Shane Lockard, EMS Chief Johnson County Ambulance District

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1 Shane Lockard, EMS Chief Johnson County Ambulance District Missouri Ambulance Association, Board Member Training July 2014

2 Workers' compensation insurance provides coverage for an employee who has suffered an injury or illness resulting from job-related duties. Coverage includes medical and rehabilitation costs and lost wages for employee injured on the job. Required by Missouri Law Chapter 287 of Missouri Revised Statues

3 Occupational injury rate higher in EMS workers that for workers in ANY other industry. Musculoskeletal injuries are the leading cause of EMS morbidity. Fatality rate for EMS workers more than twice the national average. Incidents of needle stick injury has declined. Violence and assault of EMS workers is on the rise. NHTSA, Feasibility for EMS Workforce Safety & Health Surveillance System, 2007

4 Leading Nature of Injury: Sprains and strains 62% Leading Body Area Injured: Back 58% Source of Injury: Moving a patient 36% Other not listed 24% Vehicle accident 14% NHTSA, Feasibility for EMS Workforce Safety & Health Surveillance System, 2007

5 Total Injuries/ Illnesses: 27,800 Sprains & Strains: 11,300 (41%) Event/ Cause Body exertion: 10,500 (38%)

6 Repetitive lifting of heavy people. Bariatric / obese population increasing Lifting and moving in unusually positions. Highway/ street strikes Vehicle accidents Slips and falls Violence against EMS Exposure to infectious disease

7

8 Key to calculating work comp premiums How is this calculated? A companies actual losses are compared to the expected loses by industry type Current mod calculated based on previous three years losses. A mod greater than 1.0 = increased cost in premiums A mod less than 1.0 = a decrease in premiums

9 Experience Modifier set at 1.21 Added $15,751 in additional WC cost Why high exp. Modifier? Several high cost injuries Injuries with long off work times Rotator cuff injury with surgery A couple back injuries with surgery

10 1.30 Exp Mod Exp Mod

11 Experience Modifier Exp. Modifier $$ $1,342 ($18,750) Schedule Rating -5% -25% Schedule Rating Credit ($3,423) ($28,794) Total Premiums $67,264 $84,811 Total Payroll Expense $1,237,145 $2,136,000 WC % of Payroll 5.44% 3.97% Credits & Savings $47,544

12 6.00% % of Payroll 5.00% 4.00% % of Payroll 3.00%

13 Premiums Savings $19,657 $14,938 $13,553 $33,380 $31,324 Over 5 Year Period $112,855 in Work Comp premium savings

14 Increased workers compensation premiums Lost worker time = overtime for shift coverage Administrative costs It takes time to manage a workers comp claim Once injured, an employee is more likely to have another injury Lost of qualified & experienced personnel

15 1. Proactive Strategies Prevent / reduce work accidents and injuries! 2. Properly manage work comp incidents. Claims management 3. Investigate and learn 4. Implement corrective actions to prevent re-occurrence

16 1. Identify work hazards 2. Understand the hazards 3. Take action to mitigate the hazards Be intentional and specific in goals Be realistic

17

18 1. We identified most frequent and most costly injuries. 2. We researched the root cause and contributing factors. 3. We developed an action plan. 4. Evaluate results

19 Elimination: Could not eliminate but we could reduce frequency. Revised procedures and protocols to eliminate or reduce unnecessary lifting and moving of patients. Example: Assist ambulatory patients to walk to stretcher positions outside home.

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21 Engineering Controls: Purchased equipment to assist in lifting and moving patients Purchased power lift cots Purchased track system stair chairs Purchased slide boards for all cots

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23 Over 5 year period we purchased: 10 Ferno PowerFlexx cot with ICS charging systems 10 Ferno EZ Glide stair chairs Total Capital Expense: $109,160 Over 5 Year Period $112,855 in Work Comp premium savings

24 Administrative Controls: 1. Revised SOPs providing clear guidance on lifting and moving of patients What equipment shall be used When to call for additional personnel (lift teams) 2. Implemented MANDATORY TRAINING New hire training Annual refresher training

25 1. Online lifting and moving training with video and a test. 2. Classroom review of safe lifting standards and techniques 3. Hand-on practice with observation and skills validation Lift real weight mannequin Use actual equipment we use Use real life scenarios

26 2010: 1 Injury. Strain to shoulder with doing maintenance on Ambulance Claim Cost: $18, : No cost claims 2012: 1 Major Injury to hip. Lifting patient. Claim Cost: $38, Minor Injury. Ambulance Accident Claim Cost: $ : 1 Minor Injury by lift Claim Cost: $3, : 1 Injury slip & fall on ice Claim Cost: $3,742

27 Using the Report Only All job related injuries must be reported to workers comp. Smaller injuries can be reported as a report only. Under Missouri law an employer has the right to pay up to $1,000 of medical costs on report only claims. This reduces your actual losses (claim costs) and improves your Exp. Modifier. If work is available, have a light duty/ return to work program.

28 Since 2010 we have had 26 Work Comp reports. Only 5 reports had a loss reported. 21 report only claims Lifting patient 1 Meningitis exposure 7 Bloodborne exposure 2 Combative patient 1 Cut 2 Fire/ burn 2 Poison ivy exposure 1 Slips & fall 6

29 Slips & falls 6 of the 7 falls occurred due to ice. Issued Yaktrax to all employees. $10 a pair Only one fall on ice in Employee was not wearing his Yaktrax while shoveling the walkway

30 The goal of a Just Culture is to create a learning culture, create an open and fair culture, design safe systems, and manage behavioral choices. Move away from an overly punitive reaction to events and errors. Not punitive but also not blame free. Employee can admit to mistakes. To Err and Drift is Human.

31 A human error is defined as inadvertently doing other than what should have been done. These are often referred to as a slipup, lapse, or mistake. The employee did not intend to make the error. Best addressed by coaching and counseling. Remedial training if necessary Look for ways to reduce opportunity for error.

32 At-Risk behaviors are behavioral choices that increase the risk where risk is not recognized, or is mistakenly believed to be justified. At- Risk behavior involves a knowing deviation from the desired behavior that unknowingly increases the risk and/or the likelihood of human error. They are not intentional choices to put others in harm s way, but drifting behavior that deviates from what was taught.

33 Reckless behavior involves an employee engaging in behavior that they know will increase substantial or unjustifiable risk. This behavior includes: Behavior involving a conscious disregard of a substantial and unjustifiable risk of causing harm or damage. Gross negligence - a conscious disregard of a visible, significant risk. Intentional Rule or Policy Violations an employee knowingly violates a rule or policy. Recklessness behavior requires disciplinary actions.

34 To Err and Drift is Human. 1. Provide effective training Train like you work Don t just go through the motions 2. Coaching and counseling 3. Disciplinary action when necessary

35 1. Identified most frequent and most costly injuries. 2. Researched the root cause and contributing factors. 3. Developed an action plan. 4. Evaluate results

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