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Distraction is Deadly
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EveryDayEMSTips.com
Not Urgent
Not Important
Urgent
Not Important
Not Urgent
Important
Urgent
Important
Disable Notifications
Friend Request
Tagged in a Photo
Comment on Post
Added/Removed
New Follower
X
X
X
X
X
98% 74%
Know Danger
Do it Anyway
…pilot had made and received
multiple personal calls and text
messages…while the helicopter
was being inspected and prepared
for flight, during the flight, on the
helipad…making mission-critical
decisions about continuing or
delaying due to fuel situation,
and during the accident flight.
Types of Distraction
1. Manual
2. Visual
3. Cognitive
Manual Distraction
Voice to Text
Visual Distraction
“…ambulance driver …
became distracted when he
took his eyes off the road
while reaching for a
company-issued tracking
device that fell to the floor.”
Cal Fire unit chief… “had
been texting a few minutes
before the crash and had
been talking on his phone
using a hands-free device
immediately before
the collision.”
Cognitive Distraction
Distraction Type
Distraction Type
Texting
ON
OFF
TASK 1 TASK 2
ON
OFF
“This investigation
highlighted what is a
growing concern across
transportation – distraction
and the myth of
multi-tasking.”
NTSB Chairman Deborah A.P. Hersman.
Multi-Tasking Lie Infographic
• http://www.nsc.org/safety_road/Distra
cted_Driving/Pages/The-Great-
Multitasking-Lie.aspx
ON
OFF
TASK 1 TASK 2
ON
OFF
ON
OFF
TASK 1 TASK 2
ON
OFF
Incident
Patient
Assessment
Narrative
Signatures
Billing
Vital Signs
Cardiac Monitoring
AVPU
Pulse
RR
SpO2
EtCO2
BG
GCS
Temp
Pain
ON
OFF
TASK 1 TASK 2 TASK 3
ON
OFF
ON
“When operating heavy
machinery, whether it's
a personal vehicle or an
emergency medical services
helicopter, the focus must be
on the task at hand:
safe transportation.”
NTSB Chairman Deborah A.P. Hersman.
New York Times
Gauging Your Distraction
http://nyti.ms/qgCETw
ON
OFF
Driving
Train
TASK 1 TASK 2 TASK 3
ON
OFFUsing
Phone
ON
OFFLooking
at Paper
ON
OFF
Driving
Medic
TASK 1 TASK 2 TASK 3
ON
OFFUsing
Phone
ON
OFFLooking
at MDT
We Know…
91%
5%
9%
21%
4x
0.08
“…Secondary tasks
requiring drivers to look
away from the road ahead,
such as dialing and texting,
are significant risk factors
for crashes and near
crashes, particularly among
novice drivers.”
New England Journal of Medicine 2013
F.O.S
Driving
Simulator
Manual
Distraction
Visual
Distraction
Cognitive
Distraction
It’s not you I worry
about. It’s the crazy
people out there.
“A 20-year-old woman
who exchanged a series of
text messages then crashed
into a bicyclist…
convicted of homicide
by negligent operation
of a vehicle…”
Distraction
Patient Care
Self
Partner
Community
Patient
Response Assessment Treatment Transport
Risk of Distraction?
“Medical error is...
any preventable event
that may cause or lead to
inappropriate medication
use or patient harm”
National Coordinating Council for Medication Error and Prevention
“Good person doing what
they think is the right
thing to do.”
“More commonly, errors are
caused by faulty systems,
processes, and conditions
that lead people to
make mistakes or fail
to prevent them.”
To Err Is Human: Building a Safer Healthcare System
Draw up and administer…
Problems With Environmental
Factors and Staffing Patterns
• Lack of space, crowded and disorganized
storage
• Poor lighting, excessive noise
• High patient acuity
• Deficient staffing, excessive workloads
Culture: How we act in workspace
Give Kids
a Script
Can I bother you
real quick?
Task Interruptions
1.
2.
3.
4.
5.
Distraction
“… up to a third of the
mistakes were linked
to distractions from
avoidable interruptions.”
Medication
Safety
Zone
DO NOT
DISTURB
Paramedic
Doing
Math
Close Call
Reported 8/1/2013
No Interruption Zone
Med
Cart?
Checklist
Checklist
Other
read back
opportunities
“Checklists and signage can
be used as reminders to
reduce distractions, and
are simple, inexpensive
tools for medication safety.”
Paramedic Class Schedule
Reading Review (device free)
Cardiac Lecture (Shared Google Doc notes)
**Break**
(Ins, Outs, and Inbox)
ACLS scenarios (ACLS review app)
Listen close to
what I am about
to say...
You need to
know this…
Standby for
priority traffic…
I pledge to…
NO PHONE
ZONE
DISTRACTION
ANSWER IGNORE
Important?
Urgent?
There’s an app…
There’s another app…
Unsubscribe
g***@centrelearn.com
Focus Time
Injury Prevention
Group Project
Awareness
Behavior Change
Amerilert First
Responder
Emergency Responder Exemption
• WI Distracted Driving Law ???
• MN Distracted Driving Law
– https://www.revisor.leg.state.mn.us/statut
es/?id=169.475
– “(5) in an authorized emergency vehicle while in
the performance of official duties.”
NO PHONE
ZONE
Behavior Change Opportunities
• Behind the wheel
• On scene
• In the training room
• At the dinner table
• In the patient’s home
• During transport
“But when we’re caring
for their loved ones,
they expect our competence,
our undivided attention,
our concern, our gentleness
and our best efforts to keep
them comfortable and as
free of pain as we can.”
People Care, 2nd edition. Thom Dick.
Will you?
• Speak up
• Change processes
• Consider a pledge
• Practice focus and refocus
• Challenge exemptions
Distraction is Deadly

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Distraction is Deadly

Notes de l'éditeur

  1. Distraction is Deadly: Driving, Patient care, and Education Presented by Greg Friese, MS, NRP [1.5 hour session 1330-1500]
  2. Post slideshare of slides to: Upload to SlideShare.net/gfriese Embed at EverydayEMSTips.com Paste resource links from handouts and make URL Upload handout PDF and make available for download  
  3. Divide paper into fourths Label each quadrant...hat tip to Steven Covey Important and urgent Important and not urgent Not important and urgent Not important and not urgent Place these things into each quadrant Facebook notifications – friend request, you were tagged in a post Email about a sale at your favorite store (REI) Text message from your spouse Text message from your child Phone call from friends and family Phone call from a student Email from a student Email from a vendor Email from employer Out of office reply Driving ambulance to cardiac arrest Driving ambulance for dialysis patient return to home Mild asthma Severe asthma Discuss urgent, important Discuss types of calls and messages that are Important and urgent Important and not urgent Not important and urgent Not important and not urgent (Estimate percentage of calls in each category)
  4. Experiential activity … flip the classroom … have them teach each other Day 1 Class 1. Students need to learn how to Disable auditory, visual, and kinetic notifications Disable auto refresh for social networks (Facebook, Twitter, Google+, Instagram, etc.) Put phone out of physical and visual reach
  5. 98% of people surveyed know it is dangerous to text and drive. 74% of people do it anyway. Survey by Center for Internet and Technology Addiction and AT&T http://www.washingtonpost.com/blogs/dr-gridlock/wp/2014/11/06/drivers-get-a-rush-from-text-messaging/ I can’t think of much else where the gulf between knowing danger and participating in behavior is so great…. Smoke Tobacco (18% of Americans http://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/) Heroin (1.6% of Americans have used http://www.drugabuse.gov/publications/drugfacts/heroin) Soda/Cola (48% drink on a daily basis. http://www.gallup.com/poll/156116/nearly-half-americans-drink-soda-daily.aspx)
  6. Distraction is a Real Issue http://www.ntsb.gov/news/2013/130409.html http://www.ntsb.gov/news/events/2013/mosby_mo/Abstract_Mosby_MO.pdf
  7. Pilot was sending TEXT messages …. Dozens and dozens during pre-flight. Messages sent while flying, while the helicopter was being prepared for return to service, and during his telephone call to the communication specialist when making his decision to continue the mission,
  8. There are 3 general types of distraction
  9. Manual or mechanical distraction – hands off the wheel Anything that takes hands off the wheel – eating, texting, tying boots, grooming, adjust radio – lights – sirens [this guy is doing both]
  10. Manual distraction solution…hands-free and voice to text devices are not safer.
  11. Hands free is not better. From http://tti.tamu.edu/2013/04/23/voice-to-text-apps-offer-no-driving-safety-benefit-as-with-manual-texting-reaction-times-double/ Cognitive load is not changed
  12. Visual distraction - eyes of the road Something that causes you to look away from road, patient, vial, syringe, protocol … sending a text.
  13. Example of a visual distraction Ambulance then rear ended a truck Serious injuries to patient http://www.prnewswire.com/news-releases/louisiana-jury-awards-117-million-to-woman-injured-in-ambulance-accident-while-pregnant-164761026.html
  14. http://www.fireengineering.com/articles/2014/06/judge-rules-calfire-chief-to-still-stand-trial-for-fatal-crash.html Read-ended other vehicle, killing driver. State settled for $15 million to daughters of the victim. Charged with misdemeanor vehicular manslaughter
  15. Cognitive or mental distraction – thinking of something else – mind off of driving Brain not engaged in task of driving – we aren’t aware of time we spend cognitively distracted Get your head in the game. Explanation of cognitive distraction http://www.youtube.com/watch?v=Ae-mO8OxXFA&feature=share&list=PL337F74DED367FDE7 “looking but not seeing” “Inattention blindness
  16. https://www.aaafoundation.org/sites/default/files/MeasuringCognitiveDistractions.pdf “AAA Foundation challenges the notion that drivers are safe and attentive as long as their eyes are on the road and their hands are on the wheel.”
  17. https://www.aaafoundation.org/sites/default/files/MeasuringCognitiveDistractionFS.pdf “study provides some of the strongest evidence yet that “hands-free” doesn’t mean risk free.”
  18. From 1953 National Safety Council Video on the importance of not being distracted. “Inside your head is the most difficult place in the world to get privacy” http://www.youtube.com/watch?v=D-qiQh4mrHA&list=PL337F74DED367FDE7&index=1
  19. When you read/hear about any type of collision try to understand the type or types of distraction that were contributing or causing factors: Manual Visual Cognitive
  20. When you read/hear about any type of collision try to understand the type or types of distraction that were contributing or causing factors: Manual Visual Cognitive
  21. Texting … all three distraction types …. That is what makes it so dangerous. “texting while driving is especially dangerous because it combines all three types of distractions.” http://www.cdc.gov/features/dsDistractedDriving/
  22. Multi-tasking … not possible. Can’t be cognitively engaged in two simultaneous tasks. Multitasking is a MYTH!
  23. Online conversations – in the EMS space - about the helicopter accident had a lot of people arguing that text messaging had nothing to do with this, couldn’t be proved as the cause, etc.
  24. Learn more in this infographic: http://www.nsc.org/safety_road/Distracted_Driving/Pages/The-Great-Multitasking-Lie.aspx
  25. Toggle Tasking Multi-tasking doesn’t work Brain chooses one or the other “Toggle Tasking” http://www.youtube.com/watch?v=L_Kzq2x-z7Y&feature=share&list=PL337F74DED367FDE7 This is reality … Listen to wife or read email. Listen to a presenter or read the news Browse Facebook newsfeed or play card game with kids
  26. Despite your desires, wishful thinking, or ongoing attempts at multi-tasking you can’t do both effectively. Drive or talk on telephone. Make a choice.
  27. Activity idea – recall of information while performing task of entering data into an ePCR. Patient care toggle tasking example … assessing patient while also navigating buttons/tabs of electronic patient care report Cognitive challenge … looking for button to click, dropdown, text field, etc while also listening to patient and 1 to 5 other people that might be giving you more information.
  28. You can’t do this either.
  29. Experiential activity Game measures how reaction time is affected by external distractions. http://www.nytimes.com/interactive/2009/07/19/technology/20090719-driving-game.html?ref=technology
  30. This is impossible, dangerous, and potentially fatal. “In the moments before the derailment, Garzon received a call on his work phone from Spain's national train company Renfe, court documents show. The call was to inform Francisco Garzon, 52, of the route that he needed to take. The court said Garzon was talking to train company personnel and based on black-box data recorders, appeared to be consulting a paper document at the time of the derailment. ” http://worldnews.nbcnews.com/_news/2013/07/30/19776780-investigators-driver-of-spanish-train-that-crashed-was-talking-on-phone
  31. Have you ever done this? Doing this without consequence doesn’t mean you have special skills. It means you have had a near failure. Near failures are strong predictors for actual failure.
  32. 91% or more of US adults own a mobile phone. (Pew Internet Research project) In 2011 CDC research … in the last 30 days (http://www.cdc.gov/features/dsDistractedDriving/) Almost 70% of drivers reported talking on phone regularly, fairly often, and at least once. About 31% reported reading or sending text messages or emails regularly, fairly often, and at least once.
  33. In 2012 from Driver Electronic Device Use in 2012. NHTSA February 2012 Percent of drivers holding ears to their phones while driving 660,000 vehicles driven per daylight moment * Estimate 9% of vehicle drivers using phone to ear of hands-free device
  34. 21% of all crashes involve people talking on cell phones http://www.nsc.org/safety_road/Distracted_Driving/Pages/The-Great-Multitasking-Lie.aspx Another source, NSC video 15-25% of crashes, even while the total $ of crashes is decreasing http://www.youtube.com/watch?v=3QJ26OYVfXI&feature=share&list=PL337F74DED367FDE7
  35. Drivers on phone – handheld or handsfree – 4x as likely to be involved in a crash http://www.nsc.org/safety_road/Distracted_Driving/Pages/The-Great-Multitasking-Lie.aspx
  36. Drivers on phone – in a simulator – had reaction times slower than drivers with blood alcohol content of 0.08 http://www.nsc.org/safety_road/Distracted_Driving/Pages/The-Great-Multitasking-Lie.aspx Couple that with what we know about the impact of fatigue. 18 hours without sleep can be enough to have this equivalent BAC
  37. From Distracted Driving and Risk of Road Crashes among Novice and Experienced Drivers Sheila G. Klauer, Ph.D., Feng Guo, Ph.D., Bruce G. Simons-Morton, Ed.D., M.P.H., Marie Claude Ouimet, Ph.D., Suzanne E. Lee, Ph.D., and Thomas A. Dingus, Ph.D. N Engl J Med 2013;370:54-9.
  38. http://www.swnews4u.com/section/170/article/15514/ Grant County deputies and the Platteville Fire Department and EMS responded to this crash on U.S. 151 at Southwest Road Monday around 11:35 a.m. The 2014 Ford Mustang owned by Avis Rent a Car and driven by Matthew Bruhn, 37, Jeffersron, rear-ended a tractor driven by Matthew Miller, 33, Platteville, pulling a trailer full of liquid manure. The sheriff’s department said Bruhn had been talking and texting on his cellphone when he hit the trailer. Bruhn was treated at Southwest Health Center in Platteville for a broken finger. U.S. 151 was blocked during manure cleanup. The state Department of Natural Resources 
  39. Conversation that doesn’t involve driver – frequency with which ambulance rolls with 3 people (crew, observer, student, trainee) Talk directly and ask questions to driver Create distractions for driver Manual – ask driver to open map book Cognitive – driver to recall and explain a driving near miss or accident Visual – Point to a location on a map Combination – read and reply to a text message Could do something similar on a cone course … also cause distractions to driver and spotter.
  40. Did your mom say this?
  41. http://theactivepursuit.com/texting-driver-convicted-of-homicide-in-crash-that-killed-bicyclist/
  42. View video “From One Second to the Next” Documentary directed by Werner Herzog. Available on YouTube.
  43. http://www.kbtx.com/home/headlines/Distracted-Driver-Causes-Minor-Crash-with-Ambulance--202222151.html Ambulances hit by distracted drivers Responders on the roadway hit by distracted drivers
  44. http://www.wave3.com/story/26209597/fatal-accident-involving-fire-truck-semi-on-65-south FF killed FF injured
  45. “Distracted driving was at least one of the factors in that deadly crash Feb. 16, 2013.  IEMS members Timothy McCormick and Cody Medley died, their ambulance was smashed into by a driver who ran a red light.” Read more: http://fox59.com/2013/02/18/fatal-accident-again-highlights-problem-of-distracted-driving/#ixzz31ieyjIT0
  46. “Police said Burris told investigators that he turned his head at the intersection because he saw someone he knew at the Dairy Mart before he realized that he had drifted into oncoming traffic.” http://www.courierpress.com/news/2012/oct/15/no-headline---ambulancebrf/
  47. Connected topics Just culture CRM Patient Safety We are going to continue to dig on distraction …
  48. Activity idea … [From Strategy for National EMS Culture of Safety] What is the risk of distraction during patient response, assessment, treatment, and transport? Understanding, reducing, eliminating distraction will have an impact on all community groups. to self, partner, community (bystanders), and patient Self – needle stick, lifting injury Partner – lifting, slips, and falls, scanning for cross traffic (driver licking massive ice cream cone as driving through major intersection with red lights and sirens Patient – medication administration error Community – vehicle collision
  49. What is a medical error? National Coordinating Council for Medication Error and Prevention (NCCMERP) has approved the following as its working definition of medication error: “... any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems including: prescribing; order communication; product labeling, packaging and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use” http://amcp.org/WorkArea/DownloadAsset.aspx?id=9300
  50. “Good person doing what they think is the right thing to do.” Paul Misasi Sedgewick County EMS Listen to Part 1 http://www.emseducast.com/archives/1166 Listen to Part 2 http://www.emseducast.com/archives/1179
  51. Medication errors aren’t the fault of an individual forgetting or not using the 5 Rights, 6 Rights, or 10 Golden Rules of Medication administration And the prominent Institute of Medicine report To Err Is Human: Building a Safer Healthcare System notes: “The majority of medical errors do not result from individual recklessness or the actions of a particular group—this is not a ‘bad apple’ problem. More commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them.”26
  52. Draw up and administer …. What are distractions and disruptions that happen when you are asked to administer medications … list several. Back of the ambulance can become many of these things … Med room had plenty of opportunities for visual, manual, and cognitive distraction. But also lots of chances for disruption and interruption. Share my experience with the Emergency Department “Med Room” was also … Shared by urgent care staff and supplies Storage area for lots of other supplies Buffet and eating area for staff Gathering spot for informal conversation Communication and sign-ups
  53. Lecture 1 System Analysis Slide – in a discussion of 10 key elements of the medication system from the Learning Aids: Medication Errors, 2nd Edition From the American Pharmacists Association http://www.pharmacist.com/learning-aids-medication-errors-2nd-edition Keep in mind that is mostly aimed at pharmacists, nurses, etc.
  54. There are a lot of things that contribute to distraction … Fatigue Stress Hunger Environment Culture – how we act in workspace
  55. Culture … how we act in the workspace
  56. NAME of Partner… Please put down the phone and focus on driving. Our patient is expecting us to arrive ready and able to care for their emergency. My kids are counting on me getting home safely at the end of this shift. To meet their expectations I need your help. I also promise that I will do everything I can to make sure you get home safely from this shift.
  57. Experiential activity … That is the script I use to call out distraction that puts me at risk. We should all have scripts that … Label the distraction Remind of the consequences Ask for a behavior change Promise a willing partner
  58. Plan and deliver an injury prevention program … Distracted Driving Learning facts about distracted may change student’s attitudes (about risk) and behavior (texting). Deliver to different audiences … teens, civic groups, professional drivers Injury Prevention – poster – develop and distribute. Utilize other campaigns and distribute with other student groups in college
  59. Decreasing Disruptions Reduces Error http://www.nursezone.com/Nursing-News-Events/more-news.aspx?ID=18693 Disruptions and interruptions… take lots of forms … Disruptive student behaviors (see Rom’s presentation on dealing with difficult student behaviors) Activities outside of or adjacent to classroom Novel situation – dog in the classroom Something more desirable … pizza delivery next store. Another person in the ambulance
  60. Observation of behavior Count interruptions for different tasks Times kids interrupt conversation between me an my wife :) http://www.marylandpatientsafety.org/html/education/solutions/2010/documents/communication/Medication_Interruptions_and_Distractions.pdf Distraction – diverts attention Interruption – causes stop and restart
  61. From http://www.grhosp.on.ca/epulseaugust2012 “While managing the care for high volumes of patients, staff on the bustling unit identified that nursing staff dealt with multiple interactions at the same time as they’re entering medication orders or getting medication ready for patients. Staff analyzed total medication errors over a three month period on the surgical inpatient unit. The study revealed that up to a third of the mistakes were linked to distractions from avoidable interruptions. Staff members have created a “No Interruption” policy, that uses signs and special uniforms to identify areas in which staff are not to be interrupted while doing certain work.”
  62. Grand River Hospital has implemented http://www.grhosp.on.ca/epulseaugust2012 Signs Special uniforms To notify other staff to not interrupt nurses preparing and administering medications.
  63. Preventing disruptions and interruptions We could adapt the sign for paramedics. Hang on the window of the ambulance … use in the lab. Limit the number of people that can be in the ambulance or inside the no interruption zone
  64. The following Patient Safety event was entered into the EVENT system today, August 1, 2013, at 5:28pm CDT. The record may have been altered to remove identifiers or for other administrative purposes. Description: Close-Call.  While preparing two medications for patient administration, the medic preparing them started drawing one from a vial of Adenocard, 6 mg/2 mL when they intended to prepare Zofran, 4 mg/2 mL.  The other medic caught the mistake while it was being withdrawn from vial.   No patient harm. Cause: Crew reviewed and believes that the primary contributor was multiple distractions from too many 1st responders & their wanting to converse while medic was working on preparing multiple syringes.  Both correct med. syringes were then properly labeled & medication check procedures completed before administration.  Confused vials were also the same physical size.
  65. No Interruptions Please: Impact of a No Interruption Zone on Medication Safety in Intensive Care Units http://ccn.aacnjournals.org/content/30/3/21.short No Interruption Zone Where? How to identify? When? What would you put in the no interruption zone? Paramedic doing drug calculations Cardiac arrest pit crew. Other ideas Side tracks on the safety express. Interruptions lead to errors and unfinished… Wait, what was I doing? http://www.ismp.org/newsletters/acutecare/showarticle.asp?id=37
  66. Put the code team in the no interruption zone … From Johnson County Med Act Cardiac Arrest Check List and Pit Crew Procedure
  67. How do you stay on the road or after an interruption … how do you get back on track? Ask the class for ideas … In the classroom as an instructor In the classroom as a student In the ambulance as a paramedic or a paramedic preceptor
  68. Checklists … From Johnson County Med Act Cardiac Arrest Check List and Pit Crew Procedure
  69. From Johnson County Med Act Cardiac Arrest Check List and Pit Crew Procedure
  70. Job Aids and Processes help get you back on track, as well as signaling a no interruption zone – time and place. Conversations that are scripted/organized need to be practiced and consistently used. http://www.kagoon.com/journal-of-emergency-primary-health-care-jephc-vol-7-issue-3-2009-article-990374/main “The  crosschecking‟ measure  is  also  viewed  by  Jenson  et  al  as  the  most  effective  single  measure to  reduce medication error.” What are the opportunities in class to add in “read backs” Homework assignments Quiz/test instructions Scenarios Skill sessions Sedgwick County EMS Medication Administration Cross-Check© User Manual
  71. Draw attention to … Poor communication Interruptions Preoccupation Task Saturation
  72. Innovative approaches to reducing nurses' distractions during medication administration. http://www.ncbi.nlm.nih.gov/pubmed/16022030
  73. Being clear on when and how devices can be used can help students stay on track
  74. Cue students of important information … before giving the important instructions Assignment instructions Test instructions Other critical information
  75. http://www.everyonegoeshome.com/seatbelts/ International First Responder Seatbelt Pledge Often have associated education activities
  76. http://www.everyonegoeshome.com/seatbelts/ International First Responder Seatbelt Pledge
  77. Reviewing and taking pledge could be a class activity No texting and driving pledges ItCanWait.com http://www.itcanwait.com/?WT.srch=1&wtPaidSearchTerm=don%27t+text+and+drive+pledge NoPhoneZonePledge.com http://nophonezonepledge.org/ Focus Driven – advocates for cell-free driving http://www.focusdriven.org/
  78. Digital Paramedic – Distraction Triage Job Action Sheet Essential Responsibilities Silence phone Turn off notifications Reduce inputs Prioritize incoming transmissions – with rules and filters
  79. TeXTe - Emergency SMS Anyone with the “code” word can get a text message to you … even when phone is on silent. https://play.google.com/store/apps/details?id=ravid.dev.esms
  80. Engineering Controls … app … needs to be turned on AT&T Driver Mode https://play.google.com/store/apps/details?id=com.drivemode
  81. Stop receiving emails Look for “Unsubscribe” in the fine print.
  82. Experiential activity … focus time, time on task, time tracking App or stop watch or egg timer or phone or Google search (set timer 2 minutes) … progressively lengthen time you stay focused. But also acknowledge we can’t maintain heightened awareness/attentiveness for an unlimited period of time.
  83. Time to be able to check a pulse, count breaths, listen to heart sounds, listen to lung sounds Dispatch info, size-up, giving an assignment
  84. Collect a SAMPLE history, perform a head to toe exam, start an IV, review a protocol and calculate a medical dosage Connecting to a hydrant and flowing water Set-up hydraulic tools Don Level A or B HazMat PPE
  85. Read a book chapter Research and write a portion of a presentation Listen to a lecture
  86. Plan and deliver an injury prevention program … Distracted Driving Learning facts about distracted may change student’s attitudes (about risk) and behavior (texting). Deliver to different audiences … teens, civic groups, professional drivers Injury Prevention – poster – develop and distribute. Utilize other campaigns and distribute with other student groups in college
  87. Injury prevention efforts … EMS involvement with anti-distracted driving campaigns http://news.vanderbilt.edu/2013/05/vanderbilt-county-superstar-tim-mcgraw-share-important-message-regarding-dangers-of-distracted-driving/ Highway Don’t Care Music Video http://www.youtube.com/watch?v=KmxaY_OVvWA#at=279 Featuring EMS personnel
  88. Manifesto Online https://www.youtube.com/watch?v=6oeCUM2Alaw http://thesocialmedic.net/2014/04/disturbingly-graphic-distracted-driving-psa-released-by-nhtsa/
  89. An audience could be other EMS practitioners.
  90. Citizen injury prevention campaign from Sunstar Paramedics http://www.sunstarems.com/dont-be-a-distracted-driver/
  91. Citizen injury prevention campaign from Sunstar Paramedics http://www.sunstarems.com/dont-be-a-distracted-driver/
  92. Confrontation of distraction starts with looking at our own behaviors … from a March 2010 article in New York Times. Part of a prize winning series of articles on “Driven to Distraction” New York Times, March 2010 http://www.nytimes.com/2010/03/11/technology/11distracted.html?pagewanted=all Article raises issue of state laws that ban texting while driving but exempt emergency responders
  93. http://www.amerilert.com/first-responder Feature information from Amerilert First Responder is the first and leading text messaging-based dispatch, paging and reply system for Fire Departments, Police Departments, Rescue Squads, and EMS. Amerilert First Responder is the most convenient, reliable, and easy-to-use system to reach your team’s cell phones and pagers in an instant. Responders can reply back to let you know if they are coming and when. Narrowband compatible, use it for primary alerts, secondary alerts, or routine communication for one low predictable cost. You can configure Amerilert First Responder to automatically dispatch pages from the 911 center, PSAP or dispatch center to standard cell phones and pagers of first responders. It connects to Computer Aided Dispatch (CAD) systems via the SNPP protocol for fast and efficient automated alerts. If no CAD system exists, then a police station, fire station or rescue squad can dispatch their own messages from the Amerilert cloud-based interface to the desired groups. No CAD is required for Amerilert to operate. The system can be configured to dispatch alerts to everyone or to specific groups on an alert-by-alert basis. Amerilert First Responder is a highly redundant, geographically-dispersed, hosted communication system operating with 99.999% uptime. This extreme reliability meets or exceeds the performance of many radio-based dedicated public safety alerting systems used by fire departments and rescue squads today. Enhance your CAD system with text message dispatches Dispatch to Fire, Police, Rescue Teams, EMS, etc. Call in Firemen, Off-Duty Personnel, Volunteers, etc. Call out HAZMAT, Technical Rescue, Water Rescue, etc. Call out Tactical Teams, SWAT teams, etc. See recipient’s replies and ETAs Send secondary dispatches with additional info Training, inter-department & vehicle out-of-service alerts Coordinate across independent jurisdictions and departments Improve communications by replacing faulty pager systems Ditch your alpha pagers and reach your crew’s cell phones for much less cost and hassle.
  94. “VFIS wants you to know the facts when it comes to distracted driving while operating an emergency service vehicle.” View, download, or embed full infographic at http://www.vfis.com/free-infographic-firefighter-EMS-distracted-driving.htm
  95. “This week an appeals court in New Jersey suggested that if you text a driver, you too could be in legal trouble. It’s a ruling that’s probably the first of its kind, and it’s at the outer limits of legal liability.” “Behavior change opportunity” http://www.slate.com/articles/news_and_politics/jurisprudence/2013/08/texting_while_driving_a_new_jersey_court_says_you_could_be_sued_for_sending.html 
  96. In Minnesota … as is the case with many other states … “It is illegal for drivers to read/compose/send text messages and emails, or access the Internet using a wireless device while the vehicle is in motion or a part of traffic —including stopped in traffic or at a traffic light.” https://dps.mn.gov/divisions/ots/distracted-driving/Pages/default.aspx Lots of flaws … similar statues in other states No person may operate a motor vehicle while using a wireless communications device to compose, read, or send an electronic message, when the vehicle is in motion or a part of traffic. Subd. 3.Exceptions.  This section does not apply if a wireless communications device is used: (1) solely in a voice-activated or other hands-free mode; (2) for making a cellular phone call; (3) for obtaining emergency assistance to (i) report a traffic accident, medical emergency, or serious traffic hazard, or (ii) prevent a crime about to be committed; (4) in the reasonable belief that a person's life or safety is in immediate danger; or (5) in an authorized emergency vehicle while in the performance of official duties.
  97. From “Minnesota Cell phone use is totally banned for school bus drivers.”
  98. Last sentence of chapter 1 of People Care, 2nd edition by Thom Dick.