EMS: Erik & Matt Show
After hours style conversation focused on the hidden and often overlooked parts of first responder life. Discussing everything from continuing education and home life to health and wellness.
EMS: Erik & Matt Show
Just Culture Podcast
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In this episode of the Erik and Matt Show (EMS) we explore "just culture" in EMS and fire service—a value-based accountability model that balances honest mistake reporting with appropriate accountability to improve patient safety and team trust.
Maybe if there's a systematic problem, you fix that policy or you fix that piece of equipment that caused the problem, right?
SPEAKER_02Oh, I didn't realize that med had the same color as this med. Let's start let's start tagging our syringes. There are consequences to that decision or that mistake that was made that we can't change.
SPEAKER_00With your hopes.
SPEAKER_02We've had so many experiences that this just culture thing relates to. I remember playing football as a walk-on. I was so afraid to make a mistake. It really hampered my performance. I was afraid to make the wrong block or block the wrong guy. Or that actually created a huge problem for me uh as a new football player, walking on to this the the college team, uh being so afraid to make a mistake, it actually really hurt me more than it wasn't the physical tools, it wasn't the I knew the playbook. Yeah, but when you're when you're on the field having to read a defense, whatever the blocking scheme was, right? I was so afraid to make a mistake to get made fun of in in films.
SPEAKER_01Way to go, Erica.
SPEAKER_02That's how I got the nickname Erica. I mean, I don't mind saying it. I mean, if when I first started, they they I was fast, I was strong, but I didn't have the experience. Yeah. I learned it, I made the team and and learned a lot, but I didn't learn a lot until I felt like I was comfortable making a mistake because I learned so much making a mistake. And when I stopped being afraid to make a mistake, and and I went crazy 100% for even if I'm making a mistake, I'm just gonna go all out and I'll learn from that mistake later. And I had a great coaching staff that helped me learn. But I think that's a lot with happening. I think in the firehouse, the lot of fear of m the punitive you know, nature sometimes in a fire department. I made a mistake and I'm getting punished. Now I'm afraid not only to make a mistake, but when I do, because we all do, I'm afraid to communicate it.
SPEAKER_06Yes. What's gonna happen? And it's that am I gonna get in trouble? Or uh, you know, the other guys are gonna make fun of me. It's the same kind of a culture as like a football team, you know. I don't want to get made fun of, I don't want to get in trouble, and it's just yeah, it's a bad culture, and I think that it's pretty prevalent in the fire service. And I think a lot of it, if I'm honest, I think a lot of it kind of like on a football team, right? You're dealing with type A males that don't want to be vulnerable, that they've made a mistake, they want everybody, they have this image that we're this superhero, we don't make mistakes, you know, we're all these things. And it's trying to change the mindset of it's okay to make a mistake. You're going to make a mistake. If you work hard and you're, you know, playing as hard as you can play, or you're working as hard, you're gonna make a mistake. That's okay. That's being a human, right? But from a leadership perspective, yeah, from the medical director side or from like an administrator side, we have to understand that as well. And we can't have a punitive culture in our department because that's not good either. And you know, this just just culture thing, I'd never heard of it until I went to nursing school. And that's where I'd first heard the term just culture, and I was kind of like, what is this? And then, you know, we got educated on what it is, and in my mind I thought this needs to translate into the fire service because it's all just an accountability model that we were talking about before that you know, we have to have accountability, right? There has to be accountability, but we also have to have a culture where people aren't afraid to own their mistakes, right? And and say, like, hey, I I screwed up. Okay. And then we look at okay, and we'll talk about how to go through that when somebody makes a mistake. But that's what we're talking about today, just culture.
SPEAKER_02Just culture.
SPEAKER_06And you said you had this as a doctor.
SPEAKER_02Yeah, I think well, in in uh as far as culture goes, when you're learning like a baby doctor, there's a culture of boy, if I make a mistake, I'm gonna get railed.
SPEAKER_06Right exactly.
SPEAKER_02Same as a new paramedic. Yeah, when you're doing rounds in the hospital and and uh you're attending asks you a question, you don't know the answer, you're gonna you're gonna get your butt rear end, chewed out. And uh so there's a lot of fear culture of being prepared, studying your patients and not making a mistake. But one of the cool things I think about medicine, we have these things called MM where we will go in in a safe environment to talk about these types of things and to be honest and to learn from them. And uh it's a safe environment, it's not you know not recorded or documented, it's uh it's a safe environment to speak honestly. So I always enjoyed that too, and uh learning from the mistakes of other doctors. And sometimes there's systematic errors, it's not their fault necessarily. I mean, obviously that they made the mistake, it's their fault, I guess you could say, but sometimes the reason it happened was something that was systematic, uh you know, even a human like a cognitive bias that you can learn from or whatever it might be. And then and we're gonna talk about it later. There's different types of errors, right? So uh but those are these are things that um to go back to the football analogy when I was coaching football, I would tell my guys, I said, listen, I uh I will not get mad at you for many things, um, but if you're not hustling and you have a bad attitude, I'm gonna rip you up. Yes. Hustle 100% every time and and always good attitude. Those are things you can control. Um and if you make a mistake, we can fix that.
SPEAKER_06That is the same thing in the fire service. Not so much hustle necessarily, but you know, having a good attitude.
SPEAKER_02Well, in some ways it is hustle, right? You told me the story of the you know, the this isn't uncommon. You've got that person that's sitting in the taking a nap in the in the day room and cleaning, right?
SPEAKER_01Yeah.
SPEAKER_02Get off your butt. Yeah, yeah, yeah. You know, do your job, right? Yes. I mean that's something that be here now as Chief Wells would say. Yeah. Yeah. Yeah. Ultimate team sport is that's right.
SPEAKER_06Ultimate team sport. And so this lectur this lecture, this podcast, is definitely for firefighters, EMTs, paramedics, private ambulance, flight, critical care, nursing, doctors, everybody, administrative chiefs. This is a broad-reaching topic that everybody kind of plays a role in, right? As long as we're all on the same page. And I love this quote from Dr. Leap, I think, or from professor from Harvard. The single greatest impediment to error prevention in healthcare is that we punish people for making mistakes. And like I tell all my new paramedics, like, you're going to make a mistake. We're working in high stress environments, we're trying to go as fast as we can, but yet make the right, we're making you know, critical decisions in stressful environments at the split second. Mistakes are going to happen. We're human, right? We're humans. That's okay. As long as it wasn't an intentional mistake, it wasn't a mistake of you didn't know your protocols, or you know, a laziness mistake, or it was you made a mistake and you didn't admit it. Long as it was just an honest mistake, we'll move on from that. But it's the whole system of how do we look at it when there's an incident, when somebody owns up to mistake. How do we, like as administration, how do we respond to that? As the medical director, how do you respond to that?
SPEAKER_02And I think in this context, I know that as a medical director, like you said, when we make mistakes, which are gonna happen, there are consequences to that decision or that mistake that was made that we can't change. It's like water under the bridge, right? Those are consequences. Can't put the teeth. Can't change those. Yeah. And I know in this industry in particular, we punish ourselves big time. Yes. And again, having that culture, that punitive culture where the I can speak as a medical director. I know for me, let's just say, you know, we've worked together as medical director and paramedic before. If you made a mistake, you were always mistakes too, right? Yeah.
SPEAKER_06Stepping on your neck.
SPEAKER_02You're stupid. That drill sergeant.
SPEAKER_06Yeah, yeah.
SPEAKER_02No, what I I know, and this is the culture I like to promote, and I I love it that we're talking about this, but is the guy that made the mistake has been punishing himself for days now. Yes. Me coming in there and punishing more isn't gonna do any good. Just gonna really really promote what we're talking about is such a cancer in the department. Yeah, now he's even more scared. Right. Instead, what I can do, uh in knowing how that paramedics have been punishing themselves for days and made the mistake, consequences are happening and probably will continue to happen, unfortunately. But I can walk through that with them and we can learn from it, and we'll talk about it. But that um that culture I think is so important, especially for my goals as medical director and trying to make the community safer by the care we deliver. I'm not the one doing the care. Yep. I've got to promote that culture of uh like the the just culture.
SPEAKER_06Yep. Yeah, so value-based accountability model, that's kind of what just culture is. Encourages open reporting of mistakes, right? So you make a medication error, you know, you go to your captain, you go to your EMS chief, your medical director, you own that mistake. First off, obviously we take care of the patient. Recent, recent story in the news where a paramedic was charged for, I believe, first degree murder, if I'm not mistaken right. Gave rock instead of ketamine, I think is what they wanted to give on a violent patient, gave rock. It's like just tube the guy. Like, okay, you made a mistake. You you gave a paralytic, you gave the wrong medication. First off, handle your patient. Don't just sit there and be like, well, I don't want to say anything because I'm gonna get in trouble. Well, that's gonna get you into more trouble. Had you just said, Oh crap, I gave the wrong medication, this is gonna be the side effect of that medication, I need to handle this. Yep, you know, let's just tube them, put them down, tube them, own the mistake. Yeah, you might get written up. Probably wouldn't have lost your job though, and certainly wouldn't have been brought up on charges. So, anyway, encouraging uh people to report mistake, um, and then from a leadership perspective, was this a human error? Was this reckless behavior? Was this a systemic problem? What caused this mistake to happen?
SPEAKER_02There rarely is there intent to cause harm in these things. Usually, like you said, a human error, but you could be reckless too. We'll talk about it.
SPEAKER_06Yes, yeah, absolutely. And then build trust, right? We we don't want to take away accountability, right? We have to have accountability, right? We have to hold people to a standard because we are working on patients, on people, making life and death decisions. So we have to have accountability, but it's not always about somebody getting in trouble, right? It's about understanding what we're supposed to do and become better.
SPEAKER_02Absolutely. You said a very, very important word. I don't want to just gloss over the word trust.
SPEAKER_01Yep.
SPEAKER_02If you you've got to be able to trust that chain of command when you I feel like when you do have to you know, tell them about a mistake you made. There's a lot of trust there. Uh and we've said this before, but trust is such a fragile thing. We build it with drips, but you lose it in buckets. And if and if and and if you and if your department doesn't have that culture, it doesn't just happen like that. It takes time to build it, build it over time. And that's where leadership comes in. And we've we've spoken on this, you and I. Oh yeah. It's a big deal.
SPEAKER_06Yeah, it's been very interesting going from in-the-field firefighter paramedic to more of the admin side where you're dealing with administrative issues and seeing that culture. And, you know, as firefighters, we do it a lot to ourselves, right? You know, we we get this negative viewpoint of admin when really we don't understand what admin has to do every day. You know, one of the things that I realized after I went to an administrative things, and there's probably firefighters out there and they're like, you know, I did I was in fit the field for over 20 years.
SPEAKER_04Yeah, right.
SPEAKER_06I was a firefighter paramedic for over 20 years, so I have a lot of experience as a in that role. Everybody in admin has worked in operations. Not everybody in operations has ever been an admin.
SPEAKER_04Yeah.
SPEAKER_06So to pretend like you know what their job is, you're kind of fooling yourself. So we need to be honest with ourselves as the rank and file firefighter driver, whatever. It's a lonely place. Well, yeah, but I mean you don't understand what they have to do and deal with, right? And they can't just, you know, it's not all just about getting people raises, and that that's most admins, if they're good, they're there to serve like our admin. Our mindset is we are here to serve operations. That is our role. We are here to get them the equipment that they need, to support them however we can support them. That's what we're here to do. It's not this negative mindset that we're running around looking to get everybody in trouble. And I'm sure that there's administrative staffs out there that that is their mindset. That is a bad mindset because then now your whole operations staff, they're not stupid, and they realize like, I'm not gonna say anything because I made this mistake because I know Chief So-and-so is gonna write me up or I'm gonna get a shift off. That's a terrible, terrible way to lead through fear and intimidation. It doesn't work, it never has worked, and it never will work. So that has to go away. But we still have to hold people accountable.
SPEAKER_02We do have to hold them accountable, and I still have to put them on that pip. Yep. And uh, but I'm walking through it with them. Exactly. I'm supporting them. It's not a punitive thing. This is an opportunity, we'll talk about that later.
SPEAKER_06But we have to be willing to accept the fact that we make a mistake in the field, and that's okay.
SPEAKER_02And we have to do the right thing.
SPEAKER_06Exactly.
SPEAKER_02Exactly. But if you don't have that trust environment, uh that that just culture, like you described, sometimes these things, a lot of times these things don't happen. No. What are the three cultures? Yeah. Safety cultures.
SPEAKER_06So you've got a punitive culture, we just kind of touched on that a little bit, and we'll break these down. Then you have a blame-free culture, right? Which we'll talk about that, which we've talked about. Exactly. And then you have a just culture, right? And we'll break each one of these down. The punitive culture is like we just talked about, right? Somebody makes an honest mistake. Oh, you're getting written up. Oh, you're getting a shift off without pay. Oh, you're getting PIP.
SPEAKER_04Yeah.
SPEAKER_06Like, whoa, hang on, man. I just made an honest mistake. Like we were in the heat of the moment. We had 10 things going on, we made an honest mistake. Yeah, right. Punitive culture doesn't work.
unknownYeah.
SPEAKER_06Doesn't work for leadership, doesn't work for the rank and file, shouldn't work, right?
SPEAKER_02Um if there was an opposite word to trust, I it might be fear. I I don't know. I don't know. Uh we haven't really thought about it. I haven't put a lot of thought into that, but if there was an opposite, it would certainly be related to that.
SPEAKER_04Yeah.
SPEAKER_02Because uh it's one thing to do something scary, right?
SPEAKER_06Right.
SPEAKER_02But to be afraid, that's different.
SPEAKER_06Well, and though what are you afraid of? I'm afraid of my mind being it's just like you when you said you were playing football. Like your mind's not clear to focus on your job because it's it's consumed with this fear, right?
SPEAKER_02Exactly.
SPEAKER_06And so when you're going to the fire station, we don't want firefighters, EMTs, paramedics, flight nurses, whatever. We don't want them with this fear mindset, right? Think of a flight nurse. If she's he or she is terrified of the helicopter crashing every time they take off, are they gonna be able to really truly focus 100% of their attention on the patient? No, they're gonna be terrified. Oh my god, what was that?
SPEAKER_02Well, it's true. Neurophysiologically, when you've engaged those reptilian portions of your brain, the anxiety, the fear, you are not thinking with the prefrontal cortex. And that's that's where you get your executive function, where you're accessing things you've learned and you have the confidence of knowing, hey, I'm gonna do this 100%. Yes. And I'm gonna do a good job with it.
SPEAKER_03Yep.
SPEAKER_02Unencumbered by the fear. Yes. It's okay to be anxious or not anxious. Nervous. Nervous is a better word. Nervous. Yeah. It's okay to be nervous.
SPEAKER_06And it's nervous more like if I'm nervous, like I remember the one time I cracked a patient. I was very nervous. Sure. I was super nervous. Like at the time, I think there had only been one other person in my department that had performed that skill. Sure, I trained over that skill, but now here I am on the living room floor of this patient's house.
SPEAKER_02It's go time.
SPEAKER_06Yeah. It's like this is gonna happen, you know. So I was very nervous, but I was not scared. Um, I would I mean, there was a little bit of a thought of like, man, I better be right that this is the right thing to do in the moment, but I had to make that decision very, very quickly, right? But again, it was more nerves, and that's gonna when you're doing these skills, but you shouldn't have a fear of, oh my God, if I do this, my chief's gonna like if you can justify, I could have justified all day long why I made the decision to crack that patient. And guess what? You weren't there, chief. You were not on this call, you weren't, you didn't see what I saw clinically. So kind of how are you to judge me? And that's one thing that admin gets wrong sometimes is they make a judgment. I have told my guys, and I try to stay true to this every time, when something happens or I hear about something happened, the first thing I do is I go to the crew that was on the call and I find out from them. Tell me what happened. You guys were there, I was not there, so-and-so wasn't there. I want it firsthand perspective, what happened? And 99.9% of the time, when I hear the crew's perspective that was there, I was like, I would have done the same thing. I would have done the exact same thing. So we're good. No, you know, but sometimes chiefs they have this punitive mindset and they immediately go, Oh, they screwed up, they screwed up, bring them in the office, we're doing an investigation. Why do you think all your firefighters are running around scared?
SPEAKER_02And unless you've been in that that that position in that office, yeah, it is tough. It is hard. You got the city breathing down your neck, you've got who knows what else happening. Yeah. Uh there is that's a tough situation. But as a leader, and I think you do this really well, is that you know and you understand that those paramedics, those providers were they were you were you were trusting them to do their job.
SPEAKER_01Yes.
SPEAKER_02And we and and we owe it to them to get all the information, get the context, because we did trust them that they made the best decision they could in the time. And if they did make a mistake, we can learn.
SPEAKER_06They did it thinking they were doing the right thing. I'll defend that all day long. And if you're a leader and you're getting stress from your city, leading with fear is not going to make your fire department better. Is not going to improve patient care. Just like the quote at our at the beginning. That is not going to make your firefighters better. Them feeling free to go on calls and know that I'm going to do this job to the best of my ability, and if I make a mistake, I know my admin has my back. Again, we're going to talk about why people make mistakes, right? Long as you're not being reckless, your admin should have your back.
SPEAKER_02Absolutely. And that I love that you said that. I had a a paramedic recently, a newer paramedic, made an airway management decision uh to not intubate a certain situation. And when they got into the ER, the ER doc was pissed and really made them feel bad about not intubating the patient. And then it came back to me, we reviewed it, and I I I wanted to hear, well, tell me more about the situation.
SPEAKER_04What were you thinking? Yeah.
SPEAKER_02And I and I told him I said, Well, you know, I probably would have intubated that patient, but let's talk about airway management right now. And I think honestly, in that situation, if there were a hundred paramedics lined up, there would be other paramedics that would have made that same decision as you. Maybe a minority of them, but you know, some of them would have. Yeah. Let's talk about it. Yes. And let's improve our airway management skills because making the decision to intubate is I think more important than even the skill itself. Yes, you train a monkey to do that. 100%.
SPEAKER_01Yeah.
SPEAKER_02But but but I think the airway management, there's a lot to learn there.
SPEAKER_01Yeah.
SPEAKER_02And I was so grateful that I could step in with this new pair of him to the cadaver lab. We talked about things and and it went really well. And now he feels empowered. Now he's more confident moving into that. Next time he's got to make a decision. He'll remember these things. Whereas if we had a punitive culture where he's afraid, Oh, he's gonna be more afraid. He's gonna be terrified.
SPEAKER_06I don't ever want to intubate anybody.
SPEAKER_02Next time he's in a situation like this, he's gonna have PTSD.
SPEAKER_06Or he's gonna be innovating people that don't need to be innovating because he's afraid. Yeah, because he's like, well, the last time I thought I shouldn't tube this guy, I should have, and I better tube this guy. So now, because you are in this just culture mindset, he feels like, wow, my medical director's got my back. I clinically made a judgment. Maybe it was the right judgment, maybe it was the wrong judgment, but now I've learned more because I'm a new paramedic and we're gonna talk about a knowledge-based skill, right? He doesn't have the experience, right? So now he has more experience, and now he's probably he's delivering much better care of the citizens.
SPEAKER_02I'm teaching my daughter to drive right now, and she's learning a manual transmission. That's a test of fatherhood patience, isn't it?
SPEAKER_05Yeah.
SPEAKER_02But you know it's fun, but yeah, it can be. But we we we had some some struggles initially with uh and I'm not gonna put her on the freeway yet. No. Because she's learning just learning the transmission and how to what the clutch is all about, you know. So we practice in a church parking lot. The clutch. What's a clutch? I know all the all the younger folks are there with a clutch, what? Yeah, so not all cars are automatic transmissions. You know, so she's learning on a manual transmission and she's learning the timing with the clutch and and in the church parking lot where we're practicing these things, and she's doing great. And she stalls from time to time. But I'm not stepping on her neck.
SPEAKER_06What are you doing?
SPEAKER_02Get out of the car, I'm driving. Like she's not gonna learn that.
SPEAKER_06Yeah, because that would make her feel confident driving. Yeah, exactly.
SPEAKER_02Same thing. Yeah. Learning the muscles of airway management. Yep. Let's let's let's train them up so they're ready when they do go. Yeah. But even when your boots on the ground, your first ever lead paramedic, this guy was ready. Yeah. I I checked him off. Yeah. But we had found a weakness in his airway management, somehow got missed in our we got a great FTU program. It's fantastic. I'm proud of it. But there was a weakness there, and he was in a really tough situation. Really tough. And I get it.
SPEAKER_06Was there no other well, I guess it doesn't matter. Never mind.
SPEAKER_02No, there was an he was yeah.
SPEAKER_06He was I mean, I was just thinking, was he like other because that's the crew mentality, right?
SPEAKER_02Yeah.
SPEAKER_06You know, hopefully you've got maybe a more senior guy there that could. Say, hey Eric, I think we ought to tube this guy. And just having that reinforcement from the senior firefighter, because the new guy's thinking, man, I think I should tube this guy, but I don't know. I'm kind of on the fence here. And then having that big brother come in and go, We should take this airway. Oh, okay, good. I'm glad you're on board with this. Let's do it.
SPEAKER_02You know? In this particular instance, it was it was really all about cognitive bias for him. Uh he he had anchored.
SPEAKER_06Ah, gotcha.
SPEAKER_02And uh he was so anchored on this diagnosis. This one thing, yeah. Yeah, seizures and things. But he forgot about some of the airway management things that not all seizure calls are about waiting and watching for the post ictal phase. Sometimes in certain situations, you better step in and do your job with the airway, right? So it was really great learning. Yeah. And there was no bad outcome, fortunately. Yeah. Um, but it was a really education that he needed.
SPEAKER_06And the biggest thing is that he accepted responsibility. Yeah. Right? He owned that he made a mistake, right? Let me tell you something, firefighters, paramedics, EMTs. If you own your mistake, I can almost guarantee you you are not going to lose your job. I hear it all the time, like from multiple departments, right? They're like, well, we make a mistake, we're gonna get fired. Really? Are you gonna really? Because in my 20-plus year career, when I've seen people get terminated, 99.9% of the time, it's because they weren't honest about it. It's ethical. It's an ethical thing, it's an integrity issue because we knew you made the mistake. That wasn't in question. We wanted to see if you were gonna be willing to own the mistake and learn from it, right? And if you do that, I've seen people do some dumb stuff and they owned it, and they didn't even get disciplined, they just got re-educated. Yeah, you know, and anyway, blame free culture. We talked about the punitive culture. Blame free culture is the exact opposite. Oh, you killed somebody, you gave the wrong medication. Okay, you're good. No worries, go back out on the field.
SPEAKER_02Yeah, zero accountability. And as a medical director, it's a temptation to just be everybody's friend.
SPEAKER_06Yeah, right. Same with the EMS captain.
SPEAKER_02Yeah. Chief. Don't worry about it. Let's go back and watch a movie. Yeah. It's okay, brother. Yeah. You know, let's just yeah, there's there's that lazy. It happens sometimes. Yeah, no, we're not here to make you feel good and be your friend. But there's a balance, right? There's gotta be, I think, accountability.
SPEAKER_06A hundred there has to be accountability, right? And that's the the fire the that's where operations uh needs to understand. We have to have accountability.
SPEAKER_04Yeah, right.
SPEAKER_06You can't just be out here doing whatever you want without accountability. We have to have accountability. And it's so funny how some people, I've ran across numerous people like this, that they'll gripe when they see a bad paramedic. You know, and they, well, that guy sucks. He's and I'm like, bro, I've read several of your reports and heard about several of your calls, and not overly impressive. So why don't you set the standard?
SPEAKER_05Yeah, right.
SPEAKER_06You want everybody else to be at the standard. Why don't you set that tone out in operations and be that guy, right? So we have to have accountability both in operations. That's where it starts. That's from an admin perspective. We want accountability to stay in operations. Yeah, you guys handle it, we don't want to handle it. You guys handle police yourselves, captains police your stations, battalions, police uh police your shifts, right? You guys handle it. We don't want to handle it, right? So that's where you kind of have this just culture thing, yeah, right, which is a mixture of um result in reporting, right? Accountability. People aren't afraid to come forward with their mistakes because they know I'm gonna go to that doctor axine about this mistake I made, and I know instead of yelling at me, he's gonna say, Let's go to the cadaver lab together and learn. Yep. You know, I'm gonna go to Captain Ball and be like, hey Cap, I had a guy recently reached out to me, made a minor medication error on a call. I hadn't heard from anybody. The the guy that did it sent me an email on it. So I read it through, I was like, okay, this doesn't sound terrible, simple mistake, not a big deal. Called, talked to him. In his in the email, he says, I take full responsibility and accountability and am willing to accept any punishment coming my way, or however it was worded. And I'm thinking, like, the last thing on my mind is punishing this guy.
SPEAKER_04Yeah.
SPEAKER_06Because first off, the first thought in my head was that's a guy of true honesty and integrity. Because he is coming to me right after this happened, owning his mistake. That's the kind of guy I want on my department.
SPEAKER_02I knew better.
SPEAKER_06Yeah. And so I immediately called him and he's he's like kicking himself, just like you said earlier. He's beating himself up that he made this mistake because he's holding himself to a high standard. I'm like, dude, you it's okay. It's okay. You're gonna make mistakes. We I've made a million of them. You're gonna make mistakes, you are not being punished. I will guarantee you that right now, because you have integrity, you own the mistake, this was a minor issue. You're not gonna be terminated, you're not even gonna get in trouble.
SPEAKER_02Yeah, and to me, with that intubation example I shared, some can view the remediation as a like I gotta go to the cadaver lab with my medical director, you know, as a punishment, you know, with all the new guys that are being trained, and I got this experienced paramedic now with them too. It's like, well, why is he here, right? Well, it's not punishment. To me, it's an opportunity. It's it's I get to sharpen skills. To me, I love that. Yes. And if and if my and I hope, uh and I do believe, based on our conversations, that the the the individual that needed to work on the airway management system valued that time. For sure.
SPEAKER_06Afterwards, yeah. He was like, Oh, this wasn't as bad as I thought.
SPEAKER_02Here's a great story, actually. I love I back to football again. I I had one of the the football coaches, uh, he worked with our team, uh actually he's playing in the NFL. He would work with me one-on-one on things and help me with things and step in a little bit to me. So to me that was really special. He's taking the time to help. Right, right. So but that's a culture thing, right? Whereas if if it was a punitive thing where it's like, oh crap, this this is the guy, yeah, and I'm not good enough. Uh man, I better get my crap together because I messed up big time. You know, you could you could you could paint things in a way in a narrative in your brain that's gonna engage that amygdala, and now you're not thinking with your prefrontal cortex and changing your behavior.
SPEAKER_01Yeah.
SPEAKER_02You know, it's um and so anyway, my point is is sometimes it's not punishment. I mean, you can view it as punishment potentially, right? The extra remediation or education you had to do, or you could view it as I'm gonna sharpen my skills. This isn't it may happen again, but it's not gonna happen the same way.
SPEAKER_06Right.
SPEAKER_02You're gonna learn.
SPEAKER_06Yeah, you're probably gonna make another mistake, and that's okay.
SPEAKER_02You will.
SPEAKER_06But Dr. Axene's gonna come out, and I get to go spend time in the cadaver lab with Dr. Axene and learn from him or whoever, you know, one of my FTOs or one of my senior guys, you know, oh wow, they're taking the time.
SPEAKER_02There's something else here that we haven't talked about, which I think is a really important culture thing as leaders, is when let's say this individual does it again and again. You have to you you have to be able to look at yourself and say, what have I done that has not supported this individual in a way that I was hoping it would? I must have missed something. What can I do better?
SPEAKER_01Yes.
SPEAKER_02I think you gotta look internally first. Yep. And and uh and then change your approach. You keep doing the same thing all the time and you're getting the same mistakes. Something's definition of insanity, I believe. And and if I believe that individual wanted to do better, uh and he keeps doing the same thing, uh somebody's missing something.
SPEAKER_06Yeah, there's yeah, there's something going on.
SPEAKER_02And you gotta look internally first, I think. You gotta look internally first.
SPEAKER_06From a leadership perspective, right? You gotta look internally. Is this something I did? Is this did I not train my people good enough? You know, were my protocols not clear enough? Did they not understand this new medication, whatever it is, right? Or and then as firefighters, like you gotta take some ownership, right? You gotta take some ownership. Said, man, that was I not studying my protocols, right? We got this new medication, right? Did we got this new policy? You know, did I just did I just check the box and click on the email? So Chief said that I saw that I read that policy, or did I actually read the policy, right? Because guess what? You're gonna be held to that standard, yeah, and justifiably so, right? If that's a protocol, a policy, whatever that you're expected to know, you know, you gotta know it.
SPEAKER_02I've had a couple situations in a training environment where the individual just couldn't do it. And we had to help them find a new job. Yep. It was hard, but it was the right thing to do. Sometimes we have to have standards. Yes. We have to have expectations that are high because lives are at stake. Yes. And the same thing's true in the field when you have an experienced paramedic and you s keep seeing it. It may not be a training issue. You need to what's going on at home. Got to address it. Yeah. What's going on?
SPEAKER_06Yeah, don't always go to the negative. Yeah. Yeah. Maybe they've got something going on at home that their head's just not in the right place. Yeah. And so they're making dumb mistakes that they normally wouldn't make.
SPEAKER_02That's what happens when you look internally first. What have I missed? What can I do better? Yeah. Let's get some more context. Let's get some more information about the scene, about what's going on at home, about their life, you know, knowing people. There's there's a it's not easy.
SPEAKER_06No.
SPEAKER_02It takes time.
SPEAKER_06Yep. Uh safeguards for knowledge systems. Uh so you can do for knowledge, right? For teaching these guys. Obviously, we do monthly CEs. We do live training, like we do this with fire and EMS, right? We do PIAs. We do that a lot with structure fires. Almost every structure I've been on, we would always do a big PIA afterwards. We have a battalion chief now in my department. Does a phenomenal job of he goes super in depth, he gets the dispatch tapes, he gets the time. I mean, he goes really deep. And then the whole crew will come together and they'll sit down and they'll go step by step. And it's it's an open, he actually I loved it. He came into my office the last time they were about to do one of these PIAs, and uh he's like, Well, it's time to get naked.
SPEAKER_02And I was like, Vulnerable.
SPEAKER_06Yeah, it's like time to for all of us to get in the room. All right, we're gonna get it's like that MM we talked about. Exactly. We're gonna get naked in front of each other, and we got to be open and honest with each other because that's how we get better. And I will say there was a captain in there that had made this mistake, right? And almost as soon as this training started, he immediately spoke up and was like, I I screwed up. I'm gonna say it right now. I screwed up, and this is what I did. And from my perspective, I gave that captain a tremendous amount of respect because I'm like, guess what, bro? And anybody in here who's sitting like, Yeah, you made a mistake, real okay. Guess what? I'm gonna put you under a microscope in everything that you do and see if you don't make a mistake, right? I gave that captain a tremendous amount of respect because in front of his crew, in front of the whole shift, he was willing to say, I screwed up. This is how it happened. This was where my mind was at. I got confirmation bias on something. I thought this wasn't what it actually was, and it led me astray, right? I respect the heck out of somebody that can do that because guess what? He's going to grow, become a better officer. His firefighters are going to understand, oh wow, Cap's not perfect. No, he's a human too. He can make mistakes, and he's gonna be willing that when you make a mistake, that's how we all learn.
SPEAKER_02I want my paramedics to feel comfortable coming to me to say, you know what, Doc, I'm a little uncomfortable with intubation. Just use that example again. That's the one thing that I would have loved if if we could have done this preemptively to not put our patient at risk. Yeah. Where we have a culture where and I honestly believe he didn't realize he had this deficit, this blind spot, but but to know we all have blind spots, and to know what our weaknesses are, and to come to our FTO or our EMS captain or our our medical director to say, Hey, I need some help with with airway management. Can we can we go through some scenarios and talk about some stuff? Because I the other day I felt this way on a case. Yep. Right? That kind of a culture where you feel comfortable ask for help. Yes. We have we don't like to do that typically.
SPEAKER_06No, no, especially firefighters. I don't need help. We I am the help. I am the help. I am 911. Right. You know, yeah, and if you're an FTO, um, you know, if you're in a position of any kind of leadership, EMS leadership, whatever, and somebody comes to you like that, yeah, you need to applaud that big time. Uh you need to encourage that. And if you don't know the answer to the question that you're asking, that's okay to be vulnerable too and say, you know what, that's a great question. I don't even know the answer to that, but let's go find the answer together and we'll both learn something, right? That's the kind of environment that we want to create.
SPEAKER_02You reminded me of a great story. It took place at Chico State University. I'm in the huddle, their defense was all wonky out there. Uh, I couldn't figure it out. Uh and I'm trying to figure out who I block, right? I talked to my tackle in the huddle as we're walking to the line. I said, Can you help me figure out who to block? And so he would whisper in my ear hole, he'd say 45. Oh, nice. And I knew who to block. I knew you're like, oh, thank you. But I asked for help. Sure. And if I was too proud to ask for help, yeah, right. And if I was afraid of what he would do, like make fun of me, he didn't. He told me who to block.
SPEAKER_06Yeah.
SPEAKER_02And he in my earhole.
SPEAKER_06Didn't make you look stupid, didn't call you out.
SPEAKER_02It was that game at Chico State, I'll never forget it. He probably doesn't even know how much of an impact he made on me. But he would, in my ear hole, tell me what number to block. And I just I knew I'd have to drive him out to the sideline or whatever I needed to do, but he told me the number. And but it was because in the huddle I was so confused and I was struggling. And um anyway, it was a cool story of asking for help. Yeah. And he told me what to do. Uh it was huge for me. But same thing on in the in the firehouse. Yep. When you know you're struggling, you need help, you can talk to that tackle.
SPEAKER_04Yeah.
SPEAKER_02And they'll give you the number. Let's practice this a few times. Yep. And now I started to recognize the defensive patterns. And like I I yeah, I knew it was 45. Yeah, I can tell. But thank you for telling me. Thanks, bro. I'm starting to get it.
SPEAKER_06Slap on the butt. Good job. Yeah. That's good. Yeah, that's exactly what we need to be doing.
SPEAKER_02That's knowledge.
SPEAKER_06Yeah, so that's knowledge. And then systems, right? Good policies and procedures, protocols, things like that, all your rules and regs, whatever you want to call them. You know, you know, in my department, my chief always says, he goes, we don't have these real specific policies, right? He goes, basically, the policies are kind of like the bumper guards. Yeah.
SPEAKER_04Right?
SPEAKER_06I want to give you a lot of free reign, kind of like our protocols. Yeah. You have a lot of free reign to make decisions as a paramedic. You've got multiple medication choices, you know, different things. I'm not going to tell you in this situation, you have to do that because you can't write a protocol for every single situation. Can't write a policy. We want thinking paramedics. We want thinking EMTs, nurses. We want you to think and use your brain, right? So have but have good policies and procedures in place that give them that free range to make decisions.
SPEAKER_02Absolutely. And we have to know the protocols.
SPEAKER_06Yeah, so that's the admin side, right? And then the the operation side is then, yeah, you've got to know those policies and procedures.
SPEAKER_02You've got to study them. You've got to work. You've got to study. If I turned to my tackle and asked him who to block, and clearly I didn't know the playbook, he'd have been get this idiot out of here. He's hurting the team.
SPEAKER_06Isn't it amazing, too, that in football, if you didn't know the playbook, you would be thrown off the field in a heartbeat. Why do we not do that in the fire service, too? Because there are guys out there, you know that that guy doesn't know that protocol. They don't know that. We don't hold each other to that same standard. And we should. And again, that's what we talked about. Accountability. We're not every there accountability goes across the board.
SPEAKER_05Right?
SPEAKER_06Operations, you have an accountability to know your protocols. Admin has a responsibility to, you know, do their thing, right? Everybody's got their roles.
SPEAKER_02We talked about this the other day. You had a brilliant approach to this when you're doing the the promotional exams. Because you could be a captain who's not on the ambulance, but you could be in a situation where you're first on and you're gonna have to manage that cardiac arrest patient for a few minutes. That's right. And and knowing them, that's an important thing. You could be exposed.
SPEAKER_06Yeah, why do we always with when these promotional exams, it's all based on fire in a fire department that runs EMS. Like just because you're promoting to driver to a captain doesn't mean you can't do EMS stuff. I don't expect my captains and drivers to know like the level of things that like my FTOs know. I get that. You're focused on fire ground tactics or you know, extrication rescue type stuff too, but you still have to have a general idea of the basics of things.
SPEAKER_02Because if you could be exposed in a certain situation, uh certain medical issue, you could you gotta know some of the basics. Yes. You may have to hold that baton for a few minutes. Yes, absolutely. Before the med you know it gets there or whatever it might be. Yeah, yeah, yeah. That's huge.
SPEAKER_06We gotta have uh we gotta have accountability. Um and then safeguards. Some safeguards are in place to reinforce systems, right? We give, you know, uh our uh new equipment, right? Like hand heavy is one thing that I can think. My guys love it because they're like, this has m taken a lot of the stress out of doing a medication calculation because now I can just open up the app and there it is. And so that's putting a system in place to help my people not make mistakes, right? And so putting those safeguards in place, giving them the again, going back to training, giving them uh, you know, good training on a pediatric call so that when they get that call, they know what to do, right? They've been trained on it.
SPEAKER_02And I think uh to that point, when you have a medication shortage, for example, so you're using something that you don't normally use in a different way, yes. Um having that system in place, training on it, you know, directives, whatever you have to do, really that that that's that behooves the system, the administrative system to be able to build a new system to prevent errors. Yes. That's um and we have to pivot like that because you'll have med shortages, you're gonna have malfunctions, you're gonna have to have a system of yes, equipment's gonna break, right?
SPEAKER_06You gotta know what to do. So human performance, uh there's three different types of human performance. Uh basically you have skills-based, right? This is your senior paramedic, your your you know, your 15-year crusty old nurse that knows everything and knows how to do everything in the ER, right? And their job function, they don't really have to think a lot about it, right? It's automatic because they've done it for so long. Over time, their skills of system one thinking. It's in the cerebellum. It's in the cerebellum, exactly. They're not, they're not really focused on I mean, they're focused on what they're doing, but a lot of it's just coming from past experience and it's just coming to them automatically. They see something, they don't have to think about it, oh, that's this, I need to do that.
SPEAKER_02You know, it's automatic. Pattern recognition.
SPEAKER_06Yep, skills-based performance. Then you have rules-based, right? Rules-based performance. Uh, this is recognition prime decision making. So basically you see something happen and it's causing a mental stimulation. So, one of the examples that I had was, you know, you're pumping a fire, right? And all of a sudden you run out of water while you've got active firefighting going on. Well, you should have, and this is where checklists, this is exactly, and I I tell my guys all the time, it is not a sign of weakness to have a checklist. Every pilot that has tens of thousands of hours of flight time, if something goes wrong, they have a checklist to go through to make sure in the stress and the heat of the moment, they don't miss that one thing that could fix the whole problem.
SPEAKER_02It's like the dope mnemonic, right? Yeah. You go through your dope mnemonic, troubleshoot the problem you're having. It could be an equipment failure.
SPEAKER_06Oh my god, I didn't even think about the equipment. Yeah. Yeah. Or they lost breast sounds. Oh, we got a bag harder. No, they popped a lung and you got a dart them, you know, or whatever the case may be. Right. But it's having like having checklists is so important. We have CPR checklists for medical and trauma CPR. Because in the heat of the moment, pull that thing out, flip through it. It's not a sign of weakness, it's a sign of strength to say, I want to make sure I'm doing everything correctly. Um, so that's rules-based, and then you have knowledge based. Yeah, this is your new guy, right? He for you know had this knowledge, this confirmation bias in his head that this is how it was supposed to be or whatever the situation was. And they don't have a lot of experience. So they're basing it all on what did I learn in paramedic school, right?
SPEAKER_03Yep.
SPEAKER_06Well, that's why everybody says, like, go to paramedic school, pass national registry, then we'll teach you how to be a paramedic.
SPEAKER_02Yeah.
SPEAKER_06Because the book and the real world, it's a combination of the two.
SPEAKER_02He was stuck in the seizure protocol.
SPEAKER_06Yeah.
SPEAKER_02And he and and and we weren't thinking airway. And there were a lot of signs that came up, but he because he had air anchored on that diagnosis that actually this technically be confirmation bias, I guess, not anchoring. Confirmation bias. So the diagnosis he came up with internally, even though other signs came up that should have pointed him in the air. Pointed him in a different direction, he was so focused on his diagnosis of seizures and in that seizure protocol that he'd studied so hard, he he did this. Yeah. And I think and now I think he'd make a different decision because we had a great learning experience.
SPEAKER_06Well, and guess what? Sometimes you can have a seizure patient that's having an airway emergency.
SPEAKER_02Right.
SPEAKER_06You can be in two different protocols at the same time for sure. But again, that's so he was using his knowledge base, right? It's okay. And he's got to combine that with the skills based. And that's when you start to become that's why an experienced uh paramedic, EMT, nurse, uh physician, that's why those is exp because they've got that experience combined with the knowledge to make good clinical decisions.
SPEAKER_02Oh, I've seen this before. Yeah, you know? And you can see now, based upon what you've just described, those three different uh performance uh perspectives and how human behavior can create the mistake.
SPEAKER_06Exactly. Yes.
SPEAKER_02And that's that's a problem. That's why we're human.
SPEAKER_06Yes.
SPEAKER_02And it's complicated. This is not an easy task.
SPEAKER_06No, no, and again, again, especially when you're working in high stress environments, you're making split second decisions, it's very easy to make mistakes. So, how do people make mistakes? This is David Marxist's just culture model. And he basically has three different types of mistakes. There's human error, there's at risk behavior, and then there's reckless behavior, right? And when you look at you know the healthcare system, this is the way from a leadership perspective. Perspective, we need to look when something happens. This is how we need to look at okay, was this a human error? And so his little example is you're driving and you blow through a stop sign. He didn't intend to blow through the stop sign, right? Maybe the stop sign was hidden by some trees, and this is a road you've never been down before. And you were enjoying the scenery and just happened to blow, you weren't being reckless.
SPEAKER_02Or at sunset, you get the sun in your eye.
SPEAKER_06Yeah, you're talking to your wife, you know, or listening to a good song. You just you weren't being reckless, right? You made a mistake. It was an honest mistake. Nobody got hurt, no big deal. Okay, pay attention. When you're driving, it's very important to pay attention when you're coming up to an intersection.
SPEAKER_02Or you get a new truck, lots of horsepower, supercharged. Who are you talking about? And you take at some at-risk behavior. You've got to go a little faster than you should. But that's at-risk behavior. Exactly. Things can happen if you take risks, right?
SPEAKER_06Yeah, you're knowingly taking that risk. Yeah, you're driving over the speed limit. That's at risk behavior, right? Less risky, but it's not just an honest mistake, like, oh, I just you know you're kind of speeding a little bit here, having a little bit of fun. Yeah.
SPEAKER_02Well, I think that to bring it back to EMS, it would be similar to where I know I'm tired, I haven't slept, and this is a call. I I'm I'm not a hundred percent, my hand's a little shaky, or I'm not feeling well, or whatever. Recognize those signs of a potential risk you're putting your patient into and say, hey, you know, Matt, uh, can you take the lead on the next call? I'm gonna drive this one. I know we're supposed to switch roles here, it's our agreement, but I'm not at a hundred percent right now. Can you take this call? Or we're right, you know, it's a yeah, we don't have to take that risky behavior or that put that risk on our patients when we know maybe we're not at our best.
SPEAKER_06Or another example I think of is going through your five R's.
SPEAKER_02Yeah, the five rights. Right.
SPEAKER_06I know I'm gonna I'm gonna give this man I I know the dose. I'm not gonna double check the dose. Might be a good idea to double check the dose.
SPEAKER_02Do that every time.
SPEAKER_06Right? Hey, partner, I'm gonna give 30 milligrams of ketamine. Oh, hang on, 30 milligrams, that sounds or whatever the case may be, right? That's being a little bit reckless. I got this, you know. So that's kind of uh or at risk behavior, right? Then you have reckless behavior, which is just that's where it's an attitude integrity thing, right? Now his example is you are at the bar with your buddy and drank a whole bunch of alcohol, and now you're knowingly gonna get behind the wheel.
SPEAKER_02See, now we're getting into those ethical things and integrity things, and that's where the behavior becomes reckless, and that's where you get into trouble. Yes.
SPEAKER_06These are the you know And these are rare too.
SPEAKER_02Yeah. When we're talking about at-risk behavior, we're talking about those contextual things that you learn about when you get information from the team. Right. Wow, that was going on. Well, what would we do next time if we're in this situation again? Yes. Would we do the same thing? Yeah. No? Okay, well, let's learn from this. Yeah. Right. Where sometimes if you're drinking or you're whatever, intoxicated, I mean, God forbid, it happens, that's totally different.
SPEAKER_06Yeah. Yeah, that's again, that's a reckless type of behavior, not just an at-risk behavior. You're putting your career at risk, you're putting patient lives at risk, not a smart move. And then again, that's kind of probably when you're getting into more of a punitive disciplinary type of situation.
SPEAKER_02And there are people listening potentially that are hiding some of these types of behaviors. Yep. You need to change, you need you need help or get out of it. Get help. Yeah.
SPEAKER_06Yes. Please get help before you kill somebody. So different behavior types, and you can look up this David Marxist just culture model. This is not nothing original that I created. This is all he created. Real quick, like human error. Again, first offense, right? You educate. Maybe if there's a systematic problem, you fix that policy or you fix that piece of equipment that caused the problem, right?
SPEAKER_02Oh, I didn't realize that med had the same color as this med. Let's start, let's start tagging our syringes. Exactly. You know, as part of our five right process, right? Let's yeah, anyway. No, that's good.
SPEAKER_06Change it up. Yep. Repeat offenses. You know, basically you just kind of progress from there, right? And then at-risk behavior, you know, you're gonna coach them. Hey, Eric, I know you got a super nice truck, but it's, you know, you got to keep it under 100, my guy. You know, like you can't be driving 100 miles an hour everywhere you go. You know, like be smart. I know you, I know you've got a fast truck, but like Matt, riding a motorcycle, that is at-risk behavior. Don't be splitting cars at 100 miles an hour because that's death behavior.
SPEAKER_02But you are anticipating things more than anybody on the road, too.
SPEAKER_06Well, yeah, we're that guy that came out when we were driving down the road today, and I'm like, watch that guy, because that's the way I'm looking. Yeah, I'm looking thinking, I greatest piece of advice I ever had riding a motorcycle was somebody said to me, They're like, You ride a motorcycle, like everybody on the road is out to kill you.
SPEAKER_05Yep.
SPEAKER_06And if you have that mindset, you never second or predict what somebody's gonna do, you predict the worst that they could do and be ready for that thing, you're relatively safe. I say relatively. But that's at-risk behavior. I know I'm conducting an at-risk behavior and I do it as safely as possible because I enjoy it, right? Yeah, just like maybe somebody's got a souped-up trunk and likes to drive fast.
SPEAKER_02But in the EMS world, to that to that point, when we're in a situation where we know we're putting a patient at risk, we have to we mitigate that. Yes. Because we recognize it and we have a culture where we feel comfortable to say I need help or whatever.
SPEAKER_06Yeah, we shouldn't be performing at-risk behavior when someone else is like when my wife's on the back of my motorcycle. I drive differently when she's on the back than I. I'm not saying I'm crazy when I drive, but I definitely am way more cautious and way more um cognizant of the fact that she's back there. I'm not gonna drive as fast as I would maybe if I was by myself. I'm not gonna take this corner just you know as fast. So people, other people are involved uh when you're doing patient care. So and then you have again reckless behavior. Yeah, that happens, you've got to correct that immediately. If you know somebody is recklessly out there, no. And I'm not saying that they have to be terminated, right? But you've got to set a clear message, whether you're the station captain, the on-ship battalion, the EMS captain, whatever it is, you've got to set a clear message. This is not gonna be accepted.
SPEAKER_02And if you have that trust or just culture and you recognize something in someone else, it's a safe environment to talk to them or to get them helping. What do you got to do on to get help? Right.
SPEAKER_06Is there something going on at home because you're not acting right?
SPEAKER_04Yeah.
SPEAKER_06And I can't have you out there treating patients acting this way. You're ticked off, you're yelling at people. What's going on?
SPEAKER_02That's good. That's really important.
SPEAKER_06So those are kind of the different uh, you know, human errors that people make. That's kind of the ways that they make them.
SPEAKER_02And how we respond to those things we've talked about already, right? Yes. So that's that's I think that's a leadership thing.
SPEAKER_06Yeah, I always, like I said at the beginning, I always, you know, what happened, right? The three questions I asked, what happened, how did this happen, and how can I keep this from happening again? And that's all-encompassing, right? Yeah, what happened? Okay, go to the source, go to the people that were actually on the call, and then get the different perspectives. Okay, Cap, you were on this call. What tell me what did you see? Well, I saw this. Okay, well, that's interesting because your driver, who is on this side, this was his perception of what happened. So get the full story of what actually happened, not hear, say, from all the you know, gossipers out there. Yes, the fire department is full of gossipers. Sorry, I hate to burst your bubble, but they are. Yeah, and so get it from the source and then ask, okay, how did this happen?
SPEAKER_05Right?
SPEAKER_06And then ask them, how do you think this happened? Okay, you made this medication error. Okay, were you did you go through your five rights? Did you open up Hand TV? Did you use the tools that we put? Oh man, I completely forgot about Hand TV. Okay, that's fair. It's a new app, we just got it. Remember to use that. We bought this app for you to use so that this wouldn't happen. Captain, while they're doing paramedic stuff, driver, while they're doing paramedic stuff, you could be sitting back there, hey, let's go through our checklist, let's open up Hand TV so we don't make these mistakes.
SPEAKER_02And then you have to have the personal responsibility to learn or do whatever you need to do, but you also have to have the personal responsibility to let it go. Just back to football again. You throw an interception and one set of downs. We need you to lead again that next set of downs and we get the ball back, and we're gonna we're gonna work harder to not make mistakes, and we're gonna do a better job and we're gonna get that touchdown or whatever it is.
SPEAKER_06I think that was one of Tom Brady's greatest.
SPEAKER_02It is for the forget, but at the same time, we've got to learn from it, right? So don't do that again. Yeah, right. So there's a balance there. Learning from our mistakes, using the systems we have in place to support us. But at the same time, when we make a mistake, sometimes we're way too hard on ourselves. We've got to let those things go so it doesn't affect us on the next set of downs.
SPEAKER_06Yeah, I respect the fact that you're hard on yourself because that means that you care. Yeah. You care about being a good football player, you care about being a good paramedic or a nurse, you care about what you're doing, and that's a great thing, right? But don't let that now inhibit your ability to be great.
SPEAKER_02When I see those players uh you know on the sidelines uh throw their helmets.
SPEAKER_06Oh, yeah, just get I hate that.
SPEAKER_02Yeah, it's like um um as long as they can do that and then get ready for the next dead-a-downs, but sometimes we get in such a frame of mind that it really uh affects us the next time we have that patient, like we talked about. They're so afraid to make a mistake now that with themselves or whatever. You gotta be able to let it go and learn from it and let it go.
SPEAKER_06Absolutely. It's okay that you made a mistake, we'll learn from it, move on from it, learn, you know, be better the next time.
SPEAKER_02And I'm I'm terrible at that.
SPEAKER_06Well, I think any I think any high achieving person is probably bad at that because we do hold ourselves to a high standard. I think most people in the medical field hold themselves to a high standard. And again, that is an uh that is a an honorable trait, but it can be just like anything, it can be overdone and turn into a negative.
SPEAKER_02And it's really not good for your health to hold on to these things. The brain doesn't forget them. But we have to have a system where we can let it go and not let it affect us the next time. That's right.
SPEAKER_06And that's again, how do we keep this from happening again, right? And from an admin perspective, we need to look again. Was this a systemic error? Did I not train my people properly? Maybe this is on me. And I need to go back and train everybody else on how to do this again so this doesn't happen again. So um, so yeah. Uh root cause, right? We always talk about getting to the root cause of the incident. We talked about that. How did this happen? Um, and then why does this matter, right? Again, people's lives are at stake, citizens' lives are at stake, firefighters' lives can be at stake.
SPEAKER_02We're not in the factory making widgets. Not that that's a mean meaningless job. I mean I thought a widget was a thing on my phone. Oh, yeah, I don't know. A watchamahoose. Well, I talk about this with my guys. It's like we not I don't mean to diminish another field, because all these fields and jobs that we could have in this world are important. But one of my friend's daughters is an accountant. We were actually just talking about this the other day. Um her her job is important for for accounting, but um when we're in the pre-hospital environment, yeah, nobody's gonna die if you screw up. We have lives at stake. We really we don't have a lot of bandwidth, unfortunately. Just like a pilot, right? If a pilot makes a mistake, they've got lives that they they are held to a new standard. And that's why it's so important for us to have this just culture so we can have that accountability and trust so we can do better.
SPEAKER_04Yep.
SPEAKER_02The the punitive culture, the the what's the other one, the the laissez-faire one? What do you what do we call that? Oh, the blame free clear. Blame free clear.
SPEAKER_06Just no accountability.
SPEAKER_02Yeah. Bad for patients. Both of them are bad for patients. Yes.
SPEAKER_06Gonna have both of those are gonna have bad outcomes, right? And so that's why this just culture model is is a balanced approach, right? We don't want punitive all the time. Sometimes that has to happen. So there's lots of different ways you can implement this into your into your department, into your your EMS system. Um, you got to have buy-in, right? The the leadership needs to understand what the mindset is. That we're not out to get people in trouble. We shouldn't, if if that is the mindset of your leadership, then if you're the leader, you need to change that. Because that is not going to make you the chief look good, the director, whatever the thing that's not gonna make you look good if you have a fear-based, and then if you're in operations, you need to understand that you do need to hold the standard. Yeah, you need to be held accountable, and if you make a mistake, again, I'll go back to it. If you just own the mistake, you're not gonna probably get in any trouble. They're gonna re-educate you, like we've talked about, when you're gonna get in trouble, when it's gonna be punitive, is when you're doing reckless behavior and you're not owning it. Nope, I didn't do that.
SPEAKER_02Yep, you gotta be willing, gotta be willing. Yes. Uh very quick story because I know we're coming close to the end of our time. But on um at halftime, we would oftentimes be told that, hey Eric, we gotta change our approach. We've seen this team do things we didn't expect, and pull the whiteboard out, and then this is now our new blocking scheme. Yeah, and I think the same thing happens in the fire station where as leaders we look at our QI, QA, we get the data. We didn't know as a department we were missing something. Yeah, we have been making a mistake, but we didn't know it. Yeah, and so we have to have that culture that's willing to re-evaluate and change what we do based on literature, whether it's a C collar or sepsis or whatever. So we are making mistakes right now in the department. We weren't aware of it, but because of the data, and I love what you said here, better data, we can better target our education. That is key, and but you have to have a culture though that's willing to accept these things and move forward and be willing to change what we do. Yeah, not because we made a mistake necessarily, but because we have a better way now.
SPEAKER_06Yeah, yeah. We want to do the best. I mean, I hope that anybody that's in the healthcare field wants to do its best for their patients. And so if we have a mindset, well, what are we doing this for? Well, hang on, let me explain why we're doing this, right? This is why there's better data out there. Um, so again, building using this just culture model, it is encouraging people to report their mistakes, it builds trust between operations and administration, uh, medical directorship. They realize that, okay, I can be honest and open and I'm not gonna get in trouble here, right? Actually, people are gonna all in the room, if we're all honest, we've all made mistakes, nobody in here is perfect, right? So, what's the old glass houses story, right? Yeah, so don't be throwing stones because soon enough you're gonna screw up and now you're gonna be in the hot seat. So, how do you want to be treated when you're in that hot seat, right? Treat that person that way.
SPEAKER_02You want to be trusted.
SPEAKER_06You want to be trusted, you know. We're gonna hold a standard, we're gonna have accountability, but we wanna be we want to build trust. We want to report when something's wrong. And from an admin perspective, we don't want to be punishing that. Hey man, I really appreciate you coming to me with this.
SPEAKER_04Yep.
SPEAKER_06That's good on you. That speaks a lot to me about your integrity. Like, let's look at what happened here, make sure you understand where this mistake came from so it doesn't happen again. Cool, we're good, all right, move on down the road. Don't beat yourself up on it, you're good to go. Let's let's move. So I think this is something I loved it when I learned it in nursing school, and I thought, man, this is something that you know the EMS world, the fire service really needs to start adopting because we do kind of have sometimes this, you know, get everybody in trouble mindset, and everybody's gonna get in trouble mindset, and we need to get away from that to do our jobs better.
SPEAKER_02I love it that you initiated this because um I I wouldn't have thought of it.
SPEAKER_04Yeah.
SPEAKER_02And but I love it, this relationship you and I have as educators, like, you know what? I'm the doctor, and sometimes you have better ideas. Well, and and it's a willing to listen. Yeah, and also you're willing to say, hey, you know what, Dr. Xian, instead of doing this, I think we should do this today.
SPEAKER_06Excellent conversation was listening. We're not talking about that today.
SPEAKER_02I'm grateful for you.
SPEAKER_06Well, it's a good convers conversation for sure.
SPEAKER_02This is a great, uh, great podcast.
SPEAKER_06And thanks for being open for your employee. Willing to admit I'm an idiot sometimes. All right, Erica.
SPEAKER_02Good good talk. See you on the next one. Be safe out there.
SPEAKER_00Thank you for listening to EMS.