Ambulance Safety Discussions Peak at Summit

By Dave Ross

Colorado had an EMS Conference!

Since most states regularly hold one or more educational meetings for prehospital providers, you might ask, "What's the big deal?"

Well, this one was a little different. It was a conference completely devoted to ambulance safety. As a result it was astutely dubbed "The Safety Summit." And in the interest of full disclosure, it was actually not the first Safety Summit in Colorado. The first occurred in October 2008. Since Safety Summit I was a success, we forged ahead with the recently completed Safety Summit II, held earlier this October.

I decided to write about this conference for a couple of reasons. First, as a member of the planning group officially known as the Colorado Safety Subcommittee, it's very fresh in my mind. Second, I think the concept is important enough that this column and, other EMS literature, should begin touting the Safety Summit idea to other regions of the country.

Some might wonder what the need is for a meeting devoted solely to EMS safety. In fact, any reader who follows the online EMS publications or print journals is likely well aware of the depth of the problem in the number of ambulance and fire apparatus crashes as well as the overall injury potential to those working in the prehospital environment.

It's estimated that 6,500 EMS vehicle crashes occur annually in the United States. More of these occur in urban environments but the likelihood of substantial injury and death is greater in rural incidents. Running with lights and sirens is associated with higher injury and death rates than non-lights and siren operations. The risk of a lawsuit against an EMS agency involved in a vehicle collision is estimated at anywhere from 10-35 times greater than the risk of suit related to a clinical care issue.

There have been a number of pioneers espousing the importance of safety in EMS including Nadine Levick, MD, MPH. Dr. Levick has spoken in Colorado on a number of occasions and provided thought-provoking presentations that helped solidify the direction our state EMS leadership was considering.

In fact, we were already at work on a statewide safety initiative in 2006 when two highly publicized ambulance crashes occurred in a very short period of time that resulted in three deaths. Officials at the Colorado Department of Public Health and Environment (CDPHE) — which oversees EMS in the state — were confronted by media demanding answers as to what CDPHE was doing to ensure the safe transport of patients in ambulances.

As a result of this confluence of circumstances, a number of strategies were developed. Among them was an annual educational safety meeting. Partial funding awarded to CDHE helped make the conference attainable.

Safety conference beginnings
In 2008, Safety Summit I was held with over 100 participants. The goals of that gathering were twofold. The first was to provide education to the attendees. The second was to seek recommendations from the audience as to what should be considered preferred safety equipment under the aegis of the state’s EMS grant program. Ultimately, six items of equipment were deemed important enough to receive 75 percent of funding from the state instead of the normal 50 percent typically funded in the standard grant program.

The concept for Safety Summit II was a little different from Safety Summit I. The emphasis on the most recent conference was focused on ambulance driving. More specifically, the presentations revolved around identifying characteristics and situations that might predict risky driving behavior and increase the risk of a crash. The meeting also addressed a variety of Emergency Vehicle Operations Courses (EVOC) with the goal of producing a standardized statewide recommended EVOC curriculum.

One hundred and forty people were in attendance.

I think the best way to illustrate the gist of what was presented at Safety Summit II is to provide an overview of the speakers at the conference.

On day 1, Jeff Grompert, Executive Vice President of Road Safety International, gave an orientation on the use of this equipment which gives feedback to drivers (and managers) when prescribed driving parameters are exceeded. A number of Colorado ambulance agencies had utilized the safety equipment grant process recommended from Safety Summit I to purchase the Road Safety product, and this presentation gave operations an opportunity to hear directly from the manufacturer about its use.

Jeff was followed by Laura Stanley, PhD who is an industrial engineer from Montana State University. She discussed her research on risk-seeking tendencies in rural volunteer EMS drivers. Laura has studied defensive driving and driver distractions in the general public, especially teen drivers. But she has recently added EMS driving to her research interests.

Day 2 began with an introduction from State EMS Director Randy Kuykendall and then Scott Sholes, EMS Captain from the Durango, Colo., Fire Department, presented a review of Safety Summit I and the subsequent safety equipment grants that were awarded as a result of that conference.

Nels Sanddal, PhD(c), CEO of the Critical Illness and Trauma Foundation in Bozeman, Mont., discussed a very interesting study that his wife, Teri, had recently conducted. This was an analysis of 400 EMS crashes reported the Web site Nels has a long history in preventable trauma mortality research as well as rural injury prevention. He has worked on a number of projects with the National Highway Transportation Safety Administration.

Lights, sirens, and an accident
Doug Kupas, MD, from the Department of Emergency Medicine at Geisinger Health System based in Danville, Penn., and the State of Pennsylvania EMS Medical Director, gave a talk titled "Lights and Siren — Above All Do No Harm." One of his most compelling points was that the use of lights and sirens adds virtually no benefit to patients but does add a substantial risk of injury and death to ambulance occupants and others on the road. Though a very commonly employed EMS driving tactic, the use of lights and sirens does not result in any appreciable improvement in patient outcomes, according to a study Dr. Kupas authored in 1994. In conclusion, he strongly urged strategies to reduce the use of lights and siren driving.

This presentation was followed by a panel that consisted of Laura, Nels and Doug. They were joined by Jerry Overton, current President and CEO of Road Safety International and past CEO of the Richmond, Va., Ambulance Authority, and a very well known national EMS author and speaker. The panel debated the topic of "At-Risk Drivers, and Driving, in EMS and What Characteristics Should We Be Concerned About?" This engendered a great deal of discussion between the panelists and the audience.

Although Safety Summit II was geared to ground EMS operations, we did have a lunchtime panel presentation touching on various aspects of air medical issues. In future summits, we may have a breakout session or, even a whole day, devoted to air transport.

In the afternoon of Day 2, the emphasis shifted to EVOC.

Billy Rutherford, President of American Integrated Training Systems, Inc., provided an overview of the USDOT National EVOC Curriculum's 'Train the Trainer' course that his company offers. He was part of a later panel that discussed EVOC training from local, regional, national, and international perspectives. In addition to Billy, panel participants included Darren Zuno, who has developed a winter EVOC driving course for Colorado EMS agencies geared to mountain driving, Darryl Coontz, Interim CEO of MAST Ambulance in Kansas City, Mo., and Ivan Villarreal Hurtado and Leonardo Aceves, both National Coordinators of the EMS Drivers School for the Mexican Red Cross. Hurtado and Aceves are responsible for EVOC training to EMS providers throughout Mexico.

Finally, the summit concluded with a panel of statewide experts to discuss the Colorado funding sources available for the development of initiation of EVOC training for agencies throughout the state.

Hot topics in the field
In addition to the formal lecture presentations at Safety Summit II, we had two breakout sessions— or "hot topics" — presented during the breaks. The first was titled "Don't Transport Dead People." This featured Doug Kupas and Nels Sanddal, along with noted EMS author and speaker, Thom Dick. The second was a review of a proposed American Medical Response (AMR) initiative called the National Safety Rodeo Competition. This presentation was provided by Ron Thackery and Rob Garrett.

Undoubtedly, there was a great deal of important information shared at the Summit provided by a wealth of very diverse presenters. But I think what impressed me the most was the increased number of attendees and the rapt attention they paid to the speakers at the conference. The thoughtful questions asked of the speakers provided evidence of the importance that the audience placed on the "culture of safety" in their operations. Clearly, safety issues are becoming a priority to more EMS agencies in Colorado, and that is the most important thing.

We were fortunate that members of our planning committee and our speakers were more than willing to put forward great effort and the necessary time to assure the success of the event.

Other summits
Going forward, there has been some talk of regionalizing future Safety Summits. The idea would be to open it to a greater number of states surrounding Colorado. While we have always welcomed out-of-state attendees, we have not advertised the past two summits aggressively. Nevertheless, we do plan to have future annual summits — likely in early October — whether Colorado continues to host them or not.

Regardless, I think the Safety Summit concept is an excellent model for other states or regions interested in sharing this type of information with their EMS providers. I am happy to provide information or resources we have used in the planning of our Summits to those who would like to develop similar conferences.

In addition to the Safety Summits, the Colorado Safety Subcommittee has also developed a CD-ROM training curriculum titled 'The EMS Toolkit.' The toolkit features four modules, one of which has been completed and with the second well into development. The first module is currently available. When completed, the toolkit will provide a complete educational experience for agencies related to ambulance safety. It even features a 30-second public service announcement video aimed at the layperson driver highlighting the importance the citizen driver plays in emergency vehicle safety.

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