Ambulance Safety

Purwoko Sugeng Harianto

Clinical lecturer & Emergency Nurse Clinician
Department of Emergency Medicine
Saiful Anwar General Hospital
Myths of Ambulance Services
• Emergency departments prioritize patients based on medical
severity (triage). Some people believe that calling an ambulance will
put them ahead of the line.

• People believe that ambulance is only respond to emergency scenes.

But actually, they take patients from convalescent hospitals to
doctor visits and treatment centres, also for any bedridden patient.

• Ambulance is only for transportation similar form of "gurney van."

Gurney vans do not have an attendant in the back with the patient
during transport and the driver of the van is not trained as an
emergency medical technician.
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“An Ambulance never runs, they walk with
purpose”

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Ambulance should be….

a well-equipped and
efficiently organized vehicle
with advanced
communications and
technology that can bring
needed medical supplies,
personnel, and advanced
life support care to the
emergency scene.

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 But… 5

ambulance Crashes are an issue!

What is killing?
• Literature over the last two decades has
indicated that riding in the back of an ambulance
is associated with significant morbidity and
mortality
• Estimated 12.7 fatalities for every 100, 000 EMS
• EMS injury rate of 19.6 per 100 full-time workers
• It’s very likely the more dispatch call the more
collisions can be happened…

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Brice JH at.al. Prehosp Emerg Care. 2012
Ambulance Crash Factors
• Ambulances were hit by vehicles as they attempted to go
through the intersection

• Excessive speed was also a contributing factor to loss of

control resulting in a wreck

• Ambulances were hit while parked

• EMS Providers are at a 50% greater risk of being involved

in a crash while on duty
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 Common Themes of Risk
Ambulance Safety
• Lack of Teamwork
• Distractions or Intention
• Lack of Training or Knowledge
• Lack of Standardization
• Complacency
• Fatigue or Tiredness
• Negative Culture of Safety
• Lack of Communications
• Protocol Deviations
• Poor System Design or Process
10 CONSIDERATIONS FOR MINIMIZING
CRASHES, INJURIES AND DEATH…

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1. Certified Ambulance Services

EMS organizations should may set standards for

the type and quantity of equipment carried based
on local regulations.

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2. Maintenance of EMS vehicles
• Good repair
• Safe operating condition
• Meet requirements of local regulations
• Exterior surfaces, including windows, mirrors and warning
lights
• shall be kept clean of dirt and debris
Postrun Activities: Restocking,
Cleaning, and Disinfection
• Clean and disinfect
ambulance and equipment
used.
• Restock supplies.
• Perform routine inspections.
• Decontaminate the
ambulance.
 3. Do not ‘Blowing through’
intersections

• A study of fatal ambulance collisions found that the

ambulance was the striking vehicle in over 76% of accidents.
Of those, over 60% occurred during emergency Light & Siren
use
• Lights and sirens blaring are NOT intended to blow through
intersections. Ambulance should follow all road safety
regulation.

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 Changes in Patient Condition during Transport

This table illustrates the differences between patient condition

changes during L&S vs Non-L&S transports. Only 1% of NonL&S
patients were listed as having worsened during transport.
The patients transported with L&S were generally more seriously
injured/ill with 13% dying during transport and 5% worsening 14
4. Ambulance Construction
Passenger safety and
restraint devices
• Seat belts
• Driver and passenger
air bags
• Anti lock braking
systems

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5. Crew & Patient Safety
• Crew & Patient
restraints
• Padding in
appropriate places
• Rounded corners

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Crew & Patient restraints
• 96% of patients were belted at the time of the crash
• 61% of them were restrained with only lateral belts,
while only 33% were correctly restrained with lateral
belts and shoulder straps to them secured to the cot
• Of the serious crashes :44% of patients were ejected
from their cots and patients not restrained by both
shoulder and lateral restraints

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Smith N, 2015
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Fournier M at al. 2013

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6. Safety interior design

• Compartment door
latches
• Equipment on counter
tops
• Wall mounted equipment
• Crew bench and seat belts
• Cabinets above seating
• Stretcher and mounting
brackets
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7. Crew safety attire

• Helmets
• Uniform

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8. Driver education programs

• Emergency
Ambulance Protocol
Course
• Emergency Vehicle
Operator’s Course
(EVOC)
• Coaching Emergency
Vehicle Operators
course (CEVO)
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9. Public Education
We need to make the
public aware
• laws regarding
emergency vehicles
• parking and
“standing”
regulations

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10. Audit
The objectives of the audit were to ensure that:
1. Patient transport data was accurate and adhered to
improved billing rates
2. Quality control practices resulted in positive public relations
3. Ambulances deployment and coverage was adequate and
met expected contractual service levels

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 Improving ambulance safety
• Educating the workforce
• Evaluating engineering interventions such as
electronic monitoring
• Enactment
• Enforcement of policies on topics such as speeding,
safe driving, and safety measures such as requiring
slow ambulance speed when occupants are unbelted
Conclusions
• Ambulance setting is unique to health care and presents
many challenges to providing safe, high-quality medical
care in emergency situations.

• Factors affecting safe ambulance operations should

consider the emergency vehicle, driver’s experience,
environmental conditions, lights-sirens-air horns, and
safety at intersections.

• Today’s ambulance should be well-equipped and

efficiently organized
• Safety is a critical component of great patient care 26
Reference
• Brice JH, Studnek JR, Bigham BL, Martin GillC, Custalow CB, Hawkins
E, Morrison LJ. (2012) EMS Provider and Patient Safety during
Response and Transport: Proceedings of an Ambulance Safety
Conference. Prehospital Emergency Care doi:
10.3109/10903127.2011.626106

• Fournier M, Chenaitia H, Masson C, Michelet P, Behr M, Auffray JP.

(2013). Crew and patient safety in ambulances: results of a
personnel survey and experimental side impact crash test. Prehosp
Disaster Med. 28(4):370-375.

• Murray, B., & Kue, R. (2017). The use of emergency lights and sirens
by ambulances and their effect on patient outcomes and public
safety: A comprehensive review of the literature. Prehospital and
Disaster Medicine, 32(2), 209-216.
doi:http://dx.doi.org/10.1017/S1049023X16001503
Reference
• NHTSA. (2013) Fatality Analysis Reporting System (FARS) 2013
Annual ReportFile (ARF).
• Smith N. (2015) A National Perspective on Ambulance
Crashes and Safety. emsworld.com

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THANK YOU

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