Across EMS and public safety, few will speak ill of driver training. It's accepted as a prerequisite for running a safe system, and a necessary prophylactic against consistently high crash and injury rates. Whenever something bad happens to an ambulance on the road, among the first questions you're likely to hear is, "What kind of training did they do?"
Thing is, the notion that driver training yields a safety benefit isn't quite substantiated in the literature. A review of the science by researchers with Canada's Traffic Injury Research Foundation led them to conclude that "international literature provides little support for the hypothesis that formal driver instruction is an effective safety measure." A similar review at www.ambulancedriving.com agreed that "the assumptions upon which [the safety benefit] argument is based are not supported by the research." And a spokesperson for the Insurance Institute for Highway Safety flatly told the New York Times in 2000 that "There has never been a study in this country or any other country that shows there is a reduction in crashes as a result of taking driver training."
And yet...it seems intuitively insane to put a newbie EMT behind the wheel of a rig and unleash them on the community without some specific training. So what's a boss to do? When it's up to you, how can you maximize your providers' chances of going and coming safely, ensure the safest possible environment for your patients, and do what you can to protect the citizens around you?
If you're the sort to start with evidence, you might consider a real-time driver monitoring and auditory feedback system.
"The bottom line is, the only independent data showing effectiveness and sustainability [in creating safer EMS driving behaviors] is the data on the real-time auditory feedback devices," says ambulance safety expert Nadine Levick, MD, who has authored two of the strongest of these studies (available at www.objectivesafety.com). "It is profoundly powerful data that shows up to a thousand-fold improvement in safety proxies. No other device has come close to that."
Levick's studies tracked use of the Road Safety system by Little Rock's Metro EMS in 2003-04 and Pennsylvania's Cetronia Ambulance in 2004-06. Both systems saw big improvements in safe driving behaviors. Metro improved from a baseline of 0.018 miles between penalty counts (instances of drivers exceeding defined thresholds for things like braking, turning and acceleration forces, etc.) to a high of 15.8, and saw a 99.97% drop in seat-belt violations. Most important, their crashes were fewer and less severe. Cetronia saw speeding incidents drop from 14.94 penalties per mile driven to 0.00003, and seat-belt violations from 4.72 to 0.001. During the study period, it experienced no major crashes after full implementation.
The key to these improvements, Levick suggests, is the real-time auditory feedback that alerts drivers when their operation crosses a line.
"Human beings respond to auditory stimulus much more rapidly than to visual," she says. "That's why we have auditory alarms on our medical devices, and things like microwaves and pagers. There's a lot of literature documenting that."
Yet simply sticking black boxes into your ambulances, then sitting back to tally up violations isn't enough. Services that utilize solutions like Road Safety and DriveCam (a popular video-based feedback system) aren't likely to derive full benefit from them without some additional elements. Management has to stay involved in defining desired driving behaviors, imparting and refreshing them for personnel, examining performance data and addressing those with persistent problems.