety Council 2002 reported 6,500 Nationally with 3,686 injuries.

1. A Safety Review and Risk Assessment in Air Medical Transport Nov 2002 pg.37.2. Marsh and McLennan, Fleet Benchmarking 2004.3. Detroit News Washington Bureau, “Unsafe Saviors”, Lisa Zagaroli, January 26th 2003.4. New York Bureau of EMS Policy Statement # 00-13

Rate per Marsh & McLennan Fleet

Benchmark Accidents/million miles

Accident Miles Interval

Passenger vehicle rate 13.7 5,617

Government Vehicles 8.2 121,951Utility Vehicles 5.7 175,438

300 Fatal CrashesInvolving Ambulances

82 Ambulance Occupants 275 of other Vehicles

27 On Duty EMS workersMortality Weekly Report article published in February 2003, National Institute for Occupational Safety and

Health (NIOSH)

1991 – 2000

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Table 2: Driver‐Related Factors Associated With EMS Worker Fatality Crashes

Cited Factor #1 Cited Factor #2 Cited Factor #3 Incidents Percent

Driving too fast None None 1 4

Driving too fast Not in lane None 1 4

Driving too fast Not in lane Water, snow, oil 1 4

Driving too fast Inattentive None 1 4

Driving too fast Driving shoulder Curve, hill, etc. 1 4

Driving too fast Operator inexperience Not in lane 1 4

Not in lane None None 2 8

Not in lane Driving too fast None 1 4

Not in lane Failure to yield None 1 4

Not in lane Overcorrecting None 1 4

None None None 4 16

Failure to obey None None 2 8

Drowsy, asleep Not in lane None 1 4

Erratic/reckless Driving too fast None 1 4

Hit and run Inattentive None 1 4

Inattentive Vehicle in road None 1 4

Other improper turn Inattentive Not in lane 1 4

Vehicle in road Not in lane None 1 4

Weather None None 1 4

Wrong side of road None None 1 4

Total 25 100

25 Crashes Resulted in 27 EMS Fatalities

It means that 80% of the accidents that killed EMS

workers from 1991 to 2000 were caused by

unsafe actions, at risk behavior, or poor decisions.

What does that mean?

What is an At Risk Behavior?

An unapproved work practice used for the sake of

convenience, comfort or expedience that increase the

chance of error or injury.

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Human Factors

Journal of Emergency Medical Services (JEMS) July 1989 Robert Elling EMT-P

Dispelling Myths on Ambulance Accidents48 months 1412 New York State Ambulance Accidents

“Assuming your ambulances are adequately maintained, the way to decrease the

number of accidents is to minimize the number of human errors that occur.”

Ambulance Accidents occur in Bad Weather and Poor Visibility

Weather Conditions Number of Accidents % of total

Clear 792 56%

Cloudy 220 16%

Rain 259 18%

Snow 51 4%

Sleet/Hail/Freezing Rain 13 1%

Fog/Smoke/Smog 1 .0007%

Other 5 .003%

Unspecified 71 5%

Total 1412 100%

Most Ambulance Accidents occur on dark roads or at dusk when the driver has difficulty seeing.

Light Conditions Number of Accidents % of total

Daylight 825 70%

Dawn 17 2%

Dusk 35 3%

Dark (lighted road) 261 22%

Dark (unlighted road) 22 2%

Unspecified 12 1%

Total 1172 100%

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Most Ambulance Accidents occur when trying to pass a vehicle that refuses to yield.

Manner of Collision 2vehicle accident

Number of Accidents % of total

Rear End 231 21%

Left or Right Turns 128 12%

Right Angle 447 41%

Head on 15 1%

Side Swipe Overtaking 224 21%

Other 37 3%

Total 1082 100%

Most Ambulance Accidents occur when trying to pass a vehicle that refuses to yield.

Manner of Collision 2vehicle accident


Rear End 231 21%

Left or Right Turns 128 12%

Right Angle 447 41%

Head on 15 1%

Side Swipe Overtaking 224 21%

Other 37 3%

Total 1082 100%

The largest percentage of collisions occur in intersections.

Most Ambulance Accidents occur on wet or snowy roads.

Road Surface at time of accident


Dry 891 63%

Wet 352 25%

Muddy 4 0%

Snow/Ice 78 51%

Slush 12 1%

Other 3 0%

Unspecified 74 3%

Total 1414 100%

Don’t be lulled into a false sense of security on dry roads. 4 second rule dry and six second when wet.

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Most Ambulance Accidents occur while backing the vehicle in a tight spot.

Location of Accidents Number of Accidents % of total

On Roadway, at Intersection

824 70%

On Roadway, not at Intersection and off roadway

348 30%

Total 1172 100%

The majority of Ambulance Accidents occur in an intersection.

Because of Lights and Sirens; Traffic Signaling Devices do not present a major hazzard.

Traffic Control Device at Accident Sites


None 424 30%

Traffic Signal 745 53%

Stop Sign 94 7%

Flashing Lights 8 1%

Yield Sign 8 1%

Officer 5 0%

No Passing Zone 18 1%

Other 26 2%

Unspecified 84 6%

Total 1412 100%

60% occurred at traffic signals and stop signs Intersections are dangerous locations.

Elling’s conclusions to decrease Human Factor errors?

Change the behavior of Ambulance Drivers

1.Provide Education to the Drivers and the Public emphasizing Risk Factors

2.Conduct Driver Behavior Modifications classes.

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Behavior Modification

•Proactive Behavior Based Safety Initiative.

•Focuses on what people do.•Analyze why they do it.

•Apply research and metrics to develop intervention strategies.

Elling’s conclusions to decrease Human Factor errors?

Change the behavior of Ambulance Drivers

1.Provide Education to the Drivers and the Public emphasizing Risk Factors

2.Conduct Driver Behavior Modifications classes.

3.Modify existing laws, rules, regulations, and SOPs.

Comprehensive Safety Program

1. Design safety into your equipment.

2. Design safety into your policies and procedures.

3. Design safety into your culture as evident in behaviors.

4. Proactively enforce your policies and procedures and

5. Proactive hazard Identification and redesign of systems where necessary.

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Systems Design (Equipment)

1. Buy a vehicle in which the patient care box stays on the chassis.

2. Buy a patient care box that will keeps it’s integrity when in an accident.

3. Design your interior so you team can remain belted the maximum time.

4. Buy seats mounted to stay put and stay together.

Behavior Modification

•Proactive Behavior Based Safety Initiative.

•Focuses on what people do.•Analyze why they do it.

•Apply research and metrics to develop intervention strategies.

Design safety into your policies and procedures.

• Back up Policy• Lights and Sirens• Speed Limits• Cell Phones• Seat Belts• Securing Equipment• Vehicle Preparation

• Maintenance Reporting

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Design safety into your culture as evident in behaviors.

• Concentrate on the hidden beliefs, norms, and assumptions that actually govern the work place.

• ID a safety rule or policy that is frequently ignored.

• ID the unwritten rule or reality that undermines the rule or policy.

• Why - First, ask is there a systems problem?

CASE STUDY

• What rule or policy is being ignored here?

• Is there an unwritten rule or reality that undermines the rule or policy?

• Why? Is there a systems problem?

CULTURE, do we have a problem?

• What policy is being ignored here?

• Is there an unwritten rule or reality that undermines the rule or policy?

• Why? Is there a systems problem? • Is there an education Problem here?• What should have occurred here?

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What Happened?

Criminal Court

• Metro EMT sentenced to 10 years for manslaughter granted shock probation after serving 160 days.

• Drug test discovered Methadone in her system.

• Driver had a 2005 arrest for reckless driving and possession of 6 methadone pills before being hired by Metro.

What Happened?

Civil Court

• Filed against Louisville Metro Government and the ambulance driver. Suite claims that coworkers and supervisors knew she was impaired and should have stopped her from driving. Settled out of court.

• $$$$$$$$$$$$$$$$$$$$$$$$$$$$$?Lesson Learned?

Enforce your policies and procedures

•When you say nothing about non compliant behavior; you are positively reinforcing ignoring safety requirements.

•Tools to gain information–Non Punitive self reporting programs–Drive Cam

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Black Box

Points averaged over miles traveled1. Speed 65 MPH, 75 MPH lights and sirens2. Seat Belt3. Back up Spotter4. Rapid Deceleration and Acceleration5. Sharp Turns

Three day Average Driver Level

0

2

4

6

8

10

12

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39

Days

Leve

l

Series1

Enforce your policies and procedures

• When you say nothing about non compliant behavior you are positively reinforcing ignoring safety requirements.

• Accountability, Accountability, Accountability

• Tools to gain information– Non Punitive self reporting programs– Drive Cam– Black Box– Audits

What is Behavior Based Safety ?

• Directing your safety program to reduce the number of Unsafe Behaviors.

• Changes is behaviors leads to change in attitude.

• Put the responsibility on the individual.

• Establish a system to audit and track activities.

• Makes effective use of training you already provide.

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Organized Safety Program

CRM

Audits

ChecklistWorksheets

TrainingPlan

Alcohol& DrugsPolicy

Audit

Maint.Schedule

SafetyDrills

Security Policy

KKK

Regs .

No Structure STRUCTURE

OSHA

HSEPolicy

QAOpsManual

OMTB

Hazard Identification Redesign Systems where necessary.

•Tools to collect and ID Hazards–Incident / injury / near miss reviews –Use of antecedent / incident reports –Job Hazard Analysis –Employee interviews and surveys

–Brainstorming (Safety/Clinical/QI Committees)

–Audits

Inventory of at-risk behaviors

• Develop a multi-level Team to assemble the At Risks Behavior Inventory.

• Train the Team to be observers of the at Risk Behavior.

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Trained Observers perform Audits

– Observe what people do, – Record safe and at-risk behaviors on a datasheet.– Analyzes why they do it.

– Develop research-supported intervention strategy to improve what people do.

– Provide feedback to workers.

– The feedback reinforces the necessity for safe behaviors.

– Observers identify barriers to safe behavior. – Strategies to remove barriers are developed.

What are the road blocks ?

• Employee Support– Changing a Prevailing Attitude that safety is the

companies responsibility.

– Changing the attitude that we have always done it this way.

• Management Support– Changing the Prevailing Attitude that production

and quality can work independently of each other.

– Changing the attitude that we have always done it this way.

Questions?

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9:30 – 10:30 am Breakout B Flying in the Wired Obstructive Environment

Robert A. Feerst

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11:00 am – 12:00 pm Weapons of Mass Destruction (WMD)

Steve Saltzman

1:00 – 2:00 pm Breakout A

Helicopter Safety for First Responders Stan Kocol, Safety Manager.

St. Vincent/UTMC/St. Rita’s LifeFlight

Outline ‐ 1st Responder Helicopter Safety

Introduction

Accident Scene Video

Agenda

Review of Scene Safety

24 Hour Hotlines

Witness Documentation

Media Relations

Wreckage Documentation

Wreckage Hazards

Mechanical Hazards

Composites and Fiberglass

Communicable Diseases

Hazardous Materials

Wreckage Hazards

Investigation

Aircraft Evacuation Procedures

Emergency Locator Transmitter (ELT)

Accident Scene Locations

Accident Scene Issues

Typical Helicopter Construction

Ohio Based Rotary Wing Aircraft

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1:00 – 2:00 pm Breakout Session B Inadvertent IMC for Medical Crews &

Control Flight Into Terrain Colin Henry, Director of Safety.

MedFlight Jeff Schorsch, Check Airman.


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1

Inadvertent IMC for Medical Crews and Control Flight Into

TerrainColin Henry & Jeff Schorsch

Why are we here?Fatal Accidents from 1989 - 2008

0

5

10

15

20

25

30

1989 - 1993 1994 - 1998 1999 - 2003 2004 - 2008

Why are we here?

• NTSB reports indicate that at least 30% of these accidents may have had some element of Loss of Control or Controlled Flight Into Terrain

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2

U.S. EMS Helicopter CFIT Accidents

Based on accidents in U.S. between 1992 - 2004 (NTSB Database)

1992 - 2004

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1

2

3

4

5

6

1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Year

Num

ber o

f Acc

iden

ts

Part 135Part 91

U.S. EMS Helicopter CFIT AccidentsTime of Day Threat Types

Based on accidents in U.S. between 1992 - 2004 (NTSB Accident Database)

Day16%

Night84%

IMC42%

VMC58%

Obstacle5%

Water16%

Terrain79%

Meteorological Condition

What is the difference?

• Loss of Control is when the pilot may have had some form of spatial disorientation and has placed the aircraft in an undesirable/out of control state such as being inverted, allowing aircraft to descend on its own.

• Control Flight Into Terrain occurs when the pilot is in control the aircraft’s flight but runs into something such as the ground, terrain or an obstacle.

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When can these events occur?

• When pilot inadvertently enters Instrument Meteorological Conditions (IMC)

What is VFR_VMC_IFR_IMC?

• Rules

• Conditions

What is the difference?

• Visual Flight Rules (VFR)• Visual Meteorological Conditions (VMC)• Instrument Flight Rules (IFR)• Instrument Meteorological Conditions

(IMC)

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4

IFR Program vs. VFR Program

• Aircraft

• $$$

• Experience

What is Inadvertent IMC?

• IIMC

• How does it happen?

• Why does it happen?

• What is the problem?

How to brief for IIMC

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5

Sample brief

4 Essential Flight Instruments

• Torque Gauge

• Attitude Indicator

• Vertical Speed Indicator

• Slip Indicator “The Ball”

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Spatial Disorientation

• Major illusions– The leans– Coriolis illusion– Elevator illusion– False horizon– Autokinesis

Coping with Spatial Disorientation

• Do a proper pre-mission briefing• Avoid adverse conditions• Use reliable visual references• Avoid sudden head movements• Comply with IMSAFE

Countering Spatial Disorientation

• Rely and scan flight instruments• Use good crew resource management

(CRM)• Practice/train for IIMC events ( use

simulators)

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Use NTSB recommended technology

• HTAWS• Autopilot

Terrain Database & Look Ahead Algorithm

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2:30 – 3:30 pm Sleep Deprivation/Human Factors

Christopher A. Goliver, M.D. Medical Director.


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Sleep Deprivation

Sleep is a behavioral state that is a natural part of everyone’s life. We spend about 1/3 of our lives asleep.Sleep is a required activity, not an option.Sleep is essential in maintaining normal levels of cognitive skills such as speech, memory, innovative and flexible thinking. In other words, sleep plays a significant role in who we are.

Lack of SleepThe brain cannot release hormones at needed levels and the individual can become irritable, affecting your emotions, social interaction and decision making. Sleep deprivation also affects motor skills enough to be similar to driving while intoxicated. Driver fatigue is estimated to cause 100,000 accidents and 1500 deaths annually in the United States.

Sleep DeprivationOne of the possible side effects of a continued lack of sleep is death. Usually this is a result of the fact that the immune system is weakened without sleep. The number of white blood cells decreases as does the activity of the remaining white blood cells. Animal studies have shown that death occurs almost equally in time from starvation as that compared to lack of sleep.

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Signs of Sleep DeprivationFalling asleep as soon as your head hits the pillow.Regularly need an alarm clock to wake up.Need for frequent naps.Poor performance in school or on the job.Increased clumsiness.Difficulty making decisions.Increased incidence of medical conditions such as depression, coronary artery disease, hypertension and stroke

Sleep RequirementsInfants – 16 hoursChildren – 10 to 12 hoursAdults – 7 to 8 hoursBrown Bat – 20 hoursGiraffe – 2 hoursCurrent world record for longest period without sleep is 11 days set in 1965 by Randy Gardner. 4 days into the research, he began hallucinating followed by delusions where he thought he was a famous football player.

Types of SleepSleep is a highly organized sequence of events that follows a regular, cyclic program. REMNon‐REMDuring Sleep certain hormones are released such as Follicle Stimulating Hormone, Leutinizing Hormone, Thyroid Stimulating Hormone, Growth Hormone, Prolactin. These hormones then interact with other body systems to improve health and well being.

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Non‐REM SleepStage 1 – Drowsiness – Lasts 5 to 10 minutes. The eyes move slowly, muscle activity slows down and you are easily awakened. Stage 2 – Light Sleep – Eye movements stop, heart rate slows, and body temperature decreases.Stages 3 and 4 – Deep Sleep – You’re difficult to awaken and if you are awakened, you do not adjust immediately and often feel groggy and disoriented for several minutes. Perhaps the most vital stage of sleep.

REM SleepREM Sleep also known as Dream Sleep – Typically occurs at about 70 to 90 minutes into your sleep cycle. Normally have 3‐5 REM episodes per night.Associated with processing emotions, retaining memories and relieving stress, also thought to be vital for learning and developing new skills.REM sleep stimulates learning, when a person is taught a new skill their performance does not improve until they receive at least 8 hours of sleep.

Physiologic Effects of SleepNon‐REM REM

Brain Activity Decreases IncreasesHeart Rate Decreases IncreasesBlood Pressure Decreases IncreasesRespirations Decreases IncreasesBody Temperature Decreases No Regulation

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Sleep and the BrainSleep is actively generated in specific regions of the brain. The basal forebrain, including the hypothalamus, help control Non‐REM sleep and may be the region keeping track of how long we have been awake and how large our sleep debt is. The Pons is critical for initiating REM sleep. The Pons sends signals to the visual nuclei of the thalamus and to the cerebral cortex (thought process). The Pons also sends signals to the spinal cord causing temporary paralysis that is characteristic of REM sleep.

Short Term Sleep DebtFor short term sleep debt such as a night or two of little sleep, you may just need a day or two of increased sleep. For long term sleep debt such as chronically being sleep deprived the body often requires several days to return to normal hormonal levels.

Circadain ClockAn internal biological clock that helps regulate the timing for sleep in humans. This clock is located in the suprachiasmatic nucleus (SCN) of the hypothalamus. Regulated by Exogenous (external influences) and Endogenous (internal influences). The release of Melatonin from the pineal gland is controlled by the SCN. Its level rises during the night and declines at dawn.

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Endogenous RhythmsDriven by an internal clock rather than anything external. Typically 25 hours in cyclical length. Accumulation of Adenosine promotes sleepiness. Caffeine binds to and blocks the same cell receptors that recognize adenosine. We usually sleep once daily because the pressure to sleep is hard to resist after about 16 hours, and then while we sleep we reset the various hormone levels.

Exogenous RhythmsTypically matches the day length of the environmental photoperiod. The cue that synchronizes the internal biological clock to the environmental biological clock is light.Photoreceptors in the retina transmit light dependent signals to the SCN.

DesynchronizationInability of our circadian clock to make an immediate adjustment to the changes in light cues when making a rapid adjustment (Jet Lag).Monday Morning Blues – By staying up and sleeping in an hour or more on the weekends, we push our biological clocks toward a later nighttime phase. When the alarm rings at 6:30 AM on Monday, our body’s internal clock is now set at 4:30 AM

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Sleep DisordersInsomnia – Characterized by an inability to fall asleep and/or by waking up during the night and having difficulty going back to sleep.Obstructive Sleep Apnea – Potentially life threatening condition in which breathing is interrupted, made worse in obese patients.Restless Leg Syndrome – Unpleasant leg sensation and an almost irresistible urge to move the legs. Narcolepsy – Excessive and overwhelming daytime sleepiness.

Seasonal Affective DisorderToo little bright light reaching the biological clock in the SCN can bring about decreased appetite, loss of concentration and focus, lack of energy, feelings of depression and excessive sleepiness. Treatment often involves light therapy.

Sleep and ExercisePeople who regularly exercise report having fewer episodes of sleeplessness than people who don’tExercise helps our bodies transition between the phases of sleep more regularly and smoothly. 3 workouts of 10 minutes is just as effective as a 30 minute exercise routine. Exercise should occur after awakening or at least several hours before one wants to go to sleep.

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Lack of Sleep and Weight GainLeptin and Grehlin are hormones that help the body control appetite and weight gain. Leptin suppresses the appetite, while Grehlin increases appetite.With sleep deprivation levels of Grehlin increase causing greater appetite and levels of Leptin decrease.Regardless of diet and exercise, it’s possible that some obesity is caused or made worse by sleep deprivation.

Sleep InertiaThe feeling of grogginess most people experience after awakening. Can last from 1 minute to 4 hours. A critical factor to recovery is the sleep stage prior to awakening and any sleep debt.

Effects of Sleep InertiaDecrease in Memory AbilityImpairment of the capability to make decisionsImpairment of performance and response time on tasks.

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Circadian Rhythms / Shift WorkThe adverse effect of constantly rotating shifts is the single most important reason given for premature attrition from the field. The problems of rotating shifts stem mainly from working in opposition to the body’s circadian rhythm.Social isolation is also a major problem reflected in an increased divorce rate. Shift workers are more likely to have higher rates of substance abuse and depression.

Shift WorkOne important finding about the internal clock is that it runs on a 25 hour day. This is the basis for recommending a clockwise shift rotation that takes advantage of this natural tendency.

Sleep StagesStage 1 sleep – the initial part of any sleep episode.Stage 2 sleep – accounts for the largest percent of sleep, it is the matrix from which all other stages proceed. Attempts to deprive a subject of stage 2 sleep results in total sleep loss because it is impossible to enter the deep sleep stages of 3 and 4 without going through stage 2. Stage 2 is also the stage which is least likely to be made up after a period of sleep deprivation. Sedatives result in a greater total sleep time but almost exclusively increase stage 2.

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Social Factors of Shift WorkMost of society recognizes that sometimes one must work during important social functions but they are not so forgiving if one is “only sleeping”

Night Shift SchedulingWithout having a permanent night worker the best shift rotation from a circadian perspective is to have group members work a long string of nights, 4 to 6 weeks. The other strategy is to work as few a number of nights in a row as possible, ideally one. The idea is to never reset your circadian rhythm. Working 4 to 7 night shifts in a row is universally condemned, one suffers from the worst of both systems.

Night ShiftsFor those working short stretches of night shifts, split sleep periods may be an effective strategy. Sleep in two 4 hour blocks adjacent to your normal sleep time or work schedule. With long night shift rotations, the strategy of anchor sleep may minimize desynchronization. Anchor sleep is a period of at least 4 hours during which one sleeps every day. For example if you sleep from 8am until 4pm on work days then try to sleep from 4am until noon on days off to anchor 8am thru Noon.

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The Thomas ScheduleA person works a month or longer on nights, while others work isolated nights to cover for any remaining nights. The person on nights for the month should not have more than 2 nights off in a row, otherwise they risk readjustment.

Getting Better SleepRegular exercise as little as 20 to 30 minutes makes it easier to fall asleep. Get some light to set your body clock when awakening.If you are having trouble sleeping at night, try to eliminate napping.

Things to Avoid for Better SleepAlcohol may make you fall asleep faster but reduces sleep quality by increasing stage 2 sleep.Caffeine can cause sleep problems up to 10 to 12 hours after drinking it by binding to the Adenosine receptor sites.Smoking – Nicotine is a stimulant which disrupts sleep, in addition smokers may actually experience nicotine withdrawal as the night progresses.

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A Better Sleep EnvironmentLarge enough bed.Comfortable Mattress, Pillow and Bedding.Keep the noise level down.Keep your room dark during sleep hours.Keep the room temperature cool.Reserve your bed for sleeping and exercise.

Foods that help you SleepA light snack which contains the amino acid Tryptophan can help promote sleep. When you pair Tryptophan with carbohydrates it helps calm the brain even faster.Foods which contain Calcium help the brain process Tryptophan.Examples would be: Milk with a turkey or peanut butter sandwich, whole grain low sugar cereal, yogurt, a banana, a cup of hot decaffeinated tea.

Develop a Relaxing RoutineA consistent, relaxing routine before bed signals to your brain that it is time to wind down, making it easier to fall asleep.Avoid bright light or activities which cause stress and anxiety before going to bed. Relaxation techniques not only tell your body that it is time to sleep but also help relieve anxiety. Avoid Television as this is frequently stimulating rather than calming, in addition the light can interfere with the body’s clock signaling it to awaken.

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Progressive RelaxationLie on your back, close your eyes.Feel your feet, Tense them for 10 seconds, sense their weight. Consciously relax them and sink into the bed.Feel your knees, Tense the area for 10 seconds, sense their weight. Consciously relax them and sink into the bed. Feel your upper legs and thighs, then your abdomen, arms, shoulders, neck, head, etc.

Guided ImageryLie on your back with your eyes closed.Imagine yourself in a favorite, peaceful place such as a sunny beach, in a hammock, out on the ocean. Imagine you are there, see and feel your surroundings, hear the peaceful waves, smell the flowers, feel the warmth of the sun.When all else fails think of something boring such as your current lecturer, this should get you to sleep in no time. Thanks for your kind patience.

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3:45 – 4:30 pm OACCT Landing Zone Safety

Bryan L. Spangler, BA, EMT-P, EMSI, CMTE. Outreach Coordinator, MedFlight.

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1

Landing Zone SafetySafety First!

Instructor Name

OBJECTIVES

• Request• Setting up the LZ• Aircraft• Safety• Accidents

#1 GOAL: To avoid….

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2

Landing Zone Safety

• Number One Goal –Safety First

• Vision Zero

– Address– Intersections – Mile markers– Town Centers(heading and distance)

- GPS coordinates

Making the CallLocation

Helicopter ShoppingIf program A won’t accept the flight maybe program B will?

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LZ Commander• LZ Commander

– Scene Safety• Duration• Roads• By-standers

– Communication• 5 minutes out• Landing Zone

information• Radio contact at all

times including while on ground until lift off & out of site.

– Directions– Alternate LZ– This is a job from start to

aircraft departed & out of sight

Landing Zone Guidelines

100 feet

100

feet

Landing Zone Wind Direction

At least 100’ x 100’- 40 paces

Free of debris

Marked with conesand/or lights

Note hazards (e.g.wires, towers, trees,etc.)

Clock Method

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Landing Zone Selection– Scene

– Pre-Designated

– Hospital Helipads

LZ Selection - Rotor Wash• Rotor Wash can be very strong

secure trash, debris, bystanders,mailboxes, sheets on cots, doors on apparatus, hats

Landing Zone Selection• Scene

– Shortens overall scene time– Allows the patient to get to definitive care faster– Flight crew can be an additional resource at the

scene if needed

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Landing Zone Selection• Predesignated LZ

– Established prior to the accident– Maintained in a database at dispatch center– Includes GPS coordinates, hazards, & description– May be strategically placed around your community– May assist aircraft in finding the scene– Airports, Hospital Helipads, Schools, Fields, etc.

Predesignated LZ

• Address: Geneva State Park6412 Lake Road WestGeneva, Ohio 44041

• Coordinates: N 41°51.15W 080°59.08

• LZ Description: Large parking lot, south side of road. Creek tributary just West of LZ. Lake Erie is 200 yards north of LZ

• Hazards: Wires on South side of road

Marking the LZ

• Cones• Strobe lights• Emergency vehicles

(Usually the first thing seen)

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In the aircraft….

• Flight crew is taking ground contact information from dispatch center

• Flight crew will attempt radio contact 5 minutes out (landing zone briefing)

Landing Zone Briefing• Direct the aircraft to LZ

– Landmarks– Give directions by

North/South/East/West– See/Hear the aircraft

• Landing Zone Brief– Advise surface condition –

Slope, soft ground, asphalt, snow, high grass, etc.

• Gravel is a poor LZ surface

– Perimeter Markings– Overhead Hazards (Power

lines, light poles)– Any other aircraft

Sample LZ Briefing• Helicopter 5, this is Wayne Township LZ Command –• You will be landing in a baseball field, behind the high

school, wide open flat grassy area. We have your LZ marked with five orange cones on their sides w/strobes, the fifth one marking the wind which is coming from the north.

• Be advised there are power lines along the tree line to the north side of ball field, the east & west are wide open, and the school sits to the south.

• You should also be aware there is a cell phone tower we can see about a mile to the east of this location, it is NOT lit.

• Do you have any questions?

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WIRES, WIRES, Wires!Especially High Tension Wires



You can sometimes see more from the ground Communicate!

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Final Approach• Aircraft calls “on

location/final/landing”• At least one orbit

over the scene• Charged hose lines

are optional• “Abort” if not safe

ABORT• If at anytime during the landing, you, as a

first responder on the ground, see a hazard (wires, obstructions, towers, etc.) that the helicopter is getting close to, or ANY dangerous situation developing, please immediately state “ABORT” on the radio. The pilot will immediately abort the landing and probably climb to get to a safe altitude to assess the situation

Snow or Dust• Take cover• Prolonged hovering

is not abnormal• Anticipate losing

visual contact with helicopter

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Rotor Wash

HAZMAT Situations• Hazmat and Helicopters rule of Thumb• Increase distance 1/4 to 1 mile away depending on size

& type. • Rotor wash can blow hazardous material over a large

area. • Avoid setting up the LZ in low lying areas near the

scene. • Avoid setting up a LZ down wind of an accident site. • Helicopter engine exhaust can ignite combustible gases. • Do not put contaminated items on board the helicopter. • Never assume its not a HAZMAT situation

On the ground….• Perimeter guard • Hot off load• Patient access• Aircraft remains running• Keep vehicles >50’ from

helicopter

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Nighttime Approach

No white lights directed into LZ

Perimeter guard is very important

Flashing red and blue lights are OK

Night Vision Goggles(some programs are using)

Multiple Aircraft Scene

Adequate room

Communication is key

• Unloading– Do not approach helicopter!– Assist only when asked

• Crew• Pilot

– Approach at 90°– Watch loose articles of clothing

Safety First

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DO NOT APPROACH

The aircraft when running –this means you!

• Transfer away fromhelicopter

• Quick patient assessment– Physically– Mentally

• Necessary procedures

We know time is critical!

Safety First

• Danger Areas– Main rotor– Tail rotor – Exhaust– Pitot tube

Danger Danger

Rear Loading

Caution

Safety First

Side Loading

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• Danger Areas– Main rotor– Tail rotor – Exhaust– Pitot tube

Safety First

Approach Approach

• Danger Areas– Main rotor– Tail rotor– Exhaust– Pitot tube

Safety First

• Danger Areas– Main rotor– Tail rotor– Exhaust– Pitot tube

Safety First

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• Loading Systems– Rear Loading

– Side Loading

Safety First

Safety First• Loading

– Secure loose clothing • Especially ball caps / hats

– Roadway – little help– Fields

• Four corner carry• Move at direction offlight crew• One crew posted at tail

• Day vs. Night

Rescuing the RescuerWhat you should know about the helicopter as

a 1st responder to a crash

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– Scene Safety

– Protect yourself and others

– Wait for the AC to stop moving including rotor blades!

Rescuing the Rescuer First Things First

– Jet A- Fuel (less flammable than gas)– Use foam suppression – Oxygen source on board (liquid O2 tank, D

tanks)– Small fire extinguishers on board

Rescuing the Rescuer In Case of a Fire

Flight Crew Safety Features

• Nomex Flight Suits• EMS Boots• Helmets with shields • Gloves• Ongoing Safety

Training

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The Air Ambulance can serve you only if we arrive safelySafety of the people on the ground depends on you,

the professionals at the scene

Landing Zone Practice

Can you describe the landing zone?

Can you identify the hazards?

Landing Zone #1: Ground View

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Landing Zone #5 Aerial View


LZ #6: Aerial View

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Landing Zone # 7: Aerial View

Landing Zone #8: Aerial View


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Landing Zone #10 Aerial View

Our Goal Every Day

Is for everyone, including you, to go home at the end of the shift

Created jointly by:Safety First!

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2010 safety summit saturday september 18, 2010 mcconnell ... safety conference 2010.pdf ·...

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