It's a great paradox that ambulances can represent such a dangerous environment. Their unsettling rate of crashes, per NHTSA's Fatality Analysis Reporting System (FARS) data, is 3,200 per 100 million miles-eight times the rate of cars and light trucks. Other calculations range over 5,000. According to a study conducted last year, ambulance crashes are 27% more likely to be fatal than police equivalents, and 33% more likely than fire crashes. Overall, EMS workers' on-the-job fatality rate is more than twice the national average, and nearly three-quarters of those deaths are transportation-related.
The threat is especially high when running hot, with 60% of crashes and 58% of fatalities happening with lights and sirens. Providers riding in the back are also at greatest risk. Over a 10-year period, 72% of those killed in ambulance crashes were in the back, although only 40% of total occupants were there. Many of these providers were working unrestrained, but even restrained providers can be at risk through design factors and structural vulnerabilities. Precise data can be hard to come by, but there's no doubt the perils of transport are a major threat to the safety of providers, patients and the public at large.
But there's good news too. In recent years the EMS profession has come a long way toward waking up to these dangers. And now, through the efforts of manufacturers, advocates and makers of advanced technologies like automated chest compression devices such as the ZOLL AutoPulse that benefit both patients and providers, we're doing something about it.
"There are a number of areas where there's been a lot of progress, but maybe the biggest is simply awareness," says prominent ambulance safety expert Nadine Levick, MD, MPH, who heads the EMS Safety Foundation and Objective Safety, two organizations working to advance the cause.
"What we do is both medicine and transport. While we have fairly robust guidance on the medical side-with protocols, policies, research, evaluation and oversight-what's happening now is a big movement forward on the transport side, with that same sort of focus, interest and scientific attention. That's a huge step."
In particular, the scientific aspect of current efforts is worth recognizing. The fact is that evidence-based, scientifically grounded interventions are preferable to those simply intuited, even by experts. For an example in the ambulance environment, look no further than side-facing bench seats and how providers are restrained in them. Absent crash data, you might think a body harness might keep a provider better restrained on such a seat than a mere lap belt. In truth, it transfers the entire force load in a frontal collision to the head/neck, rather than distributing it across the entire upper body, creating a large and dangerous injury risk. Such a restraint would, in reality, make a bad situation (side-facing seats) even worse.
So what does the evidence say improves ambulance safety? Start with driver monitoring systems that provide real-time auditory feedback when certain operational parameters (speed, acceleration, turning forces, etc.) are exceeded.
"The feedback devices, because they serve as both a training tool and a systemwide data collection tool, are probably head and shoulders above everything else as far as bang for your buck," says Levick. "They give you an outcome that's measurable and that's directly attributable to a safety solution."
For the research supporting that, see objectivesafety.net. Meanwhile, new smartphone-based technologies now being trialed may soon present a cheaper, easier way to accomplish similar objectives.