EMS providers, CPR quality 'at risk' during transport

The risk of occupational death is two-and-a-half fold higher for EMS workers, while EMS response is also statistically more dangerous than police or fire


By Jamie Thompson
EMS1 Senior Editor

BALTIMORE — Transport is the most dangerous thing EMS providers do — but the full extent of the hazards involved have always been tough to prove.

The risk of occupational death is two-and-a-half fold higher for EMS workers, while EMS response is also statistically more dangerous than police or fire.

Photo Jamie ThompsonMichael Kurz explains the dangers of transport to an audience at EMS Today.
Photo Jamie Thompson
Michael Kurz explains the dangers of transport to an audience at EMS Today.

A session at EMS Today in Baltimore was told how a recent study on the forces that are applied to EMS providers during transport not only highlights the risks to responders but to patients as well.

Michael Kurz, M.D., Assistant Professor in the Department of Emergency Medicine at VCU in Virginia and Operational Medical Director for Henrico County, helped lead the study. Kurz told Friday's session, which was hosted by Zoll, that the expectations of what is provided in the back of the ambulance today are significantly different than a decade ago.

"We're now seeing medics doing cardiac critical care in the back of an ambulance," he said. "It means we are spending more time in the back of the ambulance; our hands are tied up more frequently providing care and we are unrestrained."

The investigation was conducted at Richmond Ambulance Authority in Virginia; ambulances were equipped with a black box onboard monitoring system — Road Safety — that can measure speed and acceleration variations.

Fifty cardiac arrest transports over a five-month period at the start of last year were monitored, Kurz said, and data showed personnel were at significant risk of balance loss 60 percent of the time.

Kurz told the session there is an imbalance between the level of safety and protection afforded to technical rescue and hazmat responses compared to ambulance transport.

"When you get in the back of an ambulance, which you do every day, we provide very little in the way of occupational safety in the back of the ambulance for the provider," he said.

The results of the study also raise questions over the quality of CPR that is delivered to cardiac arrest patients from EMS providers being frequently off balance, which interrupts compressions, according to Kurz.

"Clearly the message here is it's putting providers at risk for no benefit at all," he said.

Among the ways to address the issues are improved driver training and real-time feedback and mechanical CPR.

"It's a lot easier to provide quality CPR if you have a device that does it for you … rather than manual CPR, which is inherently dangerous when you are likely to be off balance," Kurz said.

"If we clearly cannot provide quality CPR in the back of the ambulance, what are we doing this for?"

Kurz questioned whether EMS abandoned "Stay and Play" too soon to "Load and Go" for certain transports, and said medics can arguably provide everything he could in his emergency department in many cases.

He used the analogy of riding in the back of an ambulance as riding on a subway but with some major differences: there's nothing to hold on to, no windows which means no external situational awareness when treating a patient, not needing to stay on the tracks and the fact it can go in any direction.

"It seems absurd when presented this way but that's the occupational hazard we are exposed to daily when riding in the back of an ambulance," Kurz said.

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