This feature is part of our Paramedic Chief Digital Edition, a regular supplement to EMS1.com that brings a sharpened focus to some of the most challenging topics facing paramedic chiefs and EMS leaders everywhere. To read all of the articles included in the Winter 2016 issue, click here.
Speaking to ambulance manufacturers and distributors, it’s apparent that most ambulance purchases are still the traditional patient care compartment — a curbside squad bench, a captain’s chair at the head of the cot and a roadside patient-facing seat. Despite the availability of new seating arrangements and seat belts, as well as the ability to replace cabinets with other types of storage systems, the market is continuing to buy what it has always bought. To better understand the lack of change in purchasing behavior and improving ambulance safety, we asked members of the EMS1 advisory board to respond to three questions.
Paramedic Chief: Why do EMS leaders need to stop buying what they have always bought and instead purchase significantly improved and safer ambulances?
Chris Cebollero: When EMS leaders began buying bigger trucks, we thought they would make a difference for patient care, provider safety and maintenance. There has been no real data that has proven spending $200,000 or more per unit does any of those things. What we need to do is rethink provider, crew and patient safety.
Jeff Czyson: To put it simply, there is enough information available to show the cookie-cutter ambulance models most EMS leaders grew up with fail to provide adequate crash protection. Some design features increase morbidity and mortality. The ability to improve upon safety, ergonomics and economics exists and ideas are being shared openly.
Ann Marie Farina: There is also evidence of a correlation between sustaining minor traumatic head injuries and an increased risk of mental health issues such as depression, anxiety and PTSD. Given that EMS professionals are already showing an increased prevalence of these conditions over the general population, EMS agencies and leaders need to update their vehicles to help reduce the risks of brain injuries and mental health issues.
Kelly Grayson: EMS leaders need to make a visible commitment to provider safety, and purchasing units with better crew module design is one tangible step. We often talk about helmets and body armor for provider safety, but the real killer of EMTs goes largely ignored. And that’s vehicle collisions. As long as we’re rendering patient care sitting sideways in an accident, with little more than a lap belt and usually not even that restraining us, little will change in death and injury rates. Ditch the bench seat and replace it with twin, forward-facing attendant seats that swivel and lock into place.
PC: How can we accelerate ambulance replacement for our EMS workforce without every agency having a fatal or near fatal ambulance collision to motivate change?
Cebollero: Agencies need to get on an annual replacement and remounting schedule. If an agency has 20 trucks, there should be a plan to replace or remount four ambulances per year. Budgeting for an annual expense will allow organizations to secure the funding to turn the fleet over every five years.
Czyson: EMS leaders need to continue to share designs, features and ideas openly. Many leaders may settle for the same old truck due to the work involved with guiding or changing a manufacturer.
Grayson: This is delicate ground to tread. Upgrades in vehicle design are expensive. New ambulance standards on paint schemes and lighting systems, power-loading cot systems, and other improvements may enhance safety, but only if an agency actually purchases an ambulance with these features. When a new ambulance can cost $250,000, many cash-strapped agencies will push the service life of their worn-out vehicles even longer. If that happens, have those new safety standards actually made anyone safer?
Greenberg: Part of the problem is we only respond to our own issues. We need to start with a “Just Culture” national ambulance accident reporting programs to learn from incidents.
I responded to the Hoboken Train Station crash in September. The day of the crash, team after team of federal safety personnel, including the National Transportation Safety Board, Federal Railroad Administration and the FBI, arrived to review the incident. Very soon after, representatives from those agencies appeared on the news to report their initial findings, the next steps and how they will determine the root cause of the incident so it doesn’t happen again. If EMS could do this for every accident, maybe we can reduce the number of EMS accidents, reduce the number of provider injuries and increase the safety of our profession.
Czyson: Fear of change and the blowback it brings also stifles creativity and progress; however, taking the time to explain why change is necessary with our caregivers is very rewarding, and ultimately they appreciate what is in their best interest.
PC: NHTSA’s ongoing analysis of ambulance collisions makes it clear that the change that is needed most is drivers. How can EMS leaders immediately improve driver behavior in their current workforce and with limited budget for training?
Grayson: We can start by retraining crews in scene choreography so that doing lifesaving interventions with the wheels rolling becomes the exception, not the rule.
Greenberg: My previous agency tracked accidents per mile driven to benchmark driver performance. But we were only able to benchmark against ourselves because no one on a national scale of similar job functions was doing the same. Imagine the progress we could make on safety if we collaborated to create national benchmarks and shared what works and what does not to improve driver behavior.
Cebollero: Driving, a skill needed by all field employees, requires education, common sense and money. We cannot leave to chance that our workforce will drive the ambulance perfectly. We have to do initial education with practical tests and annual driver competency evaluations. If someone has driving challenges, there needs to be immediate remediation.
Czyson: There are several low-cost driver feedback systems on the market. Implementing one of these can help reduce forces and improve ride quality for our patient and the clinician providing care. Other benefits include the extended lifespan of wearable items on the vehicle. Taking a hard look at using response times as a measure of quality is also necessary. We should continue to strive for patient outcome measures over the speed with which we arrive on scene.
Grayson: Thinking cool new ambulances are the solution is a symptom of the disease that afflicts EMS; we always look to technological solutions rather than enhance our education or change our behavior. We’re all about the toys and ignore the need for education. Ultimately, most of these ambulance design enhancements would be unnecessary if we just slowed down. Until we change the culture in EMS and make providers realize that a lights and siren response and transport should be an exceptional situation and not the norm, we’re still going to see far more LODD notices than we should.
About the responders
Chris Cebollero is a nationally recognized EMS leader, author and advocate. Cebollero is the senior partner for Cebollero & Associates, a medical consulting firm, assisting organizations in meeting the challenges of tomorrow.
Jeff Czyson is the Allina Health Emergency Medical Services director of operations. His EMS career began in 1987 and he has held multiple positions as a clinician, educator and leader. His career has been highlighted by relationship-building and collaborative efforts. Czyson has a baccalaureate degree in organizational leadership and serves on several EMS committees and boards at various levels.
Ann Marie Farina is a paramedic in Washington state. She has been in EMS since 2003 and worked as a wildland fire medic, a dual-role firefighter/paramedic, a 911 transport medic and as an educator. Farina founded The Code Green Campaign, a mental health awareness campaign, which raises awareness about mental health conditions and suicide in first responders.
Kelly Grayson, NREMT-P, CCEMT-P, is a critical care paramedic in Louisiana. He has spent the past 18 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is a frequent EMS conference speaker and contributor to various EMS training textbooks.
Ryan Greenberg is the executive director of Pinnacle Points Health Systems. He has spent 20 years working in EMS, from EMT to Chief of EMS. Ryan has focused his career on building hospital-based EMS systems across the northeast while always remaining an active paramedic, firefighter, educator and EMS advocate.
