Sue Lani Madsen: Safety first or safety third?

Back in March when we all still agreed there was an emergency, a new cliché emerged in our standard farewell routines. “Stay safe,” said the checker at the supermarket. “Stay safe,” said the host of the Zoom meeting. “Stay safe,” said the governor at the end of press briefings. It was more annoying than “have a nice day.” There is no safe, risk-free option for living life. We can reduce or mitigate risks, balance risks with benefits or outsource risks to others, but there is no way for everyone to “stay safe.”

Wouldn’t bother me a bit to walk through a smoky bar to use a restroom in Idaho, with or without masked patrons. The benefit outweighs the minor potential of exposure to any virus, as long as I reject offers to join a stranger on the dance floor. It’s a simple risk/benefit analysis. In my life, safety isn’t first. It’s third.

Safety Third was introduced by TV personality Mike Rowe in 2009 to start a conversation about unintended hazards to occupational safety of the Safety First motto. He gives an example of a safety officer on the set of Dirty Jobs insisting Rowe wear a life jacket to stand in 10 inches of water because the “safety first!” checklist said so. Compliance over effectiveness. Safety Third training has now been adopted in formal occupational health and safety courses. Pandemic face coverings with “Safety Third” printed across blaze yellow fabric are available from MikeRoweWorks.org, supporting scholarships for people entering the essential skilled trades we’ve rediscovered we can’t live safely without.

Unenforceable mandates about masks or how many come to Thanksgiving dinner are an example of putting compliance ahead of effectiveness. Advice from Daniel Halperin, author of “Facing COVID Without Panic: 12 Common Myths and 12 Lesser Known Facts about the Pandemic: Clearly Explained by an Epidemiologist,” as quoted in the Wall Street Journal: “Many of these mandates and guidelines fixate on behaviors and settings where the actual risk is very low, such as fleeting public encounters. … Meanwhile, measures which could have the greatest prevention impact, such as re-engineering buildings to improve air circulation, are still not widely prioritized – not to mention even simpler actions, such as opening windows to allow outdoor air to circulate indoors.”

The number of public officials rationalizing violations of their own pronouncements are feeding rebellion. It confirms what we know to be true in our own lives. Context matters. And so mandates may end up ignored when they might be useful and punitively enforced where the benefit is low. Mandates are not a way to unite us forward into 2021.

To be clear, I don’t care what political message anyone thinks they are sending by wearing or not wearing a mask. Reading studies – not just talking-point headlines – on how, when and under what conditions masks are most useful is for my personal protection, not political posturing.

People living safe lives depend on those who take risks. As an EMT, I’ve been responding to 911 calls throughout the pandemic. We’ve always had good protocols for universal precautions – gloves, masks and goggles or face shields. But understanding what protection each piece of PPE provides in light of what currently is known and ever changing about COVID-19 is critical to adapting to context.

Like responding with law enforcement to a situation where masks made safe de-escalation impossible. Or trying to communicate with a patient who can’t hear you without seeing your lips, so a clear face shield without the cloth mask is a better choice. Or in the middle of CPR and your mask slips. Putting it back into place is a low, last priority.

Emergency medical services have relied heavily on a Safety First model. In every training, the correct answer to “what’s the first step” is to determine if the scene is safe. A 2018 article in the Journal of Emergency Medical Services points out the priority is to get the job done and “safety plays a role at the very highest priority level, while not itself being the highest sole priority.” If safety was truly first, we’d stay safely home when the pager goes off in a snowstorm. Safety First is shifting to Safety Third, after getting the job done and done well.

To be continued … Judging Risk and Reward

Contact Sue Lani Madsen at rulingpen@gmail.com.