It is the call or text that no chief officer (EMS, fire, police) ever wants to get; the request for the "duty chief to respond to an injury accident" involving one of their vehicles.
What happened: In early January, at about 2145 hours on a foggy and rainy night, a Kootenai County (Idaho) EMS System ambulance was struck by an intoxicated driver. Worley (Idaho) Fire Department had responded with a BLS ambulance, owned by KCEMSS, for a fall with injuries. They were transporting a female patient to a local hospital. She was a stable BLS patient with little intervention needed. She was, however, complaining of back and neck pain, and point tenderness, so the crew decided to place her in spinal motion restriction because of her complaints.
Approximately seven miles south of the hospital, on Highway 95, the ambulance was struck by a full-size pickup being operated by a driver who has since been charged with driving under the influence. At the time of this article, it is important to note that the legal process has not played out and while charges have been filed, that is all that has happened so far.
Due to fog and road conditions, the northbound ambulance was traveling approximately 50 miles per hour. The pickup was estimated by witnesses to be going at least 70 miles per hour and as fast as 85 miles per hour.
The ambulance was struck at a 45-degree angle where the cab meets the module on the driver's side. Ultimately, the ambulance came to rest facing south in the southbound lanes approximately a quarter-mile from where the impact took place.
Ambulance crew took immediate action
The driver checked on the EMT in the back and the patient, radioed for additional help and then proceeded to the pickup to check on the driver. The EMT caring for the patient continued to do so while waiting for help to arrive. He completed a new patient assessment to determine if there were any new injuries or complaints as a result of the collision. Passing motorists also stopped to assist, including the patient's family that had been following the ambulance to the hospital and had witnessed the collision.
I am pleased to report that the original patient suffered no significant additional injuries as a result of the ambulance collision. Both firefighter/EMTs suffered only minor injuries. They were transported to the hospital as a precaution, evaluated and released within a few hours. Both have returned to full duty.
The pickup driver refused medical treatment at the scene and was transported to the hospital by the Idaho State Police for further evaluation.
Vanilla outcome was the story we hoped to tell
While in the end, the outcome seems very vanilla, that's where I want to focus. I realize everyone in EMS likes a great story about a priority trauma, gruesome injuries or an amazing rescue. The real story is that KCEMSS; our commissioners, fire agency partners, informal leaders and crews took it upon themselves four years ago to make our EMS system safer. We started with ambulance design.
Our vision was to be able to tell a story just like this. Our vehicle could be in a major accident, take a considerable impact and the patient and crew were safe and walked away not much worse for the wear.
It wasn't an easy project. Changing culture is never easy. Neither is getting almost 300 responders to agree or be happy, introducing a concept that costs more, changing the way we’ve always done things or anything else associated with this project. It's also not just buying a safe vehicle, it's changing policies and procedure to match, it's purchasing safer/better equipment and all the things that go along with a new culture of safety. This effort also required replacing the entire KCEMSS fleet of 15 ambulances.
Designing a safer ambulance
Our apparatus committee did a phenomenal job of driving this project. To take us to a new level of safety, they:
- Went to trade shows
- Looked at 40 different ambulances
- Met with manufactures
- Held focus groups
- Called references
- Ultimately designed the safer product they desired
We went through a competitive bid process and most manufacturers took several exceptions. In the end, we chose a manufacturer that could deliver the product we envisioned and was willing to be a long-term partner.
All equipment secured. The ambulances were designed so that everything had a place, no loose equipment in the back or the compartments. We went with a battery-powered cot and a powered load system to hold the cot in place in case of a significant impact.
Restraints for all occupants. Safer seating for crew members, with proper restraints, was another priority. Single seats, rather than a bench, and mounts for every piece of loose equipment were included.
No compromise construction. Finally, a construction standard of the module itself was second to none. We were not going to compromise safety in our effort to do the right thing for the patient or the crew!
KCEMSS lessons confirmed
We completed the design and replacement project three years ago and this is the first major accident we have sustained since then. I am happy to report that though the ambulance in this accident is a total loss, everyone walked away because the vehicle, our policies and hard work did their jobs!
I want to share with you a few lessons learned or better, lessons confirmed from this experience.
- The patient was secured properly. ALL of the straps on both the spine board and the cot were engaged. The patient had very minimal movement during the collision according to the firefighter-EMT in the back and by the video in the patient compartment that records during an accident.
- The ambulance did exactly what it was supposed to do. It crumpled on the outside but protected the patient and crew on the inside.
- The cot and load system did its job. Obviously, because of the impact and the speed/force applied, the cot and load system have been totaled but they performed as designed.
- Equipment mounts work. No one was injured by free-flying equipment nor did we suffer a loss of a major piece of equipment inside the module of the ambulance. Additionally, all equipment in mounts in the exterior compartments were held in place and caused no injuries or damage.
- SEAT BELTS SAVE LIVES. Crew members should be strapped in at all times. Because of the force, the ambulance came very close to rolling over. Seat belts save lives.
Our system was very fortunate to do a fleet-wide standardization with safety as the priority. I understand that most EMS agencies do not do that. That said, I would implore you to consider the following:
- Buy with safety in mind. If you are buying a new ambulance, do so with safety in mind. Make responder and patient safety your top priority.
- Follow a standard. I am not advocating for one ambulance design standard or another but make it safe. It does cost a little more, but this is proof that the extra money pays off.
- Secure the cot. Consider the safety of a load system or a cot that truly locks in place. The old "horn" or "antler" locking systems do not provide the same level of security.
- Mount every piece of equipment. Even on your existing ambulances, make sure that every piece of equipment has a mount or is placed in a secure cabinet or behind a net. Do not have loose equipment. It can become a deadly projectile once a force is applied.
I am extremely glad I am sharing our lessons confirmed rather than writing about how to manage a patient and/or employee's severe injury or worse, a line of duty death. You cannot control when something tragic is going to happen or even control the outcome. We must be vigilant and proactive to make ambulance and equipment safety a top priority.
About the author
Chief Christopher Way, BA, has been in EMS for 25 years and is a paramedic. He has been the chief of KCEMSS for just over five years.