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Behind the wheel of an ambulance: Training needed

Fire and EMS agencies owe their crews, and the citizens they serve and protect, competent fire apparatus and ambulance driver/operators


By Don Cox, EMS1 Contributor

How does the transportation industry assess the competency of drivers that get behind the wheel of a 40 ft., 50,000+ pound truck, driving at 65 mph? Since 1986, driver/operators of large trucks have been required to obtain a commercial driver’s license (CDL) which includes various performance steps to acquire and maintain the license. Because these trucks parallel many emergency service vehicles, citizens may assume that ESO drivers would have similar training – especially when one considers that emergency situations often allow exemptions to various traffic regulations.

Is every licensed driver competent to drive a fire truck, ambulance or other ESO vehicle? While each state has specific ESO driver qualification standards and regulations, most states and many ESOs have exempted firefighters from the CDL requirement. According to the National Fire Protection Association (NFPA), 69 United States firefighters died on duty in 2016 and 17 firefighters died either traveling to or from an incident [1]. ESO leaders owe their team members, and the citizens they serve and protect, competent drivers.

Providing adequate driver training is vital to making the streets safe for patients, employees and the citizens that count on ESOs to protect their communities. (Photo/Greg Friese)
Providing adequate driver training is vital to making the streets safe for patients, employees and the citizens that count on ESOs to protect their communities. (Photo/Greg Friese)

To look for best practices and standards for driver training, ESOs can look to the Commission on Accreditation of Ambulance Services (CAAS), the NFPA or their insurance carrier. It’s important for ESOs to understand the various recommendations for training content as well as training frequency. For example, NFPA 1451, Section 5.2.1 identifies that “driver training shall take place not less than twice each year.” How many ESOs are providing driver training that often? Not enough.

Creating a comprehensive driver training program

According to the VFIS Emergency Vehicle Driver Training program, the following components are critical to a comprehensive driver training program [2]:

1. Identify the problem. Between 1992 and 2011, there was an annual estimated mean of 4,500 motor vehicle traffic crashes involving an ambulance. Of these crashes: 65 percent resulted in property damage only; 34 percent resulted in an injury/injuries; < 1 percent resulted in fatality/fatalities – which is still approximately 45 fatalities per year [3].

2. Select the driver. Aspects that should be covered in driver qualification include: human aspects, acquired abilities, driving records (including frequent license checks with the department of motor vehicles) and driver requalification.

3. SOP/SOGs: Standard operating procedures should outline relevant driving safety subject areas and proper procedural behavior.

4. Legal aspects of emergency vehicle driving: Drivers should receive an overview of today’s legal climate, distracted driving, emergency vehicle driving laws and privileges, along with legal principles and terms.

5. The vehicle and vehicle dynamics: Today’s fire trucks, apparatus, ambulances and technology are rapidly changing, including onboard monitoring systems and new safety devices. It’s important to keep drivers informed of each vehicle’s dynamics and capabilities.

6. Emergency vehicle operations. Provide an expectation of drivers when they are preparing to drive including sleep deprivation and safe driving, defensive driving goals and placement of vehicles at emergency scenes.

7. Vehicle inspection and maintenance. Detail the importance of proper vehicle pre/post trip inspections, out-of-service criteria and accurate record keeping.

8. Evaluation. An effective driver training program should include a competency course completion, as well as a street and highway driving evaluation, including emergency and non-emergency modes.

Developing a driver/operator SOP

According to the National Highway Transportation Safety Administration, in 2015, 3,477 fatalities and 391,000 injuries occurred due to distracted driving [4]. It’s important to specifically address distracted driving and incorporate prevention efforts into ESO training because, by design, the cab of ESO vehicles have many built-in distractions. These include emergency radios, mobile data terminals, voice communications, sirens and even camera monitors. It’s important to also note state regulations on distracted driving, some of which are specific to ESO workers.

A sterile cab environment, which is a concept borrowed from the aviation industry, is making its way into VFIS driver training methods [5]. The human brain is susceptible to distraction any time the sensory system is stimulated. In fact, when distracted, the IQ of a Harvard MBA drops to the level of an eight-year-old [6]. Therefore, it’s important to control environments to eliminate, or at least limit, the frequency and number of distractions when one is performing a critical task, such as operating an emergency vehicle.

Some behaviors to consider for an SOP/SOG on driving safety include:

  • Cellphone use
  • The driver should focus on driving and not utilize cab devices such as radios, siren activation or mobile data terminals
  • Limit verbal conversations in the cab to critical need to know items (pointing out anticipated roadway/traffic issues)
  • The person occupying the right seat is often the supervisor or lead paramedic and should utilize proper supervisory observations on driving skills and behavior to immediately correct unsafe conditions or assist in identifying hazards
  • Maintain a clean cab that secures all equipment and personal items as they can become distractions during movement or projectiles if a collision occurs

Emergency vehicles are the tool that ESOs use the most but are trained on the least. Providing adequate driver training is vital to making the streets safe for patients, employees and the citizens that count on ESOs to protect their communities. As there are many programs available to properly train and requalify ESO drivers, be sure to select one that follows best practices and standards of the industry.

To learn more, visit glatfeltercommercialambulance.com and vfis.com.

About the author
Don Cox is an education specialist for Glatfelter Commercial Ambulance & VFIS, divisions of Glatfelter Insurance Group. Don has served as a paramedic for over 35 years in Iowa, Wisconsin and Florida. He holds a Master’s degree in Adult Education from Iowa State University; is an executive fire officer with the National Fire Academy and holds designations as chief fire officer and chief training officer with the Center for Public Safety Excellence.

References

1. National Fire Protection Association – Standards 1451, 1002,1500, 1911

2. VFIS, A Division of the Glatfelter Insurance Group, Emergency Vehicle Driver Training Program

3. NHTSA’s Fatality Analysis Reporting System (FARS) 1992-2010 Final and 2011 Annual Report File (ARF) and National Automotive Sampling System (NASS) General Estimates System (GES),1992-2011

4. National Highway Transportation Safety Administration. Risky driving. Available at: www.nhtsa.gov/risky-driving

5. VFIS, Risk Communique – Distracted Driving – “Sterile Cab”

6. Pashler HE (1999). The Psychology of Attention. Cambridge, MA: MIT Press.

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