Reducing Ambulance Collisions

MONOC Mobile Health Services recently won the fifth annual EMS Safety Award from the Rutgers University Center for Advanced Infrastructure and Transportation. The Safety Awards mark excellence in four categories: enforcement, education, engineering and EMS. MONOC's award recognized its efforts to improve the safety of its ambulance operations.

Nationally, the numbers are staggering: Nearly three-quarters of EMS line-of-duty deaths are from transportation-related accidents. The actual number of ambulance-involved collisions across the country is unknown, as the requirements for documenting such events vary greatly from state to state. Some 70% of fatal EMS crashes occur while using emergency warning devices. Currently, neither a national database nor a universal reporting mechanism exists. The National Highway Traffic Safety Administration believes the number to be in excess of 8,500 accidents annually, resulting in more than 10,000 EMS injuries, and these numbers are thought to be underreported.

In 2006, MONOC undertook a critical review of its own motor vehicle collision rate and decided its numbers were at an unacceptable level, despite not having true data to benchmark against. As part of a collision reduction program, the service's Safety and Risk Management department reviewed the policies and procedures currently in place. Due to the lack of national standards, leaders developed tools and metrics internally. For each collision, we began gathering the following data elements: a police report, a review of the on-board video system, photos, communications from the Control Center, a driver statement (including a 30+-point questionnaire), a free-text narrative and a manager's investigative brief.

We then analyze this data for preventable actions, policy violations and other contributing factors. If trends or patterns emerge, we look to develop preventive strategies. This may include behavior modification in the form of coaching or discipline, revisions or clarifications to driving policies, and technological solutions, including redesign of vehicle color schemes and light patterns.

We redesigned the look of our vehicles to include a modified Battenburg pattern paint scheme commonly seen on European emergency vehicles, a chevron pattern on the rear of the vehicle, green safety striping in retroreflective material outlining the top of the truck and a reconfiguration of the emergency lights to enhance visibility.

Another feature incorporated into the safety program has been promoting defensive driving techniques, which included redefining how ambulances respond to emergency assignments. This was accomplished through policy changes, educational memos and coaching of employees.

As a result of the interventions we put place, we have seen a dramatic reduction in the number of collisions involving our emergency vehicles.

To remain on the cutting edge of safety, MONOC participates in the EMS Safety Foundation, headed up by crash expert Nadine Levick, MD, and the Transportation Research Board of the National Academies. Last summer, MONOC was represented as a team from the Foundation traveled to Germany to see the latest developments in ambulance design and safety at the RETTmobil conference. MONOC is also involved in the NFPA's technical subcommittee for the development of the new ambulance safety standards.

MONOC has not only focused on reducing the number of collisions, but their severity as well. Every accident is assigned a severity rating based upon injuries, cost of repairs and policy violations. The use of emergency warning devices automatically raises the severity score to the next level. As a result, over the three years the program has been in place, there has been a reduction in the number of worker compensation claims and auto insurance payouts, resulting in a significant cost savings.