Ambulance Safety: Is It an Emergency Nursing Problem?

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In 1976, as a new nurse on the cardiac care unit, I was asked to accompany my patient to the Cleveland Clinic for a procedure he could not receive in our hospital. I had never been oriented to the ambulance equipment, nor was there a seat belt for me in the back of the ambulance. Luckily, the trip went well for both the patient and me. Emergency nurses often are asked to get into an ambulance to accompany a patient to another facility for care. Despite the large number of air and ground transport programs in the United States, there are still times when resources or weather may impede the transport of a critically ill or injured patient by a designated service and the emergency nurse may be called upon to provide care during transport.

Almost daily, ambulances or EMS vehicles are involved in crashes. The EMSN network is one of the places where a log is kept of these incidents.¹ Probably one of the most deadly accidents recently occurred in Ohio on July 20, 2007, when 5 ambulance occupants were killed. The ambulance was responding from the scene of an accident and was struck by a commercial truck that caused the vehicle to burst into flames. Three EMTs and 2 patients were killed.²

Interestingly, unlike in the case of air medical accidents where the National Transportation Safety Board (NTSB) and the Federal Aviation Administration investigate, track, trend, and analyze helicopter and fixed wing accidents, there is no specific federal governing body that directly oversees ambulance accidents and fatalities. According to the Ambulance Transportation Safety (ATS) Task Force, the NTSB reported that as of December 2007, it does not have any plans at present to investigate ambulance accidents. The ATS Task Force, composed of representatives from EMS practice, safety, and management, is concerned about the lack of focus by the NTSB on ambulance safety. The goals of the ATS Task Force were outlined at the inaugural meeting of the EMS Subcommittee on the National Academies’ Transportation Research Board in January 2008.

In 2006, the NTSB looked at EMS helicopter accidents and made major public recommendations. Despite the fact that there are more EMS vehicle crashes, few data exist that actually describe how immense the problem may be. The latest statistics from the Centers for Disease Control and Prevention noted that emergency services personal have a high incidence of fatality compared with other workers. Riding unrestrained and in the patient compartment (where the emergency nurse usually would be) were noted as significant risk factors for serious injuries and death.³

The ATS has developed a Position Paper on Ambulance Transportation, which calls for the NTSB to look at ambulance accidents with the same intensity as it scrutinizes the air medical transport systems in the United States. An NTSB comprehensive analysis of the entire EMS transportation system would ensure a comprehensive and multidisciplinary evaluation because the NTSB has access to scientists and professionals in the automotive, transportation, biomechanics, engineering, health care, and other fields that interact with the EMS transportation system.⁴

What can we do as emergency nurses? We can review the information that is available on the Web site www.objectivesafety.com. We can contact the NTSB and ask them to investigate the fatal crash that occurred in Ohio in July 2007 and collect data on serious and fatal ambulance accidents as they do for trucks, buses, and air ambulances. We can educate our fellow EMS workers about the ATS Task Force and their mission to make ambulance transport safer for them, for us, and for the thousands of patients who require ground transport to our emergency departments each year.

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References 

1. Available at: www.emsnetwork.org. Accessed February 9, 2008.
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2. Kyle S. Ohio ambulance crash kills three EMTs and two civilians. Available at: http://www.emsresponder.com/article/article.jsp?siteSection=1&id=5791Accessed February 3, 2008
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3. Centers for Disease Control and Prevention. Ambulance crash-related injuries among emergency medical services workers—United States, 1991-2002. MMWR. 2003;52:154–156
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4. Ambulance Transportation Safety Task Force. Position paper. Available at: www.objectivesafety.comAccessed February 3, 2008
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