An Instant to Decide, a Lifetime to Regret: The Aftermath of Ambulance Accidents

Three years of informal probation and 500 hours of community service doesn’t sound like a punishment many would embrace. But for a California EMT who had faced up to 12 years in prison, it no doubt came as a tremendous relief.

That sentence was meted out to ambulance operator Matthew Swan for his role in a March 2003 accident in which an elderly motorist was killed. After originally facing a charge of felony vehicular manslaughter with gross negligence, Swan, of Doctors Ambulance Service in Laguna Hills, pleaded guilty this past May to a reduced charge of misdemeanor vehicular manslaughter.

The crash resulted from a split-second decision that yielded horrible consequences. Swan, 22, was responding Code 3 to an injury accident. He encountered a traffic jam and veered around it, crossing a double yellow line into a lane used by oncoming traffic. At that moment, 77-year-old Ralph Bellville entered the same lane from the opposite direction. Talking on his cell phone, he didn’t notice the ambulance. The four-ton rig smashed into Bellville’s Mercedes Benz, blasting it 145 feet down the road. Bellville was killed instantly.

The criminal count didn’t come for almost a year. When it did, Swan became the first emergency-vehicle driver ever charged in Orange County Superior Court for a line-of-duty accident.

Beyond the criminal fallout, there were additional prices to pay for Swan, a straight-A student and Eagle Scout who had been interested in emergency medicine since age five. His back was injured—three bulging disks will prevent him from ever lifting a patient again. He endured more than a year of physical therapy, as well as counseling for depression and post-traumatic stress.

“Really,” Swan was quoted as saying in the Orange County Register, “my life stopped on that day.”

Serious Consequences

Life-altering disasters can come with no warning. The instantaneous decisions you make behind the wheel of an emergency vehicle have consequences far beyond you, your health and your career. But is jail something you have to worry about?

Ask Mike Montecalvo, an Ohio medic who, a decade and a half ago, was running hot on a call involving injured children. As he came to an intersection, every car but one stopped. That car’s driver, a pregnant woman, rolled into the crossroads squarely in front of Montecalvo’s rig, which broadsided it, killing her. Montecalvo was convicted of felony vehicular homicide and went to jail. He served, according to the Cleveland Plain Dealer, six months of a 2–10-year sentence.

“That,” says Skip Kirkwood, EMS chief in Wake County, NC, and a senior consultant with the Platte City, MO-based EMS consulting firm Fitch & Associates, “is the banner case for bad things that can happen to you.”

Most accidents EMS drivers get into aren’t fatal, but they can still bring serious consequences ranging from disciplinary actions to the grief and guilt of knowing someone’s been hurt or killed through your actions.

Generalization is hard, of course, because state laws vary and EMS organizations have their own policies and procedures. But there are some things you can probably expect if you get into an accident.

First, there’s dealing with the immediate aftermath. That’s simple enough if you scrape a pole or something minor, but in more-serious cases it could entail tending to injuries, exchanging information, notifying the appropriate bosses and determining if you can and should keep working.

“When one of our vehicles is involved in an accident, the operator immediately notifies dispatch of their ability to continue,” says John Nohr, safety officer for Portland (OR)?Fire &?Rescue, where all personnel are at least EMT-Bs. “Dispatch will then notify the on-duty fire investigator and the appropriate batallion chief. Also, if necessary, they’ll send police for traffic control. And if it generates injuries, they’ll send fire and EMS response.”

The next steps usually involve reports to fill out and higher-ups wanting explanations.

“In our service, personnel fill out an incident report and we take photographs,” says Chuck Kearns, executive director of the Pinellas County (FL) EMS Authority. “Our management team, in particular the risk manager, and the field supervisors are paged right away. Depending on the severity of the loss, the risk manager may go out and look at things, but it’s usually handled by a field supervisor.”

Insurance carriers and, if other people were involved, attorneys need to be notified promptly as well. There also may be a cup to fill.

“Many organizations do mandatory drug and alcohol screenings after accidents,” says Doug Wolfberg, Esq., EMT-P, a founding partner of the national EMS law firm Page, Wolfberg &?Wirth. “It’s not to say there’s suspicion or to single anybody out, but rather to eliminate any possibility that intoxication is an issue.”

After that, it becomes a matter of determining exactly what happened, who was at fault and what will happen to you, the driver.

Fact-Finding

With newfangled camera and black box systems, investigating accidents has become easier. Data will show how fast you were going, how hard you braked and other things you did or didn’t do wrong.

If your service doesn’t use such devices, though, old-fashioned detective work may ensue. An internal investigator may handle this, or it may fall to your agency’s attorney or insurance carrier. Your story is considered alongside accounts from other drivers involved, witness statements and things like body damage, skid marks and other physical evidence.

“Our fire investigators are certified police officers, and they’ll conduct an investigation,” says Nohr. “Basically, they interview all the members on the vehicle, and then any witnesses and other people involved. If it results in a significant injury or death, they’ll call in the Police Bureau’s accident investigation team.”

With some organizations, you may be barred from driving until this investigation concludes.

“With one agency I was with, you didn’t drive again until there’d been a driver review board held,” says Kirkwood. “That usually involved a couple of other line employees and a management person. We also utilized a private investigator who specialized in accident investigation and reconstruction. That group would determine if it was an at-fault accident that required corrective education or discipline, or if it was not avoidable.”

If the investigation clears you, you’re usually back on the road pretty quickly. If not, a range of things could happen.

Within your service, it could include anything from a verbal warning to a written reprimand to a suspension to remedial training or even loss of driving privileges.

Beyond the agency, in some cases, criminal charges may be possible. That’s why it’s important to know your state laws. What extra leeway is given to drivers of emergency vehicles, and what conditions come with it?

“We make sure drivers understand what the law says they must do and what their responsibilities are,” says Richard Simon, a training and loss-control specialist with New York-based emergency-services insurer McNeil and Co. “We also make sure departments’ internal policies are at least of the same level with their states’, if not stricter.”

Knowing the law can’t be stressed enough. Some states extend special protections to employees of public services that aren’t given to those working for privates.

“With a public agency—a local government, for example—a driver may be subject to immunity laws that employees of a private ambulance would not be,” says Wolfberg. “A lot can depend on who owns and operates the ambulance.”

Again, it’s hard to generalize, but know this:?Whatever latitude you’re given is not carte blanche. You still have to exercise reasonable caution.

Says Kirkwood, who is also an attorney: “When a law tells you all the things you can do on an emergency run, there’s always a last line that says, ‘Nothing in this paragraph relieves the operator of an emergency vehicle from the duty to exercise due care.’ And practically speaking, due care means ‘don’t hit anybody.’ You may be able to go through that traffic light, but if you hit somebody, you pretty much own it.”

Civil suits are another possibility.

Protective Steps

There are some steps agencies can take that will help protect them if a crash occurs.

“Make sure managers are doing background checks,” advises Wolfberg. “You don’t want people driving who have histories of reckless driving or DUI. No doubt you should train, and reinforce that training periodically. Make sure folks are familiar with their coverage territory—a lot of accidents arise from hesitation, not knowing where they’re going. And do preventive maintenance, so you’re not getting into questions about things like brakes being worn thin.”

Employees must be vigilant about their rigs’ safety. Check them out before and after each shift, and don’t be shy about pointing out problems.

“If a vehicle’s unsafe, don’t use it,” says Simon. “You, as the operator, may be the one held responsible if something happens. If it’s not safe, it has to be taken out of service.”

On a broader scale, “Have good policies and procedures in place,” says Kirkwood. “Those should be developed in conjunction with legal counsel and, usually, your insurance carrier. And you need to have a culture of safety in your organization. Some of that’s training, and some is the behaviors that management encourages and values.

“A few years ago, there was a string of lawsuits against a national pizza chain, because they said if the pizza doesn’t arrive in 30 minutes, it’s free. That didn’t really mean it was free; it meant the driver paid for it. So the drivers were driving fast, and there were some bad accidents, and a whole lot of money changed hands. We have to be careful not to do that in EMS just because we’re measured on response times.”

Cultures of safety can be modeled by the bosses, but the essential buy-in has to come from the provider behind the wheel. Tragedy only takes a second, and its consequences can be as bad as you can possibly imagine.