Ambulance hazards targeted

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From www.detnews.com

Ambulance hazards targeted

Industry coalition concedes human toll, vows safety fixes

By Lisa Zagaroli / Detroit News Washington Bureau

What The Detroit News found

"Unsafe Saviors," a Detroit News investigative series, examined ambulance crashes and their causes. In the four-month probe, the newspaper found:  

A lack of vehicle performance standards, maintenance and proper safety restraint contributes to the human toll caused by at least 6,500 ambulance crashes a year.  

Speeding, fatigue, driver error and dispatch blunders often lead to ambulance crashes. Accreditation programs, driver monitoring and stricter vehicle standards could reduce the risks.  

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WASHINGTON -- A major overhaul is planned in the way ambulances are operated, designed and regulated to make them less dangerous to the medics and patients who ride in them, top industry officials say.  

Confronting a chronic problem for the first time, the ambulance industry is working on a comprehensive plan to cut down on the number of deaths and injuries that result from the more than 6,500 ambulance crashes every year.  

The initiative could result in new standards for how drivers are screened and trained, more reliable ways to protect people and equipment inside the patient compartment and new designs to make the vehicles more crashworthy and less likely to roll over.  

All the concerns were outlined in an investigation by The Detroit News earlier this year.  

"The problem is that crashes in first response -- in ambulance or police or fire -- are probably more significant than any of us understand," said Larry Wiersch, executive director of Cetronia Ambulance Corps in Allentown, Pa.  

Wiersch is a board member of the American Ambulance Association, which is coordinating the efforts of university researchers, government safety officials and the people who make, use and insure ambulances.  

The group met last week near Washington to develop short- and long-term goals to improve safety of emergency vehicles.  

"There was a clear understanding that everybody would be involved in the developments as they unfolded, that the best way to get the best outcome was having all of the folks from each discipline involved in each step," said Dr. Nadine Levick, a researcher who has conducted crash tests of ambulances and studied their safety.  

"It's such a cross-disciplinary situation. What came across is the real recognition of how each area was so important to each other."  

The effort came as welcome news to one patient who was involved in an ambulance crash.  

Rollin Ager of Ashburn, Va., who was a heart patient in a routine transport to the hospital, suffered a heart attack, a head injury and cracked ribs when the ambulance he was in flipped over several times.  

Joseph "Neal" Sherman, the medic who was caring for him in the March 16, 2001, crash, was killed.  

Authorities say the driver of the ambulance fell asleep because he'd been up all night and shouldn't have been behind the wheel.  

"Certainly I can say the ambulance being safer would be a help," Ager said. "To us, the bigger thing is the driver responsibility, the responsibility of the firm who hires these people, their control of these people and how they dispatch the driver and keep track of drivers' capability."  

Wiersch said three working groups are finalizing the goals to reach within a year in technology, vehicle design and the actions of ambulance personnel.  

In the meantime, the group wants more reliable data to define the precise dangers ambulances pose to their occupants and other drivers on the road so they can minimize crashes and their consequences.  

About 10 serious injuries a day and three dozen deaths a year are reported in ambulance crashes. The industry suspects the real numbers are higher.  

Ambulances have proven more dangerous than other vehicles driven on the job.  

Emergency medical workers have an occupational fatality rate of 9.6 per 100,000 workers per year in transportation-related incidents, compared with 6.3 for police, 4.5 for fire fighters and 2 for average citizens, according to research by Brian J. Maguire.  

He is the associate director of the University of Maryland Baltimore County's Department of Emergency Health Services.  

The industry wants to understand everything that transpires in crashes, sudden stops and other incidents that are never reported.  

"There needs to be a broader, more intense database that starts to collect not only the fatal injuries ... but how many injuries are out there that aren't required to be reported," Wiersch said.  

"We think it's a pretty significant problem from the information we have and the problem is how can we reduce that, how can we go about this methodically so we can reduce the amount of crashes that are happening out there on a pretty regular basis."  

One of the projects already under way, by the National Institute for Occupational Safety & Health, is to scrutinize a few ambulance crashes to determine what went wrong and what might have been done to prevent them.  

"We are working to try to better define the risk of ambulance-related crashes of people working in ambulance patient compartments and we are evaluating the use of occupant restraints," said Paul Moore, who works on the fatality assessment evaluation program.  

A Detroit News two-day series in January outlined how ambulance occupants were exposed to unnecessary risk because of a lack of safety standards regulating the patient compartment, poor vehicle design and inadequate seat belt systems.  

The problems, coupled with poor driver training, poor judgment and fatigue, were contributing factors in some of the 6,500 ambulance crashes each year.  

Although the National Highway Traffic Safety Administration is the federal agency that oversees vehicle safety, it has been reluctant to set standards for ambulances and doesn't require them to be crash-tested.  

NHTSA officials who attended the ambulance association meeting last week said they hoped to set up an industry meeting early in 2004 to discuss improving emergency vehicle safety.  

"I don't know if we're talking mandatory or voluntary standards," Wiersch said.  

"It has to be a flexible program. If you make it voluntary and show this can make a difference, it will naturally progress into everyone doing this and saying I need to get on that wagon.'"  

While plenty of information is available on crash dynamics and the importance of seat belts, there's a lot to learn about how ambulances respond in crashes, Wiersch said.  

"We don't know how our chassis hold up, how crashworthy are they, are there ones that are better than others," Wiersch said.  

"We don't know because we've never truly looked at how ambulance vehicles and fire trucks hold up in a crash."  

Some of the areas the industry hopes to address in the next year and beyond include:  

Employee selection -- how to choose candidates who would be good drivers and not prone to aggressive driving or other behavioral or legal problems  

Driver training, education and monitoring -- whether to require trainers to be certified, road tests, more comprehensive classroom training and on-board monitoring devices  

Company policies -- how to encourage proper seat belt restraint of both patients and medics, speed limit observation and proper equipment storage  

Emergency dispatch -- how to prioritize calls to make sure drivers aren't rushing to the scene of patients whose lives aren't at serious risk  

Ambulance selection -- how to evaluate weight limits, center of gravity, design and technology to make sure ambulances are as safe as possible when they crash as well as color schemes, lights and sirens to avoid accidents.  

Ambulance maintenance -- what is the best schedule for maintenance and whether to give drivers the right to sideline vehicles they think are unsafe.

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Brings up an interesting point (several in fact). So I pose this question. What does your agency (no need to name names) do to train it's drivers? I find it odd that to drive an ambulette you need to have a CDL with passenger endorsement and then jump through a bunch of hoops with DOT (Physical, Drug Test, Road Test, etc) to get 19-A cleared. Yet, to drive an ambulance which uses lights and sirens to get through traffic composed of people who can't seem to drive under NORMAL conditions, all some places require is a class 'D' license and a pulse.

Do you utilize the CEVO (Coaching the Emergency Vehicle Operator) course, or go the extra mile and use EVOC? Do your drivers need to be cleared before going out on the road?

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In order to be cleared to drive an ambulance in Mohegan VAC, a candidate driver must be at least 21. This person must also take an apporoved EVOC class. Once this is completed, the driver must be orientated with the operation of the rigs. After clearance by a line officer, the candidate driver is allowed to drive the rig from the hospital back to quarters after calls. After a review of the driving and the driver feels comfortable, this person can begin to drive code 3, with another driver present on the crew to review driving operations. Once this is performed numerous times, the driver is allowed to a full driver only with the approval of a VAC line officer. Although a long process, safety is the number one priority.