Why EMS needs more protection on roadway incidents

Roadway incidents are highly hazardous hot zones for EMS and other public safety personnel


Roadways are the most dangerous scene types for EMS providers and require increased safety measures from hazardous exposure to minimize death and serious injury of public safety personnel.

We regularly share news stories of fire apparatus struck while attending a motor vehicle collision, EMS providers struck while tending to a patient and police officers killed after stopping a speeding driver or checking on a disabled vehicle.

In late October, a medical helicopter was struck and tipped over in New Mexico by an intoxicated driver who drove around barricades meant to block traffic. The reckless driver also hit a fire truck. No injuries were reported, but we don't know the impact of the transport delay on the patient's outcome. We also don't know the potential impact of traumatic stress on the EMS and fire personnel who were in the midst of caring for a patient when a out-of-control vehicle plowed into their scene.

N.M. helicopter struck and tipped over by an impaired driver. (Photo/McKinley County Sheriff's Office)
N.M. helicopter struck and tipped over by an impaired driver. (Photo/McKinley County Sheriff's Office)

Six months ago, nearly to the day, another medical helicopter was struck by a drunk driver who swerved through emergency vehicles before striking the helicopter's tail rotor. The impact of this central Florida incident on the patient's outcome, as well as the emergency responders, is unknown.

Because of the frequency with which emergency personnel, vehicles and now helicopters are struck, we need to accept that erecting barricades, parking a couple of blocking vehicles, waving orange flags or setting-up temporary signs is inadequate scene protection. High-visibility apparel looks great, but if the fire truck and flashing lights don't get a drunk or distracted driver's attention, then a neon-reflective vest is the equivalent of an invisible cloak.

Roadway is a hazardous materials hot zone
Any time you are working on or near a roadway, you are in the hot zone of a hazardous materials incident. Vehicles, blunt trauma-inflicting machines, hurtle around you under the loose control of undertrained, often impaired and often distracted operators. Protect your life, livelihood and family's future by protecting yourself with time, distance and shielding.

Time: As little as possible
A lethal dose exposure on a roadway can happen in a fraction of a second. Minimize EMS personnel exposure by clearing the patient to an area of relative or improved safety as quickly as possible. Pick helicopter landing zones with limited and securable access.

A firefighter injured in a structure fire is not treated in the midst of the flames and smoke — a highly hazardous and unstable environment. Instead, the firefighter is evacuated quickly and aggressively out of the structure. The awaiting ambulance or helicopter is parked well outside of the building's collapse zone. Start visualizing any roadway incident as a fully-involved, multiple story structure fire.

Distance: Get out of the striking zone
Visual warnings — signs, flares, spotters — to drivers are nice, but not enough. Increase the frequency, visual loudness and upstream distance of warning signs from the incident.

It's even better to get out of the striking zone. Move the ambulance off the road as quickly as possible. Load and go to a parking lot, access road or location that is well outside of the striking range of impaired and reckless drivers. Find and use landing zones that are not within the accessible distance of a driver.

Shielding: Bigger and stronger wall
If personnel are stuck on the road because the patient requires prolonged extrication, build a bigger and stronger wall that is impenetrable by motor vehicles. If the opportunity exists to go around, through or over the wall of blocking vehicles, we can be sure that a determined, distracted or impaired driver will make an attempt to break through the shielding.

Finally, our brains are wired to see what we are expecting to see and poorly wired to see what we are not expecting. If you have ever driven west across South Dakota, you know that there are Wall Drug signs every few miles. Because your brain is expecting Wall Drug signs, you see nearly every one regardless of its size, distance from the road or message.

Very few drivers are ever overtaken by an emergency vehicle and thus often default to blissful unawareness or fight-or-flight driven erratic movement. Even fewer drivers are expecting a helicopter to be parked on the center line. Don't expect or rely on their impaired or distracted cognitive function to identify and react appropriately to this unexpected and never before encountered environmental change. 

About the author

Greg Friese, MS, NRP, is Editor-in-Chief of EMS1.com. He is an educator, author, paramedic, and marathon runner. Ask questions or submit tip ideas to Greg by emailing him at greg.friese@ems1.com.

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