The first National Ambulance Transportation Summit was held in Washington, D.C., last October. I was among the 40 individuals who were fortunate enough to be sitting in the audience in the National Science Foundation conference room. More than 100 other individuals from around the world joined the summit via teleconference. We spent the afternoon listening to short presentations on ambulance safety issues.

Much of the information presented echoed what a number of us have taught in emergency vehicle operator courses over the last decade. Other points were new, interesting and though-provoking. The majority of the points centered around ambulance design and human behavior.

The approach to ambulance design seems to be the bigger the better, the more lights the better, the more anything the better. But is it actually better? It definitely isn't safer. The patient compartment hasn't changed in anything but size, housing more equipment that become deadly projectiles when an ambulance is involved in a crash.

Personnel often are unsecured while riding in the patient compartment. After all, they can't be secured and still provide patient care — at least that has been the mindset. Or does it have more to do with the design of the patient compartment? Maybe it's a combination of both.

Having worked in the patient compartment, I can say that there are times when it is difficult to provide the necessary patient care while secured by safety restraints. Other times, the lack of restraint comes from complacency, not necessity. Whatever the cause, personnel are dying in unsafe working environments.

Everything we do comes back to human behavior. Ambulance design, equipment storage, safety-restraint use and vehicle operation result from human behavior, and it's difficult to change behaviors. Fire service leaders are at the center of behavioral problems in their departments — the buck stops with the chief.

The organizational culture promotes action or complacency in personnel. Ambulance safety begins with the chief taking an active stance on vehicle restraints. He or she cannot make an exception or accept any reason for non-restraint. There admittedly are some flaws with patient compartment design and provided restraints, but those are separate issues.

Problems exist not just with personnel inside the patient compartments, but with the lights and sirens on top of the vehicle. Reason and evidence don't support the use of lights and sirens in all ambulance responses and patient transports. In fact, evidence shows little time savings from running lights and sirens.

So why do we have lights and sirens on the vehicles and continue to use them? In reality, more personnel, patients and bystanders die in accidents with lights and sirens than without. It is because the fire chief has not stepped up to the plate to stop it. Limiting lights and siren use won't be the most popular change in the fire service, but it is time that fire service leaders take a hard look of how departments operate and make the right changes. (See related story.)