A Safer Place to Work

   Jim Swartz, president and CEO of Dallas-based CareFlite, Inc., is a man with a mission. Swartz is out to change the way EMTs and paramedics operate in the back of an ambulance, starting with a safer place to work. To date, CareFlite is the only ground service in the United States to completely eliminate side-facing seats in its emergency vehicles.

   "A couple of years ago, when I attended the Medical Leadership Training Institute in Wheeling, WV, it became very clear that the overwhelming majority of deaths in EMS occur in motor vehicle accidents, most of which take place in intersections, and the No. 1 cause of death is unseated medics," he says. "I started thinking if we can get a nurse and flight medic seated with a belt and shoulder harness so they can still render aid in a helicopter, we can do it in a truck. But, upon further investigation, I found out there are no rules for ambulances in the country. They're exempt from Federal Motor Carrier Safety Administration rules. Not only that-nobody in EMS knows what their accident rate is. I spoke to more than 300 people at one conference, and nobody in the room had that information. I told them, 'If you don't know what your rate is, how do you know how to improve it? How do you know if you are improving it or if your programs are helping?' That's pretty startling."

   Working with safety expert Nadine Levick, MD, and the EMS Safety Foundation, Swartz began studying emergency vehicles in places like Europe, Canada and Australia, all of which have much stricter safety standards. One of the first things that struck them was that the standard bench seats have to be changed. "If you wear a shoulder harness on a bench seat and you have a sudden stop, it's going to cut your head off," says Swartz. They finally concluded that the European-designed Sprinters were their best solution, because they have been tested to meet the European standards, and already have forward-facing seats built in. It just happens, says Swartz, that Crestline's one representative in the U.S.-Lone Star Emergency Vehicles-is based in Texas, so Swartz paid them a visit.

   "I told them the No. 1 thing I wanted was to have forward-facing seats, which are made in Denmark and are tested to 20 Gs," he says. "There's plenty of room in the vehicle for loading and unloading, because the seats fold up out of the way, then open and swivel to face forward, which is the only position you can use them in. If you leave them down in a sideward position, you can't sit in them because your knees are up against the stretcher. That was the one thing I wanted to accomplish." CareFlite now has four Sprinters in service and another 20 soon to be delivered from Crestline's Canadian facility. In addition to the new seats, the vehicles will have monitoring and suctioning equipment on the forward wall facing the medics, and special compartments for loose equipment that face the outside and are secured when the door of the vehicle is closed. "The seated medic can reach all of his soft goods without ever having to unbuckle, so there's very little that would require him to get out of that seat," says Swartz.

   In the long run, however, there's a lot more involved in ambulance safety than changing the configuration of emergency vehicles, says Swartz. "You have to have protocols about whether to treat or transport, or when it's OK to get out of your seat," he says. "The ground ambulance industry kills its employees at a rate of about 10 times that of the air medical business, and we kill more people every year than are killed in law enforcement or fire. The only way to fix this is to be proactive and do things properly. These aren't accidents-they're crashes. If you see a bunch of people sitting in the back of a pickup truck, you think, 'How can you be so idiotic?', but we think it's OK for medics to stand up in the back of a truck when it's going 70 mph down the highway. You can't be in a business that's here to save lives and then disregard the safety of the people who are giving the service."