The following sidebars accompany Associate Editor John Erich's article, Rules of the Road, in the June 2007 issue.

It's important to remember, with all the bells and whistles that can be built into ambulances and all the tools we can bring to bear in the quest for greater safety, that the biggest, most intractable and ultimately most important component is that fallible human being at the wheel.

Tools and toys can only take you so far. Inevitably, safety is a fundamentally human endeavor.

"One thing that can have immediate impact within organizations is addressing the human factor," says ICATS senior partner Rick Patrick, deputy chief for Estero (FL) Fire Rescue. "That deals with teaching them how to drive an ambulance safely and how to function in the back of an ambulance safely. That they should be restrained 95% of the time or more. If we can create that culture, we can reduce a lot of injuries and produce a lot of savings based on injuries, treatment and lost work time."

EMS attorney Orlando Blanco goes so far as to suggest the whole "cowboy" phenomenon so often blamed for ambulance crashes may be overstated. Most EMS drivers, he believes, would operate safely with the proper training and organizational support to do so.

"People like to talk about the cowboy mentality in this industry--the young kid, fresh out of high school or the military, who grew up watching police and paramedic stories on television and gets a real adrenaline rush from driving that emergency vehicle," he says. "Does that exist? Yeah, it probably exists in all of us. But I think to just write these crashes off as young kids who want to run hot ignores many of the things you could change. I've defended many of these cases, and the people I've defended are anything but cowboys. They're not people who have a history of this, yet there's this perception that many of them are just driving like madmen to get to an emergency.

"I think we're doing them a disservice by not training them properly, not clearly imparting upon them what the expectations are, and not continuously monitoring from both the training and operational perspectives so that we can enforce what we know, as trained risk managers, needs to be done to avoid accidents."

"There's a push in our industry to spend billions on crash studies and air bags and other types of controls," adds Patrick. "That's all good stuff, but any organization can realize an immediate impact by educating, training and holding their personnel accountable with practical, doable standards.

"The thing to remember is, you can't make someone be safe. You can educate them, train them and give them the tools, but ultimately, safety is personal. If an individual chooses not to be safe, no matter what else is provided, they're not going to be safe. So we have to work heavily on that culture of the individual themselves, and hold them accountable."

The Importance of Dispatch

Dispatch policies were another important factor in reducing ambulance crashes identified by McNeil and Company. Those with clear standards restricting hot responses appear to fare better.

"Folks who had a very plain dispatch policy--'We don't turn the lights and siren on when somebody's been scratched by a cat on their finger, but we do when there's chest pain or someone bleeding badly'--did a lot better," says director of loss-control services Bill Tricarico.

Agencies without dispatch policies averaged 4.9 accidents per every 10 vehicles over the five-year period studied, while those that had them averaged 2.1. What's more, in terms of dollars paid by the insurer, the latter's accidents weren't as severe.

"We found that the folks who had good dispatch policies had 39.6% less crash severity," says Tricarico. "Controlling when the lights and siren are used has a huge impact on reducing the severity of the accidents ambulances are involved in."