Remember Air France Flight 447, which crashed into the Atlantic in 2009? The investigation finally concluded earlier this year and in part found there was an overreliance on technology and not enough simulation practice. The final word is that this airline disaster, like most EMS collisions, need never have happened.
That’s not to say that technology is not helpful, particularly when trying to increase safe driving practices in EMS. A number of innovative safety tools for driving ambulances can help lower risk substantially. Let’s take a look at a few.
Driving performance and safety
The following scenario is based on available tools to improve driving performance as well as responder and citizen safety.
Medic 290, Medic 290, please be en route to headquarters. Upon arrival, please meet up with the shift commander.
Medic 290, 10-4, returning to headquarters.
Medic 290’s driver looks over at his partner and says, “I bet that lady called and complained. I hate those stickers.”
On the back of Medic 290 and every other vehicle in the fleet is a large sticker that reads, “Comments, compliments or complaints, my company cares. Call 444-Safe EMS.**"
Such bumper stickers on commercial vehicles have been there for more than a decade. Why?
The perception is they work. These are a monthly subscription fee based system. Companies are not going to pay the fees if they don’t believe they produce results.
But on EMS vehicles? Really? Is there a place?
I once spoke with a mid-sized ambulance CEO who had invested in a variety of safety systems, and this simple, low-tech safety solution was his favorite.
“It lets me know trends as they happen,” he said. “It tells me things the other systems can’t. It’s a gauge — like taking the employee’s temperature. The complaints I get are mostly about rude behavior. Often this goes hand in hand with being short-staffed and overworked crews.”
Video surveillance
Often behavior changes when someone believes someone else is watching and reacting. Let’s follow Medic 290’s crew into their meeting with Shift Commander Phillips.
Phillips: “Hi guys, sorry to call you back in. Do you have any idea why you are here?”
Both crew members shake their heads.
Phillips: “Really, I thought you might have some idea and want to talk.”
After a pause, the vehicle operator, Simon, begins, “Well, I’m thinking you might have gotten a complaint from some lady saying I cut her off.”
Phillips: “And?”
Simon: “She was going so slow. It took me forever to get around her, and I got a little angry. That’s all there was.”
Phillips: “You sure that’s all? She said you were a little rude, too.”
“Well…"
Phillips: “I also pulled the EMS SafeVID** system recording, and — what do you know? — it captured the event.”
They all watched in silence as the event replayed on the supervisor’s screen in high-definition.
“That’s not the correct finger to use to show someone you think they are no. 1.”
Video is everywhere — banks, shopping centers, intersections, airports. There are areas in the country where a person may be on six to eight cameras at any given time.
At some time in the future, medics will use video to perform live telemedicine consultation.
You may say video is too intrusive, video is “Big Brother.” But video surveillance is here to stay and will only become more common. Get over it.
That scenario is a very real possibility and it demonstrates a couple of ways that people are watching — and be assured you are being watched.
Surely you know about “red light cameras.” Cities put these on poles to capture pictures of cars running red lights. I’ve heard of some EMS agencies that, when they receive these notices, forward them to the employee to pay the fine if he or she is not on an emergency response.
Recording driver-controlled factors
The following scenario demonstrates using technology to depict driving style and looks at certain driver-controlled factors.
“Man, it’s been so busy, I thought we’d never get a chance to eat.” So says the EMT as he leans a little over the steering wheel while taking a bite of his burger so as not to get ketchup on his uniform.
Out of the corner of his eye he sees the brake lights come on in front of him and he slams on the brakes. In response, a system in the vehicle makes a noise, reminding him that his braking exceeded “safe” parameters.
He pulls over and finishes his quick lunch.
Later that same day, it’s getting close to the end of the shift, and the driver just wants to go home. He is trying to make it back to his station. The road has a posted speed limit of 30 mph.
His in-vehicle safety system begins to click at him. He looks down at his speedometer and utters a few expletives under his breath but eases off the gas pedal.
Half a minute later, a dog runs out in front of him. He hits the brakes and swerves to avoid the dog and realizes had he still been going at the higher speed, he would have had just hit the animal.
Back at the office, the safety officer is reviewing the system playback in response to an intersection collision. It shows unit 455 on the day in question on a Google map, shows the route they took — that they were not lost — shows that emergency lights and sirens were on and that his speed dropped to zero at the intersection. In fact, the replay shows that he performed as expected.
Video systems like this exist today. Two well-known systems are Drive Cam and Digital Ally.
In-vehicle monitoring systems are also available, such as ACETECH and Road Safety.
These systems simply record. They record without prejudice without caring about gender or race, religious preference or sexual orientation. If you do right, they show it. If you do not, they show this, too. Don’t fear Big Brother when the choices are yours.
Other advanced technologies
Unit 455 copy code 3 for chest pain. Address is 41 St. James Place. Patient is a 52-year-old male. Caller reports he began complaining of chest pain while working on the lawn. Telemetric data, response and transport times require an emergency response. Additional data to follow.
Copy — Unit 455 responding. Enhanced Responder Mapping appears on the nav screen. It compares data from all traffic cameras, social mapping, historical traffic flow patterns and specially equipped municipal vehicles to identify best routes, routing hazards and to recommend the fastest, safest route.
As unit 455 proceeds toward the patient’s home, a transponder in the vehicle changes all traffic signals in their favor. Also a digital heads-up displays in all area vehicles that there is an emergency vehicle in the vicinity*. Forward-facing radar (FFR) mounted in 455’s grill looks for potential hazards and, when it identifies one, alerts the operator. In addition to the radar system, high-speed video intelligence (HSVI) looks for brake lights, turn signals, pedestrian and bicycle traffic and low-angle lighting and evaluates additional hazards at a rate of 1,000 permutations per second.
As a result unit, 455 arrives safely and expeditiously on scene and is able to properly diagnose, treat and transport the patient.
Wouldn’t it be nice if all calls went as well as this scenario? While only two of these advanced technologies are available today to help reduce ambulance crashes, the others may be in the works.
The first, signal preemption, such as from Opticom, does have the ability to change traffic lights in favor of the emergency vehicle. A transponder mounted on the emergency vehicle is paired with a controller on the traffic signal. This is a costly solution because typically police, fire and EMS participate and often there are many traffic lights in any square mile.
Forward-facing radar, on the other hand, does exist, but it is not currently available for emergency vehicles as a third-party add-on.
Conclusion
Technology-based safety will only get better and more sophisticated in the future. But no matter how good, there is no substitute for a well-trained, well-practiced, properly rested EMS vehicle operator, one with the right attitude who takes full control and responsibility over the gas pedal and practices a judicious use of speed.
This in combination with a valid pre-arrival dispatch and response mode protocol and a proper understanding of response times may equal the safest system.
Remember, systems have response time requirements; individual vehicle operators NEVER should. Speed is never an acceptable substitute for a lack of trucks or the proper reaction to a super busy day.
*The vision of the transponder controlling traffic signals and notification of surrounding vehicles was part of a scenario from the NHTSA document “EMS Agenda for the Future,” written in 1996 and attempting to project to 2008. They got one right.
** This number is fictitious as is EMS SafeVID.
