Highway Safety: Protecting Your Patient and Yourself
A state trooper and I were responding to a Priority One call for a rollover on a parkway near my town. I had followed his state police car in my POV (privately owned vehicle) from an entrance ramp for about a mile when I saw him pull off on the left side of the road. As we've all been taught since driving school, if you're pulling up on a police car, you park behind it. But as we got out of our vehicles he said to me, "Don't block my lights!" I thought this was unusual, but he was right! He had a multitude of blue, red and amber LEDs, and tail-light strobes, flashers and reflective decals compared to my little blue/white rear-facing LED. His car would provide much better warning to approaching motorists than mine. I moved my car, got my trauma bag and went to work (see Figure 1). I knew my small warning light was nothing compared to the candlepower, visibility and variety of colors and reflectors on the trooper's vehicle.
That got me thinking that most EMTs and fire department volunteers light up the forward-facing part of their vehicle so cars in front of them will (hopefully) move over when they are responding to a scene. But little attention is paid to rear-facing warning lights, reflectors and other methods of protecting ourselves. Once police vehicles, ambulance or fire engines arrive, the protection comes from larger vehicles, brighter lights and more people to handle traffic, but until they arrive, we put ourselves and our patients at risk without proper scene safety.
As we all learned in EMS 101, our first duty is to protect ourselves and the second is to act as an advocate for patients and protect them from further injury. If you come upon a scene that is unsafe, the book says "Don't go in!" So while you wouldn't even think about disarming a man with a knife, you think an accident or medical victim on a highway or roadway is different because the scene is safe. Or is it?
The scene may not be safe because of traffic, and you're probably not going to wait for additional help. So what can you do to quickly make the scene safer? You pull up behind the patient's car to protect it, but what protects you? Your 4-way flashers are a start, but they don't tell oncoming traffic to slow down because there are first responders working at the scene or to move over and give you room to exit your vehicle or return to it for a secondary trauma bag or O2 kit.
I often beat fire and EMS vehicles to a scene because our emergency vehicle drivers have to stop by the rescue squad to pick up a vehicle, while I generally respond in my own POV. This probably happens more often than not and is something that should be considered by almost every squad. Quite often, it is a POV that first warns traffic of a problem ahead and places itself between the accident scene and traffic.
Following are some considerations for first responders at a scene before the manpower, high-powered lights and large vehicles arrive.
Vests and Colored Jackets
The most simple personal safety item is an ANSI 2- or ANSI 3-compliant reflective vest or outerwear. ANSI is a standard established by the American National Standards Institute. The clothing is now mandatory for fire/EMS and others working near highways. Adding reaction time to sight times, studies have shown that at 60 mph it can take a motorist up to 260 feet to notice and stop for a first responder. A person wearing blue or black can be seen at 55 feet, one in red at 80 feet, in yellow at 120 feet and one in white at 180 feet. But a reflective vest with contrasting fluorescent red-orange or green-yellow can be seen at 1000 feet!1 The ANSI-compliant clothing is required to identify the wearer as a person, as opposed to a sign or vehicle, which gives motorists plenty of warning and time to slow down. So wearing an approved vest, jacket or other clothing is extremely important as you move around the scene. To further protect yourself, put on your ANSI clothing when you first get in your vehicle so you're protected and ready to go to work when you exit your vehicle at the scene.
This clothing has retro-reflective properties that reflect light directly back to the source (e.g. oncoming cars and their drivers). According to David Hein, Director of Merchandising & Apparel at 5.11 Tactical, which manufactures ANSI-compliant clothing, there are reflectivity requirements in terms of square inches of reflective material and location, and all compliant clothing meets these requirements. The idea for manufacturers, he says, is to build something extra into the clothing like 5.11's patented shoulder area that keeps a trauma bag from slipping off the shoulder. But the main thing is to put it on!
A passive, ever-present scene safety item is a retro-reflective decal or marking on your vehicle. Placed on the rear bumper, it adds a little color during the day, but at night, retro-reflective tape reflects light brightly and directly back to the source of the light. The differences in visibility are striking. Besides the bumper, placing a decal inside the doors (see Figure 2) is a good idea, as long as it doesn't block the latch, vehicle identification or other information (tire pressure, etc.). When the door is closed, the decal is invisible, but when you get out or leave the door slightly open, it is highly visible. Keep in mind that there are federal laws regarding placement of decals and markers. In general, markers should not be placed within three inches of mandated lights, reflectors or turn signals.
The fastest and best way to warn motorists that there is an emergency ahead is with rear-facing emergency/warning lights. Typically, there is no time to put out flares or warning signs, and lights on vehicles can be seen from a long distance. The trick, of course, is to get motorists to notice them among the clutter of other tail, head and street lights. For your vehicles, look for lights that are bright, within the legal color and other restrictions of your state or locality, have a wide enough light dispersal pattern, changeable patterns and are easy to install and turn on and off.
And brighter is not necessarily better. While some studies have suggested that brighter lights are more noticeable, some New York State Police vehicles now have a switch to damp down the power of their lightbars at night to about half their daytime brightness. The idea is that the increased brightness (especially the new LEDs) at night causes too much glare and makes it hard for motorists to see their way around the accident scene.
Type of Light
Light technology, once power-hungry, incandescent-based, is now mostly LED (light emitting diode)-based. With previous light sources, to make a colored light, a white light was covered by a colored lens, which decreased the light's power. LEDs can be made in almost any color and use much less power than previously used types. And, power consumption is low. It is not uncommon for an individual LED light module to draw as little as one-half amp, meaning you can leave them on at a scene and not worry about draining your battery.
Red, white, blue, amber/yellow or green? So many choices, but which ones work best and when? Studies have shown that white is the brightest light and can be seen from the farthest distance. But in the dark it may intermingle with the headlights of oncoming cars and confuse drivers. Amber/yellow shows well through fog and mist and has been used on slow-moving maintenance trucks and vehicles for decades. Amber has the long-time distinction of being the 'caution' color (think traffic lights) for approaching motorists. Red is less visible than other colors at night but is more visible during the day; however, it may get lost in a sea of red tail-lights. Where legal, blue is getting more use. It stands out in the background of red tail-lights and white headlights and is more visible at night. Another phenomenon is that at night, drivers perceive blue light as moving toward them and tend to slow down earlier; they see red as moving away and think they have more time, even though they are closing in on a vehicle.2 This explains why drivers sometimes rear-end an emergency or other vehicle. So, if blue lights are legal in your area, including them is probably a good idea. One municipality in Florida has ordered light bars that show red during the day with a light sensor that changes the LED color to blue for better visibility at night.
Tom Huebel, Central and Western Regional Sales Manager for Code 3 says that for his purposes (and state laws allowing), he likes all the colors (except green) to be used at the same time. His reasoning is that some colors work better at night, some during the day, others on a cloudy day and still others in fog or mist. A New York State Police sergeant who was in charge of helping outfit their vehicles with lights says that amber was added in the 1990s when evidence showed it enhanced visibility when included with blue and red. Bob Van Ee, National Sales Manager at Sound Off Signal, notes that "amber is eye-catching and, in combination with red or blue, is even more so." So including amber/yellow in any rear-facing array would seem to be a good idea. Green is not typically used in this application since it is the signal to go in traffic lights and we want motorists to slow down! Look for lights that don't have an extremely narrow beam but disperse their light so approaching motorists will notice them.
An important note: Color, type and placement of your emergency/warning lights may be regulated by state and/or local ordinances. When choosing the light array to help protect you, your vehicle and patient, keep your local rules and regulations in mind.
An Inexpensive Solution
If you have a dashboard revolver with a removable flash guard to protect your vision from flashback when you drive rather than a rear-facing light, you can slip off the flash guard when you arrive on scene so the light will go to the rear as well (providing there is a clear way for light to exit the vehicle). If you have enough cord and a magnetic mount on a plug-in, place the light without the flash guard on the roof of your vehicle as a 360-degree warning signal.
There are many patterns to choose from: Warp Flash, Quint Flash, Alternating 150 FPM Triple, Power Quad, Random, Steady. Every manufacturer has its own flash patterns and many mimic one another. There is no universal agreement as to pattern. Some studies say that simultaneous flashing of two lights is better than alternating flashes.3 Others show that random flashes are better and movement to the pattern makes them more noticeable to motorists. There is much discussion and not much agreement on the frequency of the flash, but some manufacturers note that the number of flashes is not as important as the on-time of the flash.
Since each vehicle's purpose may be different, light placement will vary. Some volunteers don't want to mar the roof of their vehicle, while others don't want wires running across the vehicle to a cigarette plug. Eye-level, rear-facing lighting is generally best for placement. Bob Van Ee says that flashers around the license plate or within tail-lights are interesting, if a little gimmicky, but should not be a primary source of warning light. The main protection comes from roof and rear deck/window lighting. Positioning should also take into account that an interior-mounted warning light may be dimmed by tinted glass on the rear window or by a dirty window, which can dim the power of your lights markedly. Suction cup units are always an alternative for inside mounts (although many people find that they stop holding after a while), and magnetic choices that won't mar exterior finishes are available from many manufacturers (check manufacturer specifications for speed and holding power if you are going to use these). Tom Heubel likes the idea of having lights at three different heights: as high as possible (roof top), in the middle (at rear deck height) and at the license plate level.
My Own Research
Since New York state and local laws allow it, I decided to go with blue, amber and white rear-facing lights on my vehicle. These lights combined with my 4-way flashers give me all the relevant colors.
I borrowed a pair of Sound Off Signal XP63 lights (amber/amber on one side and blue/white on the other) and a Sound Off Signal 4 LED interior warning bar (amber/white/blue/blue) with a flash-guard, and the salesperson was kind enough to help me install them. We put them on the inside rear roof of my SUV facing out the rear window, ran wire inside the molding to the front, and installed a switch near the driver to control the lights. It took about two hours (he had been a professional installer). Compared with my little blue/white LED that plugged into the cigarette lighter, it was a great installation, with the added benefit of making my wife happy because there are no visible wires in the car and no lights falling down when the magnetic attachment is bumped. And these new lights are bright. Even when partially obscured by the tinted rear window, they are extremely visible; if I open the rear hatch, they are blinding up close.
The lights all have changeable patterns and hang close to the interior roof and rear window--out of the way for loading stuff into my SUV and not obscuring my vision rearward. Flashback seems to be minimal. I have stopped at a number of accident scenes since the installation, and no one has run into me yet. There is still the problem of people not moving over until they get close, but that may be generally inherent in driving.
Integrating This Article into Practice
EMS squads and rescue companies might think of expanding their safety plans to include 'first-rescuer-on-scene' safety options. How do you keep your first-arriving responders and patients safe on the scene? Perhaps forming a committee within each squad with the mission of enhancing first-rescuer scene safety might be in order. Then, within state rules and regulations, methods and protocols can be developed and put into place. Once in effect, protocols should be continually reviewed and updated (if necessary) in quality assurance sessions that address actual local performance.
- 1. IACP Law Enforcement, Safe Stops Program, 2007 CACP Traffic Safety Symposium.
- 2. Wells JK. Florida Highway Patrol emergency lighting research & prototype evaluation. Florida Highway Patrol, March 2004.
- 3. Cook S, Quigley C, Clift L. Motor vehicle and pedal cycle conspicuity: Part 1- Vehicle-mounted warning beacons. Summary report. DFT Report; PPAD 9/33/13. Loughborough University, March 2000.
The author would like to thank Sound Off Signal for assistance with equipment.
Jon Bloomberg is a New York State EMT, a member of Stanford Fire Co. in Dutchess County, NY, and a principal at Core Medical Systems LLC. More information can be found at www.CoreMedicalSystems.com and www.IAm911.org.