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					                  EMS Safety Foundation,
               at a PC/Laptop near you, November 12, 2009
         Innovation, Collaboration and Knowledge Transfer and Policy
                                                                                   Background:                                            Mission

                                                                         EMS Safety Foundation has been
                                                                         established to fill a gap in                          This is a team of like minded
  Key Lessons from the Workshop and                                        technical knowledge transfer                        innovators across EMS Medical
th Summit, and EMS Safety Foundation
the S    it  d       S f t F    d ti                                           ti l i t di i li
                                                                           practical interdisciplinary R & D                   Transport and a number of technical
      Developments for 2009-2010                                           evaluation and implementation of                    disciplines, who share the common
                                                                           system safety enhancements for EMS                  mission of enhancing the safety of
                                                                           and Medical Transport                               EMS delivery for all involved.
                                                                         It is a not-for-profit institute
Nadine Levick, MD MPH
Research Director, EMS Safety Foundation
CEO, Objective Safety
New York, NY




                         In a nutshell                                      So what is a Webinar?                                   Webinar Basics
                                                                       A Webinar is:
       EMS Safety Foundation is a not-for-profit
       multidisciplinary virtual think – tank and test                                                                Raise
       bed for safety innovation and knowledge                           Real time interactive web technology         Hand
       transfer
       It is a virtual network integrating the end                        No other hardware is necessary aside                                       Whiteboard tools
       users and the technical experts                                  from a computer connected to the              Text
                                                                                                                    messaging
       A tool to enhance the safety of delivery of                      internet and a microphone- if you
                                                                        choose to speak                               Type in
       EMS services
                                                                                                                    your name
                                                                                                                   and location
                                                                         These interactive seminars can also be
                                                                        stored for later asynchronous use          The ‘mic’




   ..use white board tools to mark your                                                                                   The EMS Safety Foundation
                location…..                                            Today’s Webinar is recorded!                             www.EMSSafetyFoundation.org
                                                                                       The presentation
                                                                                             and                                brings this presentation to you
Line                                                                    all comments typed in the text box
tool




                                                                           will be available for viewing via the
                                                                            www.EMSSafetyFoundation.org
                                                                                  web site within 72 hours
                                                              Today’s Webinar                                                             October 22, 2009, TN
              R&D                                                                                                              Patient and Provider killed, Attendant
     “Ripoff and Duplicate”                 Will cover -                                                                                      Critical
                                                2009 Webinar retrospective
  Avoid reinventing the wheel at all            October Workshop summary
  costs                                         October TRB Summit overview
                                                Global EMS Forum ‘Safety in the Back”
  Where are the best practices that we          Update on NFPA, SAE and ISO standards
  need to transfer knowledge from               New EMS Safety Foundation 2010
                                                developments




                                                                                                                                       EMS Safety Foundation
A tragic week…. It does happen                                          This week
                                                                                                                                          2009 in Review
                                                                                                                             January Webinar - Transferring Technical Knowledge to Operational
                                                                                                                             Practice, New Developments, and 2009 Program
                                                                                                                             March Webinar - Pediatric and Neonatal Transport Safety,
                                                                                                                             International Approaches to Ambulance Design Specifications and
                                                                                                                             Rettmobil Plans
                                                                                                                             May Webinar and Workshop - ‘Live from Rettmobil’
                                                                                                                             June Webinar - Part 1: Rettmobil 2009 Perspectives and Applications
                                                                                                                             July Webinar - Part 2: Rettmobil 2009 Perspectives and Applications
                                                                                                                             Follow up and Standards Update
                                                                                                                             September Webinar - Concepts to Practice: Fleet Safety Economics,
                                                                                                                             You and Detroit, Regulations and Guidelines, the Workshop and Summit
                                                                                                                             October Workshop - 'Design and Operational Aspects of Patient
                                                                                                                             Transport Safety: Vehicles and Stretchers'
                                                                                                                             November Webinar - Key Lessons from the Workshop and the
                                                                                                                             Summit, and EMS Safety Foundation Developments for 2009-2010




EMS Safety Foundation Ambulance          October 28th Workshop Agenda
 Vehicle & Ergonomics Workshop,                                                                                                            Workshop Outline
                                         13.00 -13:05        Workshop Introduction: Nadine Levick MD, MPH
           October 2009                  13.05 - 15.00       Session A: Vehicles
                                                                                                                               Ambulance vehicle occupant protection
                                             i.    Gene Lukianov – Vehicle and occupant systems safety                         Ergonomics as it applies to EMS
                                             ii.   Jeff Welch – Occupant protection strategies
                                             iii.  Walther Bloch – Vehicle operational and design safety                       What are the principles
                                             iv.   John Killen – Vehicle Visibility and Conspicuity
                                                                                                                               How do the different challenges of
                                         15.00 - 15.30       Afternoon Tea Break
                                                                                                                               ergonomics and automotive safety systems
                                         15.30- 15.45
                                             i.
                                                              Session B: An International Approach
                                                   Perspective from Norway
                                                                                                                               integrate
                                         15.45 – 17.30
                                             i.
                                                              Session C: Stretchers
                                                   Chris Fitzgerald
                                                                                                                               What technologies are there to assist in
                                                   a.         Overview of stretcher features                                   getting the best outcome
                                                   b.         Design influence and impact on stretcher (operational) tasks
Automotive engineers addressing             VEHICLE DESIGN and SAFETY                                                        VEHICLE DESIGN and
EMS Safety Foundation Workshop
                                                                                                                                  SAFETY
                                          Extensive Passenger Car and Light Truck
                                          Vehicle Safety Standards apply to vehicles                                    ACTIVE Vehicle SAFETY
                                          below 10,000 Gross Vehicle Weight (GVW)

                                          VEHICLES over 10,000 GVW have a reduced set
                                          of                                                                            PASSIVE Vehicle SAFETY
                                          Federal Safety Standards

                                          VEHICLE SELECTION IS CRITICAL




      VEHICLE DESIGN and                          VEHICLE DESIGN and                                                         VEHICLE DESIGN and
           SAFETY                                      SAFETY                                                                     SAFETY
 ACTIVE Vehicle SAFETY                       ESC: ELECTRONIC STABILITY                                                   ESC ELECTRONIC STABILITY
   – ESC (Electronic Stability Control)      CONTROL                                                                     CONTROL
   – ABS (Anti Skid Braking System)
     Advanced S f t Systems
   – Ad      d Safety S t
                                              – Electronic stability control systems are second only to seat belts in
                                                terms of the potential for saving lives and reducing injuries… is a
                                                major step forward for global auto safety.


                                           Statement by Nicole Nason, Administrator, National Highway
                                              Traffic Safety Administration, On the Adoption of Electronic
                                              Stability Control as a Global Technical Regulation




VEHICLE DESIGN and SAFETY                     AMBULANCE ACCIDENT
                                                                                                                        Seat Structure and Seat Belts
  Mitigating Consequences                   REDUCTION OPPORTUNITIES
                                                                                                                        Seat structure can be used to maintain occupant
                                            AVOID ACCIDENTS
 PASSIVE SAFETY: Crashworthiness             – Driver Training and Responsibility
                                                                                                                        position as well as contribute to intrusion
   – Vehicle Structural Design               – Operating Rules                                                          resistance in side impacts
                                             – Improved Ambulance Conspicuity
   – Front and Rear Compartment Design
                          p         g       Choose Vehicles with Advanced Safety Technology
                                                                                                                        Seat belts are known to be effective in passenger
                                                                                                                        vehicle rollover ejection mitigation as well as
   – Seating and Restrain Systems           Engineer Rear Compartment Interior to be IMPACT
                                            FRIENDLY                                                                    preventing excessive interior impacts
   – Occupant Containment                   Constrain Attendants SAFELY
                                                                                                                         For large compartments, these features can be
   – Impact Friendly Surfaces               Constrain Patients SAFELY
                                                                                                                        used to improve occupant protection and have
                                            SECURE all Equipment reliably
                                                                                                                        fewer concerns than active airbag systems
                                         Seat Structure                                                                         Sprinter Features Summary                                                                   Load adaptive Electronic
                                                                                                                                                                                                                            Stability Program (ESP)
                                                                                                                             Market Exclusives
                                                                                                                                                                                                                 Details and Technology (cont.)

                                                                                                                             Available left side sliding door                                                      ROM (Roll Over Mitigation) – This system helps to detect rollover
                                                                                                                             Premium CDI turbo Diesel engine with                                                  tendencies during maneuvers with low road speed and high
                                                                                                                                                                                                                   lateral acceleration.
                                                                                                                             SCR technology to meet the EPA / CARB 2010                                            RMI (Roll Movement Intervention) – This system helps to detect
                                                                                                                             emission standards.
                                                                                                                                       standards                                                                                                                     high-speed
                                                                                                                                                                                                                   rollover tendencies in dynamic maneuvers and in high speed
                                                                                                                                                                                                                   evasive maneuvers with a high lateral acceleration.
                                                                                                                             Best in class cargo capacity
                                                                                                                                                                                                                   LAC (Load Adaptive Control) – is an adaptive algorithm which
                                                                                                                             Best in class wall-to-wall turning diameter                                           calculates the vehicle mass and center of gravity using various
                                                                                                                                                                                                                   parameters such as acceleration, speed and the accelerator
                                                                                                                             Best in class available payload capability                                            position.
                                                                                                                             Superior safety standard with ABS, ASR, BAS, ESP                                      EUC (Enhanced Understeering Control) – provides enhanced
                                                                                                                             and 3-point seat belts on all passenger seats                                         stability under heavy under steer, for example when driving
   Structural Enhancement                                                                                                                                                                                          quickly through tight-radius corners.
                                                                                               From U.S. Patent 7,328,938    Most versatile commercial van on the market




      Safety First – Passive Safety
                                                                                                                                 Parametric Special Module                                                          MY 2010 Emissions Features
                                                                                                                                                                                                                   • DEF tank location on Sprinter Cargo & Bus
                                                                                                                                PSM is a “Gateway” for vehicle information
                                                                                                                                                                                                                       • Tank location under the floor RH side behind B-pillar
                                                                                                                                Control of vehicle functions
                                                                                                                                                                                                                       • Tank volume 6.6gal. = 25L
                                                                                                                                Engine-Functions
                                                                                                                                    • Fixed rpm specification                                                          • Tank features drain plug
Fold-in ridges on subframe                                                                                                          • Variable rpm control
                                                                            Front axle module                                                      (AND NAND OR NOR
                                                                                                                                Logical Functions (AND,NAND, OR, NOR, XOR etc.)  etc )
                                                                                                                                Counter blocks, flip-flops, timer stages etc.
                                                                          • A main feature in a front-end crash is the          Defined interface, easy access, short set-up times
                                                                            "disconnectable" front axle, which
                                                                            releases additional deformation zones in
                                                                            the longitudinal frame member when a
                                                                            particular force level is reached.              Remarks:
                                                                                                                               PSM preparation is standard on Sprinter
                                                                          • On a frontal crash, transmission and
                                                                            engine will be pushed underneath front              MY2008 and later
                                                                            occupants.
    Front axle module after crash                                                                                                                                               PSM located in driver seat box




         Sprinter Customer Assurance                                                                                                                                                                                         Muskoka EMS Canada
                   Program                                                                                                      EMS Safety Foundation Workshop

      American Emergency
        Vehicles (AEV)
                                 165 American Way
                                Jefferson, NC 28640
                                                      800.374.9749   Randy Hanson   Approved                                 After the FEMA study – where to now?
                                10941 Weaver Ave
        Leader Industries       South El Monte, CA
                                      91733
                                                      626.575.0880    Gary Hunter   Approved
                                                                                                                             Effective vehicle markings;
     Medix specialty Vehicles
                                 3008 Mobile Dr.
                                 Elkhart, IN 46515
                                                      574.266.0911   Tom Moleski    Approved                                 3 case studies
                                                                                                                                                     John Killeen
                                                                                                                                                               Improving the vehicle
             Muskoka EMS Canada                                                               Muskoka EMS Canada                                               profile with fluorescent
                                                                                                                                                               colour and contour
        Heavy snow environment in winter                                                   Waistline height reflectivity                                       markings
        Muskoka wanted to include corporate                                                Muskoka chose solid yellow for rear
        logo colors, but also increase visibility                                          Blue lettering is key-lined to increase
        Orange diagonal design was confusing                                               reflectivity
        and provided little conspicuity                                                    Different brands of material used to
        The lower reflective strength of                                                   achieve the result
        sweeping green & blue do not detract                                               Consultation was entirely virtual over
        from dominant yellow/green                                                         the internet with a successful result




                                                                                          Principles when purchasing                       Basic layout MB Sprinter ambulance
               Perspective from Norway                                                            ambulances
                                 Ronald Rolfsen
                                         Adviser
                                                                                         • Must fulfill all laws and regulations
        Oslo university hospital - Pre-hospital division / Ambulance department          • EN 1789 standard as a minimum
                                                                                         • Special requirements from our service:
                            Geir Vidhammer Engely
                             Asst. Section leader/Paramedic
                                                                                            • Better internal lights (White halogen)
        Oslo university hospital - Pre-hospital division / Ambulance department             • Reduced noise level (65dB A at 60 km/t
                         ___________________________                                          and
Norwegian Public Roads Administration Motor Vehicle and Driving License Inspectorate:
                                                                                              70dB A at 120 km/t)
                                    Liv Bråmark
                             Coordinator, Ambulance group
                                                                                            • Focus on securing people and equipment
                                 Stein Erichsrud                                            • Focus on hygiene / easy to keep clean
                                    Senior Engineer                                      • The attendant should reach all basic
                                                                                           equipment, communication, light and
                                                                                           climate controls without releasing the safety
                                                                                           belt.




Basic layout Volvo V70 AWD ambulance                                                    Basic layout Volvo V70 AWD ambulance                        “Together for your safety”

                                                                                                                                           Ambulance Investigation - Norway
          “Together for your safety”              “Together for your safety”                 “Together for your safety”

    National analysis group                 Ambulance investigation                             Summary
                                         Accidents involving an ambulance with       Safety of the patient and the crew are
• National Health Authority
 Licensing health professionals          injury or death                             an important issue
                                         Accidents involving an ambulance with       The use of shoulder straps on a
                                                                                     stretcher are mandatory (unless a
• National Vehicle & Roads                   j damage t property
                                         major d         to      t                   medical reason)
  Administration
 Approval and technical control of       Accidents where equipment inside the        The national analysis group can
 ambulances                              ambulance cause injury / danger of injury   implement reactions against employees
                                                                                     and suppliers.
• Paramedics from Oslo university                                                    Can we be better? Absolutely!
  hospital




Ergonomist Chris Fitzgerald
 addressing the Workshop                  EMS Safety Foundation                       Stretcher lifting & loading
                                       Ambulance Transport Innovation
                                                Workshop
                                         Design and operational aspects of
                                                X Frame Stretchers

                                           Chris Fitzgerald - Ergonomist

                                                     October 28th , 2009




  Stretcher Load - # 1 (CNLOAD01)         Stretcher Load - # 2 (CNLOAD02)            Stretcher Unload - # 2 (CNUNLD02)
            50th %ile Male                                 50th %ile Male                             Solutions
                                                                                       Reduce levels of force exertion via,
                                                                                       – Greater recruitment strategies for lifting,
                                                                                         lowering, loading & unloading
                                                                                       – Mechanisation / Design based
                                                                                          • Use lower ambulance floors
                                                                                          • Use other stretcher systems such as those with
                                                                                            independent front & rear leg system – these
                                                                                            collapse as they are loaded




                Solutions                                    Solutions                                   Slide 1




       National Academies                                                              Thank you to the EMS Safety
 Transportation Research Board’s                                                        Foundation Speakers and
Ambulance Transport Safety Summit                       TRB Summit Focus
                                                                                     Moderators who assisted with the
        October 29, 2009
                                                    'Bridging the gap between what            TRB Summit
                                                   we do and what is known             Matt Crossman                Dan Garstang
                                                                                       Sa dy ee s
                                                                                       Sandy Beers                  Gene Lukianov
                                                     Enhancing ambulance
                                                   -E h     i      b l                 Charlene Cobb                Chris Fitzgerald
                                                   transport safety through shared     Comilla Sasson               Jeff Welch
                                                                                       Ken Beers                    Eileen Frazer
                                                   knowledge of technical data'.       Wayne Zygowicz,              Jon Swanson
                                                                                       Mike Reid                    Jim Love
                                                                                       Martha Florey                Kevin Peters
http://www.objectivesafety.net/TRBSummit2009.htm                                       Art Cooper                   Dia Gainor
            TRB Summit Downloads                                           October 2009, TRB Ambulance                                       October 29, 2009 TRB Summit
http://www.objectivesafety.net/TRBSummit2009.htm                          Transport Safety Summit Agenda
                                                                            • Session 1: Burden/Benefit -
                                                                                           Safety Data
                                                                                           Economics-
                                                                                           Ethics and Risk /Benefit
                                                                            • Session 2: Transport System Management
                                                                                           Fleet/Vehicle Operations Safety
                                                                                           Operations Management
                                                                            • Session 3: Vehicle Safety – Assessment and design
                                                                                           Vehicles
                                                                                           Special Populations
                                                                            • Session 4: Information Sharing and Policy
                                                                                           Knowledge Transfer/Dissemination
                                                                                           Standards/Specifications/Policy
                                                                                           An international perspective from Oslo, Norway
                                                                            • Session 5: Panel and Research Priorities -




                        2009 TRB Summit
http://www.objectivesafety.net/TRBSummit2009.htm                                                                                              Session1: Burden & Benefit
  Brought together a spectrum of diverse expertise and representation :
     Government agencies
      •   National Highway Traffic Safety Administration (NHTSA)                                                                            • Introduction and Opening Address – 8.00-8.15am EDT USA
      •
      •
          Department of Transportation ITS (DOT)
          National Transportation Safety Board (NTSB)
                                                                                                                                              Introduction - Rick Pain PhD, Nadine Levick MD, MPH
      •   Federal Highways Administration (FHWA                                                                                               Opening address – Mr. Glenn Ludtke - (Introduced by Mr. Jeff
      •
      •
          Federal Motor Carrier Safety Administration (FMCSA)
          Bureau of Labor and Statistics (BLS),
                                                                                                                                              Lindsay)
      •   Department of Homeland Security (DHS)

     Teamsters
                                                                                                                                            • Session 1: Burden/Benefit    -         8.15-10.00am
                                                                                                                                                                                   - 8 15 10 00am
     EMS State Directors
                                                                                                                                              Safety Data –                8.15-8.50
     EMS Services
      •   private and municipal from across North America                                                                                     Economics-                   8.50 – 9.40
      •   Fire/EMS                                                                                                                            Ethics and Risk /Benefit –   9.40 – 10.00
      •   Volunteer EMS
     EMS Physicians
     Industry partners                                                                                                                        Break 10.00- 10.30am
      •   EMS Equipment
      •   Vehicles, both OEM and aftermarket
                                                                                                                                              *Webinar attendees - LOG OUT 10am- LOGIN 10.20am USA EDT*
     Academics
     Technical experts
      •   Automotive safety engineering, occupant protection
      •   Ergonomics and human factors.




                                                                                                                                               USA Emergency Vehicles
                      Ambulance Safety                                                      Ambulance Safety                                         (ground)
       The Delaware Experience                                                       The Delaware Experience
                                                                           Glenn H . Luedtke, NREMT/P
                                                                                         Director, Sussex County EMS
                                                                                 Vice-Chair, Delaware EMS Oversight Council
                                                                                 Chair, NAEMT EMS Safety Course Committee
                                                                           • Representing:
                                                                              – Sussex County EMS
                                                                              – Delaware Volunteer Firefighter’s Association
                                                                              – National Association of EMT’s                                                                             FARS & GES 1995 - 2007
    FARS – A National Data Set?                                                                                         Fatalities among EMTs and
 Small numbers – but NO data captured from 20%                                                                           paramedics, 2003-2008*                                                                       Survey of Occupational Injuries
           of the nation in 10 years                                                                                      Other
                                                                                                                                                                                                                     and Illnesses (SOII)—Nonfatal data
                                                                                                     Assaults and violent
                                                                                                             acts
                                                                                                                                             8%
                                                                                                                                                                            Aircraft incidents                  – Data obtained from an establishment survey
                                                                                                                                      8%
                                                                                                                                                                                                                  based on OSHA recordkeeping logs.
                                                                                                Other transportation
                                                                                                                                 7%                             36%                                             – National data prior to 2008:
                                                                                                                                                                                                                     • Cover private wage and salary workers only
                                                                                                 Struck by vehicle             7%
                                                                                                                                                                                                                     • Exclude volunteers unless compensated
                                                                                                                                                                                    Total = 74
                                                                                                                                                                                                                – Data for 2008 and beyond:
                                                                                                                                            34%                                                                      • Include paid State and local government workers
                                                                                                       Highway incidents
                                                                                                                                                                                                                – Case and demographic characteristics:
                                                                                                * Data for 2008 are preliminary.                                                                                     • Available for cases with days away from work only.
                                                                                                Source: Bureau of Labor Statistics, Census of Fatal Occupational Injuries




                  Cases with days away from work among                                                     Number of days away from work among EMTs
                 EMTs and paramedics, private sector, 2007                                                    and paramedics, private sector, 2007
                                                                                                                                                                                                                            Upcoming releases:
                                                                                                                                                                  1 day
                                                                               Total = 4,360                                                                                          Total = 4,360                             2008 data
                                                                                                               31 or more                                13%
                    Other
                                       24%                                                                                            24%                                                                   • National data for nonfatal injuries in the
                                                            In lifting
                                                               36%
                                                                                                                                                                    13%         2 days                        public sector:
                                                                                                                                 5%
                                                                                                                                                                                                                – Summary industry data: October 29
Contacts with objects                                                            Overexertion             21-30 days
                                  8%
    or equipment                                                                     51%                                                                                                                        – Case and demographic data (i.e. data for
                                    8%
                                                                                                                                    8%                         20%                                                EMTs): Early 2010
                                                        Other                                                 11-20 days                                                      3-5 days
          Transportation
             incidents                       9%      overexertion                                                                           16 %                                                            • Final fatality data: April 2010
                                                         15%

                  Falls on same level                                                                                        6-10 days
  Source: Bureau of Labor Statistics, Survey of Occupational Injuries and Illnesses             Source: Bureau of Labor Statistics, Survey of Occupational Injuries and Illnesses




                                                                                                                                                                                                                                       Robin Kormin                       Eric Kormin
                                                                                                                                                                                                      Stacy Garland                    Labor and Delivery nurse           Robin’s
                                                                                                                                                                                                      Driver of Ambulance              Riding in rear of ambulance        Husband
                                                                                                                                                                                                      Dead                             Severely Injured
       IF SAFETY FOR THE SAKE OF SAFETY WASN’T ENOUGH:

                                                                                                                                                                                                      Andre Jamison                                         Ken Dryden
          A WORD ON LAWSUITS AND LIABILITY                                                                                                                                                            Father of Baby                                        EMT, Garland’s Co-Worker
                                                                                                                                                                                                      Wilson                                                Severely Injured

                                                                                                                                                                                                          y
                                                                                                                                                                                                      Baby Wilson
                                                                                                                                                                                                      Died shortly after being                          Roy Bryant
                                                                                                                                                                                                      delivered following                               Driver of Tractor Trailer hit
       Michele R. Kendus                                                                                                                                                                              accident                                          by Ambulance
                                                                                                                                                                                                                                                        Injured
       Goodell, DeVries, Leach & Dann, LLP
                                                                                                                                                                                                                       Maria Wilson
                                                                                                                                                                                                                       Patient in Labor transported            D&L Logistics
                                                                                                                                                                                                                       in rear of Ambulance                    Owner of Damaged
                                                                                                                                                                                                                       Injured                                 Tractor Trailer
                                                    Mountain Regional Services            Cumberland Medical Transport

            Causes of Action:                       Cumberland’s Parent Company           Ambulance Owner who leased
                                                                                          Garland to drive Ambulance


                                                                                                                Kingdom Fire &
                                                                                                                                 Usability – Human Factors
           - Bodily Injury                          Dr. Jarvis Tannen
                                                    Garland’s Primary Care
                                                                                                                Casualty Co.
                                                                                                                Cumberland’s

          -Wrongful Death                           Physician                 Stacy Garland                     Business
                                                                                                                Automobile                 Chris Fitzgerald
         -Loss of Services
          Loss                                                       p
                                                    Cedar Grove Hospital
                                                                                                                Insurer

                                                                                                                                            (Ergonomist)
                                                    Hospital where Garland sought
        -Property Damage                            treatment for syncopal
                                                    episodes
     -Workers’ Compensation                                    Smithville Medical Center
                                                                                                   Mountain Health Services
                                                                                                   Staffing Company that
                                                                                                                                      EMS Subcommittee of the TRB Ambulance
                                                                                                                                             Transport Safety Summit
                                                               Conducted pre-employment            leased Garland to
                                                               health screening of Garland for     Cumberland
                                                               Mountain Health
                                                                                                                                                      October 29th , 2009




                  Outline                                                                                                            Fleet Safety Management
                                                         Ambulance Fleet Economics                                                           Systems
Presentation overview
• Framework to consider human factors.                   • Fleet Costs                                                            • Fleet Management                • EMS Practice/Policy
• Defining your population of users.                     • Accident Costs                                                            – Leadership                     – Safe Drive Policy
                                                                                                                                     – Driver Selection               – Seat belt use for all
• Designing for operational paramedic tasks.             • Driver Training
                                                                         g                                                             Standards                        occupants
                                                                                                                                     – Driver Performance-            – Equipment secured
• Understanding how paramedics access, use &                                                                                           identify high risk drivers     – Intersection policy
  restow equipment.                                                                                                                  – Vehicle Selection,             – EVOC – Emergency
                                                                                                                                       Inspection, Maintenance          Vehicle operators course
• Balancing item accessibility with prevention of                                                                                    – Accident                       – Communications
  strike hazards.                                                                                                                      Reporting/analysis                • Cell phones / texting
                                                                                                                                     – Program Evaluation                • In-vehicle
• Design challenges.                                                                        Canadian Ambu-Moose
                                                                                                                                                                           communication




          Total Cost of Risk                                    Corporate Cost of Risk                                            Direct Costs of Vehicle Crash
                        Fees
                      3% to 5%                           • Cost of risk                                                           • Cargo Damage
                                                             – Typically represents 1 to 3 percent of total                       • Vehicle Damage
                                   Premiums                                                                                       • Indemnity (payroll) Costs of Injured EMS
                                                               organization (for small companies may be higher).
                                  20% to 35%
                                                             – Usually the highest cost are found in workers’                       Personnel
                                                                   p                     y p       g         yp
                                                               compensation and liability depending on the type of                • Medical Costs
                                                               company                                                            • Loss of Revenue
                                                                 • EMS may have high WC cost due to patient handling or           • Administrative Costs
                                                                   vehicle crashes
                                                                 • EMS may have high GL costs due to vehicle crashes and          • Police Report
                                                                   impact to general public or patients involved in crash         • Possible Effect on Cost of Insurance
      Losses
    60% to 80%                                               – Is affected by retention levels and losses                         • Possible Effect on Cost of Workmen's
                                                                                                                                    Compensation Insurance
                                                                                                                                  • Towing Costs
                                                                                                                                  • Storage of Damaged Vehicle
                                                                                                                                                              Costs of Motor Vehicle Crashes
          EMS Specific issues                                                                   Indirect Costs of Crashes                                               Worksheet
                                                                                                                                                            Direct Costs to the Organization
                                                                                           • Lost Clients/Customers       • Damaged Equipment
• Negative impact on EMS response times                                                    • Meetings Missed                Downtime                        Workers' compensation benefits                                     $______________
                                                                                                                                                            Healthcare costs                                                   $______________

• Negative impact on regional EMS resources                                                • Salaries Paid to Employees   • Accelerated Depreciation of     Increases in medical insurance premiums                            $______________

                                                                                             in Accident                    Equipment                       Auto insurance and liability claims and settlements                $______________
• Consequences of decrease of emergency                                                                                   • Accident Reporting
                                                                                           • Lost Time at Work                                              Physical and vocational rehabilitation costs                       $______________

  care response capacity                                                                   • Cost to Hire/Train           • M di l C t P id b
                                                                                                                            Medical Costs Paid by           Life insurance and survivor benefits                               $______________
                                                                                                                                                                                                                               $
                                                                                                                                                            Group health insurance dependent coverage                          $______________
• Negative impact on service morale and ability                                              Replacement Employees          Company                         Property damage (equipment, products, etc.)                        $______________

  to recruit                                                                               • Supervisor's Time            • Poor Public                     Motor vehicle repair and replacement                               $______________

                                                                                           • Loss of Personal Property      Relations/Publicity
• Loss of other skilled EMS personnel due to                                                                              • Increased Public Relations
                                                                                                                                                            EMS costs (ambulance or medivac helicopter)                        $______________

                                                                                           • Replacement Vehicle Rental                                     Vehicle towing, impoundment and inspection fees                    $______________
  concerns regarding safety issues                                                                                          Costs
                                                                                                                                                            Municipality or utility fees for damage to roads, signs or poles   $______________
                                                                                                                          • Government Agency Costs
                                                                                                                                                            Direct Total       $_______________




  Costs of Motor Vehicle Crashes
            Worksheet                                                                                                                                     Guiding EMS Practice for OHCA
  Indirect Costs -                                                                         Clinical Decision Priorities in
  Supervisor's time (rescheduling, making special arrangements)           $_____________
                                                                                           Out-of-Hospital Cardiac Arrest
                                                                                           Out-of-                                                         • Current EMS Practice for the
  Fleet manager's time to coordinate vehicle repair, replacement, etc.    $_____________

  Reassignment of personnel to cover for missing employees (less
  efficient)
                                                                          $_____________
                                                                                                                                                             Termination of Resuscitation (TOR) of
  Overtime pay (to cover work of missing employees)                       $_____________
                                                                                                          Comilla Sasson, MD, MS
                                                                                                                                                             Unsuccessful Efforts
  Employee replacement                                                    $_____________
                                                                          $

  Re-entry and retraining of injured employees                            $_____________           Robert Wood Johnson Clinical Scholar                    • Evidence-based Recommendations
  Administrative costs (documentation of injuries, treatment, absences,
                                                                                                           University of Michigan
                                                                                                                                                           • Barriers to Implementing National
                                                                          $_____________
  crash investigation)
  Inspection costs                                                        $_____________            Department of Emergency Medicine
  Failure to meet customer requirements resulting in loss of business     $_____________                                                                     Guidelines
  Bad publicity, loss of business                                         $_____________
                                                                                                             October 29th , 2009
  Indirect Total     $_______________
                                                                                                                                                           • Next Steps
  TOTAL              $_______________




                                                                                                     Operational Issues                                   Facilitators to Knowledge Transfer
                                                                                                                                                           • Improve Communication between EMS/
                                                                                                                                                             Medical Directors and OLMC
                                                                                                                                                              - Strengthen current AHA/ILCOR
                                                                                                                                                                Guidelines on Termination of
                                                                                                                                                                Resuscitation
                                                                                                                                                           • Standardize Educational Requirements
                                                                                                                                                           • Increase Coordination of Local Services
                                                                                                                                                              - Streamline Body Aftercare and Family
                                                                                                                                                                Support System
       What We Need to Know                                                                                     Focused
                                                                                                                                 More Users, More Needs
    There are several groups that are                                                                           Factorie                              • Send the Unfocused to
                                                                                                                s
                                                                                                                                                        the emergency system
    actively working to answer the many                                                                                                               • Complicated, multisystem
    questions that have presented.                                                                                                                      disease patients
                                                                                                                                                                    g      p
                                                                                                                                                      • More needing transport
                                                                                                                                                        assistance
                                                                                                                                                      • Example: Changing
                                                                                                                                                        nature of ACS patients




     Emergency Service
   Utilization is Predictable
                                                     General
                                                    Population
                                                                           Session 4: Information
                                                                            Sharing and Policy                                    State and Federal
    EMS
                      Emergency Department        Walk-ins to ED                                                                EMS Transport Safety
                                                   325 / 1000
                       Total use 400 / 1000
                                                   Population      Session 4:
                                                                   • Knowledge Transfer and Dissemination
                                                                                                                                 Knowledge Transfer
                           Population
                                                                     Government and Non- Government Platforms
 80/1000                76 - 88% Walk-Ins
                                 Walk Ins                            Challenges                                                       Platforms
                      12 - 24% Arrival by EMS                      • Standards/Specifications and Policy
Population
                                                                                                                                EMS Subcommittee of the TRB Ambulance
           Transfer           Admit             Treat &                                                                                Transport Safety Summit
                                                Release
           0.3 - 4%          11 - 30%
                                                                                                                                          October 29th , 2009
                                                65 - 85%
Another
Transpor
    t




    State Initiatives Related to
                                                                                 Federal Initiatives                                   What’s Missing
      Crashing Ambulances
 • Mandatory crash reporting:                                        • National EMS Advisory Council --
                                                                                                                                       from this List?
                                                                       Safety Committee                                    •   Railroads
    • PA, annual report generated                                                                                          •   Commercial Trucks
                                                                     • Federal Interagency Committee on
    • ND, but #s low                                                   EMS -- Technical Working Group                      •   Aviation
                                                                       Safety Committee                                    •   Passenger cars
 • Other programs:                                                                                                         •   Marine
    • CO, conference                                                 • Transportation Safety                               •   Transit
                                                                       Advancement Group – US                              •   …
    • Grant programs for equipment                                     DOT/RITA ITS Joint Program
                                                                       Office
                                                           Non-Government
         Summary - Feds                      • Organization                                                                          SESSION 4: Information Sharing
• Federal authority and interest                – TRB, ATS Ad Hoc, EMS Safety Foundation,
                                                – Web based
                                                                                                                                             and Policy
  lacking                                          • Responder Safety.com, Closecalls.com, EMSnetwork.org, Global EMS Forum,
                                                     EMS Garage

• EMS transport safety is subordinate           – Trade Journals                                                                         Challenges – Knowledge
                                                – Foundation
                                                   • FARE / Vi i Z
                                                            Vision Zero                                                                   Transfer/Dissemination
• Committees and research are not            • Association
  enough                                        – NAEMT, NAEMSMA, NASEMSO NAEMSP
                                                                                                                                                   Kevin Roche
                                             • Accreditation
                                                                                                                                         Phoenix Fire Department, Arizona
• EMS is the “missing mode”                     – CAMTS, CAAS
                                             • Coalition
                                                   Advocates for EMS – Kurt Krumperman




    Challenges – Knowledge                        Fire Service Culture and
                                                                                                                                     How To Get Through:
    Transfer/Dissemination                                Tradition
                                               ► Pride in Service to the Community                                             ► Focused Message
►   Size of the Fire and EMS Services
                                               ► History                                                                       ► Consistent Message
►   Variety of Service Delivery Models                                                                                         ► Involvement in the Standards Process
                                               ► Tradition
►   Variety of Organizational Models                                                                                           ► Involvement in the Regulatory Process
                                               ► Change
►   Lack of Standardization                                                                                                    ► Good Research
                                               ► Risk-Takers
►   Culture                                                                                                                        Conveyed in a Way that Can be Understood
                                                   Invincibility
►   Tradition




   The National Academies                     EMS Safety Summit Wrap Up                                                         EMS Safety Summit Wrap Up
Transportation Research Board                • Burden/Benefit                                                                  • Transport System Management
  EMS Safety Subcommittee                       – Safety Data                                                                     – Fleet/Vehicle Operations Safety
                                                   • Multiple datasets – not interoperable, huge holes                              • Safety program/culture – crashes ↓ 60%
                                                   • Inconsistent definitions, incomplete collection
          EMS Safety Summit                     – Economics
                                                                                                                                    • “Trust, but verify” – vehicle “black boxes”
     Washington District of Columbia
     Washington,                                                                                                                    • Align rewards with safety, not profit
                                                     Vehicles: small f t
                                                   • V hi l                        h         fortunes
                                                                   ll fortune; crashes: many f t
           October 29, 2009                        • Data-driven business and insurance case is strong
                                                                                                                                  – Operations Management
                                                                                                                                    • EMD ↓ hot responses, hence crashes
               Summary                          – Ethics and Risk/Benefit
                                                                                                                                    • ITS: great promise in ↓ crashes
                                                   • Decision rules ↓ crashes, but few use them
                                                   • Technology also ↓ crashes, but few have it                                     • Dynamic deployment, visual systems ↓ crashes
            Arthur Cooper, MD, MS
       Columbia University/Harlem Hospital
  EMS Safety Summit Wrap Up                                                               Solutions?                                               Thoughts To Ponder
• Vehicle Safety – Assessment and Design
   – Vehicles                                                    • National Incident Management System                                    • Public Health Answering Points
      • Our engineering colleagues are way ahead of us                – Unified ICS (potential partnership with DHS)                         – Health advice for patients at home
   – Special Populations – Pediatric to Bariatric                • Together Everyone Achieves More                                        • No substitute for the human touch
      • Special populations → illustrative solutions                  – TeamSTEPPS (AHRQ/TriCare) may help                                               p                  practice medics
                                                                                                                                             – Mid level providers/advanced p
• Information Sharing and Research Priorities                    • Government can’t (and shouldn’t) do it alone                           • PC based telemedicine in rural areas
   – Knowledge Transfer/Dissemination                                 – Interdisciplinary professional collaboration needed                  – SkypeTM has shown us how to do it
      • The world is large…our “worlds” are small, and insular   • We all know what needs to be done                                      • Fossil fuels will be prohibitively expensive
   – Standards/Specifications/Policy                                  – TRB White Paper → interdisciplinary NAs panel
      • For vehicles, not patients or providers…must change!
                                                                                                                                             – Medical transport only a last resort




    The www.GlobalEMSForum.org
                                                                                  Safety in the Back?                                      Safety in the Back?- IS a system
   your public access gratis resource
                                                                           Ergonomic and Automotive Safety                               COMBINATIONS of ALL SCENARIOS MUST BE CONSIDERED
                                                                                     Challenges                                           ROAD ACCIDENT SCENARIOS
                                                                        What are the practices, technologies and                                 Frontal impacts
                                                                      challenges of ambulance safety design – in a                                Side Impacts
                                                                     spectrum of countries, a real world perspective                     Roadway Departures and Rollovers
                                                                 •    Introduction:
                                                                      Mr. Darren Walter FRCS(Ed) FCEM – Emergency Medicine Physician,                      ATTENDENT POSITION SCENARIOS
                                                                      South Manchester, UK                                                               • Seated (in position), belted in Designated
                                                                 •    A Systems and Interdisciplinary Perspective:                                                           Seating
                                                                      Nadine Levick MD, MPH, FACEM – Emergency Medicine Physician and
                                                                      Injury Researcher, EMS Safety Foundation, New York, USA                           • “Out of Position”, unbelted and/or ambulant
                                                                 •    Automotive Safety and Engineering Challenges:
                                                                      Gene Lukianov, Automotive Safety Engineer, Michigan Detroit, USA
                                                                 •    Operational Ergonomics – Key issues:                                                PATIENT SCENARIOS
                                                                      Chris Fitzgerald CPE, EMS Ergonomist, Risk and Injury Management             • Pediatric to Bariatric size and weight
                                                                      Services, Melbourne, Australia
                                                                                                                                                 • Various levels of injury and medical need
                                                                 •    Overview - Q & A




       Safety in the Back?                                               EMS Operational Ergonomics
   SO WHAT”S THE CHALLENGE?                                          Presentation overview
• Occupant Protection is a systems issue                             • Defining the framework for consideration of human
• AVOID crashes with Driver Training, Operating Policies,              factors.
  Safety monitoring and feedback technologies, Ambulance             • Defining your population of users.
  Conspicuity and Vehicle crashworthiness specifications
• Constrain Attendants SAFELY, ideally forward and rear                Designing f t k             di     f    “in the back”.
                                                                     • D i i for tasks paramedic perform “i th b k”
  facing
• Constrain Patients SAFELY, with shoulder belts                     • Understanding how paramedics access, use & re-
• SECURE all Equipment effectively                                     stow equipment.
• Engineer Compartment Interior to be IMPACT FRIENDLY                • Balancing item accessibility with prevention of strike
                                                                       hazards.
                                                                     • Design challenges.
                                                                     Standards Update                                   ISO – 39001
               User Population                                                                                Road-traffic Safety management
Who will use the ambulance                                  NFPA – forthcoming meeting in December                        systems
• Female participation rates of up to 30 to 40 %.
                                                            SAE – x2 standards underdevelopment
• Height difference between a 5th percentile female &
                                                              General vehicle crashworthiness and occupant
  95th percentile male is approximately 400 mm.
                                                              safety standard
  User size needs t b accommodated i d i f
• U      i       d to be            d t d in design for
                                                              Specific equipment and occupant restraint
  comfort & access to the patient & equipment.
                                                              standard
• Need to balancing head & shoulder clearance with
  reach distance.                                           ISO - ISO/AWI 39001 - Road-traffic Safety
• What is the height, weight and “size” range of patients
                                                            management systems
  that are to be restrained on the stretcher.                 Recent update meeting in Canada




                                                                                                               Planning for 2010 EMS Safety
             SAE development                                          Vehicles Update                        Foundation Rettmobil Delegation??
                                                               As of January 1, 2010                                   May 5-7. 2010
                                                                 USA the Sprinter will be distributed by
                                                                 Mercedes and Freightliner
                                                                 Canada the Sprinter will be solely
                                                                 distributed by Mercedes
                                                               State policy developments
                                                               EMS Safety Foundation Innovation
                                                               Consortium new vehicle and fleet
                                                               purchases




      Rettmobil 2010 Delegation                                             Time line                                   Thank you!
       Registration of Interest                                     November 2009 – June 2010
                                                                                                                      Any Questions??
                                                             TRB Subcommittee meeting Jan 13, 2010              an electronic recording and a .pdf handout of
                                                                                                              this presentation awaits EMS Safety Foundation
                                                             January 14th EMS Safety Foundation
                                                                                                                               Members online
                                                             Webinar
                                                                                                                          EMSS f t F   d ti
                                                                                                                      www.EMSSafetyFoundation.org
                                                             Rettmobil Delegation 2010, May 5-7th, 2010
                                                             Workshop May 4th, 5th and 7th , Germany
                                                            ICEM 9-12th June, Singapore
                                                            Global EMS Forum Webinar June, 2010

				
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