Why You Need a Big Brother

This article appeared in the supplement Ambulance Safety Solutions sponsored by ZOLL Medical Corporation

Expert source: Jerry Overton, Former CEO Road Safety International

In recent years, black box recorders have been primarily known for the important role they play in determining the causes of airplane crashes. But "black box" technology is also gaining a foothold as a safety measure in the ambulance industry with its ability to modify driver behavior.

"The box is designed to provide data in two different ways," explains Jerry Overton, former CEO of California-based Road Safety International, manufacturer of black box recorders. "First is real-time, audible feedback so the driver of an emergency vehicle is aware that he or she is driving over the predefined speed limit or is placing too many G forces on the vehicle. I say that in terms of whether we're giving the patient a safe ride to the hospital. The box measures whether the driver is braking too hard or accelerating too fast, or if he's taking turns too hard. When he's braking too hard, it's clearly not good for the patient or for the safety of the medic in the back of the vehicle. If the driver is accelerating too fast, he hears an audible growl as a warning that he's about to exceed the G-force limit. When it becomes a solid sound, it means he has in fact exceeded the predefined limits. With this audible feedback, the idea is to provide a safer response to the scene and a smoother ride for the patient."

"At the same time that is happening, the box is recording second by second the activities within the vehicle," Overton continues. "It records whether the seat belts are fastened or whether the lights and siren are on, so we can go back five minutes, five days or five years and look at what was going on with that driver at any point in time. The data for all of the units is recorded on a daily or monthly summary to identify the best drivers and those are violating policy, so it's a real opportunity for re-education."

Although the black box could create a "big brother" perception, once medics understand it's for their own protection, they accept it, says Overton. He gives an example of one incident that occurred when he was chief executive of Richmond (VA) Ambulance Authority that could have had a very different outcome without the black box technology. "There was a bit of paranoia when we first implemented the technology, but about a month into the implementation one of our ambulances collided with an unoccupied school bus at an intersection," he says. "The city school bus system representatives said the driver did not have his red lights and siren on and he had not stopped for the light, even though he was clearly responding to an emergency call. We immediately downloaded the data, which cleared our medics, and the school bus driver was cited. It was that type of incident that made believers of our paramedics and EMTs. Here was a situation where it was one person's word against another, and the box, which is accepted by law enforcement agencies, provided the data that showed what was going on at that specific time and exonerated our driver."

EMS services not using the technology probably don't yet understand the benefits, says Overton. Not only does it enhance patient and medic safety, he says, it's an economic benefit to the system because it cuts down on maintenance costs for key mechanical components like brakes, tires and engine parts, extends the useful life of the vehicles and makes them safer to drive. According to Overton, the black box is currently being used in more than 200 agencies in the United States and Canada, and will soon be implemented in an EMS service in England.

"From a general perspective, I've always been known as an advocate for paramedics, and we really do need to keep them safe," says Overton. "From an administrator's standpoint, there's always this concern regarding response times, and because we're doing real-time behavior modification, are the response times going to be longer because of limitations on high-speed or high-force driving? My response to that is, it's the responsibility of the EMS administrators. We should not be putting pressure on the drivers to respond quicker. We need to do everything we can to ensure their safety responding to the scene, as well as safety of both patient and medic as they respond back to the hospital. As administrators, we need to be aggressive in our attitudes toward safety so devices like the black box are not viewed as something negative, but as something positive. The box is just another tool that helps us create a complete culture of safety in our EMS systems."

For more information on Road Safety, visit www.roadsafety.com.

Optimal Solution for Enhancing Ambulance Safety

   In 2003, a prospective study was conducted at the Metro Emergency Medical Service (MEMS) of Little Rock, AR, to determine if emergency vehicle driver behavior can be modified and improved by installing an onboard computer-based monitoring device with real-time auditory feedback manufactured by Road Safety. Data were collected over an 18-month period from 36 vehicles and more than 250 drivers. Implementation was well received by EMS personnel, and more than 1.9 million miles of vehicle operations were recorded. Between April 2003 and August 2003, seat belt violations dropped from 13,500 to 4. There was a 20% cost saving in vehicle maintenance within six months, with 10%-20% less brake and tire wear and reduced oil consumption. There was no increase in response times, although call volume did increase over the study period. There was only one minor vehicle mishap.

   Authors of the white paper that followed the 2003 study acknowledge that in the first month, drivers were more aware of the black box technology, which resulted in better performance than prior to installation. By the end of Phase 1, it was assumed they had returned to more normal baseline driving habits and there was a rise in the number of violations. In Phase II, once audible tones were switched on, there was once again a dramatic improvement in safety performance.

   Authors Nadine Levick, MD, MPH, and Jon Swanson conclude there has been dramatic and sustained improvement in driver performance in every measured area with the Road Safety onboard computer monitoring and feedback system. Use of the system proved to be highly effective, requiring minimal in-service training time and demonstrating optimal safety outcome in addition to a cost savings in maintenance. The researchers encourage widespread implementation of the monitoring system throughout EMS to optimize safety.