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Emergency Medical Services: Are We Playing Whack-A-Mole?

Are you familiar with the game called Whack-a-Mole? Found in game rooms in places like restaurants, malls and bowling alleys, this is the game where a plastic mole pops up out of a hole and you have to whack it with a soft club. As the game continues, the moles pop up faster and faster until you eventually miss enough to lose the game.

There's also a book out by the same name, authored by David Marx, that discusses why we expect perfection from our people. But you'll find that even perfectionists also make mistakes.

So, have you played whack-a-mole in your organization? If someone has made a mistake, such as dropping a patient, miscalculating a drug dosage, failing to use a backer and backing into something, were they automatically punished? Are your personnel afraid of getting whacked?

Marx proposes that there are three types of behavior that lead to mistakes:

  • Human error
  • At-risk behavior
  • Reckless behavior

Each type of behavior can result in a mistake, but identifying which one was the root cause can lend to the appropriate means of addressing it.

Marx goes on to state that we should console human error, coach at-risk behavior and discipline reckless behavior. Intentional behavior, another type we may encounter, would probably fall along the lines of reckless behavior, and discipline should probably also result.

Does any of this sound familiar? If so, it's because it is part of the "Just Culture." This is the principle that is serving as the basis for the EMS Culture of Safety Project that Dr. Sabina Braithwaite, American College of Emergency Physicians, is chairing and that we have been participating in. I could write many other columns about "Just Culture," but these are the basic tenets.

Let's face it. We're all human, and we're going to make mistakes; it's impossible for us to be perfect all the time. When we add in the factors and stress of our profession, it's even more likely that we're eventually going to fail at something.

So, when a paramedic miscalculates a drug dose, was that due to a mistake, at-risk behavior or reckless behavior? Dropping a patient might not be any of these; it may be a result of equipment failure. Failing to follow policy? That might be any one of the three.

One of my battalion chiefs reminds me regularly to "get the facts before we react." Make sure you do this before you start playing whack-a-mole. I've yet to find anyone who is perfect.

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