Roundtable: Safety in EMS with Rick Binder and James Ho 

By Robbie MacCue

Special thanks to our roundtable guests, Rick Binder and James Ho! Watch our replay and comment below.

We've added timestamps and chapters on this recording.

02:28 - Rick Binder intro & his background
04:00 - James Ho intro & his background
08:52 - Why this topic?
11:50 - 3 Components of Preventing Patient Handling Injury
14:45 - 3 Categories of Patients & 5 equipment categories
21:20 - Ambulance Victoria's Equipment & History
25:45 - Selecting Equipment & Worksafe's Hazard Control
27:21 - New Leadership in 2015 Creates a Vision of Safety
33:05 - James' Intangible Benefit Story
37:35 - "The Silver Bullet"
42:25 - 3 Aspects of Effective Training Programs
46:29 - The Future / AV's Continuous Training Program
50:58 - Demo Clips of Moving Techniques
54:35 - Thoughts on Fitness vs. Proper Handling Techniques
57:19 - Organizational Perspective on Results


Our live stream as well on Facebook to the high-performance EMS page, as well as I believe on LinkedIn live. So Lisa welcome. Oh, it's so great to be here. I've been, I've been looking forward to this conversation, you know, we like to offer a lot of different opportunities and we have some amazing people here to talk about safety in particular,

you know, handling patients. Right. And you know, when we first started talking about this and we were talking about patient safety, and then of course there's a very important aspect is provider safety. And then there's an organizational aspect to this as well, because you know, the truth of the matter is, is that, you know, retention and staffing is a issue right now.

And when folks go out and they get hurt on a, on a call, then you know, that, that adds a lot of strain to the rest of the team. And then you're talking about, you know, patient safety, there's liability issues to the organization. So I think this is one of the most important topics we can be talking about right now.

Absolutely. And folks in the, that are joining us in the chat, feel free to just type if the audio sounds okay, thumbs up, but where you're joining us from. And, and of course, we've got Rick bender here, Rick, welcome. I you're joining us from your vacations. So we appreciate that. Oh, it's my pleasure.

You know, when you, when you reached out to me about a month ago or so I guess I looked at my calendar and I was so excited when I saw that I was on vacation and this is one of the few things that, that even while on vacation, I would still rather choose to sit here and, and join you guys about this topic than anything else.

So I, I couldn't be more excited. All right. And we have our other guests here is James ho James, welcome from, from the state of Victoria in Australia, ambulance Victoria. Although thank you very much for having me really excited to sit here today and talk about something I'm particularly passionate about. And my team is Great. Great. Well,

let's go around the table, Rick, if you want to just give a brief introduction for folks that don't know you and then James after that, For sure. So again, I mean, it's great Fisher, some history on why I guess so important to me and why I'm even sitting here joining you guys right now is, is really goes back about 10 years ago when my father invented the,

the vendor lift, which if you're unfamiliar is, is a, is a product to help providers safely lift patients of any size with ease. And again, that was about 10 years ago and I was an EMT intermediate at the time. And my father had first told me about this. I thought he was a little bit crazy and you know, I,

my stance hasn't really changed still think he's, he's a little bit crazy, but in the best way possible. And at that time with, as, as an EMT intermediate, I, I joined him and bringing this, this product to market. And that's really not what I'm here to talk about today. So, and so I hope if any of you joining here and saw my name and,

and association with the company, if you're looking forward to that, we'll have to have a side conversation. Cause we just don't even have time today because this topic of, of injury prevention around patient lifting and moving is it's just so much bigger than any singular product. It's really just been through the last 10 years of working with, you know, organizations and having these conversations that I have just learned an infinite amount and become very passionate about this topic,

which is really, you know, what led me to, to, to meeting James not too long ago. I don't know James, I think six months or so. So, so from there, I'll actually kind of bridge into to James. If you can introduce yourself, I think that'd be great. Thanks Rick. So I'm James and I'm a paramedic from Melbourne Victoria,

which is a site within Australia and I'm lucky enough to be in a position that is called a manual handling coordinator. I'm one of four paramedics in this team, but we collectively work within health and safety and the manual handling project. And our goal is to reduce injuries in our workplace. And as paramedics, we can offer a particular insight into the work tasks that are the paramedic work,

and then combine that with the safety specialists within our team and align with our organizational goals. And I'm really lucky. I've been part of this team for two years and making up for two of my nine years as a paramedic. So that's a little bit about me. Great. Well welcome. Welcome to you both. Thank you. Thank you. And for those of you who don't know Robbie and I,

we are the co-founders of the EMS leadership academy. We offer many programs, both in-person and online to help EMS organizations thrive and to provide leadership training. And we've been doing that together for about 10 years. My background is in organizational consulting and leadership development, primarily peak performance development. So Robby I'll leave it to you to share about yourself a little bit,

A little bit about me. My background is in emergency medical services in this industry for about 20 years and 14 of those years were as the, as the executive director of a nonprofit ambulance service. So a very small organization, but since then have worked as a flight paramedic. And, you know, I've been fortunate to fly around the world, helping patients make it home safely,

as well as in my hometown here is a municipal paramedic for, for a local government agency. So we've had the pleasure of hosting the EMS leadership summit. So we've had, geez, almost probably over 90 different speakers from around the globe. We've had close to 12,000 people tune into that conference. We do every year and you know, 40 we've had 44 different countries represented people attending from around the world.

So it's really a global conversation. It's it's these issues affect us no matter where we are in the world, when somebody calls 9 1 1, you know, there's a large percentage of the time or lifting and moving patients. And in generally it's not in the, you know, the wide open spaces, these are larger patients in the more confined spaces. And as Lisa said,

at the beginning of this, this is an organizational issue. A lot of people are worried about recruitment and retention and you know, how do you have a paramedic work in this industry and not get injured? So one of our most important assets is our people. And, and maybe I'll turn this over to Rick to share a little bit about statistics, at least from the U S when it comes to,

you know, NIOSH, the, the CDC, what are, what are the leading causes of injuries that our industry faces? Yeah, Well, yeah. You know, Robbie, I could probably take up this whole hour, just talking about that, that one question, but, you know, I'll, I'll, I'll, I'll, I'll, I'll try,

I'll try not to here and, and, and keep it fairly brief. You know, according to, according to the CDC, this is very accessible data that anybody can, can Google and find very, you know, easily, but it, that lifting patients causes more injuries, EMS providers than anything else. And this isn't just, just from the last year or two,

this isn't, this isn't cherry picking data, which I, which I think we all have probably been guilty of without maybe even without knowing at different times, this has been true every single year since the CDC started publishing this, this injury data on their website, which was, which was 2008. So this is really a pretty, you know, a pretty big issue.

And that, you know, I really could go, go further into supporting, supporting evidence from, from NIOSH and from other public and, and private organizations. But honestly, I know that I don't need to go into all those other supporting evidence because unfortunately this has been common knowledge long enough that I, that I believe we've, we've become desensitized to,

to the implications of these entries. You know, I, you know, I, I didn't, I, I promise everyone else. This isn't even something that I, that I, you know, talked about beforehand with Robbie and Lisa. But if we, if we go and we look at just employee retention, you know, just when, when we start to look at that,

I don't know the exact data on this, off the, off the top of my head, but I believe the majority of services in the U S are, are, are understaffed. And this makes the today's topic and this round table even more important than before, because in today's economy, it takes less time and money to keep the employees that you have than to find a new than to find you.

Right. And so, if we are to do a rapid assessment on where we're losing employees, it's injuries most commonly from, from lifting patients and that's where we're hemorrhaging. So if we do that record assessment, we know where we need to, to, to look at and to control the bleeding first. So when we look at retaining employees, by keeping them happy and healthy is only one of the many benefits that an organization will see when they're focusing on preventing these injuries,

there's all sorts of, of direct and indirect costs that, you know, I won't even take the time to get into, because again, I think, I think our listeners are probably aware a lot of, you know, of, of, of injury rising insurance premiums are the direct costs of, of, of an, of a claim and, and,

and all the rest of that. So I won't even take time to go, go, go into, into the problem anymore, because I want to save the majority of our, of our time here to talk about the S the solution. But before I do, I'm, I'm, I'm curious, that's, you know, I, I'm talking about the problem from the,

from our American or us lens, you know, James, is that, is that something that you guys have seen, you know, as, as a whole, for Australia, as well, as, you know, you're, you're with a large enough organization, you can have data, you know, pretty accurate data and a good data pool just from your one organization.

Is that something similar that you guys are experiencing, you know, over, across the oceans? Absolutely. From the research that I've done manual handling directly causes back injuries. It doesn't matter what industry you work in. That data is very, very clear and being a paramedic in Australia, it is still a risk. And moving patients is our job. When you really think about what being a paramedic is,

you take a patient and you'd take them to hospital, and doesn't matter how you, how you did that. You've moved them in some way or form. So manual handling is a direct part of our job. And as a result of that, we see injuries across our country. I I've often said it, you know, we're, we're, we're,

we're people movers at the core of it. Like we do a whole hell of a lot more on the side when we are moving these people, but at the cooker of our job function with EMS industry, as it is, is, is people so that, you know, that really, so that, that really, you know, to bring us into more of,

of the, of the solution, I think it's, this is it's such, it's not a, it's not a linear topic. You know, I was, I was naive enough, you know, a decade ago to believe that it was, it was more linear of a problem or a solution would be more linear than it actually is, but it's,

it's, it's, it's much more nuanced than that, but to, to, to break big ideas down, I, you know, I like, I like the number three, so that's what I always try to try to stick with. It's, it's, it's the most I can usually handle for, for information, and even that's a push in it,

but the, the really the, the three, the three parts to injury prevention that I I've seen, you know, I I've, I've worked with thousands of departments all around this topic of preventing, you know, injuries from lifting and moving patients. And, and through these conversations, I've really noticed trends, trends of deficiencies. Unfortunately, within the,

like, I would say majority of apartments that I have, I, that I've worked with and, and the deficiencies that I've seen are the, the three deficiencies and the, and the three areas that need more focus in my opinion, our equipment or, or another word for equipment is, is engineering controls and policies, or another, another word for that to is administrative controls and training.

Those are the three areas that really need to be focused on. And if you just focused on, on, on one of these areas, then you're not gonna really see near the benefit that, that, you know, you, you will, by, by focusing on one, all, all three of these topics, you know, I, again,

you know, the, the, the last a decade of experience has taught me that the engineering controls without supporting administrative controls will truly only be half effective best, but administrative controls without engineering controls will result in employees feeling like the administration is way out of touch with reality of what's going on in the field. You know, you can write whatever policy you want,

and it can be with the best intention, and it can truly be the best way to do things, but if you're not giving them any equipment that's needed to be able to, to follow through with what you're telling them to do, it's, it's only going to lead to frustration. So, so what I want to do here is take a deeper dive in,

into the three of these topics. And so the first topic we'll, we'll take a deeper dive into is, is equipment. And again, with every single, with every single kind of topic that we go into, I could probably spend a full hour just diving into just, just, just the one, one piece. But I think the purpose of this round table,

you know, can, can be a little bit more of an overview of these topics. And, and I'm always happy to go to dive in deeper for, for anyone or feel like we just scratched the surface. You know, I think speaking for James here, I'm sure you'd be happy to make a, your, your self available outside of this as well,

and to keep, keep the conversation going. But, you know, if, if we're to break down equipment and what equipment is needed for providers to do their job, I think all again, or to do their job safely, I should say I I'll break it down into three categories again, because there's really three categories of the three categories of patients are ambulatory semi ambulatory,

and non-ambulatory right. I mean, that, that truly covers every patient that we're going to be called upon to, to, to provide care for. And so when we look at that, we know that we need equipment specifically designed for each category of patient. And so, so when we look at that, there's really five categories of, of equipment that are,

that are needed and necessary for these three categories of patients and those, and I'll go through those categories and kind of what, what they look at. And, and, and for, for those of you joining us, you know, maybe you can take a mental checklist of, of the back of what's in the back of your ambulance. And see if you guys,

you know, might be missing some equipment in some of these categories, you know, so, so the first one is, is lifting assist devices. So that's, that's category one, and those can really be broken down into two sub categories, which is non mechanical lift devices and mechanical lift devices. Right. And, and when you're looking at those,

if you're looking at deployment and I might be getting a little bit ahead of myself here, but if you're looking at deploying these devices, if your service doesn't have them, it's always my recommendation to start out with non-mechanical and move to mechanical. You know, like I, I, my, I come from a carpenter background and, and carpenters, you'll never find a carpenter who doesn't own a hammer,

right? It's, it's, it doesn't, it doesn't equate. If you're a carpenter, you own a hammer, even though you still own a nail gun and an air compressor and all these other mechanical devices, mechanical devices are great. I think they're, I think they're, they're, they're the future truly. But if you, if you, you need to have a manual device to be able to fall back on,

cause they're typically able to be used in more confined spaces and they're less, less problems can arise like batteries or things like that. But you definitely, you know, organizations should definitely strive towards having both available and the, and that's into lifting, assist devices. Those are, or your, your, your ambulatory or semi ambulatory patients, you know, even a patient who is ambulatory,

you might be tempted to think that you don't need any equipment at all, but patient status is, can change very, very quickly. And so it's as a preventative measure to have an assist device, to help an ambulatory patient just in case their, their ambulatory status changes while you're, while they are walking or while you're moving them, it's really, it's a really good safety protocol or practice to have.

So then the next, the next category of equipment would be carrying devices and carrying devices. You know, this, it's a misconception that a back board is a carrying device. We carry, we carry patients on backwards all the time, but they're actually not a carrying device. They're, they're a splint, right? What we're doing is we're splinting our patient.

We certainly have used them as caring devices, but they weren't designed to be carrying devices. And the reason I say that is because they're not putting the lift or the carrier or the provider in the best ergonomic position when you're reaching your hands all the way down to the floor. And so what would actually be a carrying device on the back of an ambulance would be more like your,

your soft stretcher with handles. So that's like a tarp with handles going around the edges on the outside. And those will typically raise the lift point at least 12 inches off the ground, which has shown to be a much safer way of, of lifting patients. So that would be a great example of a carrying device next would be a transferring devices. So,

you know, we were transferring patients on every shift. I would, I would guess when you're, when you're transferring a patient from your stretcher to the hospital bed or from hospital, you know, vice versa or from the patient's bed to your stretch, or any of those are transfers. And there's a number of aides out there to help with that transfer and to reduce the amount of sheer forces being sustained by the providers and the angle of their trunk flection and,

and the rest of that, the next would be extrication devices. And so that in that category extrication devices, but those could be your, you know, your plastic sleds for a non-ambulatory patient that will kind of package your patient up and you can slide the slide them downstairs, or, or, or through a myriad of different scenarios or your, even your stair chairs.

Would it be a great example of, of extrication devices and the, the stretchers, stretchers and accessories would be your final category of, of equipment? It's, you know, I, I don't know if there's really an EMS service out there, thankfully that doesn't have a stretcher, at least. So you can, again, you know, break this one down into a mechanical and non mechanical.

And my advice here is the same as it is for, for the lift and assist devices is you start out with, with non mechanical, which I, I, I, I'm assuming almost every service has however long ago and moved towards mechanical. If you can afford, if you can afford, or if you're a new service starting out and you can just jump straight to mechanical.

Well, well then great. But even still, I would still recommend having a manual stretcher on backup for times where you need it, and you just never know power outages and you have dead batteries or different things, you know, like I still recommend having, you know, a manual stretcher that would work. If your, if your, if your powered stretcher can work as a manual stretcher,

if, if there is no power. So that really, that covers all of, all of the categories. As long as you have equipment specifically designed for each of the three categories of patients, then you have equipment in each of those categories. You know, then you can start worrying a little bit more about policy and procedures and things like that because an effective policy will not encourage improvised lifting and moving techniques,

or use the equipment in ways that are outside of manufacturer recommendation. You know, that's typically not something an organization wants to put in writing is teaching their providers to use a bed sheet that isn't weight rated to lift and move patients, you know, right. That's a liability. So normally we won't put that sort of thing in writing, but if you're putting something in writing as a policy or procedure,

you know, you're, you're going to recommend the use of equipment as the manufacturer recommends and not use improvised practices and, and things like that. But, you know, James, I, I guess I would love to hear a little bit more from you, you know, I, we haven't, we haven't, you know, done practice runs or things on genuinely curious here about,

you know, do you feel that Amiens Victoria, you know, how's the equipment and all of these categories and have they always had that? And if not, what was that to kind of the implementation process that, that, that you guys went through? Sure. So as a little bit of background, I think our manual handling project really got its roots around 2005 to 2008.

This was a period in time in which a separation of our rural ambulance service and our metropolitan ambulance service combined into one organization. And as a result, we were able to look internally to look and see what our injury statistics were and no surprise. They were high with a number of back injuries. And so it really forced the organization to look at what could change and how we could change it.

And 10 years ago, as you mentioned, you started your profession down this path. There weren't a lot of options. We were very, very limited. And despite having a policy that said, you lift as a last resort, there weren't other resorts. So it led to a lot of paramedics lifting in terms of equipment and how we got to our equipment based today.

We bet we basically purchased over a long period of time. As I said, this is between 13 years ago that we started this journey. And back then they identified that the manga ALK was just one product of many products that were available. But at the time, I'm sure it was costly and not necessarily feasible, which resulted in the manga not being purchased until 2011.

And when it was, it was eventually rolled out to every single ambulance that we have in our service. In the meantime, we purchased smaller pieces of equipment and 2015, we sold the introduction of the strike power pro X T, which is the electric hydraulic stretcher. And that was a change from our previous manual, phono 58. And we'd always dabbled in stair chairs as a deployment model,

but they were limited across the state. In 2019, we introduced a ambulance Victoria driven design, a what we call the multi-purpose chair, which was a Ferno folding, a wheelchair. And we adapted a stay attract to it and Aspen, or to produce that. And now every ambulance has i-STAT yet a manual one, not electric, but we do have electric stage is also in our system.

So over time we've accumulated a vast amount of manual handling equipment. And I do think that we cover a lot of those categories, but where I would disagree is that one of the confinements that we have for our system is that our ambulance is only a, a small Mercedes sprinter. And as a result, we don't have the luxury of carrying every piece of equipment for every single contingency.

So we do have a multiple different ambulance service system or different resources that are available, but every ambulance in the state has a statue. Every ambulance in the state has an electric hydraulic stretcher is equipped with spare batteries, as well as manga routes, as well as slide sheets and pet slides and the combi carrier from Hartwell. And then we have other vehicles.

We have a bariatric ambulance that carries a holler, Jack and Hava mat, a hydraulic lift in the back of the truck. We have a more medium TIAA, bariatric ambulance that we call that multitask ambulance. And then we have our support vehicles, which are currently a metropolitan resource, and they are a single response paramedic. They can get to jobs that require the hottest extrication support.

So very high trained paramedic, who's able to deliver how the Jack's Hava, mats, electric stages, and then the wealth of experience they have combined with the other smaller pieces of equipment. So I think we do cover those categories that you did mention, but we don't expect to do it in one ambulance. We support paramedics by deploying other resources when they're needed.

Yup. Yup. So, so was there, did you guys use, you know, your data or what, what was the, was it, was it kind of think tank rooms? What was the, what was it like? What was the process in choosing what equipment went, where, and, and the, and the order in which you guys deployed equipment?

So we are governed by a S a government organization called work safe that dictates that we must, and we are mandated to protect our staff. And we must follow. What's called the hierarchy of control. If you're not familiar with this, it's a pyramid, which the strongest controls are at the top. And the weakest controls are at the bottom. And it begins with eliminating a hazard.

If you've got a hazard, you get rid of it. If you can substitute it, you do. So if you can isolate away from the hazard, then you must do so then if you can't do the above three, you must develop engineering controls. Then you must do administrative controls. And then you must wet PPA with administrative controls, engineering and PPA falling at the bottom of that control,

because we recognize that they're not the most successful way to eliminate a hazard. So in respect to something that you were mentioning earlier in terms of equipment that should be purchased, I think there's also a really important step, and that is looking constantly for safer, smaller pieces of equipment that are available and eliminating the tasks. If you can. Now, it was completely as reasonable and practicable as the,

as the words go as to how we replaced our equipment. So one of the big organizational changes occurred in 2015 with our CEO and COO stepping in current ones, Tony Walker, and Mick Stephenson, who shifted the focus to safety and really prioritize safety, which resulted in buying the power pro X T for every single ambulance. So that was not reasonable, was not practicable prior to,

but with the introduction of our manual handling program, we were seeing such deductions in our manual handling injuries. It afforded us the ability to spend that money. And just to give a little bit of context, too, for those that don't know, again, ambulance Victoria, the Victoria is the second most populated state in Australia. Your organization responds to approximately 1 million calls a year with approximately 7,000 or 70 507,000 personnel.

So we're talking proximately 4,000 ambulances. No, so approximately 75% of that 7,500 are operational. So you're looking closer to about 5,500 of which I believe some of those are volunteers as well, but I smaller cohort. And in terms of on-road vehicles, we have roughly between eight to 900 general stretcher bearing vehicles. And then we also have single response, paramedics driving sedan platforms,

or vans. I think, I think that's the gist I'd like to comment. That's the power of having a really compelling vision and a leadership team that that's focused on. Like what really matters the safety of the personnel, the safety of the patients, and understands that this may seem insurmountable. How could we possibly spend, you know, whatever the amount is,

multiple tens of thousands of dollars on, you know, a powered hydraulic tool, a stretcher, but in reality, that structure is being loaded and unloaded multiple times multiple opportunities for injuries. And when you focused on like the bigger goal, the bigger vision, everything else is, you know, you could just figure out. And I think so that's an important lesson.

So we do have some other folks in your asking James about any centralized reporting systems for collecting data. This is big in the aviation industry SMS. So just wasn't sure if, if you're familiar with any, any systems or have used any to drive. Absolutely. So our organization collects data on a monthly basis. Our staff report, any hazards, knee misses injuries that result in time lost or non time lost at work,

that data is collected. It is cleaned for any numerical errors or any like dropdown box errors. And then that data is reported on once per year and then submitted to our annual report. That data then goes to our WorkSafe body. And James did your work and did the WorkSafe body kind of delineate what your fields were on, what data you were collecting or is that something that your team,

you know, has had, had influence over on what the data is that you're collecting? I can't answer that specifically because that's not my area of expertise. However, we do have a system that is designed for us, and it allows you to select a area of injuries such as if you think you've injured your shoulders. If you think you've injured your back upper or lower,

how you think you've injured it, whether or not they was equipment that you were using at the time. And we essentially clean that data to make sure that when we are reporting, we are reporting as factually as we can. The person may accidentally click something that is not, it doesn't quite fit, but at the time they think it fits. Can I just ask,

I'm sorry. I just wanted to ask w w was there an ROI that was measured? I mean, like there was this huge investment in, in all the equipment and all of what you've beautifully done. Was there any kind of looking at the ROI, the return on the investment? So, as I mentioned, I've been in this position for two years,

so I am limited as to my historical knowledge of what occurred, but I can't even specifically tell you how much we've spent on equipment. As I've mentioned, every vehicle over 800, have a manga calc, they have a strike, a power pro I don't know what they cost. I wasn't around at the time that those pieces of equipment were purchased. We have a limited number of all the Jackson hole mats.

And I know that they're are inexpensive device. So to my knowledge, there is no, we don't have a database for how much we've spent on just equipment alone. And I don't think there is a, it just extends beyond equipment. I think you've also got to factor in what your, how you're going to train the staff. So we have over 450 specialists paramedics,

I say a specialist. I mean that specialized in the area of manual handling and extrications of patients. And we have provided them with four to five days of training, and it's a repetitive training so that they really nailed down the muscular systems that they need to know and become natural for them. And so you've got to think about back-filling those positions. You've got to think about whether or not those staff being type of time and venue locations,

et cetera. And then there's this very large and tangible benefit as well. And do you think I've got time to tell a quick story about the intangible benefit? Oh, Of course I was doing some training with my colleagues in 2019, and I was approached by what I called at the time, and it might seem incorrect now in hindsight, but I called,

I would call these paramedics Donna souls because they had been in the job for 30 years. They had a very set value, very set way of thinking. That was the perceived notion of those paramedics to a younger generation of paramedics. And as I'm delivering this training, the direct Brett's up and he approaches me and says, I really appreciated the day of manual handling training.

I wish I'd been provided this earlier in my career. I would have my colleagues and my friends still in this job today, if we'd been given this opportunity back then, and it really, that was a turning point for me because it's, I no longer needed to see this generation of paramedics as entrenched in their values or perceptions. I mean, you're always going to have everyone like different values across the field,

but I didn't need to pigeonhole them anymore. This paramedic highlighted to me that his generation is very much the same generation almost now. You don't want to lose your friends. You don't want to not work with them. There's nothing worse than knowing that your friends can't work because of an injury. And that inspires my team every day to protect our staff and ensure that we are keeping our experience in the workforce rather than seeing them leave due to injuries.

That's beautiful. That is, that is James is I know the so-so when ROI, you know, may it's, it's just, it's too nuanced, too many things that really be able to nail down what that return on investment is. But is there, do you guys have maybe data or, or something along the lines on injury reduction on how many injuries the organization was sustaining on an annual basis from patient movement 10 years ago versus today?

Is there any, is there any of that data that, Yeah, I can say definitively that our injuries have reduced in that time. We know that there was a gigantic pivot point in 2015 where our injuries reduced by 50%. Oh, wow. What we know is that there is no one silver bullet that has done this to achieve out manual handling injury reduction.

We have not found that there is one thing that is successful. We've implemented a multifaceted approach, and that may have been unintentional. As I mentioned, we have 450 facilitators that we've trained and they were probably trained early on in their career or middle in their career. We're now seeing those individuals as managers. So we're not just supported by our CEO and CIO.

We are now supported by our mid level managers that are facilitators, and they were brought up in this value. And we have previously ensured that every graduate that starts in this career starts with one day of manual handling training that has now been shifted with approval from our organization to ensuring every graduate now starts with three days of manual handling training. And that's off the back of a really successful 2021 education program that was run over 95% of our staff were entered into a program that we called smart moves,

which was a three-day manual handling training day. And that was successful only because our 2019 date was successful. Staff really enjoy job tasks, specific training. And I enjoy training that is practicable are practical and that they can get their hands on and really feel the benefits of, and so many times they will come up to you and tell you that they've had that light bulb moment because you see a piece of equipment for the first time,

but it's been sitting in the ambulance and you've never touched it. You've never needed to use it. And all of a sudden you've seen you buy to use it. And that light bulb goes off. There's nothing like that moment. And that multifaceted approach of targeting not only graduates our mid level managers, our facilitators and our upper management has helped change that injury data.

You know, I, I have kind of a similar story, James. I, I, you know, the, again, about 10 years ago, I, I truly believed that we had the silver bullet, you know, when, when we, when we first came to market with, with the vendor lift, but then, you know, a year or two,

after that, we started to get customer data back that was showing injury reduction. And then we, you know, tested electromyography, proving sheer force reduction and all of these things. I knew I had the proof that we had the silver bullet to, to stop injuries and, you know, couldn't have been more wrong. Like, I, I believe that we have a great piece of the puzzle,

but it was through a conversation about two years in with a, with a colleague that was another vendor at a conference, and it was a slow conference. And he came up to me and said virtually the same thing, but it was about himself. And he did, he just looked at it. He was like, you know, I had that piece of device.

I would still be in the field set of set of, you know, sell selling equipment on the side. And, and at that point I wasn't even totally sure I was making a career out of, out of this, this company. It was really just in between going to paramedic school. But then this was the story was, it was a pivotal,

like a pivoting point for me when he went on to explain on, on getting a patient out of a bathtub that was a 350 pound patient. And they went to get the patient out of the bathtub by lifting, lifting her with, with, with a sheet coming up through, through her armpits. And when they got her up, she slipped in and try and keep her from falling hard.

He's, he's trying to stop her from falling and long story short. She ends up on top of him in the bathtub. He, he herniated a disc and was stuck there for, for 20 minutes until backup arrived and he needed surgery and, and went on to tell me about missing his father's funeral. And I had all of these different things from just this,

this, this one piece and this one, this one injury. And that's what really got me passionate about this topic. But then it was experience that taught me that, that there is no silver bullet. And it was experience over this last 10 years. That really just like you were saying with, with training and equipment, and it's a holistic approach that you can't it's it's,

I, I see why it's, it's, it's, it's next to impossible to really put a hard ROI or a hard, you know, you did this one thing and, and you saw this injury action from it. It's really a collective effort, which, which brings me into the, the, the, the next piece. And I'm going to actually go a little bit out of,

out of order of than what I was than what I was planning here, because you were talking about the training and what you guys were doing with the training. I just think that's so incredible. You know, that's, that's one of, out of, out of, out of everything, that's what, like, nothing will get me on a soapbox quicker than the topic of,

of training on, on patient lifting and moving. And what you guys are doing is so incredible. The reason I say that is because without an effective training program, equipment and policies will almost assuredly be ignored by a high percentage of the employees and it's, and this isn't because these employees are bad employees. It's, it's likely because they've never trained on how to properly lift and move patients.

And they, and they sexually hasn't trained frequently, you know, the hundred and 50 hours that are required to become an of, of training that are required to, to, to become an EMT. Basic, approximately 20 minutes are spent on learning the concepts of lifting and moving patients. And so when we look at where we're getting hurt, the most,

it's where we're training the least. And again, I can't speak to, to Australian standards. This is according to the, you know, our, our training standards here, but I would assume they're pretty, pretty similar. Now, of course, you know, your organization is taking it into your hands, which I believe should be what our organizations are doing.

This shouldn't be something where we're relying on an association to mandate us to do, although I'm not necessarily against it, if I'm, if I'm being completely honest, because I'm so passionate about creating change. But I really, I really feel like the Otter or organizations can take training into their own hands and not just rely on changing of what the training involved in becoming an EMT.

But part of that onboarding process like you guys are, have done is really going to be the solution to changing what we're doing. So what I've, what I've seen is that most departments, their patient handling training is really teaching their personnel how to use equipment and it ends there. And that's normally just an onboarding. You don't even, you make, if you're lucky,

you'll do it again every, every, every few years, but it's mostly focused on how to use equipment. But I think the more importantly, our trained should focus on when to use the equipment. I think that's the biggest gap that I've seen is teaching personnel when to use a piece of equipment, because equipment's really well, most of them pretty simple,

but if you're not using it at the right times, and you're not going to see the benefit. So again, if, if with training, I I'll break it down into two, three points here, I think on a training program for, for those of you who, who are, are, you know, agreeing and, and hearing what we're saying.

If you're, if your training program, you know, isn't, isn't, isn't up to, up to snuff in your, in your, in your feeling. I think you should really focus on three things. The three things are, it should be hands-on, it should be realistic, and it should be frequent those three things, because, you know,

it's this isn't though, I think LMS systems, learning management systems and doing online, and we've come a long ways, especially with COVID on, on how to do that. I think there's a place for that, but, you know, if, if, if I go to any EMS service and I hand out a paper test on what proper ergonomics is,

I would assume on nearly every service that, that I go into, we would see, you know, at least a 90% pass rate on what proper earn lifting ergonomics are. Right. You know, don't reach, lift with your legs and not your back. I'll be six. We know it, but if we're not practicing hands-on and training hands-on then,

then, then we may not that the implementation of that knowledge may not be, be happening. So that's the reason for hands-on. And we're just like to just step in and say, like, the last thing you want to do, and from an organization's perspective is, is having that provider use a new piece of equipment to when they think they need it.

Like the, what the concept you're talking about is that the training is essential to have people, you know, practice before they get put in a situation where they really need to use that equipment. So can we use it for that enough? And, you know, so, and the real, the realistic part of training, you know, really where our,

where our jobs are, the most dangerous is where we should be training the most realistic at some level, just like in the firefighting side, we'll see them go through, you know, like the hot flash chambers and different things like that. So they get used to the heat and the use of some of these dangers in a controlled environment. So that way,

when you're doing these dangerous things in an, in, in an uncontrolled environment, you're a little bit more prepared, you know, according to a survey that we've sent out to two, well, over a thousand providers, only 8% of providers have ever trained with a realistic weight mannequin or a patient. And what I mean by that, and when I say realistic weight is,

is most trainings happened, at least in the us with a, you know, a rescue Randy or some mannequin that weighs 150 pounds. But I, I, you know, I, I would assume most of us when, when we're working, working our jobs on the, on an ambulance that it's, it's, it's, it's a happy and rare day when we have,

I have a patient that's only a hundred Hope for 150 pounds. So, so, you know, that's all we're training with. We're going to be grossly unprepared when we're in the field and we're lifting a 350 pound patient, and our first time lifting a patient of this size or, or, you know, or, or pushing or pulling or moving,

you know, I, I have to catch myself. I always say lifting when I really, I mean, moving, cause just like, just like James said, you know, you were trying to, to transition away from just always your mind going to lift. No, it's really just moving whatever that safe movement is. But if your first time moving a patient of that size is in the field,

it's not going to be nearly as, as smooth and effective or a safe as if you've trained with a patient or mannequin of that way. And then frequency is the other big park here. You know, if you do it just once at onboarding, you know, that's, that's, that's great, but that still leaves plenty of room for old habits to creep back in,

especially if you're going about changing habit rather than establishing the habit from the beginning. Frequency is key because when you're in an emergency, you're gonna, you're going to fall back onto, you know, what you know, best. And if, if the best way to do something, isn't know what, you know, best you're going to do it. The not the best way you're going to do it,

just however you're most comfortable. So, so with that, James is that, is there, is there, do you have anything more to add on, on the training side for ambulance Victoria and, and, and what the continuation of training looks like after that three-day training of new employee onboarding? Firstly, I'll, I'll just say, you know, with 20 minutes I would be,

I wouldn't know what to do with 20 minutes. If that's all I had to do staff training, I could imagine that you'd be in 20 minutes, lucky to cover how to squat down to the ground and lift something from ground level safely. And staff just don't appreciate that because it's not, again, job task related job task training is what that will enjoy it is what has proven to be successful.

You can't just expect to show a video on how to lift a box properly and have that work. So as for training in the future, as I said, we have been very lucky to be supported with our vision. And every graduate will get three days of manual handling training, joining the career. And in that, in that time, they'll do repetitious tasks over and over again,

so that they get that memory muscle memory down so that they do. And our goal is to help them become aware of how they move unconsciously so that they don't do things on safely. They perhaps bring a high level of engagement when they're about to complete the task. They go through certain pieces of equipment that are regularly used, and they'll learn how to use it in multiple different ways.

I can see there's a question about how to get someone out of the bathtub. Now we don't have bathtubs built into our training centers, but it is something that we have experimented even with recently out highly specialized support vehicle staff. So that's the paramedic that works on a vehicle all on their own. And they essentially are called upon. If someone is trapped in a difficult extrication,

they might be between a bed and a wall or in a bar table, collapsed in a shower with their legs, looking like pretzels. And that paramedic program we've recently run for a few weeks now. And we went to a specialized facility and I had a bathroom set up and a bedroom set up and we were able to do that training. So I completely agree with the person that put that post that you can highlight when the highest risk activities are going to occur.

And you can talk about ways to go around them and how you can use your equipment, how you can use other paramedics on scene as like I suppose, and to keep you safe and look after your own posture. Now, every other paramedic we recognize there are certain risks in our, you know, organization. There are certain pieces of equipment that are higher risk.

And so we look to undertake training every 12 to 24 months. So for example, our stair chair, we recognize that is one device that is high risk because you are up a flight of stairs. Your patient may be that again, I'll try and do my best to convert into pounds. Your 200 pounds patient roughly or higher might be sitting on a chair and you don't want to drop them.

And worst case you don't want to tip your state chair over that staircase and have that patient and crew fall down the stairs. So you need to have that retraining. We've been lucky to have this training 2017, 2019 and 2021. We have those facilitators that can do ad hoc training and field ad hoc training at branch. And we have our responders that are able to attend a case and provide training whilst they're on a case.

So we hope that we are creating a self-sustaining model in which training can occur, even if we don't have scheduled time. However, we don't know what the future looks like, where newly registered profession here in Australia. So we don't know whether or not that's another path that we can explore as well. Hmm. I think it, just with you talking about training,

I once heard a quote that people don't rise to your level of expectation. They rise to the level of training that you've provided. And this is just such a great example of as an organization that, that you should expect better results. If you're, if you're implementing structures like you're talking about to, to impact and support those results. And James, I know you've,

you've distilled down hours of training videos into a short little clip for us. And as we approach the top of the hour, I'd love to give folks a little preview that, that you can either, if you want to stop and narrate through that, or just play it all through, we'll be happy. I think I'll, I'll play it all through.

They're all very short clips. And so if I would have stopped and narrate each for second part of the clip, I'd be here for the next hour. Sure. Now I apologize if there's no audio, There's certainly plenty to take in. Cause this is definitely a pretty well edited video. So folks can see different, you know, tools that you're using to support Them.

Some it is recognizable to, right? And so throughout this video, you're seeing our manual handling facilitators. These are our individuals that fall into that 450 group category. They receive training once every one to two years, sometimes more frequently than that. And then they had our most skilled individuals, Some great techniques being demonstrated here. I mean, in watching the posture and just fascinated by,

you know, how people are standing and using, you know, lifting from their knees, like so many things people forget about in the heat of the moment Yeah. Is a very particular one. It's something that you need to revisit constantly and have people watching you and you need to perform it perfectly multiple times. You can't expect to change your posture just in one day.

You know, it's incredible seeing how many of your movements are that, that push and pull movement. It's, it's, it's very creative on the way you guys have, have managed to, to implement that. He's a good example of a squat, about to come. So, you know, if even those simple basics come in. Yeah. It's,

it's funny. The, you know, for, for probably 10 years I was lifting moving patients often and it wasn't until I went to a gym where they were focused on proper squatting techniques for lifting barbells that I realized, well, a patient is almost identical to a deadlift and that if I use a different posture, that, that, that it can,

it can drastically change or at least drastically changed my back pain or lack of back pain after that. So, yeah. Great techniques in that video. Thank you for sharing that. We've got people asking if that video is available anywhere, and I know James, you said you were going to, with your organization to see if it's okay to release that because there was definitely a lot of,

a lot of information in there. Yeah. I'm really glad that people have enjoyed that video. Again, it's something that as an organization, we've taken a lot of pride to this program that we've developed. And with that comes, I guess, I don't know some security around that. It's been out baby for some long, if this is still a very new territory for us to be sharing this or being asked to share it,

which assigned we're very proud of number of states have started asking us for assistance, which is something that w again, we're just starting to explore now. So yeah, I will ask whether or not I can share that it might, I might be able to put it on to an HIV specific profile, like our LinkedIn, but no promises, Actually, frankly,

if folks are going to be able to watch the replay, they can, that was recorded. So access that. That's why there was a question in there, Robbie, just about fitness. And there is something to, to say about that. We don't focus here on our staff fitness. There, there is an element of job task fitness that is required in order to complete our work.

And we acknowledged that. And when staff injured themselves, they need to be rehabilitated to a certain level of fitness, but we don't target a certain program. We don't say you have to be able to do this. We don't, you certainly don't need a deadlift in your spare time in order to lift patients, because whilst lifting and white training is useful in some regard to how you recover and how you perform some lift,

you might even benefit from just being more aware of your imposters, like deadlift, for example, you might just bring some more awareness to how your back is postured rather than being hunched over. But all that is going to do is make you stronger. You make your joints used to lifting with force, but they may not be able to sustain that twisting and stretching motion.

So you also need a flexible body. Strength training is not the only solution. In fact, I don't think there's been any successful studies to show that if you are exercising and have a certain weightlifting program that you are going to reduce your injuries, job task training has been, has been researching systematic reviews and the job task training, getting them used to how to push,

pull, slide patients and move them in those certain positions. That is what we consider successful. That's great. That's a really important point. And like you said, people get engaged in doing, you know, training that's that's job specific. And, and, and I just think that's brilliant that you do it over three days so that they get, you know,

repeat it and, and get used to it. Right. I mean, I remember being on a job one time where it was many, many years ago where, you know, I was around hot fryers, you know, it was early days when I was in the restaurant business and I got like one 15 minute, you know, thing like, and I'm like,

oh, I can remember it really badly. And it was like a 15 minute you know, safety. Okay. Now sign this paper that you've been trained. And I was like, wait, you know, so, I mean, I think that that's so important, you know, to just have the training and then to have it repeated and not assume that you didn't miss something right.

In the 20 minutes that you get trained. Sorry. As we, as we wrap, we're coming to the top of the hour here, and I know we did say about an hour for this conversation. There's so much, we can go into a little more deeper with each of these topics, but maybe from an organization perspective, because we've had a lot of questions,

you know, about specific equipment. And I think it was brought up on this panel that there is no magic bullet, right? That it's, it's almost brilliant that that folks are going upstream, right? They're going upstream to the cause of the problem rather than reacting to the constant, you know, who loves to fill shifts out there, right? Who loves to,

to have to manage the schedule and, and, and fill the gaps that are being caused potentially by provider burnout by provider injury. So, Lisa, is there any advice we can give organizations, I guess, and I'll open up to the panel after that for, you know, how to approach this, this elephant, right. How to approach, how to,

how to really tackle this bigger challenge. My initial thoughts are just getting some, some frontline folks and key decision makers in a room to brainstorm. Like, what are the ideas? You know, if anything were possible, one of my favorite questions is if anything were possible, how do we really want it to be, what do we really want? Let's not talk about limitations of what we think we can get.

Yes. Hydraulic equipment is very expensive. Yes. We've got, you know, a thousand ambulances or 5,000 is, and what do we really want? And I feel like that is a compelling enough, like conversation starter for people to brainstorm new ideas, to hopefully results. I agree with you that you, you, you have to go that far, even further upstream,

I think then than most people think. And that is, like you said, it's like creating what you want and then backwards planning and designing the organization to produce that result where most of the time people are on the ground looking at what is the problem we have, and then try to put this in or trying to put that in. And then without looking at the unintended consequences of that.

And you know, when that often is like, you know, putting a bandaid on a hemorrhage, right. So instead starting with, and it sounds like James, this is what, what happened to some degree in your organization when Tony Walker took over and your COO took over his, they were like, safety, let's start there. Right. And then how do we create an organization where we have,

you know, whatever they decided on and what, or whoever was involved in that conversation. So that's where manual handling coordinator came from, right. It wasn't just like, oh, let's just have a manual handling coordinator and start there. No, they went way upstream to, what is the vision? What do we want to create? What is the,

what do we want to have happen? And then designing the organization, designing structures and procedures. So that, that result naturally occurs. Yeah. That's what do we always say that, that your organization is perfectly designed for the results you have. Now, if you have injuries, your organization is designed that produces, produces it that way, which is the great news,

because you can change the structures like James and Rick have beautifully outlined tonight. You can change structures that will change results. Yeah. Yeah. You can attack it from both ends attack is not the right word, but you know, it's not like in the meantime, oh, let's let everybody get hurt. Right. You can start some kind of training program or,

you know, invest in the kind of equipment that you can afford at this time. But no, no, that you're doing that as a stop gap measure in the building of what you want to create. So I think those two things happen simultaneously way upstream. And then what's the most pressing issues that we have D you know, in the moment. Yeah.

Rick James, any, any thoughts as we wrap up this conversation on safety, the short conversation I could, again, much like Rick, I have a sign I'm passionate about. My team is really passionate about, we could talk for hours on this and that's indeed how we have our positions that we could talk for hours. I think there's not one thing again,

that we've done perfectly. We've learned through trial and error. It's a code over 13 years. This hasn't been a, a fast process, but I think to our credit again, we did have a vision. I remember being told back in 2015, that this was something, a dream to have. Every paramedic get three days in manual handling training. Every paramedic doesn't matter who you are.

And then as you start, every paramedic gets three days and we've achieved that now. So there's with, got to move out goals. We've got to dream bigger next, I guess, but where it all started with his eyes, small vision and starting small. So when I'm working with new graduates, my focus is on protecting myself and then protecting them.

So if I'm only, if it's just the two of us in the ambulance, my job is to protect myself and then protect them and start small, try and change their culture. Yeah. Brilliant. And something. You know, how I, how I usually, you know, try to try to end these conversations is, is really reminding that, that if we've always,

if we always do what we've always done, we'll always get what we've always got. Right. I mean much smarter than me is, is who I'm quoting here. But it, it, it really stands true as much then as a, as a, as it does now. And so really with time to change our behaviors so that we can change our outcomes.

And just like James was saying, this can be, this may seem a little bit overwhelming at first on. How, how do I afford the equipment? Or how do I enforce a policy, you know, around patient lifting and moving, or how do we even create the time for training or any of these things, if you won't get it at all,

like, you know, altogether can seem very overwhelming, but something, I always remind the people who I work with is better, is better, right? It doesn't matter what you're doing. It's a very simple concept, better is better. And so if we can just make the next best decision or implement the next best thing and keep making it better over time,

it may take 13 years, but your organization can most definitely be in a much better spot than they are. Now, if you start today, When my husband was recovering from his brain injury a year and a half ago, somebody told me 1% better. Every day means that a hundred days, you're a hundred percent better. And that really stuck with me because,

you know, when we can do that at any level, right, we can be 1% better. Each of us, or we can talk about our teams. We can talk about an organization. How do we get 1% better today? And I think that is, that goes along with what you're saying, Rick better is better. Well, I'd like to thank all of our panelists for joining us today.

Thank you for taking the time and the energy and effort, your enthusiasm, both James and Rick behind this topic. And, and I know James, you've got a much bigger team at a V that is also just as passionate about this topic. So really shout out to all of them and anyone who's joined us with all these great questions and written in with a lot of emails.

We hope you found this helpful. We are going to have the replay available if anybody wants to check those out. So I'm going to ask our panelists just to hang with us for a moment. And we'll, we'll, we're just going to stop this live stream.

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Robbie MacCue

Robbie is the cofounder of the EMS Leadership Academy, host of the EMS Leadership Summit, and paramedic captain in Albany, NY where he serves in the Special Operations Division for ground rescue, flight, & tactical medicine. He performs international medical flights with North America's largest fixed wing Air Ambulance service. For more than 14 years, Robbie served as President of a non-profit EMS organization advocating for increased funding and raising the bar of excellence. In addition, Robbie is an American Heart Association advocate who is passionate about empowering others to save more lives. He has taught physicians, nurses, and other medical providers Advanced Cardiac Life Support at medical schools and hospitals throughout Manhattan. Robbie has undergraduate degree from Rensselaer Polytechnic Institute, and a MBA from Case Western Reserve University and provides business consulting that combines his love of technology with healthcare.

Robbie MacCue

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