Ambulance Crashes: Fatality Factors for EMS Workers

In a Morbidity and Mortality Weekly Report article published in February 2003,1 the National Institute for Occupational Safety and Health (NIOSH) identified 27 EMS worker fatalities in ambulance crashes reported in the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (FARS) for 1991--2000. This article presents a more in-depth look at the 25 crashes that resulted in these 27 fatalities, focusing primarily on ambulance configurations, roadway and environmental conditions, and driver-related factors.

What We Examined

FARS is "a collection of files documenting all qualifying fatal crashes since 1975 that occurred within the 50 states, the District of Columbia and Puerto Rico. To be included in this census, a crash had to involve a motor vehicle traveling on a trafficway customarily open to the public, and must [have resulted] in the death of a person (occupant of a vehicle or a nonmotorist) within 30 days of the crash."2 Data for FARS are collected primarily from police crash reports.

Cases for this study were selected by searching the "Special Use" variable for those vehicles coded as "Ambulance." EMS workers were identified by searching the "At Work" variable for occupants of ambulances; only those coded positively for at-work were defined as on-duty EMS workers to be included in this analysis. As stated above, the years examined included 1991--2000; however, while there were ambulances involved in crashes, no EMS worker fatalities (using our definition) were reported in FARS in 1999 or 2000.

Findings

Overall--During 1991--2000, 300 fatal crashes occurred involving occupied ambulances, resulting in the deaths of 82 ambulance occupants and 275 occupants of other vehicles and pedestrians.1 Of the ambulance occupants killed, 27 (33%) were on-duty EMS workers.1 Twenty-five ambulance crashes accounted for the 27 EMS worker fatalities: two incidents each in which two EMS workers were killed, and 23 with single EMS worker deaths.

Vehicles--Using the make, model and weight code for trucks and vehicle identification number data, one ambulance (4%) was identified as Type I (truck chassis with patient compartment attached), five (20%) as Type II (van with extended roof) and 11 (44%) as Type III (cutaway van chassis with patient compartment attached). Eight (32%) were not classifiable with the information available.

Roadway/Environmental Condi-tions--Eighteen of the 25 fatality incidents (72%) occurred at non-interchange (all roadways on the same level), non-junction locations--or, more simply put, did not occur at intersections. The remaining seven (28%) took place at intersections or were intersection- or crossover-related. Of the 300 total crashes, 132 (44%) occurred at non-interchange, non-junction locations; 134 (45%) occurred at non-interchange intersections.

Fifteen of the 25 fatal crashes (60%) took place in daylight; 18 (72%) in normal ("fair") weather; 17 (68%) on straight, level roadways; and 18 (72%) on rural roads.

Ambulance Role (Striking vs. Struck)--Designating a vehicle as "striking" does not necessarily mean that vehicle was at fault. For example, in a head-on collision between two vehicles, both may be designated in FARS as having the role of "striking" for the incident. In 233 (78%) of all 300 crashes involving fatalities, the ambulance was a striking vehicle; for those 25 in which an EMS worker was killed, the ambulance was a striking vehicle in 20 (80%). Three of the incidents in which an EMS worker was killed were defined as "non-collision" (12%), and two of the ambulances (8%) were struck by other vehicles.

Driver-Related Factors--Data pertaining to the driver of each vehicle involved in a fatal crash are included in FARS; therefore, it is possible to examine a number of driver-related factors that may have contributed. "Not in lane" (the ambulance not traveling in the proper lane) and "driving too fast" (for conditions or in excess of posted speed limits) were the most-cited driver-related factors. Since more than one of these factors may be entered in FARS for each incident, these two factors are cited a total of 19 times, either individually or in combination, in 15 (60%) of the 25 crashes.