Taking a Stand On Safety

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

Expert source: Jerry Johnston, Past-President, National Association of EMTs

   The National Association of EMTs (NAEMT) has been a long-time advocate for patient and provider safety. In response to members' concerns about the number of ambulance crashes and unsafe driving behaviors, NAEMT developed the following position statement:

   "EMS is a transport-based emergency service with practitioners providing a variety of treatment modalities conducted during patient transportation to a healthcare facility. Serious factors exist in ambulance safety, creating a high risk of occupational injury and death for EMS practitioners during patient transportation. NAEMT supports the development of a culture of safety in all EMS systems in our nation. NAEMT is committed to advocating for the safest practices and regulations that protect and promote EMS patient and practitioner wellness during ambulance transportation."

   Following is a partial list of requirements specified in the position statement:

• Federal funding for ongoing research and testing of ambulance vehicle design
• Federal or state development of a reporting system to identify and track ambulance crash-related injury and death
• The Department of Transportation tracks ambulance crash data and makes safety recommendations
• EMS systems implement a safe ambulance operation management program that includes risk management
• Employer required proficiency training, orientation and continuous quality assurance on vehicle driving and operation
• Employer monitoring of driving behaviors through observation and use of onboard monitoring systems.

   "There's no solid data on ambulance crashes and safety as far as a central repository, but, anecdotally, it's startling how many people are hurt in the line of duty overall," says NAEMT past president Jerry Johnston. "One of the things that struck us is that there have been no modification or design changes in ambulances. With few exceptions, they're built the same as they were in the 1970s and '80s. We've rounded corners and added padding and safety nets, but there is a question whether that does any good."

   NAEMT's decision, says Johnston, was to look at ambulance safety as scientifically as possible rather than just advocate for design changes that couldn't be proven to be any safer.

   "We now have a position on NFPA's committee, which is talking about coming out with an ambulance specification that has a better design, not only from a safety standpoint but from an end-user's standpoint as well," he says. "There's more to this injury thing than working in the back of an ambulance, but that's probably the most significant. There's no way to secure a medic who has to hover over a patient. People have tried harnesses and other things that don't work. The safest place in the back of an ambulance is still seat-belted in the captain's chair at the head of the patient."

   All of the important players are working on the issue, says Johnston: ambulance manufacturers, NFPA, NIOSH and GSA, which has written the KKK specs for many years.

   "One of the things that has really come to the forefront in the last five years is that the KKK spec was used for the federal government's procurement process. That's how they buy their ambulances. A lot of EMS organizations believe their ambulances have to meet the KKK specs, but the GSA office is quick to point out they never intended it to be a federal ambulance standard," Johnston says. "So it's good to have them bring a historical perspective to the process. I don't think anyone says we don't need to build a better, safer ambulance, but coming up with data to back it up is a real challenge, because the information isn't out there."

   As an administrator and still-practicing paramedic, Johnston believes this is an industry-wide issue--not just a federal government policy-making decision.

   "It has to start with the people who work in the ambulances and their administrators saying, 'We have to fix this problem. We have to quit hurting and killing our people in the line of duty as best we can. The onus is on all of us who work, administer or write policy. We all have to work together to address this.'

   "As far as NAEMT is concerned, this position statement was actually the genesis for our Health and Safety Committee, which is a cross-section of our membership that has been working on a safety course for EMS providers that we want to have available in the next year," continues Johnston.

   "In addition to our members, I believe there's even a representative from the insurance industry on the committee, so we're trying to capture anyone who has a vested interest in having safer EMS practitioners. The course will address operational aspects of EMS safety, as well as health and wellness and the entire gamut of what we can do to create a better, more healthy work force that is safer on the job."

   For NAEMT's position statement on EMS ambulance safety, go to www.naemt.org.

GET 1.5 CE CREDITS COURTESY OF ZOLL

After reading this supplement, go online to rapidce.com to take a test and receive 1.5 CEUs courtesy of ZOLL Medical Corporation. This CE activity is approved by EMS World, an organization accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS).

Objectives

• Explore the risk to EMS professionals inherent in their work to assess, treat and transport patients
• Identify specific causes of death and career-threatening injury to EMS professionals
• Understand tools, techniques and technologies for mitigating risks to EMS professionals during patient treatment and transport
• Explore how EMS professionals can apply situational awareness concepts to their job performance