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Relative Risk of Injury and Death in Ambulances and Other Emergency Vehicles

Relative Risk of Injury and Death in Ambulances and Other Emergency Vehicles. Les R. Becker, Ph.D., NREMT-P Associate Research Scientist Public Services Research Institute Pacific Institute for Research & Evaluation Calverton MD 20705. Acknowledgements.

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Relative Risk of Injury and Death in Ambulances and Other Emergency Vehicles

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  1. THOMCO EMS SAFETY NET SEMINAR, 2007

  2. Relative Risk of Injury and Death in Ambulances and Other Emergency Vehicles Les R. Becker, Ph.D., NREMT-P Associate Research Scientist Public Services Research Institute Pacific Institute for Research & Evaluation Calverton MD 20705

  3. Acknowledgements • This research was supported by US Health Resources and Services Administration Emergency Medical Services to Children Grant No. 1 H15 MC00069 to the Johns Hopkins University and Grant Number 5 RO1 OH03750-02 to the Pacific Institute for Research and Evaluation. THOMCO EMS SAFETY NET SEMINAR, 2007

  4. Introduction • EMS response is a fundamental feature of EMS systems (Boyd et al., 1983). • Ambulance crash studies have lagged behind the growth of EMS in the U.S. • The first examinations of ambulance crashes began in the early 90’s. THOMCO EMS SAFETY NET SEMINAR, 2007

  5. Overview • Review of Early Studies • Review of the PIRE Study • Review of EMS Seat Belt Use • Discussion of Prevention Approaches • Proposal of a New Approach THOMCO EMS SAFETY NET SEMINAR, 2007

  6. Earlier Studies • Auerbach (1987) studies a very small sample of Tennessee ambulance crashes: • Approximately 50% of vehicle-drivers and front-seat occupants were wearing occupant restraints; • Over one-half of prone stretcher patients were restrained; • 15% of bench seat and 100% of jump seat patients were wearing restraints. THOMCO EMS SAFETY NET SEMINAR, 2007

  7. “We conclude that passenger restraints for both ambulance attendants and passengers should be mandatory and we suggest that traffic signals be strictly heeded at intersections and speed limits in urban settings be obeyed.” Auerbach et al., 1987 THOMCO EMS SAFETY NET SEMINAR, 2007

  8. Earlier Studies • Larmon et al. (1993) reported that 67.9% of 900 EMTs surveyed identified inhibition of patient care as a reason for non-use in the patient compartment. THOMCO EMS SAFETY NET SEMINAR, 2007

  9. Earlier Studies • Saunders and Heye (1993) • San Francisco Public Health Department ambulance crashes; • Over 27 months; THOMCO EMS SAFETY NET SEMINAR, 2007

  10. Earlier Studies • Four percent of 439 emergency medical technicians responding to a survey in New England reported that they had been involved in a crash (Schwartz et al. 1993) • Sayeh et al. (1998) surveyed 2,672 EMTS in New England and Los Angeles. • 37% in New England reported crash involvement; • 26% in LA reported crash involvement. THOMCO EMS SAFETY NET SEMINAR, 2007

  11. Earlier Studies • Pirrallo and Swor (1994) compared emergency and non-emergency ambulance crash fatalities. • Retrospective, cross-sectional, comparative analysis of 109 fatal crashes (126 deaths) from 1987-1990 using FARS data; • NY, MI, CA and NC accounted for 37% of all fatal crashes. THOMCO EMS SAFETY NET SEMINAR, 2007

  12. Earlier Studies • Pirrallo and Swor (1994) [cont’d]: • 69% occurred during emergency runs and 31% occurred during non-emergency runs; • Most emergency run fatal crashes occurred between 1200h and 1800h. • Most non-emergency fatal crashes occurred when lighting conditions were poor. THOMCO EMS SAFETY NET SEMINAR, 2007

  13. Earlier Studies • Pirrallo and Swor (1994) [cont’d]: • No statistically significant differences between emergency and non-emergency crashes based: THOMCO EMS SAFETY NET SEMINAR, 2007

  14. Earlier Studies • Biggers et al. (1996) studied one year of ambulance crash data in Houston. • Driver history of a prior EMS vehicle crash was a key risk factor for future crashes. • Drivers with a history of previous crashes were involved in 33% of all collisions. • Five drivers accounted for 88.2% (15/17) of all injuries. THOMCO EMS SAFETY NET SEMINAR, 2007

  15. Earlier Studies • Kahn et al. (2001) analyzed 1987-1997 FARS data and found that unrestrained rear occupants were most at risk for fatal and/or incapacitating injuries. • Most crashes occurred at intersections; • Dry, straight, improved roads; • On clear days; • Striking a second vehicle; • 84% of the crashes involved fatalities; • 78% of the fatalities were not ambulance occupants; THOMCO EMS SAFETY NET SEMINAR, 2007

  16. Our Work

  17. Methods • Merged 1988 through 1997 GES and FARS data; • Police, ambulance vehicles and fire trucks; • Modified KABCO scale • No injury; • Possible/non-incapacitating injury • Incapacity injury • Fatal injury THOMCO EMS SAFETY NET SEMINAR, 2007

  18. Methods • Ordinal logistic regression rather than separate odds ratio calculations; • Independent variables: • Vehicle type • Response Mode • Restraint Use • Seating position • Dependent variable • Injury severity (KABCO score) THOMCO EMS SAFETY NET SEMINAR, 2007

  19. Results

  20. Number of Crashes, 1988-1997 THOMCO EMS SAFETY NET SEMINAR, 2007

  21. Number of Fatalities, 1988-1997 THOMCO EMS SAFETY NET SEMINAR, 2007

  22. Number of Non-Fatals,1988-1997 THOMCO EMS SAFETY NET SEMINAR, 2007

  23. Injury Severity of Ambulance Occupants, 1988-1997 THOMCO EMS SAFETY NET SEMINAR, 2007

  24. Incapacitating InjuriesBy Response, Restraint Use & Seating Position THOMCO EMS SAFETY NET SEMINAR, 2007

  25. Fatal InjuriesBy Response, Restraint Use & Seating Position THOMCO EMS SAFETY NET SEMINAR, 2007

  26. Relative Risks THOMCO EMS SAFETY NET SEMINAR, 2007

  27. Summary of Findings • Unrestrained ambulance occupants involved in a crash had nearly 4 times greater risk of fatality than did restrained ambulance occupants. • Unrestrained ambulance occupants involved in a crash had nearly 6.5 times greater risk of suffering an incapacitating injury than did restrained ambulance occupants. THOMCO EMS SAFETY NET SEMINAR, 2007

  28. Summary of Findings • The risk of a fatality versus no injury for ambulance rear occupants was over 5 times greater for ambulance rear occupants than for front-seat occupants if involved in a crash. • Ambulance occupants traveling non-emergency were 2.7 times more likely than occupants traveling emergency to be killed if involved in a crash. THOMCO EMS SAFETY NET SEMINAR, 2007

  29. Summary of Findings • Ambulance occupants traveling non-emergency were nearly 1.7 times more likely than occupants traveling emergency to suffer an incapacitating injury if involved in a crash. THOMCO EMS SAFETY NET SEMINAR, 2007

  30. Conclusions • Clearly, occupant restraints are not used consistently in ambulances. • Unrestrained ambulance occupants, occupants riding in the rear compartment and especially unrestrained occupants riding in the rear compartment are at substantially increased risk of injury and death when involved in a crash. • One prior study suggests that occupant restraints are more commonly used for patients than for crew members. THOMCO EMS SAFETY NET SEMINAR, 2007

  31. Implications for EMS Safety Practices • Ambulance occupants, including providers, should use safety restraints whenever feasible. • Individuals accompanying patients during transport should ride in the front seat of the ambulance whenever feasible. THOMCO EMS SAFETY NET SEMINAR, 2007

  32. SEAT BELTS & PREVENTION

  33. Prevention Fact!

  34. “The use of safety belts is the single most effective means of reducing fatal and nonfatal injuries in motor vehicle crashes.” Dinh-Zarr, Sleet, Schultz et al., 2001 THOMCO EMS SAFETY NET SEMINAR, 2007

  35. Seat Belt Use in the U.S. THOMCO EMS SAFETY NET SEMINAR, 2007

  36. Seat Belt Use in the U.S. THOMCO EMS SAFETY NET SEMINAR, 2007

  37. Seat Belt Use in the U.S. THOMCO EMS SAFETY NET SEMINAR, 2007

  38. What do we know about seat belt use in EMS?

  39. Perceived Need for Freedom Cook et al., 1991 THOMCO EMS SAFETY NET SEMINAR, 2007

  40. Seat Belt Use by Providers Larmon et al., 1993 THOMCO EMS SAFETY NET SEMINAR, 2007

  41. Prevention Approaches • The ‘Three E’s’ • Education • Engineering • Enforcement THOMCO EMS SAFETY NET SEMINAR, 2007

  42. More Prevention Fact!

  43. Single Approaches In Isolation are Rarely Effective!

  44. Solutions? • Education • EVOC • Driving Simulators • Engineering • Speed regulators (“governors”) • “Black Box” Approaches • Harness Systems • Enforcement • Organizational policies and sanctions THOMCO EMS SAFETY NET SEMINAR, 2007

  45. Solutions? THOMCO EMS SAFETY NET SEMINAR, 2007

  46. Effectiveness? • At least one small-scale study • 36 vehicles over 18 months • >250 drivers • Over 1.9 million miles, distance between penalty counts increased from baseline of 0.018 to high of 15.8 miles • Seatbelt violations from 13,500 to 4 • The vendors of systems marketed today advocate effectiveness based on small-scale trials. • NIOSH will be reporting preliminary findings from their harness studies at the upcoming NHTSA-sponsored Ground Ambulance Safety Roundtable. THOMCO EMS SAFETY NET SEMINAR, 2007

  47. Another Approach? Aligning provider safety with patient safety. THOMCO EMS SAFETY NET SEMINAR, 2007

  48. Provider Safety THOMCO EMS SAFETY NET SEMINAR, 2007

  49. Provider Safety THOMCO EMS SAFETY NET SEMINAR, 2007

  50. Patient Safety THOMCO EMS SAFETY NET SEMINAR, 2007

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