Driver training typically is conducted at the beginning of a career and then in many cases forgotten about. Imagine if we trained ﬁreﬁghter/paramedics in cardiac care once and only once.
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.)
EMS personnel train on many aspects of patient care, yet the equipment they use the most tends to be what they train on the least — vehicle driving. Driver training typically is conducted at the beginning of a career and then in many cases forgotten about. Imagine if we trained firefighter/paramedics in cardiac care once and only once. CPR is renewed every two years, yet there are no requirements to show proficiency in driving an ambulance or emergency vehicle. Yet every time personnel are called to service, someone must drive to the incident, even if they never transport a patient. Until fire service leaders change their minds and give driver training higher importance, personnel will not change their behaviors.
The design of patient compartments has stayed the same for years. It is time to break the mold. The limited crash tests demonstrate how unsafe the patient compartment really is for both the care providers and the patient. The Winter Park (Fla.) Fire Department has stepped out of the box and worked to design a safer ambulance patient compartment. The EMS provider in the patient compartment is secured with a five-point harness. This is a step forward in the right direction.
An ambulance manufacturer at the summit was asked if safety factors could be incorporated in the patient compartment. He responded absolutely, but with a caveat — customers haven't wanted the changes.
You are the customers. Why don't you want to provide a safer environment for your personnel and the patients your agency transports? No one wants to embrace change. I always use the analogy that the only person who likes change is a baby with a wet diaper, and even a baby screams through the process. However, comfort comes with a new, dry diaper. The baby smiles and settles down to enjoy the change.
Another enlightening discussion covered the reflective striping on the rear of units. Again, more is not better. The V-patterned reflective striping should cover no more than half of the unit's rear. More than 50% actually decreases the striping's safety factor.
Further summit discussions and illustrations demonstrated how sitting sideways — as is typical on a bench seat — is one of the most dangerous positions a person can be in during a crash. Maybe it is time to change the entire layout of the back of the ambulance. Do you remember the old Cadillac ambulances? The provider seats faced forward and backward alongside the patient. Granted they left little room to provide patient care. Who will step up and redesign the patient compartment to provide a safer environment for personnel?
Speaking of design, where and why do departments continue to purchase monster rigs? What difference does a monster rig provide in patient care versus a smaller, more economical vehicle? Departments around the world use much smaller units that work much more effectively and efficiently. I challenge you to find any evidence that demonstrates that the bigger rigs provide better patient care. With the escalating cost of vehicles and fuel, it is time to re-think the design of the entire vehicle. The ambulance manufacturer at the summit said that companies can build safer vehicles and will do so if that's what the customer wants.
So it comes down the chief of the organization. You are the leader, the person who makes the final decision. Why aren't you asking for a safer vehicle design in your ambulances?
The safety of our personnel starts with the fire chief. Fire service leaders need to step up to the plate and make change. Popular or traditional doesn't always equal safest. The fire service always has done it that way, so why change? Change for the safety of your personnel and the patients you provide care for and make sure that everyone goes home.
If you would like to review additional information on the summit you can find the proceedings and recording of the event at www.objectivesafety.net/TRBSummit2008.htm.
Jeffrey T. Lindsey, Ph.D., EMT-P, CHS IV, is the director of graduate studies at George Washington University in Washington, D.C. He also is the education coordinator for 24-7 EMS. Lindsey has more than 29 years of experience in the emergency services and retired as fire chief from Estero (Fla.) Fire Rescue.
For More Info
Emergency Vehicle Operations
by J. Lindsey and R. Patrick
2008 Ambulance Transport Safety Summit