Study Examines Crash-related Injuries Among EMS Workers

March 7, 2003
Ambulance crashes are one of many hazards faced by emergency medical services (EMS) personnel. A new study published in Morbidity and Mortality Weekly Report (MMWR) examines risk factors for injuries and fatalities for EMS workers involved in ambulance crashes.

Although no complete national count of ground ambulance crashes exists, the total number of fatal crashes involving ambulances was determined using the National Highway Traffic Safety Administration (NHTSA) Fatality Analysis Reporting System (FARS).

From 1991 to 2000, the most recent year for which data were available, 300 fatal crashes occurred involving occupied ambulances, resulting in the deaths of 82 ambulance occupants and 275 occupants of other vehicles and pedestrians. The 300 crashes involved a total of 816 ambulance occupants. FARS does not differentiate ambulance workers from passengers among those experiencing nonfatal injuries in fatal crashes; however, the seating positions for all occupants and the severity of injuries can be determined from FARS data.

EMS personnel in the United States have an estimated fatality rate of 12.7 per 100,000 workers, more than twice the national average. The MMWR report documents 27 ambulance crash-related fatalities among EMS workers over a 10-year period. The surveillance data and case investigations identify riding unrestrained as an important risk factor for EMS workers. Among all ambulance occupants, riding in the patient compartment was associated with greater injury severity.

However, in 27 incidents coded as "fatal injury at work," seven (26 percent) of the EMS workers killed were drivers who were not wearing a restraint, and two (7.4 percent) were unrestrained in the front right seat. Six (22 percent) of the EMS workers killed were not wearing restraints while riding in the patient compartment.

The National Institute for Occupational Safety and Health (NIOSH) and NHTSA investigated case reports of ambulance crashes and the MMWR report summarizes three of these investigations, presents surveillance data and makes recommendations for prevention measures.

In the first case, an emergency medical technician (EMT) died when her ambulance was struck head-on by a pick-up truck. The EMT was riding unrestrained in the patient compartment while attending a patient during a nonemergency transport. During the collision, the EMT struck the front bulkhead of the patient compartment; she died en route to the hospital from blunt force trauma to the head and chest. The patient and pick-up driver also suffered fatal injuries. The ambulance driver was driving unrestrained and suffered multiple serious injuries, including a fractured leg.

In the second case, an EMT died when her ambulance struck an elevated train-track support column. She was riding unrestrained in the patient compartment while attending a patient during a nonemergency transport. During the collision, the EMT and the patient both struck the front bulkhead of the patient compartment. Both the driver and patient were hospitalized; the EMT was transported to a hospital, where she was pronounced dead.

In the third case, an EMT, who was driving, and a paramedic were injured when their ambulance struck an oncoming vehicle head-on and overturned. The paramedic was riding unrestrained on the patient compartment squad bench while attending a patient during a nonemergency transport. A relative of the patient was seated in the rear-facing attendant's seat and was wearing a seatbelt. During the collision, the unrestrained EMT driver sustained minor injuries. The paramedic struck the interior cabinets and shelves of the patient compartment. The EMT and the paramedic were transported to a hospital, where the EMT was treated and released; the paramedic was hospitalized and released two days later. The patient's injuries included scalp and shoulder contusions and a shoulder laceration. The patient's relative sustained minor internal injuries.

In the three cases published in MMWR, the EMTs and paramedic who sustained the worst injuries were riding unrestrained.

Researchers noted less than half of EMS workers use restraints in the patient compartment. This occurs because lap-belt restraint systems commonly provided in patient compartments do not allow full access to the patient. When properly used, the squad bench lap belts position the EMS worker against the side wall, making it impossible for the worker to bend forward to access the patient.

If the EMS worker needs to access the cabinets along the driver-side wall, the belts must be unbuckled to allow the worker to stand up. If CPR or other procedures such as intubation or insertion of IVs must be performed, EMS personnel might need to stand over or kneel near the cot. For these reasons, EMS workers often ride unrestrained, seated on the edge of the squad bench. Researchers noted also that unrestrained or improperly restrained patients who become airborne in a crash might pose an additional injury risk to EMS personnel and to themselves.

NIOSH recommends employers ensure EMS workers use patient compartment vehicle occupant restraints whenever possible, that drivers and front-seat passengers of EMS vehicles use the occupant restraints provided, consider equipping ambulances with patient cots that include upper body restraints, and ensure that EMS workers who operate ambulances are qualified and trained appropriately. In addition, suggest the authors, ambulance manufacturers should evaluate and develop occupant protection systems designed to increase the crash survivability of EMS workers and patients in ambulance patient compartments and ensure that such systems allow EMS workers mobility to access patients and equipment.

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