(Transcript is automatically generated)

Erik: [00:00:00] If you're the best medic and you don't document, then...

Matt: you're not the best medic. There go Our brothers and sisters.

Erik: That's right. I hear 'em. 

Matt: Go get 'em brothers!

Narrator: You are listening to EMS with your hosts, Erik Axene and Matt Ball. 

Erik: Here we are again. Matt. 

Matt: Here we are again. Once again, we're talking about, we just filmed a lecture on this and now we're gonna talk about this in our podcast. 

Erik: High risk errors. 

Matt: Yes. Errors. Errors. 

Erik: Errors, yes. Mistakes. Yeah. Lapses in judgment.

Matt: Yeah. What we're gonna, we will discuss like what are the most common errors. Yep. And then we can discuss some ways to prevent those errors. Correct. Very important. But before we do, if you listen to us, like sharing, subscribe Yeah. To our podcast, helps us out, share this with other first responders that you know.

Mm-hmm. I love it when my guys are like. Listened to your podcast the other day on this. That's cool. What's the last one that [00:01:00] we did? Oh gosh. Do you remember what was Oh, uh, well we can't say it. I, we can't say surprise. 

Erik: Oh. What's the last one that was released? 

Matt: Uh, oh gosh, I don't remember. 

Erik: Because I know we record and then we kind of storm up and release.

Yeah, 

Matt: we don't, yeah, we don't always release 'em in the same order that, 

Erik: so I can't really say who we're having next, which is exciting. That's right. So I guess we'll just leave that. 

Matt: That's right. Okay. And people always don't listen to 'em in order either, so. No, no, that's a good point. Yeah, it doesn't really matter.

But yeah, like share and subscribe. Mm-hmm. So. Errors. There are some common errors. 

Erik: Yeah. We did some research on this. Yeah. To look for the more common places where we make mistakes as high risk areas. There are a lot of different ways to categorize them or group them up. We, we've broached it in different ways.

Yeah. I think the simplest way is, uh, there's evaluation errors. Mm-hmm. There's management errors and there's system errors. Mm-hmm. I think that's probably the easiest way to organize it. Um, evaluation errors. Um, I guess we could start there. 

Matt: Yeah. 

Erik: Um, one of the first [00:02:00] things that comes to mind, like we talked about in our lecture, right?

Mm-hmm. How long can you live without food, Matt? 

Matt: That's right. 40 days. 

Erik: 40 days, 

Matt: something like that. Yeah. 30, 40 days. 

Erik: Actually, I heard a story of a guy that lived for hundreds of days without food and he just lived off. He was overweight and he lived off of his own, 

Matt: lived off his off fat. His body was eating itself for a hundred days.

Erik: He was supplementing with. You know, nutrients, water, and all that stuff. Vitamins and stuff. Yeah. Truly fasting though. You can, your body's got enough reserves about, about 40 days before you start really causing... 

Matt: I go about four hours and I'm starving. 

Erik: I get hangry after, 

Matt: depending on the time of day.

Most firemen go about four hours and they're like, me Mongo need food. 

Erik: It's true because we, you get into that, that pattern of Yes. Of. Which we'll talk about actually is probably the system. Area. You get into a pattern of doing something. Yes. And you get hung a habit. Quick habit. It gets a habit. That's right.

So, so 40 days without food, about four days without water. Yep. Depending upon, can't go along that long that way. The circumstances. Yep. But without Air Boy, I can hardly hold my breath for a minute. Yeah. [00:03:00] Four minutes, maybe. That's a long time. I think I read though that about six minutes of oxygen deprivation and not breathing, um, you've got about six minutes depending upon metabolic rate and body temperature before you start killing brain cells. So 

Matt: yeah. That's why those guys that dive do it in cold water. 

Erik: That's right. Yeah. 

Matt: Slows down their metabolic rate. Yep. 

Erik: But the reason I bring that up though, is that we don't have much time. No, with, with airway evaluation and management, um, I guess we can kind of combine them both here. Mm-hmm. Uh, evaluating an airway, whether you're BLS or an ALS provider can be really, um, high, high stakes sort of a, an assessment.

Matt: Yeah. And we're not really necessarily talking about, I mean, we are talking about assessing an airway for the difficulty of that airway, but we're talking more about potential for respiratory distress going into respiratory arrest, like looking for those warning signs that. Ooh, this person's got a big problem here.

They're, yep. They, I can't, I've got that COPD or, and I've listened and I don't hear anything. I've got a silent chest 

Erik: and they're altered. 

Matt: And they're altered. Yeah. Or I've [00:04:00] got that kid with real bad strider, you know? Yep. And. Scaring me. Mm-hmm. Um, wheezing real bad. Wheezing. Yeah. Or even a silent chest on an asthmatic kid.

Erik: It could be worse. That's right. Yeah. You gotta be careful. 

Matt: All those kind of things, those are warning signs. 

Erik: Uhhuh, 

Matt: that, like we talked about, that our BLS providers, you need to be aware of those that mm-hmm. Hey, do I need to load this patient up? Do I have time to load and go right now or do I need to call for more help?

Right. 

And you know, if you have any options of doing things, you know, different protocols mm-hmm. Offer different things for BLS providers. You know, if you can give 'em epi, if you can bag or throw in a super cloud airway. Right. Um, but you have to base that on your transport times. Yeah. Your protocols. 

Erik: It's nothing, nothing simple.

Matt: Nothing simple, right? So everybody's a little bit different. And then, and then paramedics, you need to decide, am I gonna take this patient's airway? If, if you have that ability in your protocol, 

Erik: right. 

Matt: Um, you know, you gotta, and sometimes you gotta make that decision really quick. 

Erik: Well, regardless of what you can do for managing the airway, you know, whether you're ALS or BLS provider able to intubate or not, RSI, I mean all, [00:05:00] even ALS providers and some jurisdictions don't have that in their protocols.

But, um, the assessment though, all of us. Need to be experts at airway assessment. You gotta recognize, uh, the emergency. Yeah. Which is huge. And there are some situations where, uh, you, you may even be intubating while you're, you know, with a patient that's talking to you. Yeah. So we, you've gotta intubate you because your tongue's getting bigger.

Yeah. 

It may be okay right now, but, uh, in the last five minutes you've described to me increasing tongue size in the next five minutes, it could completely occlude your airway. Yes. 

Matt: Right. We need to figure that out pretty quick. You know, one thing I teach my people is something that I watched you guys do in the hospital all the time.

Mm-hmm. 

My new paramedics. 'cause you know, the reality is, is that, you know, guys' been doing this five, they get into 10 years and they start to get real complacent, especially with their assessments. 

Right. 

They get real complacent. Very rarely do you see in my experience. 

Yeah. 

Uh, paramedics listening to lung sounds on every patient.

Hmm. 

Right. Very rare that [00:06:00] they do that. Right. If it's a difficulty breathing. They'll listen to lung sounds 

correct, but 

just the run of the mill patient, they don't always do that. Mm-hmm. But over my years, I would always see ER docs, you bring a patient in, it really didn't matter what the, yeah. What they were being brought in for.

Mm-hmm. Almost every single ER doc I've ever saw on every single patient. Yeah. They will always do a quick head to toe. They will listen to breath sounds right front and back. They will kind of checklist, right? Mm-hmm. They will do a systemic checklist of their patient on every patient, regardless of their ch obviously if it comes in, you know, as a trauma of something, they're dealing with that.

But, but we don't really do that a lot, and I don't think that's preached enough in the pre-hospital environment that, and especially younger people, when you're first learning, do an assessment. 

Erik: Mm-hmm. 

Matt: We've talked about this before. Secret service. How do they know what a counterfeit bill looks like?

Because they know what the real thing looks like. They've mastered that. 

Erik: Studied normal. 

Matt: If you are constantly steady, normal, you know what normal breath sounds are, you will know when something's not normal. Mm-hmm. 

Erik: Same thing's true with heart [00:07:00] sounds. 

Matt: Heart sounds are the same thing. We don't listen to heart.

Yeah. Abnormal sounds, same thing. All those things. And so I think that assessment, we take it for granted pre hospitally. 

Yeah. 

And because the reality is most people. Fire based EMS specifically, they didn't get into the fire service. All everybody to do EMS where everybody that's a doctor or a nurse. 

Yeah.

Obviously they know that's what they're doing for their job 

of course, 

but huge part mm-hmm. Of preventing errors and obviously is the best thing for our patient, but it's us doing the right thing, which keeps us safe as well. 

Erik: Right, 

Matt: right. Doing the, doing the right thing. 

Erik: And the, the, I would say the common, um, you know, when you're taking an airway.

Um, when I know that I can bag a patient, I have a, a certain amount of security in that, right? Yes. Because I can bag 'em all the way to the hospital if I have to. 

Matt: Meaning that if you push paralytics Yeah. If you push sedation, you push rock on somebody, you know you're gonna knock their airway out for 40, 45 minutes.

Erik: Right. 

Matt: It's okay. I can maintain their SATs with an IGEL or [00:08:00] with, you know, an oral airway in. 

Erik: Exactly. That's, yeah. And that's another big potential error is when we don't bag properly. Yes. Whether you're bagging too much. Too fast or if you have a bad seal. These are some of the high risk sorts of BVM situations.

Matt: What do you guys use in your department for BVMs? Do you have the full size adults? I think there's a thousand. 

Erik: We have, I think we have the full size and a pediatric. 

Matt: Yeah, you got the, you should have we used to carry the adult, the, uh, pediatric and then the infant back. 

Erik: Yes, yes. Yeah. 

Matt: So we've, yeah, we've switched to, it's an adult child, BVM.

Yeah. And I'm pretty sure, if I remember, it's 500 mls. Mm-hmm. Sounds about right. Um, and again, even at that, it's an adult 

Erik: doesn't, I mean, a huge person may need a little more 500, but five hundred's. Good. 

Matt: Yeah. So, yeah. And that's if you're crushing the bag, I mean, yeah. So that's another big thing. They've gone away.

You know, some, some departments have gone away from That's good. Big, huge kids, I mean. Mm-hmm. Oh man. You see that EMT kid? Oh yeah. I remember walking into a nursing home one time and a private ambulance company was in this nursing home that was in my district. We'd go [00:09:00] there all the time and we got called for a CPR.

Yeah. And we showed. We showed up. And this big guy, he was the paramedic, and he comes out and you can just see the stresses all over him and he's sweating and you can just see he is just freaking out. And he's got this young girl, this 19, 20-year-old girl, EMT partner, and she's so excited. She's in there and she's bagging.

Yeah. And she's just bagging. And this guy is, he's just because he's by himself. Mm-hmm. Right? And so we walked in and it was like. You know, thank God somebody else, some more other paramedics are here. And so, uh, but she was all disappointed when I was like, do you want us to transport the patient? He's like, would you?

And I'm like, yeah, we'll take it man. No worries. We'll we'll handle it. And she was all bummed out. She wasn't gonna get to drive code to the hospital, but I remember her just crushing that BVM, squeezing all that 50 times a minute, just thinking she was saving a life, man, Uhhuh, she didn't know any better.

Erik: No. 

Matt: But yeah, very important. 

Erik: Yeah. Sometimes too much of a good, of a good thing could be [00:10:00] bad, so, ah, yes. Yeah. We gotta be careful with tidal volume and, and rates and all that. That's good. 

Matt: We, we talked about this in our lecture Uhhuh, but I think it's important to note here, 'cause we, we, I just saw this, you were talking about patients with beards.

Erik: Oh yeah. This is great. Love this. 

Matt: I saw the social media post and it was a picture of guy with a big, heavy beard. 'cause beards are very popular right now. Right. And how do you get that good mask seal? Mm-hmm. Genius. I don't know who, I gotta look up who this was that posted this, but they said take a tegaderm.

And put it over the beard and it'll give you that plastic kind of plastic to plastic seal. Yeah. Yeah. It's probably not gonna be a perfect seal, but it's gonna be a whole lot better than that big, thick beard. It's brilliant. Genius idea. Genius idea. 

Erik: Oh, that's really good. I love that. Um, well there's a lot of different airway concerns because it is such a high risk situation, you know, before we move on to medications, which is something else we're gonna talk about.

Yeah. Um, you know, I was actually thinking about this driving to the studio today, so it's interesting to think about all the things that didn't show up. In our research of looking for the high risk situations, cardiac arrest, for example. 

Oh, yeah. 

You know [00:11:00] why, I mean that's, there's risk in everything we do, but why wasn't it one of the top six things?

Right. Well, I think a lot of it's because it's so protocol driven. We're we're so good at it. Yes. And it's something that's relatively common. We're talking about those high risk, high stress, high consequence situations that are low frequency. 

Matt: Well, and you in a cardiac arrest, I tell people this all the time, like cardiac arrests are pretty easy to, you know what the problem is?

It's whether, am I shocking? Am I not shocking? Yeah. That's really the only difference. Other than that everything's the same. Yep. These situations when you're trying to determine. Ooh, do I need to take this guy's airway? Ooh, do I need to go to this facility or this facility? Yeah. That's, that's where that clinical Yeah.

Uh, judgment comes in and that critical thinking comes in. Yeah. And that's where experience plays a big part in that. 

Erik: You're right. 

Matt: Um, but yeah, a lot more in or, uh, error prone mm-hmm. With those high acuity calls. 

Erik: Another error prone area is medications. You know, some of the medications that we've been authorized to deliver.

In the pre-hospital environment are very, very powerful [00:12:00] medications. Medications that can completely paralyze you. 

Yes. 

Medications that could even potentially stop your heart, 

make you stop 

breathing, right? Yeah. So they're, they're not benign and used correctly. They're lifesaving. Yep. Used incorrectly.

They can, they can like taking Oh, you watch the news, right? With ketamine. 

Yeah. 

They're, you dose it wrong. You don't monitor your patient properly. These are deadly, deadly medications that can alter your physiology. 

Matt: And a lot of those cases, not all, but a lot of those cases, something we'll talk about later is that yeah, a lot of paramedics have gotten in trouble, even face some criminal charges.

Right. 

But they also tried to hide it and lie about it. 

Oh yeah. And don't do that. Like definitely if you do make a mistake, we we're, you're, you're going to make a mistake at some point on something, right? You'll hopefully, it's a minor mistake. No, no negative outcome to your patient, but you're gonna make a mistake.

And when you do. Like, make sure somebody knows about it. Tell that right away if you gave, I'll tell you a mistake. I had, uh, I was on an ambulance and we were riding with a [00:13:00] guy, patient was having chest pain. Mm-hmm. And uh, my partner was in the back of the ambulance with me. And, um, I drew up some morphine. To give the guy some morphine.

And the way I do morphine is we would carry 10 milligrams in one ml. Yeah. Very common concentration. So to make it easier, because our dose was two to four milligrams per dose, right? Mm-hmm. A max of 10. And so I would drop the one ml of morphine and then nine of normal saline. So I had 10 and 10. Very easy.

Easy, right? Instead of doing 0.1, you just push an ml. 

Mm-hmm. 

So I mixed that up, handed it to my partner and said, Hey, give him two milligrams. Of that, uh, that morphine, I turned my back. I was doing something, and this is my fault. I should have been more clear. 

Erik: Yeah. 

Matt: And I turned back around and as I'm turning back around, the whole syringe is going in and I'm like, I mean, it's 10 milligrams of morphine.

Like it's probably, then the guy's blood pressure was very stable, you know, but, and he was a young guy, but still I was like. Wow. What did you do? [00:14:00]

Erik: Yeah. 

Matt: Why did you push all that? But again, that was my fault. I didn't. Mm-hmm. And that communication, 

Erik: well, that's a big part of leadership. What you just demonstrated is when, and I agree with this, some people don't, but as, as a leader, taking responsibility Yeah.

Regardless of what went on. Yeah. A good leader's going to take responsibility for those things. I was, we all senior medic, we have a part to play, but um, it's my responsibility. The buck stops. Yeah. It's good. 

Matt: Absolutely. 

Erik: Um, I was gonna say, uh, with, uh, back the ketamine mm-hmm. Um, you know, medications like that.

Um, the dosing obviously is, is a big deal. And the, and the, uh, the, uh, the actual medication itself, um, there should be a certain amount of humility. I think in giving these medications. We can get really comfortable with things that we do. And you know, all these medications have side effects and some of the medications have side effects that we have to be prepared for.

Mm-hmm. And they can happen. Complete respiratory depression, cardiovascular collapse. These situations do occur. We have to be [00:15:00] prepared. You prepared to do them. Yep. Anytime I do a procedure in the hospital, I have to be prepared for the complications. Yeah, absolutely. If I drop a lung, I have to know how to put it a chest tube.

That's right. You know, things like that. It's important that we understand and respect and are humble. Yeah. And we think about how powerful these medications are. 

Matt: Absolutely. Absolutely. Yeah. I mean, it's not a big deal. A lot of these cases that we've seen with ketamine. Like if they would've just controlled the airway, they'd have been fine.

Right. 

Throw in an OPA, start bagging the patient, maybe intubate 'em. If your protocols called for that, like you would've been, the patient wouldn't have died. Yep. Right. You, you probably, you know, you might've got your hand slapped, maybe written up or something like that, but maybe you're not being brought up on criminal charges.

Right. Yeah. So, yeah. 

Erik: And then we're gonna get to it later. And you kind of mentioned it, but, you know, making a mistake. Uh, it's usually a systems problem. It usually is a systems problem. And if you did make a, you had a lapse in judgment and you're honest about it mm-hmm. And you own up to it, you take responsibility for it and recognize the fact, yeah, I could do more training, or I [00:16:00] could, you know, you know, it's, it's something that, uh, is dependent upon culture.

I think 

Matt: I'm gonna look something up because I wanna make sure that I say it right. But it's something that we talk about. We don't talk about it enough in the paramedic pre-hospital world. Mm-hmm. But we talked, it was, it was heavily talked about, um, within the nursing world. Mm-hmm. And it's just culture.

Erik: Yes. 

Matt: Right. And I'm sure you probably are familiar with the just culture, uh, thought process, but it's, um, investigate for safety, respect others, embrace different perspectives. Um, be fair, seek improvement, strive for learning, trust. Um, but as a, somebody in administration or like from a medical director standpoint, uhhuh, whenever there's an error or something that happens, right?

Mm-hmm. Somebody has a medication error, right? Yeah. Yeah. I'm looking at it like, okay, what, what was this? Was this, did I fail you as your EMS captain? Did I not? You're a new me, uh, paramedic, right? Right. Did the FTO, did we not properly educate you on [00:17:00] how to do drug calculations? 

Yeah. 

Was this a system error that.

Maybe we changed the concentration of that medication. Right. And we didn't, I didn't tell you that. Right. 

Mm-hmm. 

Um, or was this a negligence failure? Mm-hmm. That you, as the paramedic, had never looked at the concentration before? 

Yeah. 

Um, or was this just like you didn't care mm-hmm. And you've had a pattern of this behavior and this is an individual problem.

Right. And like you said, most of the time it's probably an educational or a systemic failure. 

Erik: I think it is. 

Matt: Yeah. That Well, I mean, 

Erik: yeah. I think you're right. I had a, you, you shared some of your experiences with an error that had occurred. You took responsibility for I, uh, I, I made an error not too long ago.

Um, I got a new set of raptors. Those, those Oh, the shears? Yeah, the shears. And I didn't know that there was a ring cutting device on that. Oh yeah. 

Matt: Oh, you've told me this story this morning 

Erik: and, and then I had a patient when I realized that, I think it may have even been that shift or, or maybe one or two shifts later.

Matt: You were excited to use your new tool? I was. I was excited to use [00:18:00] my new 

Erik: tool. Yeah. I had all the confidence in the world that this is gonna be a great experiment. I even shared with the patient, it's like, yeah, these new, new shears I have and it's got a ring cutting thing on here and I'm gonna fix your ring up right now.

We're gonna cut it off and I'll give it back to you obviously, and you can take a two jeweler. Fixed. And we went through the whole thing and I went to cut it. And, and I know some of us are just listening online right now and can't see me demonstrating this, but when I went to cut the ring off, I wasn't paying attention to where the, the cutting mechanism was.

And I cut her hand so badly and I felt I made a mistake. Yeah. And, and you know, I think about it, and it really was a systems problem. I had a new device, I hadn't practiced it on anybody. And I practiced it on patient and, and obviously I would never make the same mistake again. Right. But I made a mistake.

Right. 

And I was trying to fix a ring, which I did fix. Yeah. But I wasn't aware of the other end of the business, end of that shear. And I cut her hand pretty good, and I to sew it up. 

Yeah. 

[00:19:00] But, and she was a nice lady. It all went well. And I paid, you know, had her medical bill covered and everything. But, um, it, it's a good reminder though, to remember to, to, you know, learn from your mistakes.

Mm-hmm. Own up to it. Yes. Don't blame anybody. Nope. Um, and then also let it go. Yeah, we tend to hold onto these things and then it affects our care in the next patient. It's like, oh, I'm so terrible. 

Matt: Yeah. You're probably better at letting it go than I am. Oh, 

Erik: I don't know, man. Oh, really? 

Matt: You think so? Really? I think so.

You're so, yeah. You're more, I think you're more laid back. Uhhuh, where I'm, oh, I see. Where that would really, like when I make, I don't like making mistakes on things, and it really bothers me, and I have a really hard time moving past it. It's like I just, I'll just dwell on it, which I've heard them say like, that's the mark of a really good quarterback.

'cause you're gonna make a mistake. Like you have a bad, okay, it threw an interception. Okay. Don't let it ruin the rest of the game, man. You made a bad play. Let's move on. 

Erik: Heard it's over. I've heard, yeah, I've heard NFL quarterbacks interviewed and talking about just that. Yeah, it's being able to throw an [00:20:00] interception and then on the next series.

Completely forgot about it. Right? Yeah. In between the series you're looking at, oh, what did I do wrong? How did I not see that coverage? Yes. How did I not recognize that defense? Yeah. Boy, they did a, they scheme that thing beautifully and disguised that coverage. Right. And you missed it. Yeah. But you learn something, right?

Yeah. And so that next series, you're out there, you're a little better. You're not carrying that weight of a failure with you that's gonna affect your performance, right? That's right. So I, I would tell, you know, we didn't. Really plan on talking about this, but I think handling mistakes is certainly worth talking about.

It's a big deal. It's uh, um, to me the way I handle a mistake is I will self loath talk really. Badly internally. Nobody hears this about myself. Yeah. Way to go, idiot. Right? I'm thinking those words. Yeah. Oh, a hundred percent. And I feel terrible, you know, like the worst doctor in the, the world, you know, kind of thoughts and, and it, it takes me a while to get over them.

Yeah. It's interesting to hear you talk about that and, and, uh, from the outside looking [00:21:00] in, you say, oh, he's a doctor so he doesn't make mistakes, you know? Well, you know me 'cause I make mistakes all the time, but, well, 

Matt: yeah. Every doctor makes mistakes. They're humans. That's right. We all make, make mistakes.

Erik: And the same thing too. And a patient looks at you as a paramedic and thinks, oh, they, they're gonna save me now. 

Matt: Yeah. 

Erik: You know, and they, they're putting their trust in your hands. Gotta do our best to not make mistakes. But like you said, nobody's perfect. 

Matt: Nobody's perfect. 

Erik: And we have to live with ourselves.

So we talked about medication. Mm-hmm. And dosages and things 

Matt: like that. Airway, we talked about medication five R's too. We didn't really talk about this that much. 

No, you're right. We 

talked about it in the lecture, but, and I, and we've talked about this before, but it's so important. I would always teach my new paramedics this.

That get in the habit if you, if you're just starting out an ems mm-hmm. Please get into this habit. If you have been in EMS for a while, please start doing this, but make it a habit that, no, I don't care if you're giving somebody an aspirin. 

Yeah. 

Right. Verbalize what you're giving. Hey, I'm giving my patient 324 milligrams of aspirin.

Uh, that's four [00:22:00] pills. They're 81 milligrams apiece. Expiration date is this. I'm giving 'em four Zofran. Right? That's good. That way when you get to that high acuity patient and you're gotta push dose going and you've got, uh, your ketamine drop and you're resuscitating, you're trying to get the pressure up, and now you're trying to get airway go, all these complicated things going on, right then this you, it's habit.

Yeah, it's 

have it to do that. And the one of the crews that I worked for for a long time, that was just what we did. 

Yeah. 

And so it was just automatic. We didn't think about it. It doesn't take any more time to do it that way. Yeah. And it dramatically increases your, yeah. Uh, increases your chance of success and decreases your chance for error.

Erik: And the fact that you could hold onto that process in the midst of chaos Yes. Where you have a sense of calmness. That's, 

Matt: but it you did because it, we be, it became a habit. 

Erik: Right. 

Matt: We didn't think about it. It second nature, this is what we do, especially when we're doing IV medications. This is how we, this is our process.

Yep. And we don't deviate from it. Yep. Right. That's good. And so that's, uh. Yeah. [00:23:00]

Erik: We make 35,000 choices every day. Yeah. And those choices turn into habits, just like you said. That's right. And that's where we build culture. 

Matt: That's right. Yeah. 

Erik: Um, so then, uh, you actually kind of mentioned it to go back to the five rights.

Mm-hmm. That really our next thing that we had talked about in the lecture was communication. Mm-hmm. And closed loop communication. And being able to communicate or, you know, I, I need this. Matt, can you get me this? 

Yeah, 

sure. Erik, I'll get you exactly what you said. Yeah. Right. And then I'll confirm and say, okay, good.

Thanks. I'm doing this now. You know, it's like a, that closed loop communication, uh, but it's not just the closed loop communication that's important. It's also, we talked about a dispatch. Mm-hmm. Right? Is communicating to us, did we get that information? Yeah. Are we getting information from our patients when we communicate with 'em?

Uh, are we, uh, calling it in appropriately? Yeah. And helping the ER prepare. And then how's our handoff? 

Yeah. 

All these communication points along the line of that patient care. Uh, all so important. 

Matt: Yeah. Yeah. Hugely important. And, and communication goes along with assessment. If you're not a good [00:24:00] communicator, which one of the things I've seen was, you know.

Electronic devices. 

Yeah. 

A lot of the younger generation, I'll say, communicates through a phone. So face-to-face communication is not really, 

yeah. 

Some people aren't comfortable with it. 

Right. Well, 

you better get comfortable with it if you're gonna be a pre-hospital provider because you know you gotta communicate.

You gotta sit in front of your patient, you gotta talk to 'em. Yeah. 98% or is it not? I think it's 98% of all communication is nonverbal. Or is it not? 

Erik: Yeah, the, the vast majority of it, yeah. I can't remember the percentage, but yeah, most of it is, but the 

Matt: inflection, it's not just the words that you say. The tone eye contact, right.

Uhhuh. Like if I say, yeah, Erik, I really care about what you're telling me. 

Erik: Oh, gosh. By the way, if you communicated that way, this would be impossible. 

Matt: Yeah. 

Erik: This would be totally impossible. Yeah. If, if one of us was disengaged Yes. And not, I mean, this wouldn't work 

Matt: and I can say the same God, I, I really am, I care about what you're telling me today.

Erik: Yeah. 

Matt: The, I said the exact same words. Yeah, but the inflection in my voice is different. 

Erik: Yeah. 

Matt: Where [00:25:00] I'm looking is different. My body language, every, and that said way more than the words 

Erik: now imagine being in a life and death situation with a patient and communicating with family communication. Yes. With significant others.

Yes. I mean, that communication is so crucial to have it right. Yes. It's very helpful. And practice that. That's really good, Matt. Yeah. Language barriers is a big deal too, right? We talked about that. As well. Mm-hmm. Uh, we, we live in a culture with lots of cultures in it. Oh yeah. Lots of languages. Different languages.

Matt: Yeah. It doesn't matter where you live, there's gonna be probably somebody that doesn't necessarily speak English, at least not their first language, so. 

Erik: Mm-hmm. 

Matt: Yeah. Utilize your resources. We talked about AI a little bit. That's gonna come along. Yeah, 

Erik: that's a good thing. I mean, AI can be good and bad. Um, yeah.

I think communication is certainly good with the language. Mm-hmm. Um, it's never gonna help you with culture. 

Matt: Nope. 

Erik: Uh, it's different. Yep. Different cultures have different practices and you know, first time you norms, first you see a 

Matt: 5-year-old with cupping Yeah. Uh, signs in their back and you're thinking, oh my gosh, abuse.

They're beating this [00:26:00] kid. Yeah. Nope. They're trying to heal the kid. Yeah. 

Erik: Or you walk. Yeah. There's all sorts of different cultural norms that, that, uh, could boy if you don't understand them and are, aren't sensitive to them mm-hmm. You could really shoot yourself in the foot with communication and Yeah.

Just blow trust outta the water. 

Yeah. 

Um. But, uh, I'm being sensitive to those things and showing respect to those cultures and understanding a little bit. 

Mm-hmm. 

I'm not saying it would be impossible too, to memorize everything about every culture. Oh, yeah. You're never but know your area. Yeah. There's certain cultures that may be in your area where you are gonna encounter them, be good to understand them a little better.

Matt: And most of the, you know, I find that if you're just like nice and patient and calm. Like you can get, you don't need to know the, all the nuances about every single, but if you're nice like people, even if they don't speak English again, body language. Yeah. They can see that like. Like, you know, you're confident, you're calm, you're trying to communicate, you're doing the best that you can do.

And they realize too that this is an emergency situation. 

Yeah. 

And you're trying to do the best [00:27:00] where if you're freaking out and panicking. Right. Not, it doesn't matter what language you're speaking, people can read that. So 

Erik: no, that's not good. 

Matt: Another big factor to communication for sure. 

Erik: You know, we, we mentioned briefly, and, and, and it comes out too in our documentation lecture and the air lecture, but is the, the, the things, the system errors that we have and, and one of those is cognitive bias.

Mm-hmm. It's like we tend to want to Oh yeah. Have tunnel vision. Yeah. You know, you like, you've got this patient that was, you know, dispatched as a an MVC, so you're just thinking trauma. Well, you may miss the fact that the reason they got in the car accident was because they had passed out at the wheel because of some other medical issue.

Right. You know, there's, it's, um, it's complicated and I think that the tunnel vision can really shoot yourself in the foot. Oh, yeah. With assessment, uh, 

Matt: anchoring, 

Erik: we talked about that, 

Matt: or just using your initial assessment as like, okay, that's what the problem is. That's right. And never, you know. Oh yeah.

Well, he, you know, is on some drugs or he's intoxicated. Well, oh, I forgot to check a blood sugar. Like he thought he was [00:28:00] intoxicated and you didn't even do your due diligence of checking a blood sugar. Right? Yeah, yeah. Uh, don't, you know, constantly reassessing your patient. Mm-hmm. 

Erik: Right. 

Matt: Oh, 

Erik: that's huge. Yeah.

For improvements. 

Matt: Mm-hmm. On whether improvement in their overall condition. 

Erik: Right, right. On 

Matt: any of your treatments, is that helping or not helping? What's going on with your patient? Very important. 

Erik: And then, you know. We're gonna kind of bridge the gap from the errors to, you know, strategies to prevent errors.

Mm-hmm. Um, but one of the thing I think as far as the error producing things is the culture. Yeah. We, this is really important because if you're in a culture where you're not comfortable to share a system error you experienced mm-hmm. You're gonna hide it, you're not gonna communicate it. And it's an unde.

We talked about this actually, a, a, uh, an error that you don't disclose is a permanent error. It's never gonna change. 

Matt: Never gonna fix it. 

Erik: So, and, and I understand. I've been in some bad culture environments where you're not gonna share anything because you're gonna get ripped apart. Yeah. And because of culture issues, you [00:29:00] know, people aren't comfortable sharing 'em.

It's just easier just to hide it, 

Matt: be macho, be cool. I'm the smartest guy in the room. No you're not. 

Erik: Yeah, no, you're probably not. That's another, no, that's another way to look at it. It's hard anyway, but culture's big. So prevention. How do we prevent No, no. Actually, did we, I think documentation, we never hit documentation.

Matt: Well, documentation is another big Yeah. High risk area, right? Yeah. Um, that we have to document correctly. 

Yep. 

Right. And there's a lot of reasons why we don't fatigue, bias. All these different things can play into why we don't document correctly. It's two in the morning. I'm on my 15 call of the shift. I'm exhaust.

Or I've run on this guy 10 times in the last month. Right? Yep. I'm tired of dealing with this guy. Yep. Right. 

Erik: But that's no excuse. No, it's not. And, and it's if, uh, and I love what you said, I say it wrong, you say it right. How do you say it's not what you do, 

Matt: it's what you document. Exactly. Yeah. 

Erik: Yeah. And I think, I think it's, it's almost, it can't be separated.

If you're the best medic and you don't document, then. 

Matt: You're not the best medic. 

Erik: You're not. Yeah, that's [00:30:00] right. Yeah. You can 

Matt: be, you know, it's like, yeah, you can be a subpar paramedic and document really well and make yourself look really, really competent. 

Yeah, 

and I've seen on, on the flip side, and the problem is that at the more experienced you get, the more comfortable you get with patient care, the better you get at patient care, the worse your documentation becomes.

At the beginning, you're really detailed, and then you start to get complacent or overconfident. And then your documentation goes down. 

Yep. 

And that the documentation needs to be at a high level, right? 

Erik: Yeah. It needs to maintain that. It's like eating your vegetables. It's like nobody likes the document, but it's really important that we do it.

It's gotta be good meat taste guy though. 

Matt: I don't like eating vegetables. 

Erik: Well, I know you need the micronutrients, Matt. You need it. And then I know we're not talking about that. You don't get that from 

Matt: steak? 

Erik: No, they're micronutrients there. Well, you know, actually they, I, I think it's just like you have a.

A balanced diet. 

Matt: Yeah. 

Erik: I think, uh, if you're uber focused on documentation and you're losing sleep because you, you, I mean, you're not gonna provide great [00:31:00] care to the next patient. You've got. Right. Or you get, if you, you're gonna get so far behind in your charting, you're for forget anything. Never gonna be effecti.

It's a balance there. It's always a balance. Yes. So, and if you're using an AI tool to generate your narratives, be careful. 

Matt: Yeah. Double check what it's saying. Yeah. AI hallucinations is a real thing. Mm-hmm. Yeah. Uh, so double check. You don't ever just, oh, I did an AI generated narrative. I'm good without reading it, because that comes up to another documentation here is conflicting information.

That's right. 

Right. Something that's in your flow chart, something that's in your primary impression or whatever contradicts what your narrative said. 

Erik: Yeah. 

Matt: Oh, okay. That's a problem, 

Erik: right? Yeah, no, that's so true. That's so true. Well, you know, it's kind of funny as we talk about the different things that can cause errors.

Doing the flip side, like closed loop communication or, uh, having a good culture is a really a preventative strategy. But one of the preventative strategies we haven't really talked about is teamwork and trust. Mm-hmm. I think that's part of culture, I suppose, but remembering that you're not on an island.

Yeah. You're with the team [00:32:00] communicating appropriately with your team and, and leveraging other brains in the room. That's right. Like you said, calling out the dose you're giving. Yeah. And ev Wait, hold on a second. That didn't sound right. 

Matt: Yeah. How much time are you, oh, shoot, what was I thinking? Yeah. 

Erik: You know, kind of a thing.

Matt: I meant 10, not a hundred. Yeah, yeah. Well, it's like for my fire guys out there. Right. And, and I talk about this, that you don't fight a structure fire by yourself. 

Erik: Mm-hmm. 

Matt: Right. You're not gonna get water on the fire. Yeah. You're not gonna do forcible entry and search and ventilation and utilities and overhaul.

Yep. You're not gonna do all those things by yourself. It's impossible. Right. You have to work together as a team. Mm-hmm. And all that is inherent upon communication. Right. So crucial communication between crews, communication with command, and it's an or. It's, it's a well orchestrated machine. And if everybody does their, their job, right?

Yeah. Right. It's like Bill Belichick used to say, just do your job. Mm-hmm. Just know your job and do your job and we will win. Yeah. Right. Yeah. But same thing goes here, like if you're running a cardiac arrest. [00:33:00] You know, you can't just, you gotta have more. I mean, some providers, unfortunately, you might only have yourself and your partner.

Yeah. And you do the best you can with what you got. Right. Do 

Erik: the best you can. 

Matt: But if you have more people, like communication is the key to success there. 

Erik: Mm-hmm. And being willing to, uh. You'll be aware of. Well, you have to be aware of mistakes, but being willing to do something about it. Right? Yeah. Um, like you said, there's a, there's also a stigma of, you know, not wanting to change.

Matt: Well, nobody wants to, especially in the fire service. Nobody wants to say that they don't know something. 

Right. 

You know, I don't want say that I'm not as smart as you are. Right. Nobody wants to say that. Right. We all have this bravado that we have to keep up. Right? Right. And we kind of need to go away from that because there's no way you're gonna know everything, right?

Mm-hmm. You're a brilliant, smart guy doctor, right? Mm-hmm. I know for a fact that you know way more about medicine than I do because you went to school for 12 years to learn it. I went to paramedic school for six months. There's no doubt that you know more. Right. So I have to humble myself to say, teach me.

Right, 

right. But I'm sure that you don't think for a [00:34:00] minute that you know everything. 

Erik: No, no. 

Matt: We go to Dr. You or Dr. Gar and learn things. 

Erik: Well, and, and actually even you, uh, you know your environment better. I've learned so much being a medical director about the environment that you're in and how to do that paramedic job a little bit more effectively.

Mm-hmm. A lot of the things that. You know, these, these other pieces of knowledge and information don't really matter. 

Yeah. 

And learning and understanding your role in an ambulance has helped me to be a better medical director to really get it. Yeah. Uh, I think that's a big part too. And being willing to consider another perspective.

Matt: Yeah. But just because you're a doctor doesn't mean you understand my world. 

Erik: That's exactly right. Yeah, that's very true. So I think that. Uh, that's an important part of it. Um, you know, the, uh, um, so, but beyond awareness, I think there's, there's this willingness to be able to, um, learn from the mistakes. I think.

I think that remembering that any mistake that you might make is an opportunity to, for growth. Yeah. Make your department better, improve patient care, improve yourself. I mean, these are all [00:35:00] positive things. 

Matt: Yeah. We gotta put our ego down and, and be willing to. Review calls. Mm-hmm. If somebody comes to a case review, like instantly everybody gets their guard up.

Like, oh, here comes the medical director. He's, he looked at one of my cases, like, no, he wants to come educate you. Yeah. Like, Hey, what were you thinking here? Right. Tell me what you're, don't get so defensive. Yeah. Right. Be open to learning something new. 

Erik: Yeah. We're all different. Yeah. With, uh, you, you and I know we work together a lot, right?

Yeah. So I, I tend to be more of a, I'm willing to change things and to make Yeah. You're fly by to see your pants. 

Matt: I'm like, whoa, whoa, whoa. Where's the step-by-step process of how we're doing this 

Erik: now? It's interesting though. We, we, we actually, last week when we were in the studio filming, we had an interesting experience, right.

I tried something new. Oh, yeah. With, with our content to try to improve things and I hated it. You, you, you, but you're honest, like, because I did try to change, 'cause uh, this, we don't need to go into the details with content development. Right, right. But there's a lot of research. Oh yeah. There's a [00:36:00] lot of time with graphic design, uh, you know, in, in multiple states.

I mean, things are getting passed around. Thank you, Eli. Yeah, thanks. Thank you. Go Detroit. Uh. And then we have editing and auditing. Yeah. And there's a lot that goes on. So I was trying to improve the process. Mm-hmm. And in the process of me improving the system, maybe Right. We get into the studio and you felt comfortable mm-hmm.

Saying, Hey, I know you spent a lot of time on this, but I don't like it. Yeah. Right. And I, I could have been butt hurt. Yep. Right. Yeah. And said, well, hold on a second. I put a lot of effort into this. What, what are you talking about? Yeah. But what happened? You, well, you, first of all, let me back up. You, you said it in a way too, that was.

Respectful and kind, and like, 

Matt: Hey idiot, what this crap. 

Erik: But you know what, actually you could have said that and it probably would've been okay, because we have a relationship with friends, right? So, and you know, I was joking anyway. Yeah. And we both have a common goal, right? Yes. We wanna create excellent content Yes.

To, to do, uh, uh, help improve patient care. [00:37:00] So when we, we kind have that common mission, right? Yes. It was easier for me to receive it and listen. It's like, oh, okay. Yeah. I think Matt's got a good point instead of thinking to myself. 

Matt: Who's he to tell me, I created this PowerPoint, right? Yeah. I did all this work.

Erik: But, but what is that? That's culture, right? Yeah. And then what did we do this week? 

Matt: Yeah, 

Erik: we changed it. Well, we changed it. Yeah. And then you're like, Hey, that's a whole lot better. 

Matt: We all thought it was better. 

Erik: Yeah. Yeah. But when I got the original product back from Eli, from Detroit, yeah. I didn't like it so much.

Yeah. 

I had to change it. Yeah. 'cause he, I thought we went too far on that spectrum. Right. And, and we brought it back a little bit. And today I think things were so much better. Way better so. There's a lot of teamwork involved. Communication. Devin behind the cameras involved. Yep. Communication culture. 

Yep.

Where we found a systems problem. Mm-hmm. You felt comfortable communicating it. Mm-hmm. I received it. Heard it. Mm-hmm. And, and responded, made things better. Mm-hmm. And now this week we actually took some big [00:38:00]steps forward. Not only does it save time and content development. Yeah. It makes it better. 

Matt: Yeah.

Erik: We're actually doing something better now. 

Matt: Yeah, 

Erik: because you felt safe to say it 

Matt: right. 

Erik: Um, and I, and I felt like I could receive it. Yeah. And we could reverse the roles too, right? Yeah. We, we could have a reverse conversation and you maybe, I feel comfortable talking to you or, and, you know, anyway, that's culture.

Yes. And, and you know, we could talk about mistakes toward blue in the face. We're all gonna make them how we handle them as culture. And I think that's probably. Well, not more. I don't think there's anything really more important, but if you have bad culture, the mistakes that are gonna happen, event, inevitably we're not gonna get better.

Matt: Yeah, it's, and let me say like especially in the fire service, your culture is not created by your admin. Mm-hmm. So. Your admin is not in the fire station every day. Right. You create the culture at the station level. Right? Right. Now I can create the culture as somebody in admin and or in a leadership position of learning, [00:39:00] right?

Erik: Right. 

Matt: I'm creating a culture in the classroom of if we're gonna cover a certain topic or we're gonna work a certain scenario. Right. And I think that what's, that's what makes you and I good instructors, is we don't have big egos and we. If somebody asks a question that somebody might look and go, well, that's a dumb question.

Well, you know what? Maybe that's, maybe this guy's been a paramedic for two months. Yeah. And he doesn't know that. Yeah. So I am never gonna make, even if somebody says something that's maybe a little bit off and everybody else might be like, Hey, no, that's a good question. You know why? Because you didn't understand it.

You had the balls to ask the question. I'm gonna acknowledge the fact that at least you're trying to interact. You don't say that to them. 

Oh, I do all the time in my Oh, you do? Oh, that's cool. Oh, absolutely. I love that. Oh, no, I'll absolutely say that. Like I appreciate the fact that somebody has the guts.

To speak up and a question that some people might go, well, that's kind of a dumb question. You didn't know that when The reality is, is that probably 80% of people in that room gonna say, didn't know that, but they're looking like way to go. Idiot. I'm sure glad he asked that question 'cause I [00:40:00] was wondering the same thing.

So then you, you don't, you applaud that. Hey, great question. No, it's not. I know this might be a stupid question. No such thing. No such thing. Only stupid people. No, I'm just kidding. No such thing as a stupid question. If you don't know it and you don't understand it, then. Ask 

Erik: right away too. Yes. We talked about this in the, in the lecture with football analogy, right?

Yes. You're implementing a new scheme mm-hmm. For a team that you know you're gonna be playing that next weekend. Mm-hmm. Go bears and when you first implement it, right? Mm-hmm. The Chicago Bears implement a new scheme 'cause they're playing the Dallas Cowboys and you got Ben Johnson baby. There you go. Uh, no, but you, you implement a scheme when you're implementing a new scheme.

A good coaching staff is gonna implement that thing in a way where they create a safe environment to make mistakes and to try it out and Oh, wow. I'm gonna have to change the way that my footwork here as a lineman to get that block. This is gonna be a tough block for me. Yeah. You know? And so we can, we can make mistakes as we are starting to implement that scheme.

Yeah. Man, the day before, [00:41:00] game day, when you're doing walkthroughs, this is not the time to try to, you know, figure things out, right? 

Matt: You work all the bugs out. 

Erik: This is the plan. You know your role. I know my role execute, and so there's a lot of awareness in our weak points. There's a lot of. There's a lot of being willing to admit that I'm weak here and I need to work on this.

Yeah. Um, so we don't have a mistake at game day. Yeah. Right. And if you do find a mistake at game day, looking back, it's like, how did I miss that? Yeah. Oh wow. I should be doing this. Right. 

Matt: Or if you do make that mistake, moving on from it. 

Erik: And move on. 

Matt: Okay. Screwed up. Let's move on to the next play that's gonna make mistakes.

Yeah. Let's move on to the next play. 

Erik: And don't be dishonest. Don't, don't make those integrity mistakes. That's because that's how you get fired. 

Matt: That's how you get disciplined. Everybody talks about that, that you make a mistake, you're not gonna get fired. 99.999% of the. 

Erik: Yep. 

Matt: You are not gonna get fired for making a mistake.

That's right. 

You're going to make a mistake and then you're gonna do something dishonest around it. You're gonna falsify your [00:42:00] documentation. You're not gonna tell the doctor at the ER that you made a medication error. You're not gonna tell your EMS leadership, Hey, I screwed up here. You know, whatever the case may be.

That's where discipline's gonna come in. Yep. 

Erik: Or the integrity to not own up to a mistake. Yeah. And to be hubris or overconfident arrogant about it. 

Matt: Yes. That's what leads to the discipline is Exactly, because it's an integrity character issue. Right? Right. We know you're gonna make a mistake. Yep. Because you're a human and you're in these high acuity, life threatening, high stress, very fast paced environments.

Mistakes are going to happen is the reality. 

Erik: Low frequency too, and that's what really creates the problem. Yeah. Yes. You 

Matt: don't do this all the time. Right. So we know mistakes are gonna happen. So if you make a mistake, own it. We'll learn from it so that the next time we'll be better. But boy, you try to lie about, lie about it and hide it.

First off, lemme tell you something, they're always gonna find out. 

Erik: Always, 

Matt: always gonna find out. And then you don't want Bill Bonnie coming after you. No, [00:43:00] no. Yeah. I don't want Bill Bonnie coming after me. He's a, that scares me. 

Erik: Yeah. So if you, people listening, probably don't know who he is, but he's, oh, some people do.

Oh yeah, I'm sure some, some people, yeah, a lot of people probably do. Yeah. The guy's like, like the, he's, well, I think he's leading the task force right now. Oh, yeah. Yeah. He's led the Yeah. Lots of lot of stuff. 

Matt: Committees around here, 

Erik: but, but internally in the department where I'm a medical director, his expectations are super high as they should.

And, and I, I, I like to, I just like having that expectation set where people don't wanna cross Chief Bonnie. Yeah. Right. No. Um, and they, they really want, don't wanna let him down. Yeah. A lot of. Folks have, have shared that with me. It's respect. It's respect, yeah. But keeping the culture to where you're not afraid to make a mistake.

Right. Where you're, you're just trying to comply with protocols and just watch your, you know, P'S and Q's and just make sure you don't mess up. That's not the way to function. Yeah. It's a commitment to being the best you can. Yes. [00:44:00]And to performing in a way that's like you're treating your family. 

Matt: Yeah. 

Erik: Uh, that's, that's really the goal.

Matt: Yep. For sure. 

Yeah. Well we've talked a lot about different errors, potential errors, uhhuh, and then let's talk about prevention. Yeah. So how do we prevent these errors? 

Erik: Well, I think, uh, we, again, a lot of this is reiteration. Uh, but if I had to pick one thing in our department to. To prevent errors. Uh, 'cause they're going to happen and um, the errors are gonna happen. We've established that. Mm-hmm. We're not perfect. Yeah. We are human. Yeah. And culture is gonna help us to either communicate those errors or handle them hopefully in a way that's constructive is an opportunity to change. Right. But I think sandwiched in the middle, like my favorite part of an Oreo.

Right. Is the creamy good stuff. Anyway, uh, I don't know where the Oreo analogy came from, but my point is you gotta have a double stop though. Training. Training, yes. Is training. It's something that I think, [00:45:00] uh, we could probably have a whole podcast just on training alone. 

Matt: Oh, for sure. 

Erik: Is, is, um, being prepared.

For those emergencies when they happen. Mm-hmm. Because, um, the training is a big part of the system mm-hmm. In education training, um, being prepared with scenarios. Mm-hmm. And, and, uh, knowing that these low frequency, high stress events are gonna happen eventually. Mm-hmm. And we want to be ready for them to create an a, a learning environment where we can train properly.

So I think training would be, um, I think one of, as a medical director mm-hmm. The most important things that I can help to facilitate, to minimize errors that are gonna get, um, they're gonna affect patient outcomes. 

Matt: Don't train on it till you get it right. Train on it until you can't get it wrong. That's the way you wanna look at it.

Erik: Right. And I, and I think that, you know, it's one thing as a medical director to teach somebody, but when I can teach it to my paramedics to teach the newer ones. Oh yeah, for sure. You, what is it? Do one, learn one, [00:46:00] teach one or something. Do 

Matt: one. Uh, yeah, do one. Sorry. Watch one, do one. Teach one. 

Erik: Yeah. 

Matt: Yeah.

Erik: That's it. So I think training would be, what would you say, uh, the most when you think preventing errors? I'm thinking training, thinking. 

Matt: Yeah. Training is a huge part of it, right? You have to be trained on the skill that you're doing. 

Mm-hmm. But. 

When you're actually doing the skill in the environment, sure you're gonna fall back on your training, but having a sy a checklist, 

mm, that's good.

Right. 

Having a checklist that in the moment, because we've talked about system one and system two thinking. Mm-hmm. We don't want to be in system two thinking. 'cause in our, we're talking about high risk calls, right? Mm-hmm. We're not talking about. Somebody that we've got some time on, we're talking about, we just showed up on a 5-year-old who's got a crashing airway and we gotta make a decision right now.

Are we gonna tube this kid? 

Yeah. 

Right. And we gotta get all this stuff in place, right? It's huge. And so. If you have a checklist, we have to be in system one thinking because we have to just act. [00:47:00] Right. And so having a checklist will make sure, because there's problems with System one thinking they're prone to mistakes.

Uhhuh, because you're overly confident I know what my drug dosages are. Yep. But I'm not gonna forget to check the blood sugar. Yeah. I'm not gonna forget to put end title on my tube. I'm not gonna forget what, whatever the thing is, right? Yep. Um, I'm not gonna forget to push. Uh, sedatives before I push my paralytics.

Right. So having a checklist, right? So like we have a high performance CPR checklist. Mm-hmm. Right? We have an RSI checklist. A resuscitate before you enter pain. Mm-hmm. Right? What's your pulse ox at? What's your blood pressure at? Are, are they setting at 80% and you've been bagging for five minutes and you can't get it up?

You really wanna push? That sucks. I mean, maybe you have to. It depends on the situation. Mm-hmm. What's your blood pressure? Right. Well, hang on. What do we, you know. So checklist of things so you don't make a mistake in the moment. Yeah. I think is super important. 

Erik: And those checklists of critical actions Yes.

Those types of mistakes Yes. Can be really devastating. [00:48:00] Yes. It's a good point. It's one thing to give a little too much or maybe make a miscalculation. That could be a bad error too. Give a little 

Matt: bit of morphine, probably not gonna kill somebody. 

Erik: Right. But, but not getting that EKG and recognizing the fact they're having a stemi but they called for weakness.

Right. You know, that type of a, uh, a, an error. Could be mitigated by a checklist, just remembering to do those critical actions. That's right. That's really good. 

Matt: Yeah. I think that's probably the best. Uh, again, in the moment, heat of the moment on these calls, that's the best way to, to prevent some errors.

Mm-hmm. And just having good habits. Yeah. Right. Like we talked about with communication with the five rights, um, those kind of things. I think that's super important. If you create good habits. That in com, combination with experience and then checklists and training, you're, you're gonna be good. 

Erik: Now I answered your question, which is a great question, by the way.

Um, from a medical director perspective. Mm-hmm. But I would answer it different differently from a practitioner's perspective. So in internally, [00:49:00] personally for me mm-hmm. As the one who's responsible for my actions. Mm-hmm. And not wanting to make mistakes, not wanting to be in that situation. Yeah. Where I'm like ripping myself apart because I made a mistake, wanting to avoid that at all costs.

Yes. I would say that the most important thing, um, in that is, is really a sense of, uh, I don't know if it's humility or. Just the like, um, just being willing to admit the fact that there's more to learn. Yeah. Humility. Yeah. I'd say that's humility. Yeah. I think, I think, I think that's, that might be something maybe internally for all of us, is that you get a team of people all feeling that way.

Yeah. Where we got more to learn here from each other and from the literature and from our medical director, from our chief, our FTO is not feeling like. We've arrived. Yeah. We've, there's always more to learn. There's always some rough edges to sharpen. Yeah. Uh, I think that might be another thing I would say would be most important, I think internally, not as a leader in a [00:50:00] department, as a medical director.

Mm-hmm. But, um, but more as just personally for me as a doctor Yeah. Is always being willing to, to relearn and reevaluate. Look at new literature. 

Matt: You have to, like when I went to paramedic school 20 plus years ago, like. We don't, we didn't do tourniquets back then. Yeah. That was like a, oh my God, you don't put a tourniquet on somebody's arm.

Yeah. Right. Trauma patients. Yeah. Two large bore IVs. Give them all the fluid you can give 'em. That's so 

true. 

You know, so you have, but I think again, the problem with a lot of, especially fire based EMS folks is, well, I went to paramedic school and I learned it. Now I'm done. 

Right? 

And it's like, well, no, you're not.

You are con if you're not constantly learning current. Things. 

Erik: Mm-hmm. 

Matt: You're doing yourself and your patients in the community a disservice period. There's no question about it, because if you're basing your patient care off of 20-year-old medicine. You're way off. 

Erik: Yeah. And that's just the reality of it.

They change fast and they're changing faster now. I think with, yes, with [00:51:00] the more AI and you know, ChatGPT and all this like information. Well, and they're changing 

Matt: faster with pre-hospital because they're doing more data and research True in the pre-hospital environment, which before they didn't. And especially I think since 2020, they're doing more.

More like, whoa, these guys can have a dramatic impact on patient care. We need to study this, we need to study that. Right? And so yeah, if you are not, if you think you know it all, 'cause you went to paramedic school 15, 20 years ago, no bro, that's a bad mindset to have. Yeah, you need to change that. 

Erik: So. Well it's been a good podcast, man.

A lot of good reminders. We all make mistakes. We're not perfect. We need culture. We need to work together, need to train. Gotta be honest and humble. Yep. Trained, really communicate good. Lot of good information there. I hope our viewers and listeners. 

Matt: Well, I think if they're listening to this podcast, they're doing a lot or most of that, or they're on, they're on the right path.

At least 

Erik: I think so. 

Matt: Not 'cause it's us, but because they're listening to a podcast that's gonna help 'em grow. 

Erik: So you can close the loop by doing your assessment [00:52:00] questions. There you go. For this podcast. There you go. And then, uh, show us 

Matt: if you're getting CE credit for it. 

Erik: If you're getting CE credit. 

Matt: Yeah. If you're not getting ce CE credit for it, shut it off and move on to the next one. Be safe out there. See you on the next one.

Narrator: Thank you for listening to EMS, the Erik and Matt Show.