In 1992, Bill Clinton beat George H.W. Bush for the presidency of the United States. Bush was seen as unbeatable because of his leadership during Gulf War I and the fall of the communism and the Berlin Wall. Clinton's political strategist James Carville wanted to get the national attention off Bush's foreign policy wins and get the American people to start thinking about the economy, which Carville contended Bush had not addressed because of a recession. Carville coined the phrase, "It's the economy, stupid."
Carville's message became the slogan for the Clinton campaign and the rest is history. The phrase has been adapted to depict many scenarios where the focus should be directed somewhere else.
The same can be said of ambulance accidents. Go to EMSclosecalls.com and you will see how many ambulance accidents occur in the U.S. every week. But just like Carville's slogan, we don't seem to be focused where we should be when it comes to ambulance accidents.
Last year, it was estimated that there were more than 5,000 accidents involving ambulances. Among those statistics is usually an average of about one fatality each month for someone working on an ambulance. There are more fatalities among civilians riding in ambulances or in other vehicles also. The injuries also each year are in the thousands.
One of the largest contributors to the deaths and injuries that result each year from ambulance crashes are those who are in the back of the ambulance riding unrestrained. Last year alone, there were 11 firefighter deaths from riding in apparatus unrestrained, although not all of these were ambulance accidents.
When you ride in the back of an ambulance unrestrained, you are subject to being tossed and thrown about. If the ambulance is going 50 mph and suddenly stops because of a crash, you unfortunately are still going 50 mph when you are thrown into the front wall of the ambulance. Sharp edges or points where compartments come together in the back of the ambulance also can add to the problem when you are tossed in the back of an ambulance. The other factor in high-speed ambulance crashes is the equipment that is tossed around the rear when an impact occurs.
It is nice to say that anyone treating a patient in the back of ambulance should be restrained, but that is not always a reality. Many times, treatment requires the EMT or paramedic to be unrestrained in a standing, sitting or squatting position.
The other problem with the ambulance is that the box on the rear is basically sheet metal wrapped around some strut supports. Someone recently sent me pictures of ambulances where the entire side of the ambulance box had been ripped open. I am familiar with another case in Missouri where an ambulance box ripped open, spilling the paramedic and patient onto the highway after flipping several times. The patient died and the paramedic suffered brain injuries. I am also familiar with a case in Colorado where a paramedic tried to pass a tractor-trailer on the left and sliced open the right side of the ambulance box on the back of the tractor-trailer, again, spilling the paramedic and the passenger in the rear, who were riding on the bench seat, onto the highway.
Sheet metal wrapped around aluminum struts does not offer great protection when the ambulance box receives some high impact. The box disintegrates and occupants inside are subjected to being ejected. There are few safety standards and no crash-safety testing guidelines that relate to ambulances in the United States. Few safety standards have been established for ambulances. Although there have been some efforts by some organizations to increase safety, there is still much that can be done.
In July 2008, the Standard Council for the National Fire Protection Association (NFPA) reviewed a request for a new project to develop a technical committee to address ambulances with an emphasis on safety standards. As I write, the NFPA is seeking comments on this proposed project. Hopefully, this project will be approved. The NFPA process of developing consensus standards for such things as other fire apparatus, SCBA, clothing, etc. has worked. I hope that developing consensus standards for ambulance safety also will work.
Forming a consensus standard for ambulance safety design is not going to prevent our people or civilians from getting killed when involved in ambulance accidents. There is still human responsibility. That includes driving cautiously and carefully; stopping at intersections and proceeding only when all is clear; completing an emergency vehicle operator course; ensuring all equipment is firmly secured; wearing all seatbelts, even in the back of the ambulance if possible; secure all passengers in seatbelts; and secured the patient on the stretcher with the over-the-shoulder belts as well as the chest and thigh belts. Only through safety can we arrive alive.
GARY LUDWIG, MS, EMT-P, a Firehouse® contributing editor, is a deputy fire chief with the Memphis, TN, Fire Department. He has 30 years of fire-rescue service experience. Ludwig is chairman of the EMS Section for the International Association of Fire Chiefs (IAFC), has a master's degree in business and management, and is a licensed paramedic. He is a frequent speaker at EMS and fire conferences nationally and internationally, and can be reached through his website at www.garyludwig.com.
