Head-on EMS

Today I was reading an article entitled, "The Risky Side of Response" by David Williams and Christine Zalar in the April 2007 edition of JEMS magazine. It was a study of the number of fatalities and injuries that occur during emergency transport of the dead and dying across the United States. While the article was mainly focused the difference between air ambulance transport and ground transport, I was struck by some of the statistics on injuries/fatalities occurring during ground transport because this is something I am quite familiar with.

I've been a volunteer EMT for over 20 years and currently serve with 2 different agencies. I have been fortunate that I've only witnessed one accident involving an ambulance which sent members (or anyone else) to the hospital. According to the research in the article, there are 32.5 fatalities resulting from ground ambulance accidents. Why is this statistic not a matter of concern to any single government agency? The FAA regulates the air ambulance industry, but no single agency regulates the ground transport ambulance. In fact, the authors of the article had difficultly even piecing together the statistics because there is not even a central reporting agency.

One of the items mentioned in the article was a need for training. I know from personal experience that there is no standard for driver training. One agency requires certification from the National Safety Council's Coaching the Emergency Vehicle Operator course as well as successful completion of a cone driving course. The other agency does not. A third agency that I've worked with merely required some over-the-road driving time with a "trainer". There was no objective criteria. These agencies are all located in the state of New Jersey and are in fact, less than five miles apart.

In addition, there is no limit to hours worked. This too, is amazing. A standard "over the road" trucker is only allowed to work a limited number of hours, but the EMTs in this area have no such regulation. Many of them will work 12 hour shifts, some work a full day at their "day job" and then serve as a volunteer at night. Depending upon how busy the agency is, this could be a very long time without rest.

The question then arises, what is the government doing about this? It's not as easy as merely mandating training because they need to balance the fact that many of these services are run by volunteers who must weigh their training time versus their availability. In addition, to mandate new training on the local level means that 73 agencies need to be monitored in our county alone. This is a great deal of oversight required by the regulating agency.

Clearly, the burden falls upon the EMT training center. The national curriculum needs to expand the amount of time spent on ambulance operations which includes driver training. (In fact, the EMT curriculum should be reexamined in general, but that is a different blog.) Right now it is a 3 hour (out of 130) overview of operations which includes driver training, radios, call reports, and other things.

Thoughts anyone?