Ambulance Transport Safety-

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					                    16th Darke County, EMS Seminar,
                   Greenville, Ohio, January 26th, 2008
                                                                                                              … Nov 8th’s Fatality


   Ambulance Transport Safety-                               To quote Steve “Sid” Caesar –
                                                             Director IHS ES
                 What You Can’t Afford
                    Not To Know                              “We want everyone to get home
                                                             safely each day”

Nadine Levick, MD MPH
Research Director, EMS Safety Foundation
CEO, Objective Safety
New York, NY




     And Nov 10th’s 2007 obituary….
                                                                       In a nutshell
                                                                                                             Your Interactive Handout
                                                                                                              awaits you online at…
                                                                   Am here to try to save you
                                                                   Lives                                  www.objectivesafety.net
                                                                   Time and
                                                                   Money                                       This WILL be FAST!!
                                                                                                        No need to take any notes – all text
                                                                                                        slides will be awaiting you in your
                                                                                                                  online Handout




                                                          A tragic emergency health care intervention
    http://www.objectivesafety.net                                        outcome                           A devastating tragedy…

                                                                                                         An ETT down the wrong hole
                                                                                                        may kill your patient and be a
                                                                                                        terrible burden for the pts family
                                                                                                        and for the medic involved
                                                                                                         BUT an EMS crash can kill all
                                                                                                        involved AND wipe out an EMS
                                                                                                        systems response capacity……
                                                                                   It does happen….
                           “…I’d like to know what can be done         Friday July 20th 2007...
Thursday July 5th 2007……
                             so this never happens again….”         The worst ambulance crash in
                                                                            USA history




                                                                          Jan 18th, 2008




     Jan 23rd, 2008        Charged with Vehicular Homicide       …as he had been trained to do…??
  2 killed, 3 injured….      2 counts of vehicular homicide…        November 5, 2007
September 23, 2007 - PA          November 5, 2007 - PA




An interhospital transport
                                          Firstly!               Testing the real world
   ? “Do no harm….”?



                               An accident ?
                             or
                             a predictable and preventable
                             event




           So

                                What’s going to save your life   What’s going to hurt you
  What’s important

                                What might take your life        What’s going to protect you
  What’s not important
                                                                                                                    Outline
                                                                                               I. Review of data on ambulance crashes and safety
                                                                                                  standards and guidelines that exist for the
                                                                                                  ground EMS
         What is factual
                                                             What is new                       II. Identification of ground EMS transport safety
                                                                                                   issues, hazards and areas of risk to patients,
         What is garbage                                                                           providers and public
                                                             What is not new
                                                                                               III.Highlight unacceptable mythology and
                                                                                                  challenges to advancing EMS transport safety

                                                                                               IV.Profile innovation, new safety technologies and
                                                                                                 strategies and knowledge transfer to enhance
                                                                                                 safety and reduce risks of ground EMS and
                                                                                                 patient transport




     EMS Transport Safety                                   Benefit of Safety                              Unique workplace

 ‘patient safety’                                    Any cost of addressing these issues
                                                     is dwarfed in contrast to the huge            In vehicles
 AND also                                            burden of not doing so - in financial
 ‘provider’ and ‘public safety’                      costs let alone the personal, societal,
                                                                                                   At roadside and other emergency
                                                     ethical and litigation costs
                                                                                                   scenes




                                                                                                 An ambulance is not an ED /ICU
 the EMS transport process                         The Emergency Department (ED)
                                                                                                          on wheels
communications/dispatch
the patient                                   T
restraining device/seat                       I
transporting device/gurney
                                              M
paramedics/transport nurses, doctors & family
patient monitoring equipment                  E
clinical care & interventions
protective equipment
the vehicle
                                              &
the driver/driving skill
                                           PLACE
other road users
the road
                                                                                                       Ground Transport Safety IS
                                                                                                      Complex AND Multidisciplinary
                                                                                                          Epidemiological           Risk            Public
                                                                                                          Data Collection        Management         Safety

                                                                                                      Ergonomic
                                                                                                       Research                                      Transport
                                                                                                                                                       Policy
                                                                                                  Biomechanical
                                                                                                   Automotive               Transport
                                                                                                                                                         PPE
                                                                                                     Safety
                                                                                                                              Safety
                                                                                                  Biohazard/Chem                                      Driver
                                                                                                     Research                                        Training

                                                                                                 Communications                                     Fleet Safety
                                                                                                                     Safety         Regulations
                                                                                                   technology                                        Program
                                                                                                                   Technology      and Standards




                                                                                                             National EMS data
                                                                                                                                                                   Is it your service’s tragic year?
                                                                                                 In the USA*
    Is there an acceptable rate                                                                    ~ 50,000 vehicles
                                                                                                                                                                     ~ 50 fatalities a year
    of morbidity and mortality                                                                     ~ 5,000 crashes a year
                                                                                                   ~ One fatality each week                                          15,000 EMS services
     for pre-hospital transport                                                                       ~ 2/3 pedestrians or occupants of other car

             systems??                                                                                Approximately 4 child fatalities per year                      Each year one in 300 services
                                                                                                   ~10 serious injuries each day                                     experiences a fatality
                                                                                                   Cost estimates > $500 million annually
                                                                                                   USA crash fatality rate/capita 35x higher than in
                                                                                                   Australia                   *FARS/BTS 2005-6




           Predictable risks                                                                          Absence of standards and                                      What a fabulous Ambulance!
Fatal crashes more often at intersections, & with another                                                    oversight
vehicle (p < 0.001)*
70% of fatal crashes EMS crashes during Emergency Use*
Most serious & fatal injuries occurred in rear (OR 2.7 vs                                            Challenges in identifying best practice
front) & to improperly restrained occupants (OR 2.5 vs
restrained)**                                                                                        Myriad of unregulated commercial
82% of fatally injured EMS rear occupants unrestrained**
> 74% of EMT occupational fatalities are MVC related***                                              products
Serious head injury in >65% of fatal occupant injuries#                                              No safety performance standards
More likely to crash at an intersection with traffic lights
(37% vs 18% p=0.001) & more people & injuries/crash than                                             Absent national safety oversight
similar sized vehicles##
                    *Kahn CA, Pirrallo RG, Kuhn EM, Prehosp Emerg Care 2001 Jul-Sep;5(3):261-9
                    **Becker, Zaloshnja, Levick, Li, Miller, Acc Anal Prev 2003
                    ***Maguire, Hunting, Smith, Levick, Annals Emerg Med Dec 2002
                    #NIOSH, 2003
                    ##Ray AM, Kupas DF, Prehosp Emerg Care 2005 Dec; 9:412-415
                                                                     1960 to 2007                                         Tragedy you don’t want to be
          USA 1960’s                                                                                                              involved in
                                                                      A passenger vehicle - sure




                                                                                       A ‘laundry or mail truck’ - ??




                                                                   A passenger vehicle – yes!




Some recent adverse outcomes                                UPS and Laundry trucks have                                           Some odd facts
                                                             very similar design and even
                                                                                                                        Ambulances are generally not built by the
                                                                more stringent safety                                   automotive industry
                                                            requirements to EMS vehicles                                Intelligent Transportation Systems (ITS),
                                                                                                                        transportation safety engineering is not
                                                                          BUT                                           generally integrated into EMS systems
                                                               very different cargo……                                   Although all EMS systems have medical
                                                                                                                        direction and oversight, it is rare for there
                                                                                                                        to be transportation expertise oversight
                                                            People are passengers and
                                                             NOT packages or parcels




“Ambulance transport has a death
toll…. “

        Carl Craigle EMT-P, Chief Platte Valley Ambulance
                             Colorado Springs, April 2007
 EMS Transport General Concerns                     and who’s life was he racing to                   Clinical Care?
Consequences can be predictable & likely                         save?                            Occupational Health and
preventable
                                                                                                       Safety…..?
Costs of these adverse events are high in loss of
life, financial burden and negative impact on
delivery of EMS care
                                                                                           This IS a Transportation and
Other high speed vehicles (eg. racing cars) have
a different safety paradigm                                                                Automotive Safety issue
Design of interventions to mitigate injury is                                              This is a Systems safety issue
predicated on a valid testing model
Complex both engineering and public health
issues




  This is not how you want to see                        ‘Workplace’ Hazards
  your partner during a transport




                                                                           ?




              Preventable…                                                                      and what is killing EMS ?
James Woodman
  is a paramedic who, on his first day as a                                           EMS personnel fatalities*
  paramedic, suffered a severe TBI when the
  ambulance he was riding in (in the back) was t-
                                                                                          74% transportation related
  boned and rolled onto its side.                                                            1/5 of ground transport fatalities were struck
  He remains in a persistent vegetative state in                                             by moving vehicles
  an ECF in Colorado.                                                                    11% were cardiovascular
It is assumed that when                                                                  9% were homicide
the ambulance rolled                                                                     4% needle sticks, electrocution, drowning
onto its side, the lifepack 10                                                           and other
struck James in the head.......
                                                                                      * Maguire, Hunting, Smith & Levick, Occupational Fatalities in Emergency
                                                                                      Medical Services: A Hidden Crisis, Annals of Emergency Medicine, Dec 2002
                                             Occupational transportation                                                                           What do ambulance crashes
 So does it make sense ?                             fatalities..                                                                                         really cost ?
                                                                               Occupational transportation fatalities/100,000 workers
                                                                                                                                                 Loss of life and injury
                                                                                                                                                 Negative impact on EMS system
Gloves and universal precautions?...                                      12




                                             fatalities/100,000 workers
                                                                          10
                                                                                                                                                 Collisions are the largest liability cost and
… good biohazard protection BUT                                           8
                                                                                                                                                 exceeds malpractice or negligence
                                                                                                                                        EMS
aren’t going to give much protection                                      6                                                             Police
                                                                                                                                                 Besides the direct financial costs of replacing a
                                                                                                                                                 damaged ambulance and equipment, there are
in a ambulance crash                                                      4                                                             Fire
                                                                                                                                                 additional hidden costs incurred:
                                                                          2
                                                                                                                                                   investigating the ambulance collision
                                                                          0
                                                                                                                                                   litigation /settlement/lawsuit
                                                                                                                                                   medical/disability costs of injured EMTs
                                            WE HAVE A BIG PROBLEM HERE                                                                             hiring of new employees to replace injured personnel
                                                                                                                                                   retraining and psychological counseling of personnel
                                       * Maguire, Hunting, Smith & Levick, Occupational Fatalities in Emergency                                    involved and others
                                       Medical Services: A Hidden Crisis, Annals of Emergency Medicine, Dec 2002                                   increased insurance rates




                                                                                                                                                              Jan 25th, 2008
                        June 2007
                                                                                            A problem
                                        2007 Insurance data –

                                            27 fold more likely to have a claim
                                           based on transport than related to
                                           medical care




      Benefit of Safety                     This is about you and your                                                                            Balance of concerns and risk
                                                      safety                                                                                            during transport

Safe practices save lives,                 What safety practices do you use??
                                                             Seat belts ?
time and money
                                                             EVOC training ?
                                                             Equipment lock down ?
                                                             Helmets ?                                                                                   Response and transport time
                                                             Driver Feedback technology ?                                                                Clinical care provision
                                                             Tiered dispatch ?                                                                           Occupant safety/protection
                                                                                                                                                         Public Safety
                                                             What do we know now??
                   Goals
                                                    Intersection crashes are the most lethal
                                                    There are documented hazards, some which can
                                                    be avoided
   Standards for safety                             Occupant and equipment restraint with standard
                                                    belts is effective. (Over the shoulder harnesses for
                                                    patients should be used, with the gurney in the upright
   Policy based on Science                          position where medically feasible)
                                                    Some vehicle design features are beneficial -
                                                    automotive grade padding in head strike areas,
   Databases to demonstrate outcome                 seats that can slide toward the patient
                                                    Electronic Driver monitoring/feedback systems
                                                    appear to be highly effective                                                 It does happen….
                                                    Head protection??




                                                        New EMS helmet prototypes for
 Role of a head protective device                                                                                         Hmm…
                                                                   2008
A simple, immediate and inexpensive adjunct –
a protective device -

  To protect occupants from hazardous interiors
  As vehicle crashworthiness design advances
  As driver training advances
  For when equipment becomes unsecured
  As EMS Safety Standards are developed, for both
  EMS vehicles and EMS occupational safety




                                                                                                              So.. The real world for an EMS
             So why is it…                                  And very Predictable…                             vehicle approaching a red light

That the EMS providers -                                Intersections are lethal environments                  You think they heard you…
  Were wearing navy blue – one of the most                                                                     You know they must have seen you..
  difficult colors to see at night                                                                             And maybe they did
  Had no head protection, when all other
  emergency personnel at the scene did
                                                                                                               ….. But..
  Had no protective clothing, when other                                                                       There is NO way humanly possible
  emergency personnel at the scene did???                                                                      that they could stop…..
                            The real world
    Intersection passenger car stopping distance*                                                                                      Safety concepts out there now
                at 40 mph dry and wet                                                              What are the solutions?
                                                                                                                                      Fleet Safety Management
                                                                                                Training?                              Z-15
                                                                                                                                       Driver monitoring and feedback
                                     44 feet
                                                                      Dry
                                                                                                Practice Policy?
                                                                      Stopped at                                                      Enhanced ambulance vehicle design
                                                                      176 feet                  Transportation Systems Engineering?
                                                                                                                                      Intelligent Transport Technologies - ITS
              Perception + Reaction time           Vehicle Braking time (dry)
                                                                                                Automotive Engineering?
40 mph        Perception + Reaction time           Vehicle Braking time (wet)                                                         Visibility and Conspicuity
                                                                                   Wet          Education of other road users???      New Safety Standards
                                                                                   Stopped at
                                                                                   220 feet
                                                                                                                                      Life Safety Initiatives
* Stopping distance:
                                                 +                                                                                    Resources and information
      Perception time + Reaction time + Vehicle braking time
     (varies with age, skill, agility, alertness + vehicle type, tire pressure, road etc)




                                                                                                           The Driver                            Driver issues
                       The Mabel Rule

         Never make a left                                                                       Driver selection
         Make three rights instead                                                               Driver monitoring and feedback
                                                                                                 Driver Impairment
                                                                                                 Driver training




                                                                                                 Air EMS is a role model for
                         R&D
                “Ripoff and Duplicate”                                                           safety initiatives and focus

         Avoid reinventing the wheel at all
         costs

         Where are the best practices that we
         need to transfer knowledge from
                                                                                       Knowledge transfer
                                    Safety is Good Business

                                                                                               July 2007

                                                                             Commercial Motor Vehicle Driver Training Curricula and
                                                                             Delivery Methods and Their Effectiveness
                                                                             Commercial Motor Vehicle Carrier Safety Management
                                                                             Certification
                                                                             The Role of Safety Culture in Preventing Commercial
                                                                             Vehicle Crashes
                                                                             The Impact of Behavior-Based Safety Techniques on
                                                                             Commercial Motor Vehicle Drivers
                                                                             Health and Wellness Programs for Commercial Motor
                                                                             Vehicle Drivers




         July 2007                     UPS: The ‘Big Brown’                  ASSE Transactions, Fall 2007


                                 No left turns – instead make three rights
                                 Don’t back up
                                 Don’t employ any drivers under 25 years
                                 of age
                                 Don’t employ anyone with a history of
                                 driving convictions




Valuable information from the   Transportation Research Board is an                      IAFC June 2007
   transportation industry       excellent resource… we should be
                                              using it!!
   No need to reinvent the wheel...                                                                                      USFA Emergency Vehicle Safety                 VFIS Summer 2006
                                                                                                                                  Initiative




                                                                                                                              An excellent model                             Coming Soon!
          Tips for Emergency Vehicle                                                                                                                            Traffic Incident Management Systems
                   Operations                                                                                                                                                    (TIMS)
                                                                                                                                                                 USFA report to be
                                                                                                                                                                 released any day
                                                                                                                                                                 Research and writing
                                                                                                                                                                 by IFSTA
                                                                                                                                                                 Covers setting up
                                                                                                                                                                 safe roadway incident
                                                                                                                                                                 work areas and using
                                                                                                                                                                 unified command at
                                                                                                                                                                 these incidents
                                                                                                                              http://www.EveryoneGoesHome.com
                                                                                                                                                                 Will be available in a
                                                                                                                                                                 downloadable format




        Ambulance Safety Research:                                                                                      The Crash Event - Crash Testing
               A New Field                                                                                                                                         Intrusion vs Deceleration
                               Dan Berry
                               Transport Canada, Ministry of Health

                                          Best,
                                                                                                                          An introduction                         Intrusion
                       Turbell et                           Levick Levick Levick Levick Levick Levick Levick
engineering            al,
                       Sweden
                                          Zivkovic,
                                          Ryan
                                                            et al  et al  et al  et al  et al  et al  et al

                                                             Bull,
                                                             Talty
                                                                       EMSC PED-SAFE-T
                                                                       Levick et al
                                                                                                  Levick
                                                                                                  et al
                                                                                                                          What one needs to know                  = vehicle to vehicle or vehicle to
ergonomic                                                    et al                                    Highnett
                                                                                                                                                                  fixed narrow object
                                      Saunders et al
                                                                       Woodward,
                                                                       Fleeger et al
                                                                                        De Graeve,
                                                                                        Deroo, Calle
                                                                                                      et al
                                                                                                                          What do the tests really mean
                                      FEMA
epidemiology NHTSA/                                  Biggers,
                                                                     Weiss, Maguire, et al
                                                                Calle,
                                                                et alet al
                                                                                               Becker,
                                                                              Hunting, MMWR Zaloshnja,
                                                                                                            Johnson,
                                                                                                            Lindholm,
                                                                                                                          And, what tests are meaningful
                                                                                                            Dowd
                                                                                                                                                                  Deceleration
                  NTSB/ Auerbach           Pirrallo, Zachariah,      Kahn, Smith, NIOSH, Levick, Li, Ray
                  EVOC et al               Swor      Pepe            Pirrallo Levick CDC       Miller     Kupas

                                                                                                                                                                  = sudden stop – ie. sled test
 1960      ‘70   ‘78       ‘86 ‘93 ‘95 ‘96 ‘98 2001 ‘02                                ‘03 ‘04 ‘05 ‘06
         non                         ? safe                                              safer
        issue
                                                                   If we know this – and its
                Dynamic Safety Testing                                                                              Why do we do this?
                                                                         published….
                       requires sophisticated, expensive
                       equipment

                       measurably demonstrates forces
                       generated during collision

                       accepted international standard
                       for vehicle restraint systems




            Full Vehicle Crash Testing
         Test 1 – Right side impact
                                            2




                              1


 1 – Target vehicle,
 Type I ambulance
 2 – Bullet vehicle,
 Type II ambulance
 Closing speed 44 mph
                                   Johns Hopkins University




And this all takes place in 60 millisecs                                                               Fire Service Emergency Vehicle Safety Initiative
                                                              NIOSH Ambulance Occupant Safety Crash
         – the blink of an eye                                              Testing                    – Phase II
                                                                                                            Developed an innovative web based emergency vehicle
                                                                                                            safety educational program to support the volunteer
                                                                                                            fire service in partnership with the NVFC:
                                                                                                            http://www.nvfc.org/evsp/index.html
                                                                                           Impact
                                                                                           Direction
                                                                                           25 MPH !
 And keep focus on ‘All hazards’                                           What’s new                                                                         Safety oversight of what and by ….
 in addition to crashworthiness                                                                                                                                             whom
                                                  New expertise and collaborations
  Driver age?                                                                                                                                                     Vehicle Safety
  Driving history?                                New automotive and transportation safety
                                                  technologies                                                                                                    Vehicle Design
  Patient condition?                                                                                                                                              Safety Equipment Design
  Dispatch?                                       New Information
                                                                                                                                                                  Vehicle and Safety Equipment
  Vehicle stability?                              New events                                                                                                      Testing and Standard development
  Driver feedback technologies?                                                                                                                                   Safety policies




           Risk/Hazards                     EMS Best Practice, Sept 2006                                                                                           American National Standard
                                                                                                                                                                     ANSI/ASSE Z15.1-2006
                                                                                                                                                              Safe Practices for Fleet Motor Vehicle Operations

    Predictable risks
    Predictable fatal injuries
    Serious occupational hazard
    Public safety hazards




                                                               Z15 Incident Rates                                                                                   Use proven safety tools
    What Z15 encompasses                 Incident rate based on number of vehicles operated:
                                          Incident rate = Number of incidents x 100
Safety Program                                             Number of vehicles


Safety Policy                            Incident rate based on vehicle mileage:
                                          Incident rate = Number of incidents x 1,000,000
Responsibilities and Accountabilities                         Vehicle mileage


Driver Recruitment, Selection and        Injury incident rate based on vehicle mileage:
                                             Injury incident rates, the most frequently used indicator of incident severity, are useful for tracking events
Assessment                                   that have the potential to affect financial or operational performance of the operating unit.
                                          Injury incident rate = Number of incidents with injury x 1,000,000
                                                                        Vehicle mileage
Organizational Safety Rules
                                         Incident rates based on service activity:
Orientation and Training                     Motor vehicle operations that pose injury risks other than those associated with driving should also use
                                             the service activity as the basis of a safety performance rate. The number of deliveries, stops, or loads
Reporting Rates and Major Incidents to       should be considered as appropriate indicators of performance.
                                           Incidents per 10,000 transports = Number of incidents x 10,000
Executives                                                                     Number of transports


Oversight                                Vehicle injury rates based on work hours:
                                           Vehicle incidents per 200,000 hours = Number of incidents x 200,000
                                                                               Number of hours worked
                                                                                            Patients must be in the over the
NAEMT July 2006 Position statement        Policy makes a difference…
                                                                                         shoulder harness, medics restrained
                                                                                           in seat belts, equipment secured




      WEMSA Leadership                       WEMSA – October 2007                          WEMSA covered some key and
                                                                                         important policies and procedures
                                                                                                       But….
                                     1.   Emergency Vehicle Operations Policy
                                                                                          What about hours of service?
                                     2.   Vehicle operations training and evaluation
                                     3.   A program of graduated driver responsibility    What about visibility at the scene? For
                                     4.   Drivers only age 25 and over
                                                                                          providers and the vehicles…?
                                     5.   Complete stop at an intersection                What about protective equipment?
                                     6.   Restricted use of Red Lights and Sirens         What about ambulance design safety?
                                     7.   Monitoring of emergency vehicle operations      What about reporting of adverse events?




  What about changing driver
  behavior in the real world??            Demonstrated Effectiveness                        Purpose of ‘Feedback box’
                                                                                                    Program
                                          Change driver behavior                            Enhance Safety
                                          Carrot not stick                                  Improve Driver Performance
                                          Vehicle maintenance improvement                   Save Maintenance Dollars
                                          Decreased administrative burden                   Aid Accident / Incident Investigation
                                          Insurance benefits
    How the Device Works                                      Demonstrated Effectiveness                                                                                                                                                                                                                                                                                            And when a rare crash happens….
                                                                                         MEMS MONTHLY OVER SPEED VIOLATION TREND 2003/2004

                                           600,000



Computerized monitoring device installed
                                                                    550,353
                                           500,000




on each vehicle to measure parameters      400,000                                                                                                            Series1

                                           300,000


Each driver has individual key “fob”       200,000
                                                          216,922             179,721


                                                                                                                                       4,046


Data collected every second
                                           100,000
                                                                                      2,074                                                                                                        3,069
                                                                                                   1,609                     547                                                        780                                               2709
                                                                                                                285                                                         710                                 1,004       1657
                                                                                                                                                       207        407
                                                0


  including: vehicle speed and




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                                                                                                                                                        Dec
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                                                                                                                                            No
                                                                                                                                            MONTH                                                                                                           MEMS ABC Miles Per Month
                                                      I             II                  III
   performance, driver behaviors




                                                                                                                                                                                                                                                                                                                                                                      2
                                                                                                                                                                                                                                                                                                                                                                 19 .3
                                                                                                                                                                                                                                                                                                                                                  17 .49
                                                                                                                                                                                                                                                                                                                                                                               20
   and emergency mode




                                                                                                                                                                                                                                                                                                                       17 .43


                                                                                                                                                                                                                                                                                                                                         16 .61



                                                                                                                                                                                                                                                                                                                                                           .76
                                                                                                                                                                                                                  3




                                                                                                                                                                                                                                            3




                                                                                                                                                                                                                                                                                                                                15 .25
                                           I – blind data, no growls




                                                                                                                                                                                                             15 .84




                                                                                                                                                                                                                                                                                                                                                           15
                                                                                                                                                                                                                                         14 .82

                                                                                                                                                                                                                                                   9




                                                                                                                                                                                                                                                                                                                                                                      13 .11
                                                                                                                                                                                                                                                  .42
                                                                                                                                                                                                                                                                                                                                                                               15




                                                                                                                                                                                                                            9
Auditory feedback of warning




                                                                                                                                                                                                                        12 .05




                                                                                                                                                                                                                                                  13
                                                                                                                                                                                                                                 9. 94
                                           II – growls & tones ON




                                                                                                                                                                                                                                                             9




                                                                                                                                                                                                                                                                                        9. 61
                                                                                                                                                                                                                                                        9. 31


                                                                                                                                                                                                                                                                     9. 41




                                                                                                                                                                                                                                                                                                               9. 27
                                                                                                                                                                                                                                                                                                                                                                               10




                                                                                                                                                                                                                                                                                                       7. 57
                                                                                                                                                                                                                                                                                8. 39
‘growls’, and penalty tones




                                                                                                                                                                                                                                                             7. 24


                                                                                                                                                                                                                                                                         6. 9
                                           unidentified data capture




                                                                                                                                                                                                              4
                                                                                                                                                                                                          5.24




                                                                                                                                                                                                                                                                                                               9
                                                                                                                                                                                                                                                                                                           4.28
                                                                                                                                                                                                        886




                                                                                                                                                                                                                                                                                                2.27
                                                                                                                                                                                                                                                                                                                                                                               5




                                                                                                                                                                                                   4 3.
Data downloaded automatically every day    III – identified data




                                                                                                                                                                                      March 0.018

                                                                                                                                                                                        May 0.04
                                                                                                                                                                                       April 0.017
                                                                                                                                                                                                                                                                                                                                                                               0




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                                                                                                                                                                                                                                                                                                                        *January 2005
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        Unit 302 Accident                                                                                                                                                                                                                                                                                                                                                               Demonstrated clearly
                                                              Extensive Indirect cost savings

                                                                    Fewer out of service vehicles                                                                                                                                                                                                                                                                                    Driver risk behavior can be
                                                                    Improved transport times                                                                                                                                                                                                                                                                                         substantially modified and improved
                                                                    Decreased administrative lost in                                                                                                                                                                                                                                                                                 with monitoring device, with real time
                                                                    managing unsafe behaviors                                                                                                                                                                                                                                                                                        auditory feedback.
                                                                    Decreased legal burden
                                                                    Automatic system wide data
                                                                    Insurance benefits




                                                                               You want a system that                                                                                                                                                                                                                                                                                 News we don’t want to see
        The jury is out on                                                           works!!

        Opticon                                                     Does the system really work
        Simulators                                                  Is it going to be a major burden on
                                                                    your staff to implement
                                                                    What are the real costs
                                                                    Are you going to have video of your
                                                                    company vehicle on you tube??
 …..May 21st, 2007, Seattle                Worker visibility Act:
                                                                                       There are grants to assist you..
                                 Help is on the way !! November 24th 2008




Science not, next best guess




Visibility and Conspicuity …?.        Being seen at the scene….                               Recent Visibility Webinar
                                          November 4, 2007                                   www.GlobalEMSForum.org




                                                                            http://eclass.circl.pitt.edu/recordings.html?s=1192161600000&e=1192247999999&sort_column=date&change_direction=false&page=0
         Under Way…                    Policy and practice ignorant of
 Emergency Vehicle Visibility and       existing technical safety data           Good visibility!
       Conspicuity Study
Funded by the USFA;
                                       X                              X
conducted by IFSTA
Looking at the
effectiveness of
reflective markings
used on emergency
vehicles
Doing best practice
research and working
with manufacturers          X




Make sure that EVERYTHING is
                                    Very cool – even high visibility hoses!!
         tied down!




                                        This looks cool AND SAFE!              Not rocket science..
 And what a smart vehicle!!
          Very cool !!!                        Day visibility                   Night visibility




                                          Safety Management                 Ambulance Standards??

                                      A Safety Culture                           KKK?
                                      Protective Policies
                                                                                 AMD?
                                      Protective Devices
                                       To prevent a crash                        FMVSS?
                                       In the event of a crash                   NFPA?
                                      Continuous Education and Evaluation




‘Safety’ approaches being driven by        USA Ambulances:                  Propaganda that kills…
  manufacturers claims and sales            FMVSS Exempt
  rather than by science and data




     ?
 USA ambulance purchase                                                                          Occupant protection……??
                                         KKK – static ‘safety testing’
      specifications                                                                                    July 2007
GSA:KKK-A-1822F, Aug 2007              Ignorant of automotive safety principles –         Medic                                  Medic
                                                                                                                                 Fatality
                                                                                          Survivors
                                       and specifies that a ‘successful test’ is -
Static Pull test
                                         No structural damage to any load bearing or
2200 Lbs. (8G’s) in Longitudinal and     supporting members, i.e., torn or broken
Lateral                                  material, broken welds, popped or sheared
No dynamic test                          body rivets, bolts, and/or fasteners, shall be
                                         evident during the application of the force
No definition to manikin mass            and after the release of the force.
No restraint for equipment
Voluntary




   30 years later, 1,600 fatalities    Unacceptable, and ridiculous current
    and still the same problem                2007 USA ambulance                               No ‘a’… then NO ‘F’ !!!!!
                                          ‘safety testing’ practices !!??
                                                                                                      F = ma
                                                                                                      where   F – force
                                                                                                              m – mass
                                                                                                              a – acceleration




     KKK certified and FMVSS
                                               FMVSS exempt……
           exempt..?
           A closer look
                                            A few key words about restraint
                                                      systems…




                                                                                                 Side facing 4-point harnesses demonstrated to be
                                                                                                     lethal, even at slow ground vehicle speeds




 NIOSH Ambulance Occupant Safety Crash       Being seated IN an automotive                             Increasing awareness …
               Testing                        seat is what will protect you

                                          Anything that allows or encourages you to
                                          get up out of your seat will also encourage
                                          you to be injured or killed – it is potentially
                              Impact      lethal to be out of your seat in any fashion
                              Direction   4 or 5 point harnesses for sidefacing
                              25 MPH !    occupants are potentially lethal – and is in
                                          NO WAY SUPPORTED BY ANY DATA OR
                                          AUTOMOTIVE SAFETY EXPERTISE




                                                                                                                 ?
Rash of “Safety Concept” vehicles…..                    Bigger is not necessarily
  Devoid of substantive automotive                                  better……
 safety engineering input or testing




             ?
                                                                                    OUCH!
                                                                                    My liver!!




                                                           OUCH!
                                                           My spleen!!
                                    Safety concepts out there now              Major events for innovation sharing
                     Innovation                                                 – but regional and often language isolation



                                    Driver feedback technologies
                                    Tiered dispatch
                                    Enhanced ambulance vehicle design
                                    Intelligent Transport Technologies - ITS
                                    New Safety Standards




   Vehicle Occupant Safety design         Ergonomic design                     Ergonomic layout and equipment
2007 European design
Safety technology is a
key focus




       NSW Australian vehicles             Flexibility to manage two
                                                     patients                         Securing equipment
                                         Protective devices/concepts                              Back up Camera….. Shouldn’t all
                                                                                                    vehicles have one of these?
                                         To prevent a crash
                                           Driver feedback
                                           Driver monitoring
                                           Driver training
                                           Vehicle Intelligent Transportation System (ITS)
                                           technologies
                                           Tiered dispatch
                                           Appropriate policies


                                         In the event of a crash
                                           Vehicle crashworthiness
                                           Seat/seat belt systems
                                           Equipment lock downs
                                           Padding
                                           Head protection




       Breaking News!!
      National Academies                   Creating a Safety Culture                                 Some simple and available
TRB EMS/Medical Transport Safety                                                                      solutions out there now
  Subcommittee – Jan 16, 2008             within a company must start with upper
                                          management’s commitment to safety                        Intersection Policy

                                                   Awareness                                       PPE
                                                   Training
                                                   Incentive                                       Black boxes




  What do we know works…                      What you can do now                                     Important Principles !
                                                                                             1.   A culture of safety
 Vehicle Operations Safety Policies
                                       Have a written and implemented ‘safety program’       2.   Drive cautiously
 Squad bench lap seat belts
                                       Secure all equipment                                  3.   Wear your belts & restrain all occupants
 Patient over the shoulder harnesses   Secure occupants with standard belts                  4.   Secure all equipment
 Securing equipment                    Don’t drive through red lights/stop signs
 Forward and rear facing seating                                                             5. Integrate scientific data into your
                                       Use properly implemented “Feedback Boxes”
 Some electronic technical devices                                                              policies and procedures
                                       Monitor crash events with common
 Safety awareness                      denominators (ie. per 100,000 miles and per trip)
                                                                                                  - Unrestrained occupants and equipment
 Cultural change
                                                                                                  are a potential injury risk to all occupants
    Very Important Principle                          small changes can make a
                                                         BIG DIFFERENCE
                                                                                                     PREDICTABLE
 Ambulance transport safety is
 part of a SYSTEM, the overall
                                                    PREPARE – TEACH – REACH – RESPOND
                                                     Look at your own safety record                  PREVENTABLE
 balance of risk involves the
 safety of all occupants and
                                                     Teach safety and hazard awareness
                                                     Reach out with safety information to all your       and
                                                     EMS providers
 the public                                          Respond with the best safety practices          NO ACCIDENT




              Conclusion
EMS transport has serious hazards and safety                         And….
issues
Major advances in EMS safety research,
infrastructure and practice over the past 5 years    It is no longer acceptable for EMS to
New technologies for vehicle design, occupant        be functioning outside of automotive
PPE and equipment restraint and driver               safety and PPE safety standards for
performance are now available
Development of substantive EMS safety                prevention of and protection of EMS
standards is a necessity and a reality               providers and the public from injury
Failure to transfer knowledge from transportation    and death
and automotive safety is unacceptable and
dangerous
EMS is still way behind the state of the art in
vehicle safety and occupant protection