Crash Capture
While ambulance crashes across the country kill and injure responders, patients and civilians annually, there is no central database to capture just how serious the issue is.
There have been a number of studies in various areas of the country. While the numbers may vary, one thing remains constant—working in an ambulance is dangerous.
Common factors involved in wrecks whether they were in a rural or urban area include human error, operational issues, vehicle design and environment, according to Dr. Robert Bass, executive director of Maryland Institute for Emergency Medical Services Systems (MIEMSS).
Speaking recently at the Winterfest EMS conference on Maryland's Eastern Shore, Bass said that without a central database to track the numbers, it's difficult to grasp just how many crashes occur.
"Statistics likely under represent the magnitude of the problem," Bass said. "There's a need for a national system to collect data on emergency vehicle collisions."
A study in 2003 in the Detroit News estimated 6,500 ambulance collisions annually injured 10 people daily, and killed two a month.1 Bass noted that other authors also speculated that an ambulance is 13 times more likely to be in a crash, and five times more likely to involve an injury. These statistics were published in Prehospital Emergency Care in 2004.2
Another study published Annals of Emergency Medicine in 2002 showed EMS personnel have a fatality rate of 9.6 percent per 100,000 workers compared to 6.1 for police officers and 2.0 for firefighters.3 This article also indicated that more than half of workplace fatalities for EMS are transportation related. The lack of seat belt use increases the possibility of serious injury or death for everyone in the ambulance.
"The sicker the patient, the less likely the provider will wear a seat belt," Bass noted.
A study examining fatality data between 1991–2002 showed 7 of 11 drivers, 2 of 5 right front passengers and 6 of 7 providers in the patient compartment were not restrained.
In addition to the provider being buckled up, patients on the cot and children also need to be properly secured, he said.
"Equipment also needs to be tied down. In a wreck, it flies around and can hurt or kill you."
Bass also suggested crews take a look at the use of lights and sirens. One study showed 91% of ambulance crashes occurred during emergencies.
"Lights and sirens frequently do not save that much time, and infrequently improve patient outcomes," he said.
The use of both saved 43.5 seconds in Greenville, N.C., he said quoting a study.
Fatigue and distraction, as well as bad drivers, also contribute to the ever-increasing number of ambulance crashes.
A sleepy driver is a dangerous driver, he said, adding that it generally takes someone 45 minutes to be fully awake. He also voiced concern about how alert a person is nearing the end of a 24-hour shift.
Bass said he knows some personnel on shift work arrive tired from working their other jobs. "You'd think they'd be ready to work, but I know that's not always the case."
He also mentioned that several studies showed that many people behind the wheel of ambulances had poor driving records including previous crashes.
Ambulances also are full of things to distract the driver from paying attention. They include the radio, switches for lights and siren, computers as well as chatter.
While the NTSB has recommended standards regarding occupant protection, driver training and design, Bass said they have not been adopted.
He told the crowd that they can help change the culture by promoting education as well as enforcement and engineering.
Committed to making things better in Maryland, Bass formed an Ambulance Safety Taskforce. That group, which Bass is chairing, is comprised of EMS personnel, firefighters, doctors, nurses and others. They have formed several sub-committees and will look at operational and vehicle design as well as human and environmental issues.
"They will come up with a white paper with recommendations on how we can improve ambulance safety in Maryland," he said, adding that a symposium on the issue also is planned for later this year.
More information about the Maryland Ambulance Safety Task Force can be found at https://miemss.org/home/
References
1. Zagaroli L, Taylor A. Ambulance Driver Fatigue a Danger: Distractions Pose Risks to Patients, EMTs, Traffic. Detroit News Washington Bureau, Washington, DC, USA, 2003.
2. Eckstein, M. Primum non nocere—first do no harm: An imperative foremergency medical services. Prehospital Emergency Care, 8(4), 444-446, 2004.
3. Maguire BJ. Hunting KL. Smith GS. Levick NR. Occupational Fatalities in EMS: A Hidden Crisis. Annals of EmergencyMedicine. 40(6): 625-632, 2002.
