State of Emergency

Emergency medical services (EMS) is a funny discipline. It is a little bit health care and a little bit transportation, and it is certainly more of an art than a science to make an ambulance service work for a community. A fundamental problem rests in the EMS vehicle fleet. There are very few standards governing the design of an ambulance. Indeed, as my good friend Dr. Nadine Levick of the EMS Safety Foundation likes to point out, there are more standards governing the transport of cattle than sick and injured people in the United States. What this has given us in the United States is a lot of large, bulky ambulances that perform poorly in crashes and are not ergonomically optimal for the care of patients or safety of healthcare providers. Indeed, if the box of an ambulance is struck or rolls over, the result is often devastating. Attempting to alter the system is as altering any behemoth machine or bureaucracy is, next to impossible. But there’s a small group of renegades who have kindly invited me along as they work to incite change.

My direct relationship with the Transportation Research Board (TRB) dates back to Fall 2009 when I was a Christine Mirzayan Fellow assigned to the board under the guidance of Dr. Rick Pain, the guy everyone goes to if transportation safety is involved. Dr. Pain’s responsibilities include the oversight of safety related committees and subcommittees (if you’re interested in learning about TRB committees, click here), one of which is the EMS Transport Safety Subcommittee. The real beauty of TRB committees and subcommittees is that they often bring together many perspectives on an issue. I often think of it in terms of shining a white light through a prism. In terms of the EMS subcommittee, it brings together physicians, civil engineers, ergonomists, emergency medical technicians, and even vehicle designers. Seminal to the mission of this subcommittee has been the presentation of three EMS safety summits. The second was in October 2009, and the third was this past month on February 29^th.

The goal of this third summit was to tie together the results of the previous two summits, set an agenda for moving forward, and illustrate solutions—both that can be implemented today and others that may require a greater depth of planning. For me this meant making the trek from State College, PA to Washington, DC. But when it’s your colleagues at stake, it’s a no-brainer to make the trip and be committed as an agent of change.

During the summit we looked at tackling the problem through improved education, application of scientific research, and shifting fleets over to safer equipment. Some of the highlights included:

• The introduction of NAEMT’s 8-hour safety class
• Illustrations and diagrams of ergonomic studies looking at where providers actually touch and reach within an ambulance
• Implementation of the “safest ambulances on the road” in Ontario and Texas
• Fleet management systems for reducing fuel costs, improving driver behavior, and understanding area needs in large emergency medical services systems
• Listening to EMS leaders consider system improvements from an interdisciplinary perspective.

The final result of these summits is intended to be a document. The summits culminate in the span of a day. A written document, as well as the recordings of the summits, have a much longer life and ability to reach a broader audience. The recordings from the last summit are already online here. The document, on the other hand, is a greater project, brining all three summits together and describing where we’re going and ways to get there. That document is may area of greatest influence and a responsibility I am keen to manage.

But perhaps most importantly, contributors are not paid. All participants have day jobs who do this just because it is import. We are all volunteers even though it doesn’t match the stereotype of the high school candy striper or young male volunteer fire fighter. Volunteerism is alive and well in transportation, and in this case we’re conquering a true state of emergency.