Every day, calls for emergency assistance come in, and ambulances respond with lights and sirens to assist the sick and injured. It would be a safe guess that many, if not most, of the EMTs and paramedics driving these vehicles never slow down to think about exactly what they are doing. They are, in fact, taking a vehicle that can weigh more than 10 tons, turning on its lights and sirens and, by the inherent nature of driving, placing themselves, their partners, their patients and the communities they serve at risk of injury.
In the relatively short time that EMS has existed, it has made many advances in the training and education of providers in clinical areas. New paramedics are mandated to have knowledge of cardiac care, advanced airway skills and a multitude of medications. However, nowhere in most curricula is training and education for the use of an emergency vehicle addressed. This leaves individual educational institutions to formulate their own training programs, or to use a program such as the Emergency Vehicle Operators Course (EVOC) or Coaching the Emergency Vehicle Operator (CEVO). In the rush to train students on the actual operation of the ambulance amid everything else that must be accomplished prior to the Registry exam, the educational portion pertaining to the responsibilities of the driver and the factors that contribute to poor driver performance are often neglected. This can lead to an important lack of knowledge, and without identification and further education by an employer, it may contribute to accidents involving ambulances.
What does it take to operate an emergency vehicle in a safe and defensive manner? First, the operator must formulate a proper attitude toward the process of driving a vehicle. According to work by Dr. Noel O. Mintz of Emporia State University, in almost every case of an automobile crash, there "appears to be an attitude or attention problem. The driver of an automobile involved in a crash has most likely ignored reduced-risk driving practices while driving into…a situation that could have been avoided." He goes on to state that, "It is far better to develop skills in anticipating and recognizing danger than to rely on dodging skills, responses in emergencies, or fast reaction time."1
Mintz also cites a 1994 report to Congress in which the Department of Transportation indicated that "In many cases, [traffic] crashes are not caused by a lack of knowledge of basic traffic laws or lack of basic vehicle handling skill."1
Both of these references speak directly to the need for drivers to develop a defensive attitude toward the process of driving. This is even more paramount when driving an emergency response vehicle. Simply having the skill to dodge an object is not enough. Having to dodge an object probably means the driver could have taken an action to prevent being in that situation in the first place. This is a key element of a proper driver attitude and is important to recognize in becoming a safer driver.
Driver and Attitude Types
Drivers have historically been placed into two camps. The first, aggressive drivers, we hear about all too often in the news. The New York State Police define an aggressive driver as one who "Operates a motor vehicle in a selfish, bold or pushy manner, without regard for the rights and safety of the other users of the streets and highways."2
Has anyone ever had a partner who, while responding to a call, would tailgate the car in front of the ambulance until that driver moved to the right? How about a partner who, during an emergency response, drove 20 or 30 mph above the posted speed limit in traffic or entered an intersection without stopping and fully checking for other vehicles first? These are indicative of an aggressive attitude and failure on the part of the operator to act with regard for others.
Notice the key part of the above definition: "without regard for the rights and safety of the other users" of the road. This phrase speaks directly to the "due regard" law present in most states. Due regard can be thought of as "legal terminology found in the motor vehicle laws of most states that sets up a higher standard for the operators of emergency vehicles."3 In other words, you, as an emergency vehicle operator, may, during an emergency response, be exempted from certain traffic laws, but you will also be held to a higher standard and held directly responsible should you be involved in an accident. More important, due regard speaks directly to the type of defensive attitude the driver should have when driving an emergency vehicle.
The other camp of drivers can be thought of as defensive drivers. A defensive driver can be defined as a "preventive driver who seeks to avoid potential accidents, hazards or miscommunication."2 This type of attitude is a direct reflection of the intent of the due regard laws found in most states and outlined above.
Defensive drivers are those who drive in a manner that assures the protection and safety of the persons, vehicles and property around them. A defensive driver would never tailgate a vehicle; instead, he/she would allow enough room in front of the ambulance to assure that it could be stopped should the other driver suddenly stop in the road instead of pulling to the right (as is all too often the case). This type of action by the ambulance operator is one of anticipation and prevention. It will not delay the response to a call any more than would have tailgating and risking a preventable accident.
Factors That Influence Attitude
Understanding the types of drivers and where you might fit does not go far enough. Even the best drivers can be affected by outside influences. Proper understanding of environmental factors that can have a negative effect on driver attitude is also essential to the defensive driving process.
Overcrowding-Anyone who lives in a metropolitan area of any size can attest that the streets are becoming more crowded almost daily. Increased traffic volume will impede the ability of the ambulance operator to reach emergency calls. This can lead to frustration and may result in mistakes such as tailgating and improper clearing of intersections.
Temperature-Studies have shown a direct relationship between high temperatures and driver aggression. The American Automobile Association cites a study done by Kendrick and MacFarlane that shows a "direct influence of heat on driver aggression."4 Emergency vehicle operators are not immune to this.
Use of Lights and Sirens-The use of lights and sirens can give an operator a false sense of security and cause other motorists to behave in unpredictable ways. This, compounded with an inattentive emergency vehicle operator or an operator with a poor attitude, can lead to tragedy. In addition, it is believed that continuous use of lights and sirens can contribute to poor performance by the vehicle operator. A 1989 crash in Virginia is cited as an example. In this incident, the unit was responding to a call with lights and sirens. During the course of the response, the operator failed to properly clear a railroad crossing, resulting in a crash. A subsequent National Transportation Safety Board report indicated that "excessive stress can lead to substandard performance. When a person's arousal level is unduly increased by stressors, the focus of attention is narrowed to performance of the task perceived to be the most important [in this case, arriving at the scene], while the quality of the performance of any peripheral task(s) [in this case, driving the vehicle across the tracks safely] deteriorates."5
In the above case, the NTSB employed the term sirencide, which is "a phenomenon used to describe the emotional reaction of emergency vehicle drivers when they begin to feel a sense of power and urgency that blocks out reason and prudence, leading to the reckless operation of the emergency vehicle."5 Studies have shown that inexperienced drivers tend to increase their speeds by as much as 15 mph while operating a vehicle with lights and sirens.5
Noise-It is believed that environmental noise leads more to frustration than actual aggression, but that noise influences the intensity of aggression that has already been provoked.
Defensive Driving Practices
Good drivers adhere to practices that will reduce their risk and the risk of those around them. Below are some defensive driving tips that should be employed in all phases of emergency vehicle operations:
- Look ahead. Determine where you are going to be in about one city block and watch for any potential problems.
- Don't tailgate. Stay at least two seconds (3–5 or more on the highway or in bad road conditions) behind the vehicle ahead of you. This is about 1½ car lengths for every 10 mph.
- Make sure other drivers see you. Unaware drivers can be potential hazards. Stay out of blind spots. Always use your signals when turning or changing lanes.
- Give yourself room to maneuver. You want a position that allows you the most options in case of an emergency. Maintain as much room as possible on all four sides of your vehicle.
- Scan the roadway for potential clues. A rolling ball may mean there will be children chasing it. A car that just pulled into a parking space may mean a door will be opening.
- You should never insist on the right of way. If another driver does not yield to you, let him or her go first.
- Always ask yourself "What if?" What if someone cuts in front of me? Do I have enough space to stop? Can I safely move to the next lane? If you answer no to one of these questions, adjust your position in traffic and/or reduce your speed.
As can be seen by the above list (taken from the State of Indiana website), proper defensive driving techniques can be applied to any driving situation.6 Emergency vehicle drivers operate in unique circumstances that place them and those around them at increased risk, but the above tips still apply, even while using lights and sirens.
Everyone needs to be reminded that being an emergency responder is a dangerous profession and driving a vehicle only increases its risk. Ensuring that the proper attitude and behavior needed to operate an emergency vehicle are learned and exercised is something that all emergency providers can do to reduce the risk both to themselves and to the public. Most calls for assistance begin and end with the operation of an emergency vehicle. Develop and maintain the proper defensive attitude before getting behind the wheel.
1. Mintz NO. The most neglected driver attribute remains attitude. www.adtsea.iup.edu/adtsea/TheChronicle/summer_95/the_most_negle cted.html.
2. New York State Department of Motor Vehicles. Aggressive driving. www.nysgtsc.state.ny.us/aggr-ndx.htm.
3. Bledsoe B, Porter R, Cherry R. Paramedic Care: Principles and Practice Special Considerations/Operations, p. 326. Upper Saddle River, NJ: Prentice Hall. 2001.
4. Connell D, Joint M. Driver aggression. www.aaafoundation.org/resources/index.
5. United States Fire Administration. EMS Safety: Techniques & Applications, p. 19. Emmitsburg, MD: USFA Publications, April 1994.
6. State of Indiana Defensive Driving Techniques. www.aips-indiana.com/Indiana/Pages/In3.html.
1. National Highway and Traffic Safety Administration. Driver Attitude. www.nhtsa.dot.gov/people/ injury/buses/Brady%20Web/topic_1/page3.html.
2. Olsen E. Driver Attitude: The aggressive and defensive styles. www.geocities.com/ergonomicintro/dred.html.