Increasing Safety at Your EMS Agency

by Bob Elling May 13, 2025

When we discuss actual cases involving the topic of safety in our emergency services training courses, the cases selected seem to involve: the “deadly ambulance crash,” the “provider shot,” the “rolled over school bus MCI,” or the “responders struck by traffic on the highway.” In a world where every action movie seeks to leave the viewer at the edge of their seat, a discussion of routine responses seems to be more difficult in keeping audience (student) attention.

Opening Your Training with a Case
It is at those routine familiar responses that many responders continue to be injured.

In the past year I personally know of three emergency responders who were injured and have sustained significant costs (i.e., emotional, physical, and financial). Not to mention the time stolen from their life and the impact on their agency and coworkers. One came very close to losing a leg, one fell and sustained cervical spinal fractures, and the third has sustained a shoulder injury that requires surgery. Each of their injuries has resulted in surgery, hospital time, extensive physical therapy, and time away from work.

As a paramedic who retired after more than four and a half decades in the field, I have a sense of what many of the direct and indirect costs of these injuries add up to. I usually say I am one of the “lucky ones” who survived EMS! I was only in three ambulance crashes, but fortunately I was not the driver in those wrecks. I walked away from two of them, but the third one happened to be the only time I have ever ridden in an ambulance as the patient. Of course, after laying in a busy ED all night because they couldn’t decide to admit me or not, I signed myself out, drove myself home for some sleep. The next day I called my physician for a referral to ortho for x-rays only to find I sustained two fractures in my lumbar spine and one in my thumb.

In another instance, in a dark unlit stairwell, I had an EMT, patient, and stair chair fall a flight of stairs on top of me. On calls I broke a couple of ribs and had a few back strains from lifting heavy patients the wrong way. Over the years, I sprained my ankle more times than I remember but I never lost a day of work. On one snowy night, I slipped on a patch of ice and limped to calls all night. After a few days of nursing my “swollen ankle” with ice, an ACE bandage, and NSAIDs, I finally got the referral to ortho and x-rays. I walked out with a cast on my broken left tibia and drove myself home!

As I said I survived, “mere flesh wounds” as Monty Python would say, and usually went right back to work. In retrospect, most of my injuries probably could have been prevented with a keener sense of safety and situational awareness. I do firmly believe that “scene safety” is not a box you check off or always that bad guy around the dark corner. You rarely know the environment where calls are unless they are in your house and sometimes the safety issues are those potholes or dark stairs. The scene is never safe, we just try hard to minimize the risks.

Rather than starting your safety training reviewing a dramatic case, which falls into the “never going happen here (or to me) mentality,” I suggest you pick a couple of routine familiar responses that have involved injuries to your communities’ emergency responders. Take the time to discuss all the direct and indirect costs as well as why they occurred and how the injuries could have been prevented. Some relatively “minor” injuries last a life-time. I would suspect in a lineup of EMTs it would be easy to find the responders who have used the old Ferno Model-30 stretchers for a good part of their career.

A Few “Rs” to Consider
Preparing to increase safety at your agency involves an analysis of a few key steps: Research and Review, Reflect and Rethink, Renew and Recommit to Safety.

What is “safety” anyway? According to the American Heritage Dictionary, “safety” is the condition of being safe; freedom from danger, risk, or injury.

In the rush of responding to calls, safety shortcuts are often taken and not addressed unless something tragic occurs. This applies to situations inside the agency station, in the emergency vehicle, at the incident scene, on the road, at the ED, and then at the station or post location between calls. It pertains to actions taken as an individual, between peers, and when caring for patients and their families.

Research and Review
Consider the published data that is available on safety incidents in your state/region. Take a look at reports from the near-miss sites, analysis of previous crashes, and training programs that are already available. There is value in reviewing the “near-miss” web sites the emergency services organizations have. There is lots to learn from reviewing NHTSA reports analyzing major incidents and crashes. Once the litigation is over and with appropriate permissions, share the facts of your stories so others can learn from them and not repeat them!

A good starting point would be to review the EMS Safety Practices, an online FEMA and US Fire Administration publication released April 2022. The report is a good overview of the history of safety policies and best practices. They discuss important concepts such as: risk identification, developing a culture of safety strategy, situational awareness, and worker physical and mental health. Many of these topics are expanded upon and brought up to date in the NAEMT EMS Safety course. Basically, you should ask yourself, “Are your agency SOPs up to date and do they cover current best safety practices?

Reflect and Rethink
Since your employees/members will need to buy into or have ownership in the updates you will be making to agency safety, ask for their participation and be open-minded to ideas. A good question to ask a group of instructors about safety would be: How can instructors integrate safety mindfulness, best practices, and actions (that they can model) into all their courses? You will be surprised at all the great ideas you get when the discussion is about why and how and not about who did what. Do not assume every new idea costs money your agency does not have to spend. Some ideas reflect a time commitment and attitude adjustment. How about those safety policies you already have in place, are they working for your agency? Does everyone comply? If not, then why not? Sometimes there are better ways of doing things. The answer for why we do things a certain way should not be, “because we have always done it that way.”

Renew and Recommit
Finally, after the previous steps and you have come to some consensus on changes and/or updates to your safety program it is time to share with 100% of the personnel and help them understand the reasons for any updates. It is important for people to understand the “Why” to changes so they do not just chalk it off as change for the sake of change or to think of the updates as some type of punishment the 5% of the employees/members who previously crossed the line. If you have done an excellent job at selling the updates to the agency safety program and you practice what you preach it is not unreasonable for everyone to recommit to making safety front and center at all time. After all the scene is not the only place that is usually not safe!

Not Really “Accidents”
We can all think of stories that turned into a near-mis. In an open discussion, when there are no potential penalties or repercussions it is not surprising some of the unsafe practices that occur. These are usually not really accidents, rather they are usually preventable events simply waiting to happen. The common denominator usually includes: lack of focus, distraction, complacency, an angry response, fatigue, or simply not committed to following the SOPs.

Here are a couple of examples:

While enroute to an emergency call… I asked my partner, who was driving the ambulance, “What is that beeping noise?” Having never heard the “fasten your seatbelt” beeping when in an ambulance, it took me by surprise. When going home to my family uninjured is on the table I can be a real pain in the butt. How about you? It is not your coworker that makes the job unsafe…it is his/her behavior.

Arriving as the second unit on call for a child in the stream. It was evident emotions were running high seeing all the responders diving into the water to attempt to find the young victim (no PFDs).

Training on a hot day is not an excuse for not wearing PPE. It is a good reason for rotating personnel, properly hydrating, and exercising the rehab sector.

Cutting corners with no gloves or eye shields on a medical call and getting sick from exposure to body fluids or stuck with a bloody angiocath is simply unacceptable.

How about that one partner with the big mouth that always seems to get you in trouble.

In an informal discussion with responders bring up the question, Ever get that gut feeling the scene was not safe for you to be there? The answers are frightening.

Key Training Points for Crew Leaders, Supervisors, and Training Officers
In my humble opinion, I believe that all training is safety training. Emergency services trainers (BLS, ALS, at all levels, FTOs, lab instructor, clinical instructors, specialty instructors, driving instructors, etc.) should always remember that your students learn the behaviors you model. They learn to wear their protective equipment or in some cases to not wear it since their instructor took “short cuts.” We all need to model the behavior you expect to see in your students and coworkers.

Those “old photos” in your personal presentations do make an impression. Sometimes they make the wrong impression. If for historical purposes rather than illustrating contemporary techniques clearly point that out. When I worked in NYC I had a friend who was a press photographer who gave me a box of black and white 8x10 photos of emergency services in action. I would occasionally show some of those photos in the context of how important it is to wear your PPE. I would tell my students they should always treat their PPE with respect. They should understand that in most cases those responders who came before them often had to “earn” the (gloves, helmets, eye-protection, protective boots, protective coats and reflective vests), sometimes with their own blood and or lives!

How Can Your Agency Recommit to a Culture of Safety?
Start reviewing your training, your SOPs and comparing and sharing “best practices” with other agencies that you respect. Be sure to model safety at all points and you will start to notice that your members/employees are beginning to do the same. There are many suggestions, from which to begin your safety journey, found in the two NAEMT courses that can be adopted to fit the specific needs of your service and community. The hardest part is to just get started moving in the right direction. As mentioned, it is best to learn from other’s incidents and prevent similar incidents from occurring in your community. We cannot simply avoid safety training as looking the other way just increases the risk of an event that could be tragic for your members/employees.

I would strongly suggest the leadership of your organization be encouraged to seriously consider these two NAEMT courses which reinforce the importance of developing a culture of safety:

The EMS Safety Course, Third Edition, aims to promote a culture of EMS safety and help reduce the number and intensity of injuries incurred by EMS practitioners in carrying out their work. This course is also available in a 5-hour online version.

EMS Vehicle Operator Safety (EVOS), Second Edition, trains EMS providers to recognize the specific behaviors that must be changed to promote a culture of safe driving.

Coming Up Soon: May 20 is EMS Safety Day
According to the EMS Week website, “To promote Safety for the EMS professional, the patient, and the public, Safety Day encourages first responders to focus on risk and prevention rather than possible negative outcomes and aims to advance safety measures for both the community and the profession. This is a great day to highlight stress reduction, self-care, and mental health awareness programs. Other options for programs include improved situational awareness, driving and roadway safety, vehicle and device maintenance, proper lifting techniques, or violence awareness.” For more information, check out the EMS Week website.

Summary
Here are a few concepts I have learned, sometimes the hard way, that make sense to me and hopefully to you too:

Every day should be EMS Safety Day!

All emergency service training is safety training.

There is no place for road rage in emergency services.

The scene is never safe. Don’t be paranoid, be prepared and situationally aware at all times.

And as always be careful out there!

EMS Safety Course Manual

EMS practitioners are 2 ½ times more likely to die on the job and 3 times more likely than the average worker to miss work as a result of injury. To combat this epidemic, NAEMT created the EMS Safety course to promote a culture of safety and to help reduce the number of on-the-job fatalities and injuries.

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