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New research published recently in the journal of the National Association of EMS Physicians, Prehospital Emergency Care, finds that EMS deaths could be reduced if citizens yield to ambulances and EMS personnel embrace strategies that allow them to remain seated and restrained in the back of the ambulance. The research was co-authored by Dr. David E. Slattery, EMS Medical director, Las Vegas Fire & Rescue Department.
Among other findings, the research noted that 74 percent of EMS worker deaths are transportation-related. The article reports that failure of an oncoming motorist to yield to an ambulance is the primary cause of ambulance crashes when an ambulance has its lights and siren on. The risks of death and severe injury for EMS personnel are four-to sixfold higher for the unrestrained compared with restrained ambulance occupants. In addition, riding unrestrained in the back of an ambulance poses additional risks to EMS personnel. Often EMS workers have to perform critical patient care while unrestrained, such as performing chest compressions, airway management, critical procedures and patient control.
Las Vegas Fire & Rescue, under the leadership of Chief Greg Gammon, has already started implementing safety measures in its rescues such as deploying the AutoPulse® device and automated ventilators for cardiac arrest patients, strategic positioning of supplies and equipment to be within the reach of seated providers and increasing provider awareness of the dangers of code-three driving.
“The lack of seatbelt use plays a pivotal role in the hazard of delivering care in the back of a moving ambulance,” said Slattery, who also serves as assistant professor and research director for the Department of Emergency Medicine at University of Nevada Las Vegas. “Technology is being developed to help allow EMS workers to be seated and restrained, for example automated chest compression devices like the AutoPulse, which allows the medic to sit down as opposed to standing over a patient performing CPR.”
Automatic ventilators, which provide regular breathing for patients, also free up providers’ hands for personal balance and protection during transport.
Although the immediate goal is to develop strategies for keeping providers seated, restrained and hands-free, other possible solutions include developing better ambulance design and safety standards and implementing crew resource management strategies while driving lights and siren.
“While the work of EMS personnel can at times be dangerous, there is no reason that the risk of occupational death is two and half times higher for EMS workers compared to other American workers,” Las Vegas Fire & Rescue Chief Greg Gammon said. “Often, people don’t realize the types of safety issues that EMS workers face.”
Ambulance crashes were fatal 27 percent more often than police crashes and 33 percent more than fire truck crashes, and there were 57 percent more people injured in ambulance crashes than fire truck crashes and 4 percent more than police crashes.
Nearly killed when his ambulance was in a rollover in a storm, former EMS worker Matt Deicher of Mosinee, Wis. knows the importance of being restrained and underscores the need for equipment to be safety-checked, “We were transporting a patient with hip pain who was going into cardiac arrest, and as I was trying to care for him, we moved from cement to asphalt, our tires slid and we flipped.” Matt, who is a quadriplegic because of the crash, believes that it is important that steps are taken to keep his colleagues safe. “People may not realize, how high the risks are for EMS personnel and their patients, and that there are solutions which can be as simple as regular ambulance maintenance, better communication within the ambulance and access to new technologies.”
The National Association of EMS Physicians (NAEMSP) is also focusing on the safety of EMS personnel. According to Dr. Theodore Delbridge, NAEMSP President, “While EMS personnel work diligently to safely treat and transport their patients, we need to work to ensure the safety of EMS personnel. Standards for vehicle design, particularly in the patient compartment, should maximize patient and EMS personnel safety while allowing the necessary care to continue. Similar attention should also be paid to the equipment and supplies that must be readily available so that they are not potential risks but might even improve both patient and personnel safety in a moving ambulance.” NAEMSP is holding a special meeting this fall to focus on ambulance safety and possible solutions.
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