By Meg Chandler and J. Todd Sheridan
Motor vehicle collisions continue to pose a significant risk to EMS providers and our patients. Some agencies have responded to this risk by addressing factors that can contribute to aggressive driving. But we must also avoid neglecting the impact of distracted driving.
According to a recent report, distracted driving led to 3,477 deaths and an estimated additional 391,000 injuries in the United States in 2015 [1]. While it’s unclear to what extent distracted driving contributes to EMS injuries and fatalities, it’s likely that we are at even greater risk for distracted driving than the average driver. Here’s five reasons why:
1. We’re distracted at baseline
The National Highway Traffic Safety Administration (NHTSA) identifies a list of common distractions, both internal and external, that affect driving [1]. Cell phones play a significant role as an avoidable distraction, but they are hardly the sole cause of distracted driving.
Anything that takes the driver’s eyes, hands or mind off the task of driving is a distraction. Distractions often arise when a driver attempts to multi-task behind the wheel. But research shows that human beings don’t multi-task very well. Instead, what we do is better described as task-switching – shifting our attention from one task to another [2].
In addition to the distractions faced by ordinary drivers, EMS providers face additional external and internal distractions. Operating emergency lights, sirens, radios and navigation aids all take away attention from driving. We may be able to mitigate the effects of this task-switching with good cab ergonomics, and by delegating these tasks to a partner in the passenger seat when possible.
Maintaining disciplined and professional radio traffic also reduces distractions to drivers. Finally, it’s important for EMS providers to avoid unnecessary task-switching behind the wheel in the form of food, drinks or phones. Leadership can support this behavior with staffing and deployment models that give providers a chance to get out of the vehicle for their meals.
Internal distractions are thoughts or emotions that take cognitive bandwidth away from the task of driving. At baseline, the EMS community suffers from dangerous levels of chronic stress, to say nothing of the acute stress that can arise in the course of a shift [3]. Agencies that support defusing, stress debriefing and access to employee assistance programs may help to mitigate the effect of these internal distractions.
2. We overestimate our abilities
In 1999, Cornell researchers published a study on college students’ ability to accurately assess their skills in a variety of domains. They found that the less skilled the student was, the more they overestimated their skill [4]. Dubbed the Dunning-Kruger effect, this cognitive bias has been demonstrated in multiple subsequent studies.
Other studies have also demonstrated unconscious biases that impede accurate self-assessment of driving ability, including the concept of illusory superiority [5]. The legendary stand-up comedian George Carlin described this cognitive bias at work behind the wheel: “Have you ever noticed that anybody driving slower than you is an idiot, and anyone going faster than you is a maniac?” [6].
It’s very difficult to outsmart an unconscious cognitive bias, but we can compensate for it by seeking out more objective sources of feedback. Distracted driver simulations, available online, can provide valuable insight into how using a cell phone degrades our ability to pay attention and our reaction time.
Finally, it’s important to acknowledge that limited insight into one’s own driving skills is not a moral failing – it’s just how human brains are wired.
3. We don’t adequately train or test for driving skills
As EMS leaders, we regularly train and test our providers’ competency in performing CPR, regardless of their experience or expertise. Operating an emergency vehicle is a far more complex task, yet as a profession, we do not regularly evaluate continued competency in this skill.
National standards for certification and recertification focus primarily on clinical skills, leaving it to training centers, certifying bodies and individual EMS agencies to determine how or even whether to measure competency in driving.
Setting standards for driving performance, and regularly training and testing providers to these standards, may serve to counteract the complacency that can lead to inappropriate attempts to multitask behind the wheel. This training is also an opportunity to prepare your workforce with techniques to reduce distractions while driving.
4. We don’t give good feedback
Real-time driver feedback systems that measure speed and gravitational forces can help to reduce overly aggressive driving. However, they don’t always capture other indicators of distracted driving, such as unintentional lane departure.
For distractions stemming from cell phone usage, often the best indicator is observation of the driver behind the wheel [7]. Some driver feedback systems include video recording within the cab. This may deter cell phone usage, but may also be received poorly by employees who perceive the cameras as a violation of their privacy. Video recording also doesn’t provide real-time feedback to drivers and enable them to correct a dangerous situation. Feedback that enables the driver to make immediate corrections is more valuable in preventing a collision.
Some feedback comes in the form of reports or complaints from crewmembers, patients or other agencies, such as law enforcement. Careful evaluation of this feedback is crucial to crewmember safety. In some cases, driver feedback systems can help to either validate this feedback or exonerate drivers who were operating appropriately.
5. We don’t speak up
All of the above factors can stifle discussion about the potential impact of distracted driving on our safety. High baseline levels of distraction can lead to acceptance of distracted driving as the status quo. Unrecognized cognitive biases can make drivers defensive about their performance. A lack of clear driving standards makes it difficult to hold individuals accountable. And the scarcity of feedback that captures distracted driving behavior makes it difficult to pinpoint where changes need to occur.
Fortunately, strategies exist to help us communicate. Just Culture can help agencies create an environment where it is safe for providers to identify sources of human error, and where at-risk or reckless behavior is managed appropriately [8]. Crew Resource Management training can improve providers’ skills in situational awareness and communication, equipping them to identify and intervene when distracted driving poses a risk [9].
The habits and assumptions that set the stage for distracted driving are baked into our culture as a profession, but they do not have to be our destiny. Individual providers can influence the culture of an agency, and agencies can drive change that influences practice beyond their response area. Cultural change is not easy, but it is a life-saving intervention that belongs in our scope of practice.
About the authors
Meg Chandler, MSN, RN, ACNP-BC, NRP, manages the Specialty Care Transport unit within the Robert Wood Johnson University Hospital Mobile Health Service. A paramedic since 2001, her clinical experience includes urban and suburban EMS, emergency department and critical care nursing, specialty care transport, and advanced practice cardiothoracic nursing. She has partnered with the Safe Patient Handling Committee of Robert Wood Johnson University Hospital to explore safer practices for Mobile Health Service patients and staff. Her research interests include EMS provider wellbeing, professional development of specialty care transport personnel and mobile integrated health.
J. Todd Sheridan is a performance-driven leader with expertise in operations, organizational development and data analysis. Before joining Fitch & Associates, he served in various EMS and fire agencies, including the Richmond Ambulance Authority. In that role he led special operations for disaster and event planning, and daily operations including deployment planning and data analysis. He was a member of or led various clinical, operations and communication committees that created new protocols, policies and procedures adopted both locally and regionally.
References
1. National Center for Statistics and Analysis. (2017, March). Distracted driving 2015. (Traffic Safety Facts Research Note. Report No. DOT HS 812 381). Washington, DC: National Highway Traffic Safety Administration.
2. Multitasking: Switching costs. (2006, March 20). Available at: www.apa.org/research/action/multitask.aspx
3. Mental health and stress in emergency medical services (Publication). (n.d.). Available at: www.nemsma.org/images/pdfs/Mental_Health_and_Stress_final.pdf
4. Kruger J, Dunning D. (1999). Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. [Abstract]. Journal of Personality and Social Psychology, 77(6), 1121-1134.
5. Ehrlinger J, Johnson K, Banner M, Dunning D, Kruger J. (2008). Why the unskilled are unaware: Further explorations of (absent) self-insight among the incompetent. Organizational Behavior and Human Decision Processes, 105(1), 98-121. doi:10.1016/j.obhdp.2007.05.002
6. Rodrigues L. (Adapter). (2012). Idiot and maniac [Video file]. Available at: www.youtube.com/watch?v=XWPCE2tTLZQ
7. National Traffic Law Center. (2017, May). Investigation and prosecution of distracted driving cases (Report No. DOT HS 812 407). Washington, DC: National Highway Traffic Safety Administration.
8. Boysen PG. (2013). Just Culture: A Foundation for Balanced Accountability and Patient Safety. The Ochsner Journal, 13(3), 400–406.
9. LeSage P, Dyar JT, Evans B. (2011). Crew resource management: Principles and practice. Sudbury: Jones and Bartlett.
