Emergency Services Mortality?

[air.stump]

I think it has nothing to do with healthcare or lack of. I think the high mortality rate speaks volumes to the state of EMS in the US. This only proves that the profession puts more emphasis on response and transport times than the proper operation of vehicles and following proper safety procedures.

It also shows a lack of proper education. EVOC is nice but it is only the tip of the ice berg. Practical driving experience is the component that lacks from this course. There is no way a person can be competent after sitting in a classroom and driving around a few cones.

All this "lack of healthcare" talk just muddies the water. You don't drive to the patients expectation or the medical emergency (or lack of) they have. A person drives the same way regardless of what is in the back. The emergency is theirs, not the drivers.

[zippyRN]

I don’t mean to sound disrespectful, rude or ill-informed but I really can’t get my head around this, what’s the go with the high mortality rate within the American emergency services?

It seems every time I log on there’s a new post informing me that an ambo crashed a truck, a helicopter crashed into another, firefighters died in a fire, first responders crashing even before they make the scene and the list grows longer…

I just can’t seem to work out why this is happening? Lack of training? Not thinking straight? No sense of danger? I just can’t work it out… I mean Australia certainly has emergency services related fatality or server morbidity events but it seems nothing compared to the US, it’s certainly not a daily/weekly event and we certainly don’t have a website dedicated to recorded the death of Emergency services workers.

training and education has part of it as does operation policy

look at the UK's emergency driver training , Police, Fire (full time and retained) and NHS Ambulance staff all do at least 3 weeks emergency driver training before being let loose on the public roads with lights and noise ...

i don't know how much driver training Aussie ambos do , but the urban guys and girls are all peopel with substantive contracts and those out i nthe sticks really are i nthe sticks where the biggest RTC hazards are hitting a roo or being mown down by a road train if you venture on the highway

air ambulance crashes - the UK safety record is so good because to- scene operation is daylight VFR only in twin engined aircraft with either 2 pilots or pilot + trained air observers, to scene at night either doesn't happen or is in military or military type 3 crew aircraft (e.g. sea king family or Merlin) with NVG, nite suns ... etc etc

the only First responders in the UK responding with lights and noise are people who had the 3 weeks driver training - so a few FR groups and 'staff' responders ( i.e. people who work for the service)

retained FFs don't respond to scene in POVs ...

[zippyRN]

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I worked in EMS for 15 years, logged over 50K miles per year and never once responded to a bad accident involving an ambulance. maybe I wasn't in the right place at the right time but I've responded to plenty of accidents involving big rigs that were very bad.

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surely that's a function of the services you've worked for ... good services don't have lots of RTCs becasue the drivers are trained and both peer pressure and the management keep the excesses under control ...

[Just Plain Ruff]

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surely that's a function of the services you've worked for ... good services don't have lots of RTCs becasue the drivers are trained and both peer pressure and the management keep the excesses under control ...

Absolutely but here are the other factors of some of the services I've worked for (all these services do many many miles a year on long distance transfers. Not unusual for a crew to put 300-600 miles on in a day on transfers)

1. Experience - at one service I worked for the average experience level of the providers was 10 years. That's a lot of driving and good quality ems experience. (in the 2 years I worked there 0 accidents) in the past 10 years at that service 0 accidents overall (and they do 100K miles per year or more on long distance transfers)

2. Driver training - every driver had EVOC training(at one service) 0 accidents at that service

3. Lights and siren use - At service #1 above, rarely if at all did we drive with lights and sirens on. Small town, one stoplight, 0 accidents in 10 years

4. Another service I worked for had a quality dispatch system and their accident rate was quite low. less than 1 accidtent in the 8 years I worked for them

Accidents happen all the time, we respond to them daily. But with common sense, vigilence and just plain driving like you should, there should be a minimum number of accidents.

[sevenball]

What about 24 - 38 hr. shifts, couldn't that have something to do with it as well. They say that every hour over 16hrs. is equivilent to drinking a beer. By time 24 hours roll around, technically, your tanked. Does our friends in the U.K. or Australia do 24's, are they allowed? When I was young and strong, I would pull 48's very often.

[zippyRN]

What about 24 - 38 hr. shifts, couldn't that have something to do with it as well. They say that every hour over 16hrs. is equivilent to drinking a beer. By time 24 hours roll around, technically, your tanked. Does our friends in the U.K. or Australia do 24's, are they allowed? When I was young and strong, I would pull 48's very often.

most UK EMS personnel on shifts are doing either 8/ 10 or 12 hour shifts ... the EU workig time directive has limits ofn shift time in that there are daily rest and weekly rest requirements and there should be 11 hours between shifts ... also in most of the Uk 24s simply wouldn't work because it just doesn't stop ( there's a lull between 0300 and 0500 but that's aobut it ... ) i think there were a few tations in rural bits of Scotland , wales and the North East Ambulance area that were doing on call working at night but IIRC even that has been stopped now...

[sevenball]

I'm with you, it doesn't stop here either, but that doesn't stop some companies from running 24's and such. I can attest, it really does make you feel drunk by the time you're done.

[Flasurfbum]

I don’t mean to sound disrespectful, rude or ill-informed but I really can’t get my head around this, what’s the go with the high mortality rate within the American emergency services?

In the Fire Service, our numbers as far as LODDs have stayed the same (2001 excluded) for 30 something years, but if you look closely at it, the numbers are somewhat skewed.

The 78 year old volunteer who has an MI while he is cleaning the station is counted as an LODD, just the same as the 25 year old urban city FF who dies when the window in a tenement lets go, and he is killed by rapid fire progression, or the 14 year old junior Firefighter who rides his bike to the station during a call, is hit and killed.

It seems every time I log on there’s a new post informing me that an ambo crashed a truck, a helicopter crashed into another, firefighters died in a fire, first responders crashing even before they make the scene and the list grows longer…

I just can’t seem to work out why this is happening? Lack of training? Not thinking straight? No sense of danger? I just can’t work it out… I mean Australia certainly has emergency services related fatality or server morbidity events but it seems nothing compared to the US, it’s certainly not a daily/weekly event and we certainly don’t have a website dedicated to recorded the death of Emergency services workers.

In fact the last article I can find relating to an emergency vehicle accident was a few months ago.

I keep hearing silly like story’s about firefighters going into fully involved buildings for internal attack when there’s no conformation re entrapment only to have the roof come down on them or ambos driving at incredible speed to get to a call or members responding in POV to calls yet there vehicles haven’t undertaken a road worthy to drive at high speed.

It all just seems mind blowing and I really can’t figure out why it’s happening.

I am not quite familiar with any FFs going into a fully involved structure for an aggressive interior attack, but that does not mean that it is untrue.

If you look on youtube, you will be able to find a number of "training" videos shot by amateurs who want to look tough, entering well, or fully involved fires to get their gear crusty, or blacken up their lid.

A big part of Fire Service training is aggressive interior attack, and searching. However, there is not enough training on when enough is enough. With the new lightweight construction, and higher fuel loads, fires burn hotter, and the construction can't hold up, since it is built cheaper, and lighter. 5 minutes of burning can lead to structural compromise.

As far as driving, I am guilty of driving like an ass. When I first started out, I drove too fast, and too recklessly. After working for a company who had drive cams in their vehicles, and strict rules for responding, ie STOP at all red lights, and clear one lane at a time, no excessive speed, and they were aggressevly enforced, my driving habits changed dramatically.

Perhaps having DriveCams installed in all Fire/EMS vehicles would encourage those of us to slow the frack down, and drive sanely, especially when there is video and audio proof of what we did!

[UMSTUDENT]

In my mind this question has many answers. I'll touch on one.

I recently visited a friend of mine who works at a very respected flight service in the VA area. While I was there we had a discussion about the type of safety measures they utilize before going into the air. Unlike many HEMS services, this program utilizes true resource management . ANY member has the right to deny a flight for any reason. No questions, no banter from management. The sky could be completely blue.

At his company all pilots are IFR certified and capable of utilizing their instruments in inclement weather. Both the pilot and crew have access to military night vision technology.

Safety seems to be their biggest virtue and is constantly on everyone's mind.

I don't believe this is the case in ground EMS at all (and some flight services). How many times have all of us walked onto an ambulance at the beginning of our shift and simply believed that our ambulance is structurally stable? If our fluids are adequate? Can you guarantee exactly how many 7.0 endotracheal tubes are in your intubation kit? Why are there no simulators in ambulance training? Why don't we simulate catastrophic events?

We need to start adequately training our providers for the types of situations they will deal with on a daily basis. There seems to be too much "on-the-job training" and improvisation instead of hard, preparatory education and training.

[Just Plain Ruff]

actually, when I was in the field I could guarantee that each piece of my inventory list was there. IF it wasn't I didn't go anywhere, of course there are pieces that may not be as important as ET tubes but if there was 4 7.0 et tubes then there were 4 7.0 et tubes.

If there was supposed to be 25 alcohol swabs, then there were 25 unless of course we caught a call before I could get them all counted and I didn't consider them ciritcal pieces of equipment when I could get them form the ER.

We in EMS (street) do not really have the luxury of refusing to go on a call. If we did then maybe we'd be different but Air EMS is different, There is minimal to no surviving a helo crash. That's the difference, you have a good chance of surviving a ambulance crash. i also think that being able to refuse in certain instances like hurricane, torrential rainstorm with major flooding, or a serious Ice storm that we should be able to do that.

Tornado would be on my list too.

if you can't get to the call then you don't go.

But in the overall scheme of things, you go where called. It's up to you to make it there safely. Sometimes that is harder than it appears.