There is a spectrum of safety issues for the Emergency Medical Service (EMS) transport environment and an increasing number of potential solutions - addressing provider safety, patient safety and the safety of the public in a systems approach. This paper outlines risks and hazards involved in EMS transport, highlighting the automotive safety, workplace safety including ergonomic and engineering perspectives, as well as existing and developing standards and guidelines. Despite the large strides that the automotive industry, occupational health and safety as well as public safety have made in the last 30 years, this expertise has not yet been translated to the safety of ambulance transport. This is a unique transportation and health care delivery environment for a number of reasons. In the USA there are no specific EMS transportation safety databases, so that ascertaining the overall safety of the system is very challenging, also there are few applicable system safety standards, no comprehensive personal protective equipment standards and no vehicle crash safety testing standards that pertain to ambulance vehicles.

Unfortunately, because no reporting system or database exists specifically for identifying ambulance crash related outcomes, injuries and their nature, specific details as to which injuries occurred and to whom and what specifically caused them are extremely scarce. There have been extensive studies that have identified that the rear patient compartment is the most dangerous part of the ambulance for its occupants, yet this part of the vehicle is currently not regulated by the Federal Motor Vehicle Standards. Furthermore it has also been demonstrated that for each ambulance occupant fatality in an adverse event involving an ambulance vehicle, that there are 3 non-ambulance occupants fatalities, largely related to intersection crashes, and secondarily pedestrians struck.

This paper demonstrates that utilizing a systems safety based multidisciplinary approach-addressing patient, provider and public safety with comprehensive data capture, strategic highway safety planning integration, ergonomic and automotive safety perspectives in conjunction with vehicle and fleet safety standards development-is necessary to ensure improved outcomes in EMS transport safety.


Emergency Medical Service is a unique transportation and health care delivery environment for anumber of reasons. Even though there is comprehensive medical and clinical oversight, training and standards in EMS - this is not the case with the transportation safety aspect of this system. In the USA there are few applicable transportation system safety standards for EMS, essentially no vehicle crash safety testing standards that pertain to ambulance vehicles patient compartments and no comprehensive personal protective equipment standards. There is only very limited national data captured on the safety of this EMS transportation system, primarily by the Fatality Analysis Reporting System (FARS), which captures fatalities only and has no denominator data. Thus ascertaining the safety of EMS transport system, its vehicles and products remains limited to expert and peer evaluation in a piecemeal fashion.

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