E.M.S. A Dying Breed

Colleen Ryan, Ph.D. student

Walden University

PH 8165

Dr. Raymond Thron

Winter ‘09

Emergency Medical Services in the United

States

Emergency Medical Services in the United

States Paramedics Emergency Medical Technicians

First Responders Other Responders

The U.S. System Employs

The U.S. System Employs

Providers= 900,000 Full time= 180,000 Paramedics=154,000

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

ResponsesResponses

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

Fatigue Anyone?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

FactFact

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

Haddons Matrix for EV

Collisions Chart

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

Haddon’s Matrix for EV collisions Human/Host Vehicle/agent Physical environ. Pre-event (Pre-injury)

•Fatigue •Poor driver training • Impaired hearing • /ETOH substance abuse •Non- use seatbelt •Distractions, stress •Poor driving skills •diesel fume exposure •smoker •speeder

•Poor maintenance •Poor design •Poo /r inappropria tetires or tire pressure • lack of driver’s seatbelts • lack of driver’s side airbag

•Poor visibility •Hazardous conditions •urban v. rural • inadequate agency policy • inadequate money for research fo rprevention

Event •Employee’s health •resistance to impact KE

•Protrudin g object si. .e sharps contain ,ers O2 regulators •Unsecured equipmen t (LP, O2)

•Lack of guidelines

Post-event •Employee’s health •Resistance to care •Priorit y to others over self

Presence of hazmat •Availability of trauma centers •Availability of ambulances

Occupational Risk Factors

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

Deadly CrashesDeadly Crashes

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Crashes ContinuedCrashes Continued

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What Kills EMS Workers?

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/dispellingmyths1.htm

11 year retro analysis- Prehospital Emergency Care, July-Sept. 2001

Accident Incidence

Accident Incidence

6,300 ambulance crashes a year

10 injuries a person/day

Death of 1-2 persons/month

Dr Maguire ‘s Notes

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

Insurance Industry Reports

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

When do crashes occur???

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

Do more crashes occur on wet or

Dry Roads???

Do more crashes occur on wet or

Dry Roads??? Dry road surface = 69% Wet Surface = 23% Frozen = 8% Elling, B. Ambulance Accident Prevention

Seminar

Area of Impacts in a Crash occur ???

Area of Impacts in a Crash occur ???

Side swiped /angled crashes = 56%

Head on Collision 15% Right angle = 41% side swipe/over taking = 21%

Fact !!!!! Fact !!!!!

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

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Elling, B. Ambulance Accident Prevention Seminar

New York State Dept. of Health

Personal Injury Costs???

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

Impact of Ambulance Crashes

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

CollisionsCollisions

Greatest liability cost exceeding:

malpractice or negligence

Criminal negligence (Brooklyn crash)

New York Dept. of Health

Broad SolutionsBroad 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

Solutions on a Personal LevelSolutions on a Personal Level

Appropriate hours of rest Exercise accordingly Healthy diet Decrease the intake of alcohol

No smoking Learn remedies to de-stress

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Questions?????Questions?????

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

ReferencesReferences

Elling, B. Ambulance Accident Prevention Seminar

Levine, S. American AmbulanceMaguire 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.pdfhttp://www.objectivesafety.net/2007BostonHO.pdfNew York Department of HealthDepartment of LaborEmssafetyfoundation.org