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.