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How to reduce harm from ambulance and helicopter crashes

Every ground ambulance and helicopter crash has different causal factors, but we must look at system design and safety behaviors to prevent further crashes


Ask an EMS leader what keeps them up at night, and the common answer might be an ambulance or air medical crash. There are different factors for why ambulance or air medical crashes occur, however, there is universal agreement that crashes often lead to tragic consequences.

We are all at risk for crashes in EMS, whether in a ground ambulance or a helicopter; and when a crash occurs, there are multiple victims, including the crew, the patient and the organization. Currently, there are determined efforts underway to reduce the occurrence of crashes and to make these events more survivable. The Center for Patient Safety receives a variety of reports related to ambulance and air medical crashes and near misses.

Air medical crashes are just as concerning. One study of EMS helicopter crashes, called "EMS helicopter crashes: What influences fatal outcomes" referenced various factors. A review of crashes resulting in at least one fatality were most often linked to post-crash fires, darkness, bad weather and other hazardous conditions.

Lee Varner, BSEMS, EMT-P, Project Manager for CPS EMS services said, "Ground and air services log countless hours transporting patients in our communities. It’s easy to take safety for granted or become complacent until we hear about a crash. It’s easy to develop a bias and think it won’t happen until it happens to you or someone you know. Every crash is different and each has its own causal factors but we should all look at our system design and safety behaviors as a place to start."

Factors vary widely for every crash; however, lessons learned from other high-consequence industries might present learning opportunities for greater patient and provider safety in EMS.

Crash reduction recommendations
Great strides in crash reduction have been made in helicopter operations with the implementation of new technology, safety culture and education. These successful efforts have been driven by leaders, associations and other stakeholders. Today we are starting to see some these efforts pay off; however, there is still more work to be done.
To reduce harm to providers and patients involved in a ground ambulance crash, the CDC recommends EMS employers encourage the following:

  • Providers should use patient compartment vehicle occupant restraints whenever possible.
  • Drivers and front-seat passengers of EMS vehicles should use the occupant restraints provided.
  • Insure all belts are appropriately used on the stretcher including the shoulder restraints.
  • Implement an annual vehicle operations and safety review class or program.

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