When you tally the costs associated with an ambulance accident, there are obvious ones, like repairing the vehicle and managing injuries, and then there are more subtle hidden costs. Nadine Levick, MD, MPH, CEO of New York, NY-based Objective Safety LLC, has done extensive research into accidents involving emergency vehicles, including what they actually mean in terms of cost to the agency that owns them, the providers who work in them and the patients who rely on them for emergency care and transportation.

     "One example of a hidden cost is when you're a small system that has only three or four vehicles and one of them is involved in an accident en route to a call," says Levick. "Suddenly, there's a burden on your system's ability to respond generally, as well as to manage what's involved in that crash. If you have one vehicle out of service and another one needed to respond to that crash, it can negatively impact the response time of the vehicles that are left, and a negative impact on response times will have financial sequelae. And there are other elements associated with that crash: Will your insurance rates rise? Will you lose personnel and have retraining costs for replacements? Will there be counseling costs for staff emotionally traumatized by what happened to their colleagues, even if they themselves weren't involved in the crash?

     "The data we have so far show that two-thirds of fatalities and serious injuries involving ambulance vehicles were not to staff, but to third parties," Levick continues. "That goes into the whole realm of managing your staff and dealing with lawsuits. There are medics who've had to serve time for vehicular manslaughter and similar problems, and the costs of managing those situations are huge."

     Those who believe it costs money to be safe are fooling themselves. It costs much more to not have safety measures in place, says Levick. It's like a ripple effect, she says, starting with the immediate event and spreading through the entire system. As an example, she cites an ambulance crash in Brooklyn that involved major damage and serious injuries to the vehicles' occupants. But the real financial impact to the EMS system was that 28 emergency vehicles responded to the two-vehicle crash.

     "When people think of a crash, they aren't thinking about what's happening with that service long-term-only the immediate. I've been told that two or three years down the line from a very serious event, services are dealing with issues with present staff and staff who are still out on disability," says Levick, "and those are real costs."

     So what can EMS management do to reduce costs, both obvious and hidden?

     "There are a number of ways to do that," says Levick. "First is being aware there's a problem. The next is identifying which methods for improving safety are suited to EMS. Clearly, it doesn't cost a thing to change practices to include issues like safe driving; minimizing the use of lights and siren for emergency response; driving within posted speed limits, when possible; and changing intersection policies, as intersections are where ambulance crashes with the most critical injuries and fatalities occur.

     "Change your policies about ambulance occupants," Levick continues. "We know that 82% of the rear occupants who were killed in crashes were unrestrained, and we know it's difficult to provide care while restrained. In the air medical industry, you must notify the pilot if you're vulnerable, so he takes more care in managing the aircraft. In EMS, we do the opposite. When there's a critical patient, we all get unbelted and tell the driver to go fast. We can't do emergency care competently when the vehicle is speeding, and both we and our occupants are at risk when that happens."

     There are other ways to reduce ambulance crash costs, says Levick. Make sure all equipment in the cabin is firmly secured; look at how drivers are being trained and who is being allowed to drive; and utilize research technologies that monitor driver performance, which have made a dramatic difference by saving maintenance dollars and extending the lives of emergency vehicles.

     For more information, visit www.emssafetyfoundation.org.

-Marie Nordberg