Nationally standardized driver training: The time is now
Training needs to occur in 4 sections: Lecture, skills, road test, driver training simulators
By Robert Raheb
"Medic 14 to dispatch, Medic 14 to dispatch!" "Medic 14, go ahead." "Medic 14 we've been involved in a collision at the intersection of... "
Unfortunately, we have all heard this radio transmission too often. The names change, but the circumstances leading up to the collisions pretty much stay the same: A crew working a busy shift, long hours, the last four intersections were clear, this car came "out of nowhere," on and on with the stories and the excuses.
Having 32 years in fire and EMS, I've traveled around the country, and every time I hear about a collision, I already know how it's going to turn out, who will be at fault and how it "couldn't" have been prevented.
When are we as an EMS system going to stop kidding ourselves and do something serious about driver training and EVOC? The USFA just released its end-of-year statistics on firefighter fatalities, and guess what? They are the lowest numbers in history. The downside is that fatalities in collisions still rank second only to medical conditions such as heart attack, stroke and fatigue-related deaths. But even those numbers are down when compared to previous years. Why?
Every department has a policy regarding the use of seatbelts, but on the fire side they have been running a campaign for years about wearing them. Is the EMS community doing the same? Sure, EMS agencies have policies in place, and some even strictly enforce them. But again, where is the nationwide push for their use? Everyone should be wearing them, "unless actively involved in patient care."
Why isn't there a bigger push to design either a seatbelt or vehicle restrains us without restraining us from doing our jobs? Enough with the prototypes and concept vehicles — design and mass produce safer vehicles now! Our lives depend on it.
We have standardized training in every field of emergency medicine: EMT, EMT/P, HAZMAT Awareness, HAZMAT Technician, NIMS, etc. Wherever you travel, whomever you meet, when one of those titles is mentioned, along comes awareness that the same curriculum and number of hours to complete the course were achieved.
But in EVOC — or should I say VOC or "driver training" (we can't even agree on the name) — the number of hours, the curricula and the skills tested are so random that EMTs from different parts of the country compare their EVOC programs to others. And yes, there are some really decent programs out there, but the majority of them fall so short of the mark that they might as well just have the student drive the proctor (notice I didn't say "instructor") to the local donut shop for a cup of coffee. Oh, wait, some actually do.
So what can we do?
For starters, let's develop a national standard for EMS EVOC instructors — no more of "you're our best driver, so start teaching." We should also create a national curriculum that goes along with that certification.
If we're waiting for Congress to do something, fuhgeddaboudit; it cannot even balance a budget. If we are waiting for the private sector to do something, fuhgeddaboudit. We need to start doing something about it now. We need to choose, design and implement a standard training program that can be instituted throughout the country.
There are already several good programs out there and more will be developed as long as they know the requirements. The NFPA has two very good starting points for EMS:
- NFPA 1451 Standard for a Fire Service Vehicle Operations Training Program
- NFPA 1002 Standard on Fire Apparatus Driver/Operator Professional Qualifications
Both are being revised to meet the growing demands of EMS operations within the fire service, but EMS as a whole (private, hospital-based, third-service municipality) needs to be included and required to meet a set of standards that apply to everyone.
A lot of good people out there want to make a difference, and we do not need to reinvent the wheel. Associations such as the National Registry, NAEMT(P), and NAEMSE, to name a few, could help in bringing cohesion to a splintered band of do-gooders.
Training needs to occur in four sections without the mixing and matching or eliminating of sections because they don't fit. The last one is probably the most important, but not everyone has access to it right now, even though that is also changing.
Elements of VTL, policy and procedure, intersections, scene safety, etc., must be taught. Most, if not all, systems do at least this much.
An actual driving course with set maneuvers that develop a student's eye-hand coordination, spatial awareness and depth perception is necessary to develop a good understanding of what the vehicle can do. Not every agency does this, and driving around the streets or returning from a hospital after a call has very little value.
3. Road test
Develop a circuit that would allow the student to perform residential, commercial and highway driving. Identification of potential hazards, markings and the ability to navigate the roadways should be evaluated.
4. Driver training simulators
Some will argue that simulation driving is not real driving, and they are right, but would you want to be the instructor sitting in the passenger seat trying to teach a student how to clear a busy intersection against the red light and left of center in the real world?
Is it legally and morally right to endanger everyone involved while trying to teach this skill? Think of the repercussions if a collision did occur. Can you go back in time and recreate all the exact conditions that occurred a few minutes prior? The answer is a resounding "no." But with simulation training, all of these are possible.
The best way to train, evaluate and measure the response segment of driving is with simulation training. Students learned what to do (lecture) and how to do it (skills), but simulation provides the method to teach the student when to apply it (judgment).
- 37 percent of all ambulance collisions occurred at a controlled intersection
- 82 percent of all fatal ambulance collisions involve the ambulance striking the other vehicle 74 percent of the time
Developing good driving judgment is equally important as, if not more than, developing good driving skills. Drivers with exceptional judgment and forward thinking do not have to perform exceptional maneuvering because they will recognize the potential hazard before it occurs.
We need a nationally standardized EVOC training curriculum and instructor program now.
Remember, drive like your life depends on it — because many times, it does.