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Why EMS needs to expand the scope of safety from scene to call

Why focusing solely on line-of-duty deaths is doing a disservice to the health and wellness of those in the industry

By Catherine R. Counts

Recent news headlines suggest that vehicular safety poses the greatest risk to the lives of EMS providers. While that may be true if the focus is solely on line-of-duty deaths, the majority of EMS deaths occur because of skewed priorities that are too rigorously focused on a single issue. As with any other improvement effort, there is no silver bullet to preventing the death or disability of EMS providers, but there is such a thing as silver buckshot. And while the process of solving can seem daunting, what begins with simple changes can add up to substantial outcomes.

First responders face an above average risk of dying in the line of duty. Data from 2003-2007 show that EMS providers experience 6.3 fatalities per 100,000 compensated employees, while firefighters have 6.1 fatalities per 100,000 employees. A recent news article is shining light on the fact that fire truck and ambulance collisions lead to a large number of these deaths.

In-vehicle death and injury
A 2011 study published in Prehospital Emergency Care provides support that some of the deadliest situations EMS providers face, are in a vehicle. Of the 65 EMS provider deaths studied, nearly 88 percent were related to transportation. Twenty-nine happened on the highway, 20 occurred via a form of air transportation, and the remaining eight were unspecified, but included those struck by a vehicle while on scene.

Even with research continuing to support the idea that vehicle safety is an issue, a 2012 study of fire truck crashes by the Association of the Advancement of Automotive Medicine shows that little has changed. Beyond a small number of safety feature improvements to response vehicles, the authors argue that a primary contributing factor is the absence of a culture of safety within the industry which leads to reckless driving as well as a decreased reliance on seatbelts. Even though the data in this study centered on firefighting, it is easy to imagine that these same issues exist within EMS.

Expand safety focus from “scene safety” to “provider safety”
Safety isn’t episodic, so it shouldn’t only be considered when arriving on scene. Perhaps we should re-evaluate how we’re teaching students to conceptualize safety, such that instead of focusing on “scene safety”, students learn to think about “provider safety”.

In light of regular active shooter incidents and the emergence of hybrid targeted violence, like the recent coordinated terrorist attacks in Paris, it seems trivial to remind providers to wear their seatbelts and drive with a bit more caution, but provider safety goes well beyond driving behaviors.

Provider safety is about wearing reflective vests when the call is on a roadway, donning a hard hat or helmet on Independence Day and New Year’s Eve, and pulling out the stab vest when protocols (even those overly restrictive protocols) suggest it’s in your best interest.

Provider safety is about regular physical exercise and grabbing a salad for lunch instead of a burger and fries, even though the latter is logistically so much easier to eat and to access. It’s about knowing when the stress of the job has become too much, and having the capacity to ask for help.

Provider safety is about departments providing reflective vests, hard hats or helmets, stab resistant vests, and defensive driving training as willingly as they provide exam gloves. It’s about departments setting a good example and prioritizing employee health and wellness such that finding funds for exercise equipment and allocating space in the station receives the same level of support as revamping clinical processes.

Provider safety includes recognizing the toll this job takes on EMS providers, and ensuring they have knowledge of and access to the necessary resources, like The Code Green Campaign and an employee assistance program, in a time of crisis.

It’s about funding agencies and payors realizing that EMS is just as dangerous as our other public safety counterparts. They see firefighters run into burning buildings and police officers run towards gunshots, so they rightfully recognize that those industries face perils that the typical office worker can’t comprehend. But for a multitude of reasons, we haven’t been able to convey that same sense of urgency for EMS. That has to change.

Explore these resources, many of which are applicable to EMS providers.

About the author
Catherine R. Counts is a doctoral candidate in the department of Global Health Management and Policy at Tulane University School of Public Health and Tropical Medicine where she also previously earned her Master of Health Administration. Counts has research interests in domestic health care policy, quality and patient safety, organizational culture and prehospital emergency medicine. She is a member of AcademyHealth, Academy of Management, the National Association of EMS Physicians, and National Association of EMTs.

Counts is the author of a blog focused on applying the concepts of health services research to the field of prehospital emergency medicine. Connect with her on Twitter or contact her via email at

Catherine R. Counts, PHD, MHA, is a health services researcher with Seattle Medic One in the Division of Emergency Medicine at the University of Washington School of Medicine. She received both her PhD and MHA from Tulane University School of Public Health and Tropical Medicine.

Dr. Counts has research interests in domestic healthcare policy, quality, patient safety, organizational theory and culture, and pre-hospital emergency medicine. She is a member of the National Association of EMS Physicians and AcademyHealth. In her free time she trains Bruno, her USAR canine.

Connect with her on Twitter, Facebook, or her website, or reach out via email at