Analysis of an Ambulance Crash: A Case Study in Why EMS Vehicle Operator Safety Should be at the Top of Your Agency’s Plans
Each year, all response agencies should take the time to review the past year’s memories, challenges, and accomplishments, both the good and the bad, and set goals for the coming year. Issues like budgeting, developing the yearly training plan, review of SOPs, updates and innovations, human resources and wellness policies, maintenance of equipment and the fleet, and the update of emergency management plans are all important to address.
One area that’s not always considered is emergency vehicle operator safety training. However, evidence tells us it should be a core part of any agency’s training process. Ground ambulance crashes are the leading cause of work-related deaths for EMS professionals. In 2023, the National Highway Traffic Safety Administration (NHTSA) reported that from 2012 to 2018, nearly all ground ambulance crashes (92.6 percent) involved ambulance operator/driver error.
Let’s take a deeper look at emergency vehicle operator training and why this important facet of instruction should be at the top of your agency’s plans.
What Causes Ambulance Crashes and Incidents? Two Words: Operator Error
The NHTSA figure cited above is no anomaly. Here’s more from the study:
Improper clearing of intersections, traveling against red lights, and operator fatigue were noted as factors in the crashes. Lights and sirens were active in 40.7 percent of the crashes.
NHTSA has several recommendations based on the study’s outcomes:
- Strengthen organizational safety polices;
- Reduce operator errors through training;
- Create a culture of safety; and
- Adopt new vehicle safety designs or technologies.
Despite the data and the recommendations, it turns out good training is difficult to come by. Often there is no designated expert on this topic within fire stations or EMS departments.
Also, there is no standardization or consistency around emergency operator vehicle safety training. According to a recent research study of ambulance operations, only 31 of 50 states require even a basic Emergency Vehicle Operator Course (EVOC) for ambulance drivers.
The National Registry of Emergency Medical Technicians (NREMT) cognitive and psychomotor examinations don’t include driving an ambulance. Most states don’t require a driver’s license in order to obtain an EMS license, and in most states, only a valid passenger car driver’s license is required to drive an ambulance. Some states have a special endorsement for ambulance drivers, but few if any require a commercial driver’s license, even for the largest of ambulances.
These are facts and statistics, but let’s examine what actually happens out there on the roadways.
Crash Analysis: Passing Out at the Wheel
The case below is excerpted from my new text, EMS Vehicle Operator Safety, Second Edition, cowritten by my friend and EMS expert Robert Raheb.
This incident involved a single-vehicle crash of a 2014 Ford E-350 Type III ambulance that occurred on the roadside of a five-lane, undivided highway. The crash occurred during the afternoon on a cloudy day with a temperature of 35°F. The posted speed limit was 50 mph and analysis of the event data recorder (EDR) reported speed revealed the ambulance was traveling 54 mph just prior to swerving and leaving the road. The vehicle was occupied by a belted 26-year-old male driver, an unbelted 49-year-old female paramedic, and a 76-year-old male patient who was restrained on the Stryker cot.
The ambulance crew was conducting a nonemergency transport of a patient from one medical facility to another, and the EVO was operating the vehicle without emergency lights and siren activated. The ambulance was traveling east in the left lane when the EVO suffered a diabetic episode (hypoglycemia) and lost consciousness. He had a history of type 1 diabetes.
The ambulance departed the right side of the roadway, and the front of the ambulance struck the end terminal of a blocked-out, W-beam steel guardrail and then continued down the embankment. The ambulance struck several trees and rolled end-over 180 degrees coming to rest on its wheels facing west.
The EVO, who was properly restrained, remained in his seat throughout the rollover and was transported by an ambulance to the hospital where he was treated and released.
The paramedic happened to be standing up at the time of the crash and was thrown about in the back of the ambulance ending up in the side stairwell with the patient partially resting on her legs. She was taken by helicopter to the trauma center and spent the night in the hospital. The paramedic stated that the three straps and shoulder straps were secured on the patient during the transport. She also stated that in order to take a BP she removed the patient’s coat and the shoulder straps.
During the collision and the rollover, the stretcher remained secure but the patient did slide up and partially off the stretcher. The patient sustained multiple injuries of the head and torso from contact with the hard surface of the patient compartment wall. In addition, there were lower leg abrasions, an abdominal contusion, and a liver laceration. The patient was pronounced dead at the scene of the crash.
The ambulance service covers a 300-square-mile area with a population density of 614 people per square mile. They operate 18 ambulances by contract for emergency and nonemergency calls and they screen driver’s records prior to employment. They also provide an 8-hour classroom driving course as well as defensive driving and an obstacle course maneuvering and on-the-job driver training. No recertifications are required.
In the text, I present two simple questions:
1. How could this crash have been prevented?
2. Does your agency have a standard operating procedure (SOP) for use of all restraints on your cot?
There are a few answers, but certainly prevention is better than having to react to a devastating crash.
Get the Latest Materials for Emergency Vehicle Operator Training
In 2018, the author team of myself and Raheb collaborated with the National Association of Emergency Medical Technicians (NAEMT) to design a robust and engaging EMS vehicle operator training program. The course has been taught throughout the USA and internationally in its 8-hour didactic and/or 16-hour didactic and skills range versions.
EMS Vehicle Operator Safety, Second Edition has an open format that allows jurisdictions and agencies to incorporate local laws and regulations and SOPs, making it a course that is credible, flexible, and relevant to all EMS providers.
The program focuses on what matters most: creating and maintaining a culture of safety. Its paramount goal is to reduce crashes, injuries, and fatalities involving EMS vehicles and providers. Built on the most current research, this evidence-based course underscores that both vehicle dynamics and human factors contribute to collisions, and that certain behaviors must be changed to promote a culture of safe driving. EVOS emphasizes increasing the EVO’s awareness and understanding of vehicle safety, and the critical importance of understanding local laws and SOPs. It also challenges EMS providers to think critically by analyzing real-life scenarios and typical crashes, highlighting the specific hazards that lead to collisions and giving practical strategies to avoid them.
Over the past 18 months the EMS Vehicle Operator Safety, Second Edition book and course have been updated to incorporate the latest concepts. The first step in the revision process was to survey instructors who were teaching the course, as well as those who train EVOs using other course materials, to obtain their input on adjustments and additions to the program. We also did an extensive search of the published literature on each of the EVOS topics. Content was updated with an emphasis on evidence-based findings as well as policy updates which help the EVO prepare for the hazards driving an emergency vehicle on today’s roads. The text includes a series of actual collisions that were investigated (not just headlines) and the lessons that can be learned from their review.
The second edition text, course, and instructional package address the following:
- Developing a safety-first attitude to ensure the EVO’s own safety, their partner, the patient, and any passengers.
- Distinguishing types of laws affecting EMS vehicle operation including consideration for responding to emergency and non-emergency calls.
- Taking appropriate precautions when performing specific maneuvers and when driving under various road and weather conditions.
- Performing daily vehicle inspections to manage potential mechanical issues.
- Discuss controversies with lights and siren operation and change in the paradigm.
- Practicing mental, emotional, and physical preparedness.
- Proactively preventing vehicle crashes and learning how to respond if one occurs.
- Developing special awareness and practicing skill maneuvers in a driving skills course.
- Evaluating new and future EMS operations technology.
- Utilizing simulation training to integrate knowledge learned during lectures with the technical abilities acquired through skills practice and judgment to choose when to use it.
- Developing effective SOPs for key aspects of EMS vehicle operation.
EVOS: EMS Vehicle Operator Safety, Second Edition
EMS Vehicle Operator Safety (EVOS), Second Edition, addresses the vehicle operations and transport safety knowledge gaps that lead to injury and death.
Request Your Review Copy
Related Content:
- Highway Scene Safety 101: Training and Best Practices for EMS & Firefighters
- Vehicle Rescue and Extrication: What You Need to Know
- Lights and Siren Use in EMS is Changing. Here's What You Need to Know
About the Author:
Bob Elling, MPA, Paramedic (retired) – has been a career paramedic, educator, author, and EMS advocate since 1975. He was a paramedic with the Town of Colonie EMS Department, Albany Times Union Center, and Whiteface Mountain Medical Services. He was also an Albany Medical Center Clinical Instructor assigned to the Hudson Valley Community College Paramedic Program. Bob has served as National/Regional Faculty for the AHA and involved in many successful life-saving legislative campaigns with the You’re the Cure Network. He also served as paramedic and lieutenant for New York City EMS, a paramedic program director, and the associate director of New York State EMS Bureau. He has authored hundreds of articles, videos, and textbooks to prepare EMS providers for their career. Bob is the ECSI Medical Editor for the CPR and First Aid Series, Co-Author of EVOS, and Co-Lead Editor of Nancy Caroline’s Emergency Care in the Streets.