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While we continue to analyze the data, our most significant finding has been a tragically simple one: EMS personnel are not buckling up. Fully 4 in 5 EMS providers in the back of the ambulance were unbelted at the time of a serious crash. Of the 45 providers in the patient compartment at the time of the crash, only (16%) were wearing a seat belt at the time of the crash, meaning 38 (84%) were unrestrained.4 In addition, 11 of the providers (22%) driving the ambulance were unbelted. Data from every fatal crash involving an ambulance for the last 20 years shows a similar pattern of results—most ambulance occupants are not wearing seat belts during crashes. We found that whether ambulance occupants wear seat belts or not significantly predicts the severity of occupant injuries and fatalities. And unbelted providers are doing more than just getting injured: They also risk injuring their patients. Occupant-to-occupant contact was identified as a source of the injuries sustained by patients, and in at least two cases, these injuries were fatal. When EMS arrives at a scene and patients are load-ed into the ambulance, they and their families should feel safe knowing help has arrived. Because of this, the EMS profession has an incredible responsibility; keeping our patients safe during a call is paramount to good care and should be a priority for any EMS crew transporting a patient. The good news is that EMS personnel are excel-lent about buckling up their patients: Investigations show that 96% of those patients were belted at the time of the crash. The bad news is that 61% of them were restrained with only lateral belts, while only 33% were correctly restrained with lateral belts and shoulder straps to keep them secured to the cot. Of the serious crashes investigated, 44% of patients were ejected from their cots and patients not restrained by both shoulder and lateral restraints were at a significantly greater risk of being ejected from the cot and sustaining serious or fatal injuries. In other words, simply using those shoulder restraints can save our patients’ lives and prevent devastating injuries. Our analysis found that providers reported that a shoulder harness was not attached or available in 33% of serious crashes.5 However, in more than a third (38%) of the cases, providers reported that though the shoulder harness was attached to the cot, it was not used.

Identifying Ambulance Crash Factors

Factors associated with ambulance crashes are not unlike those of the general driving population, although they are sometimes exacerbated or influenced by the nature of EMS work. NHTSA is address-ing several of these to help keep responders safe. Fatigue affects everyone—especially those who work long shifts or in the middle of the night. A number of recently published peer-reviewed research studies have demonstrated not only that about half of EMS providers report symptoms of severe fatigue, but also that drowsy or fatigued EMS providers are substantially more likely to be injured on the job,6,7 commit a medical error, or perform a safety-compromising behavior while driving. This year, NHTSA’s Office of Behavioral Safety Research will begin bringing together fatigue experts and EMS stakeholders to help improve fatigue-related guidelines, scheduling and reporting in EMS.

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