EMS Safety - Analysis of Ground Ambulance Crash Data

The "Analysis of Ground Ambulance Crash Data From 2012 to 2018" report by the National Highway Traffic Safety Administration (NHTSA) highlights that driver error was involved in 92.6% of fatal U.S. ambulance crashes during this period.

Common errors included improper intersection clearing, running red lights, and driver fatigue. Lights and sirens were active in 40.7% of these crashes, often inappropriately. The crashes resulted in an average of 28.4 fatalities per year, with 40.2% being ambulance occupants. Other contributing factors were speeding, unbelted occupants, and driver impairment or distraction.

“The SCI [the NHTSA’s Special Crash Investigations Unit] reports for 2012 to 2018 showed nearly all crashes (92.6%) involved ambulance operator/driver error,” said the NHTSA report.

“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. The expert reviewers noted that lights and sirens were often used in situations that were not recommended according to best-practice guidelines.”

As for the human toll from these errors, “Ambulance-involved fatal crashes remained relatively rare from 2012 to 2018 with a national average of 24.7 fatal crashes per year and 28.4 fatalities per year reported in FARS [the Fatality Analysis Reporting System],” the NHTSA report said.

“Of the individuals killed, 40.2 percent were ambulance occupants (operators/drivers, front seat passengers, and clinicians or patients in the cabin), 52.3 percent were occupants of other vehicles involved in the crash, and 7.5 percent were non-occupants (e.g., pedestrians, bicyclists).”

To put it mildly, these statistics disturb NHTSA EMS Specialist David Bryson. Most of all, “We need to reduce operator error because in 92.6% of the 27 SCI crashes investigated, ambulance operator error was a significant factor,” he told EMS World. “Improper clearing of intersections was a big one.

Ambulances must come to a complete stop at red lights and make sure the way is clear before they proceed. But many of these emergency vehicles did not stop completely before traveling through the intersection.”

Other factors that contributed to these fatal crashes were speeding (14.8%), unbelted occupants (14.8%), driver fatigue (11.1%), impairment caused by alcohol or other drugs (3.7%), driver medical condition (3.7%), and driver distraction (e.g., GPS or cell phone use, 3.7%).

In conclusion, the NHTSA report underscores the critical need for improved safety measures and training for ambulance operators. Reducing driver errors, such as improper intersection clearing and driving against red lights, is essential to decrease the frequency of fatal crashes.

Additionally, addressing factors like speeding, unbelted occupants, driver fatigue, and impairment is vital. Enhanced protocols, adherence to best-practice guidelines, and a commitment to safety can help mitigate the risks and ensure the protection of both emergency responders and the public.

Further Reading:

Graham, L., Thomas, F. D., Finstad, K., Dennert, R., & Southcott, T. (2023). Analysis of Ground Ambulance Crash Data From 2012 to 2018 (Report No. DOT HS 813 480). National Highway Traffic Safety Administration. Accessed August 6, 2024

EMS Medication Administration - Buccal Route

EMS Providers need to be knowledgeable about buccal medication administration to ensure effective and safe patient care. 

Here are some key points they should know:

1. Indications and Contraindications

Indications:

• Need for rapid absorption and onset of action.
• Medications commonly administered via buccal route include glucose gel (for hypoglycemia), midazolam (for seizures), and certain analgesics or antiemetics.
• Patients who can follow instructions and keep the medication in the buccal cavity without swallowing.

Contraindications:

• Altered mental status or decreased level of consciousness.
• Inability to follow instructions or maintain medication placement in the buccal cavity.
• Severe oral infections or injuries.
• Allergy to the medication.

2. Mechanism of Action

• Rapid Absorption: Medications administered buccally are absorbed directly into the bloodstream through the mucous membranes in the cheek, bypassing the gastrointestinal tract and first-pass metabolism in the liver.

3. Preparation and Technique

Medication Preparation:

• Verify the “Six Rights” of medication administration: right patient, right medication, right dose, right route, right time and right documentation.
• Ensure the medication is appropriate for buccal administration and prepare it according to protocol.

Patient Preparation:

• Ensure the patient is in a seated or semi-reclined position to facilitate administration and reduce the risk of choking or aspiration.
• Clear the buccal area if necessary to ensure the medication can be placed correctly.

4. Administration Techniques

Administering the Medication:

• Instruct the patient to open their mouth and gently pull back their cheek.
• Place the medication between the patient’s gum and cheek.
• Instruct the patient to hold the medication in place and not to chew or swallow it.
• Ensure the medication remains in place until it is fully dissolved or absorbed.

5. Patient Communication and Education

Explain the Medication: 

• Inform the patient about the purpose of the medication, how it will help, and any potential side effects.

Instructions: 

• Provide clear instructions on how to keep the medication in the buccal cavity without swallowing or chewing it.

6. Monitoring and Follow-Up

Observe for Effects: 

• Monitor the patient for the expected therapeutic effects and any adverse reactions.

Reassessment: 

• Regularly reassess the patient’s condition to determine the effectiveness of the medication and any need for additional intervention.

7. Complications and Management

Ineffective Absorption: 

• Ensure proper technique to maximize absorption; consider a second dose if no response and protocol allows.

Adverse Reactions: 

• Be prepared to manage potential adverse reactions, including allergic reactions or local irritation.

Oral Discomfort: 

Reassure the patient about any transient discomfort in the buccal area.

8. Special Considerations

Pediatric and Geriatric Patients: 

• Adjust instructions and dosage appropriately; children may require more gentle handling, and the elderly may have difficulty keeping the medication in place.

Environmental Factors: 

• Consider the environment, such as the need for privacy or managing in a moving vehicle.

Patient Condition: 

• Be aware of any conditions that might affect buccal administration, such as dry mouth or oral lesions.

9. Training and Proficiency

Simulation Training: 

• Regular practice using simulation models to maintain proficiency in buccal medication administration techniques.

Continuing Education: 

• Stay updated on best practices, new medications, and techniques for buccal administration.

10. Legal and Ethical Considerations

Scope of Practice: 

• Adhere to the legal scope of practice for their certification level and local regulations.

Informed Consent: 

• Obtain informed consent from the patient or guardian whenever possible.

Documentation: 

• Accurate documentation of medication name, dose, route, time of administration, and any observed effects or adverse reactions.

Conclusion

Effective buccal medication administration requires EMS providers to combine theoretical knowledge with practical skills. 

Continuous training, adherence to protocols, and understanding the indications, techniques, and potential complications are essential for safe and effective patient care.

Further Reading:

Alexander, M. & Belle, R. (2017) Advanced EMT: A Clinical Reasoning Approach (2nd Ed). Hoboken, New Jersey: Pearson Education

Bledsoe, B. E., Cherry, R. A. & Porter, R. S (2023) Paramedic Care: Principles and Practice (6th Ed) Boston, Massachusetts: Pearson

Bledsoe, B. E. & Clayden, D. (2018) Prehospital Emergency Pharmacology (8th Ed). Boston, Massachusetts: Pearson.

Guy, J. S. (2019) Pharmacology for the Prehospital Professional (2nd Ed) Burlington, Massachusetts: Jones & Bartlett Learning.

Mistovich, J. J. & Karren, K. J. (2014) Prehospital Emergency Care (11th Ed). Hoboken, New Jersey: Pearson Education

Peate, I. & Sawyer, S (2024) Fundamentals of Applied Pathophysiology for Paramedics. Hoboken, New Jersey: Wiley Blackwell 

EMS Equipment - The Power Paradox

Despite powered advancements in patient movement, the initial ground lift remains a manual task for EMS providers.

The attached JEMS article addresses a critical issue in EMS that despite heavy investments in advanced power stretchers and other power-assisted patient handling devices, the initial task of lifting a patient from the ground remains manual and risky. 

This inconsistency, termed the "power paradox," exposes EMS Providers to significant musculoskeletal injuries, with nearly half of EMS workers experiencing such injuries due to manual patient handling.

While EMS agencies have invested significantly in technologies like power stretchers, power loads, and power stair chairs, they often overlook the necessity of power patient lifts.

The lack of a comprehensive power-assisted patient handling approach leads providers to use makeshift solutions like bedsheets, increasing the risk of injuries to both the patient and the provider. 

Statistics from the National Institute for Occupational Safety and Health (NIOSH) highlight that nearly half of all EMS workers suffer from work-related musculoskeletal injuries, underscoring the need for a complete and integrated approach to patient lifting.

The solution lies in incorporating power patient lifts, which are affordable compared to the costs of potential injuries and liabilities. These lifts can significantly reduce the physical strain on EMS providers and enhance patient safety. 

The article emphasizes that EMS agencies need to prioritize injury prevention by embracing a holistic approach to powered patient handling. 

By doing so, they can protect their personnel, improve patient care, and mitigate liability risks, ensuring the sustainability and effectiveness of EMS operations​.

Journal of Emergency Medical Services 2024 

For more information, access the attached article link.