E.M.S. A Dying Breed
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Transcript of E.M.S. A Dying Breed
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