First Do No Harm: Why Seatbelts are a Patient Care Issue Noah Smith, NHTSA Office of EMS
Hi, I m Noah
Standard Bureaucratic Disclaimer To the extent that I mention specific brands or products in this presentation, it is for informational purposes alone and does not constitute an endorsement of the brand/product. 3
Our Objectives Provide an overview of ground ambulance crashes in the United States Highlight NHTSA s ambulance crash and defects investigations and research findings Demonstrate the importance of bucking up for providers and our patients Lead a discussion on Ground Ambulance Safety
The Office of Emergency Medical Services Mission Statement To reduce death and disability by providing leadership and coordination to the EMS community in assessing, planning, developing, and promoting comprehensive, evidence-based emergency medical services and 9-1-1 systems.
Fifty Years of Supporting EMS 6
The NHTSA Approach to Ground Ambulance Safety Collect comprehensive traffic crash data and conduct research, including investigating serious ambulance crashes Collaborate with national organizations & Federal partners to provide EMS leaders with the information they need to improve ground ambulance safety Foster consensus around strategies to promote safe EMS systems Support projects of national significance to accelerate improvements in ground ambulance safety
An Overview of Ground Ambulance Crashes in the US Between 1992-2011 (20 years), there were an annual estimated average of 4,500 motor vehicle traffic crashes involving an ambulance. Of these crashes: 65% resulted in property damage (only) 34% resulted in an injury/injuries <1% resulted in a fatality/fatalities *Injuries and fatalities include occupants in all cars involved in a traffic crash involving an ambulance Sources: NHTSA s Fatality Analysis Reporting System (FARS) 1992-2010 Final and 2011 Annual Report File (ARF) and National Automotive Sampling System (NASS) General Estimates System (GES),1992-2011 8
Estimated Traffic Crashes involving an Ambulance 1992-2011 3000 Mean Crashes 2500 2000 1500 Property Damage Only Injury 1000 500 Fatal 0 9 1992-1996 1997-2001 2002-2006 2007-2011 Year *bar represents average number of crashes over 5 years *Injuries and fatalities include occupants in all cars involved in a traffic crash involving an ambulance Sources: NHTSA s Fatality Analysis Reporting System (FARS) 1992-2010 Final and 2011 Annual Report File (ARF) and National Automotive Sampling System (NASS) General Estimates System (GES),1992-2011
Fatal Crashes involving an Ambulance 1992-2011 Between 1992-2011 there were an annual average of 29 fatal ambulance crashes and 33 fatalities (includes occupants and nonoccupants of all vehicles involved) 50 45 40 Fatal Crashes Fatalities Frequency 35 30 25 20 15 1992 1996 2000 2004 2008 Year 10 Sources: NHTSA s Fatality Analysis Reporting System (FARS) 1992-2010 Final and 2011 Annual Report File (ARF)
Estimated Ambulance Crashes resulting in Injured Persons 1992-2011 Between 1992-2011 there were an estimated annual mean of 1500 injury crashes involving an ambulance and 2600 injured persons* (includes ambulance occupants and occupants of all other vehicles involved)**. 3500 3000 Injury Crashes Persons Injured Mean Annual Frequency 2500 2000 1500 1000 500 11 1992-1996 1997-2001 2002-2006 2007-2011 Year *bar represents annual mean number of crashes and injuries over 5 years **does not include data on non-occupants of a vehicle (pedestrians and pedalcyclists) in injured persons Sources: National Automotive Sampling System (NASS) General Estimates System (GES), 1992-2011
Where does this data come from? Census of Fatal Crashes (FARS) Obtained from many documents including: Police Crash Reports Vehicle Registration Files State highway Department Data Other Records National Estimate of Non-fatal Crashes (NASS-GES) Data are obtained from police reported crashes only. Collected from 410 police jurisdictions in 60 sites around the US Sample about 57,000 police crash reports per year Fatal Crash Data Injury and Property Damage Crash Data 12
We Have Limited Information on Who Was Injured or Killed in Crashes Ambulance Driver Person driving Ambulance Ambulance Passenger Includes all other occupants in Ambulance - EMS personnel, patients, and passengers Occupant of Other Vehicle All occupants of vehicles involved in the crash driver and passengers Non-Occupant Includes all non-car occupants, such as pedestrians and pedalcyclists 13
Persons Killed in Crashes Involving an Ambulance: 1992-2011 Ambulance Driver 4% N = 662 Ambulance Passenger 21% Occupant of Other Vehicle 63% Non-Occupant 12% Sources: NHTSA s Fatality Analysis Reporting System (FARS) 1992-2010 Final and 2011 Annual Report File (ARF)
Estimated* Injured Persons** in Crashes Involving an Ambulance: 1992-2011 N = 10,400 Ambulance Driver 17% Occupant of Other Vehicle 54% Ambulance Passenger 29% *data represent mean number of crashes and injuries over 5 years **does not include data on non-occupants of a vehicle (pedestrians and pedalcyclists) in injured persons Sources: National Automotive Sampling System (NASS) General Estimates System (GES), 1992-2011
Emergency Use in Crashes involving a Ground Ambulance 1992-2011 Of the annual average 29 fatal crashes involving an ambulance: 58% while in emergency use 42% while in non-emergency use Of the estimated annual average 1,500 injury crashes*: 59% while in emergency use 34% while in non-emergency use These percentages do not account for proportion of time ambulances spent in emergency vs. non-emergency mode. *7% unknown if in emergency use/non-emergency use Sources: NHTSA s Fatality Analysis Reporting System (FARS) 1992-2010 Final and 2011 Annual Report File (ARF) and National Automotive Sampling System (NASS) General Estimates System (GES),1992-2011 16
Summary of 20 Years of Crash Data Between 1992 2011 (20 Years) Annual estimated average of 4,500 crashes involving a ground ambulance 29 Fatal Crashes* 1,500 Injury Crashes** 33 Fatalities 2600 Injured Persons 4% Ambulance Driver 21% Ambulance Passenger 63% Occupant of Other Vehicle 12% Non-Occupant 58% Emergency Use 42% Non-Emergency Use *all fatal column data are annual averages **all injury column data are annual estimated averages 17% Ambulance Driver 29% Ambulance Passenger 53% Occupant of Other Vehicle 1% Non-Occupant 59% Emergency Use 34% Non-Emergency Use Sources: NHTSA s Fatality Analysis Reporting System (FARS) 1992-2010 Final and 2011 Annual Report File (ARF) and National Automotive Sampling System (NASS) General Estimates System (GES),1992-2011 17
NHTSA Special Crash Investigations (SCI) Program We investigate ambulance crashes that result in significant or fatal injury to occupants inside the ambulance SCI investigates: Pre-crash activities of the persons involved Contributing factors to serious/fatal injuries sustained in crash Environmental/Roadway factors Vehicle/Equipment factors 18
NHTSA Special Crash Investigations (SCI) Program Process of Ambulance Crash Investigation Crash reported to NHTSA Office of EMS OEMS confirms investigation criteria Fatality or Hospitalization of Ambulance Occupant Failure of Ambulance Equipment Suspected Malfunction of Ambulance Other extenuating crash circumstances CA12032 19
NHTSA Special Crash Investigations (SCI) Program Process of Ambulance Crash Investigation SCI launches Investigation Technical Report Released CA12032 20
NHTSA Office of Defects Investigation Identify design or manufacturer defects relating to motor vehicle safety Assure defects are remedied promptly and effectively Assure information relating to defect investigations and safety recalls is readily available to the public ODI cannot put vehicles out of service, all NHTSA authority lies with the manufacturer. 21
NHTSA Office of Defects Investigation (ODI) What is a Defect? A flaw in a motor vehicle or motor vehicle equipment presenting unreasonable risk of accidental death or injury in a crash. Defect Examples: Failure of Anti-Lock Braking System (ABS) Suspension Failure 400 Amp Fuse Corrosion Occupant Seat Mounting Failure of Patient Cot Fastening System Mounting Bracket Failure Seat Belt Anchors Mounting Failure CA08034 CA09082 22 CA12034
NHTSA Office of Defects Investigation Report a safetyrelated ground ambulance vehicle or equipment complaint to NHTSA: www.safercar.gov HOTLINE (888-327-4236) 23
Ambulance Crash Investigations: Seatbelt Use by EMS Personnel NHTSA/NIOSH Investigations: 34 of 38 (81%) of drivers wore safety restraints 40 of 50 (80%) of EMS providers (non-drivers) did NOT wear safety restraints 14% Lap Belt Only 6% Shoulder and Lap Belt Unrestrained EMS providers are at significantly greater risk of sustaining severe or fatal injuries in serious crashes 24
Ambulance Crash Investigations: Seatbelt Use by EMS Personnel # of EMS Personnel 20 18 16 14 12 10 8 6 4 2 0 Injury Severity and Use of Safety Restraints in EMS Providers Restrained Injury Severity
Ambulance Crash Investigations: Seatbelt Use by Patients Patient Restraint System Use 97% of patients were restrained at the time of the crash, restraint system use varied 61% Lap Belt Only 33% Shoulder and Lap Belt Used (Harness) 3% Used: Type not reported 3% Not Used Sources: NHTSA Special Crash Investigations Ground Ambulance Crash Reports 2002-2012 and NIOSH Fire Fighter Fatality Investigations and Prevention Program 2001-2010 and Fatality Assessment and Control Evaluation 2001
Ambulance Crash Investigations: Patient Restraint Systems Use and Ejection from Cot 100.0% 90.0% 80.0% Not Ejected from Cot 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Not Used or Partially Used Shoulder and Lap Belt Used Sources: NHTSA Special Crash Investigations Ground Ambulance Crash Reports 2002-2012 and NIOSH Fire Fighter Fatality Investigations and Prevention Program 2001-2010 and Fatality Assessment and Control Evaluation 2001
Getting the Word Out: NHTSA Infographic
Two Critically Important Research Studies Emergency Vehicle Operator Training National survey of state and local EMS agencies How much and what kind of training is offered? Required? Continuing requirements? What happens after a crash? Driving history? State and local roles? Fatigue Management Developing voluntary fatigue risk management guidelines and resources Evidence-based Tools for local leaders Online scheduling that takes fatigue and work hours into account Maximize opportunity to sleep 33
NHTSA s Ground Ambulance Safety Activities NHTSA National Center for Statistics & Analysis Provide statistics and analytical support on ground ambulance crashes NHTSA Office of Special Crash Investigations Ongoing investigations of ground ambulance crashes NHTSA Office of Defect Investigations Track emergency vehicle safety issues NHTSA Office of Behavioral Safety Research Research on Human Factors issues in EMS, for example: Analysis of SCI and FARS ground ambulance crash data Characterizing EVOC programs in the United States Exploring the impact of fatigue in EMS 34
Office of Emergency Medical Services noah.smith@dot.gov (202) 366-5030 35
Discussion Questionssion Questions In your service, how do you talk about safety? What motivates managers, supervisors and providers to act in response to safety concerns? What resources have you turned to for information on improving ambulance safety? What information would you love to have that would actually help you change and improve practices in your service?
Resources National Highway Traffic Safety Administration (NHTSA) http://www.nhtsa.gov/ NHTSA Office of Emergency Medical Services http://www.ems.gov/ NHTSA Fatality Analysis Reporting System (FARS) http://www.nhtsa.gov/fars NHTSA National Automotive Sampling System General Estimates System (NASS-GES) http://www.nhtsa.gov/nass NHTSA Special Crash Investigations http://wwwnass.nhtsa.dot.gov/bin/logon.exe/airmislogon NHTSA Traffic Safety Facts 2012: A compilation of Motor Vehicle Crash Data from the Fatality Analysis Reporting System and the General Estimates System http://wwwnrd.nhtsa.dot.gov/pubs/812032.pdf NHTSA Office of Emergency Medical Services Safety Initiatives http://www.ems.gov/safety.htm National Institute for Occupational Health and Safety EMS Workers Injury and Illness Data (2011 Data) http://www.cdc.gov/niosh/topics/ems/data2011.html Working Group Best-Practice Recommendations for the Safe Transportation of Children in Emergency Ground Ambulances http://www.ems.gov/bestpracticerecomendations.htm Model Minimum Uniform Crash Criteria (MMUCC) Fourth Edition (2012) http://wwwnrd.nhtsa.dot.gov/pubs/811631.pdf Reporting Vehicle and Equipment Problems with Emergency Response Vehicles http://www.safercar.gov/vehicle+owners/emergency+response+vehicles NIOSH Center for Motor Vehicle Safety: Partnering with Industry to Build Safe EMS Work Environments http://www.cdc.gov/niosh/topics/motorvehicle/ncmvs.html The National EMS Culture of Safety Strategy http://www.emscultureofsafety.org/ FirstResponder.gov: Supporting First Responders through Science and Technology http://www.firstresponder.gov/sitepages/homepage/firstresponder.aspx 37