E.M.S. A Dying Breed

1
E.M.S. A Dying Breed

• Colleen Ryan, Ph.D. student
• Walden University
• PH 8165
• Dr. Raymond Thron
• Winter 09

2
Emergency Medical Services in the United States

• Paramedics
• Emergency Medical Technicians
• First Responders
• Other Responders

3
The U.S. System Employs

• Providers 900,000
• Full time 180,000
• Paramedics154,000

Maguire BJ, Hunting KL, Smith GS, Levick NR.
Occupational Fatalities in EMS A Hidden Crisis.
Annals of Emergency Medicine. 2002 40(6) 625-632
4
Responses

• 31 million response a year
• 22 million patients a year

Maguire BJ, Hunting KL, Smith GS, Levick NR.
Occupational Fatalities in EMS A Hidden Crisis.
Annals of Emergency Medicine. 2002 40(6)
625-632
5
Fatigue Anyone?

• 21 hours of Sleeplessness .08 Blood Alcohol
  Level
• In the U.S. commercial drivers legal limit.04
  BAC

Arnedt JT, Wilde GJ, Munt PW, MacLean AW. How Do
Prolonged Wakefulness and Alcohol Compare in the
Decrements They Produce on a Simulated Driving
Task? Acid Anal Prev. 2001 33 3 337-44. CDC
National Center For Chronic Disease Prevention
and Health Promotion. Alcohol and Public Health
6
Fact

• EMS workers rate of illness and injuries is 6
  times higher than the National average

Maguire BJ, Hunting KL, Smith GS, Levick NR.
Occupational Fatalities in EMS A Hidden Crisis.
Annals of Emergency Medicine. 2002 40(6) 625-632
7
Haddons Matrix for EV Collisions Chart
Maguire BJ, Hunting KL, Smith GS, Levick NR.
Occupational Fatalities in EMS A Hidden Crisis.
Annals of Emergency Medicine. 2002 40(6) 625-632
8
Occupational Risk Factors

• Back/Neck Injuries 44.7
• Knees/Ankles 14.2/ 9.1
• Over exertion 49.5
• Assault 2.6
• Fatalities 12.7 (per 100,000)

National Highway Traffic Safety, Dept. of Labor,
National EMS Memorial Service
9
Deadly Crashes
10
Crashes Continued
11
What Kills EMS Workers?

• 74 of deaths are transportation related
• 20 are struck by moving vehicles
• More than 65 of occupant fatalities involve
  closed head injuries
• 70 of fatal crashes are involve lights and
  sirens(code 3) transport
• 82 of fatalities are unrestrained rear
  compartment occupants
• www.emergencydispatch.org/articles/dispellingmyths
  1.htm
• 11 year retro analysis- Prehospital Emergency
  Care, July-Sept. 2001

12
Accident Incidence

• 6,300 ambulance crashes a year
• 10 injuries a person/day
• Death of 1-2 persons/month

13
Dr Maguire s Notes

• 50 fatalities /yr.
• One in 300 services annually experience
  fatalities

Maguire BJ, Hunting KL, Smith GS, Levick NR.
Occupational Fatalities in EMS A Hidden Crisis.
Annals of Emergency Medicine. 2002 40(6)
625-632
14
Insurance Industry Reports

• 50 million Transports annually
• 1/2 are to the Emergency Departments
• Less than 1/3 are classified as emergency calls
• www.objectivesafety.net

15
When do crashes occur???

• More than half of crashes occur during the day
• Noon - 1800 39
• 0600- Noon 20
• 1800- 0000 24
• Elling, B. Ambulance Accident Prevention Seminar

16
Do more crashes occur on wet or Dry Roads???

• Dry road surface 69
• Wet Surface 23
• Frozen 8
• Elling, B. Ambulance Accident Prevention Seminar

17
Area of Impacts in a Crash occur ???

• Side swiped /angled crashes 56
• Head on Collision 15
• Right angle 41
• side swipe/over taking 21

18
Fact !!!!!

• More likely to crash at an intersection with a
  traffic signal _at_ 37 V. 18 approaching a Red
  Light

Elling, B. Ambulance Accident Prevention
Seminar New York State Dept. of Health
19
Personal Injury Costs???

• Cost per year for 180,000 EMS workers is
  equivalent to 100,800,000 dollars
• Average injury cost for 100 full time employees
  is 56,000/year

Maguire BJ, Hunting KL, Smith GS, Levick NR.
Occupational Fatalities in EMS A Hidden Crisis.
Annals of Emergency Medicine. 2002 40(6)
625-632
20
Impact of Ambulance Crashes

• Loss of life and injury
• Negative impact system wide
• Decrease in available resources
• Decrease in public perception of EMS and
  professionalism
• Extended alert times
• Increase in the public driving themselves
• Extended and untreated maladies (MI worsening
  Dyspnea)
• Levine, S. American Ambulance In House Training

21
Collisions

• Greatest liability cost exceeding
• malpractice or negligence
• Criminal negligence (Brooklyn crash)
• New York Dept. of Health

22
Broad Solutions

• Professional demeanor/work ethic- ego in check
• Recognize hazards
• Slow down
• Ambulance may not pass stopped school buses
• Ambulance may not pass activated railroad
  crossings
• Ambulance may exceed only 15 mph over the speed
  limit only in emergency mode
• Ambulance driver must drive defensively
• Levine, S. American Ambulance

23
Solutions on a Personal Level

• Appropriate hours of rest
• Exercise accordingly
• Healthy diet
• Decrease the intake of alcohol
• No smoking
• Learn remedies to de-stress

24
Questions?????
25

• Thanks for your time
• Colleen Ryan MHA/MBA EMT-P Ph.D. candidate Walden
  University

26
References

• Elling, B. Ambulance Accident Prevention Seminar
• Levine, S. American Ambulance
• Maguire BJ, Hunting KL, Smith GS, Levick NR.
  Occupational Fatalities in EMS A Hidden Crisis.
  Annals of Emergency Medicine. 2002 40(6)
  625-632
• http//www.nasemso.org/Meetings/MidYear/documents/
  Maguire-EMS-occ-risks-Jun09.pdf
• http//www.objectivesafety.net/2007BostonHO.pdf
• New York Department of Health
• Department of Labor
• Emssafetyfoundation.org