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EMS Fleet Telematics and

Nadine Levick, MD MPHResearch Director, EMS Safety FoundationCEO, Objective Safety, New York, USAChair, TRB, EMS Subcommittee, National Academies

Telematics and Safety Technology

Tools

97% are routineONLY 3% are life threatening critical

EMS Transport Surprising FACTS

g25% there is NO Patient TRANSPORTED

Vehicle/Fleet SafetyOccupant protectionDriver performance monitoring and feedback

Key elements to fleet transport safety policies

feedbackHours of serviceDriver/provider wellness and fitnessDriver/provider impairmentPublic safety

Transport Medicine

Impact BiomechanicsTransport ErgonomicsTransport ErgonomicsFleet Safety

A “Fleet” to many in Emergency Medical care means….

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CrashworthinessVehicle designO t t ti

Impact biomechanics

Occupant protection

Operational tasksHuman factors analysisRange of reach

Transport Ergonomics

Range of reachPatient loading and unloading

Operational policies – dispatch, safetyFleet mixVehicle selection – safety, ESC, loading heightDriver performance and monitoring

Fleet safety

Driver performance and monitoringScene safetyVisibility and conspicuitySafety measurement and management

Evidence in clinical studiesvs

evidence in engineering

Parachutes reduce the risk of injury after gravitational challenge, but their effectiveness has not been proved with

randomised controlled trials

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When it comes to engineering, the laws of physics prevail…

The Laws of Physics Prevail..

Philosophiæ Naturalis Principia Mathematica, July 1687

Change and Innovation

• Improved data systems for injury• Enhanced data on denominator• New technologies• New policies/standards• Interdisciplinary collaboration

R & D“Ripoff and Duplicate”

Avoid reinventing the wheel at all costs

Where are the best practices that we need to transfer knowledge from

TRB MISSION

To provide leadership in transportation innovation and progress through research and information exchange, conducted within a setting that is objective, interdisciplinary, and multimodal.

Special role for EMS at TRB

One of the Key 4 E’s–Engineering–Education–Enforcement–Emergency Medical Services

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Transportation Research Board is an excellent resource… we should be

using it!!ANB10 (5) TRB EMS

Subcommittee Mission'Bridging the gap between what we do and what is known

E h i b l t t- Enhancing ambulance transport safety through shared knowledge of technical data'.

Fragmentation Panacea

ANB10(5) is an independent platform for:Bringing fragmented information togetherUniting diverse disciplinesUniting diverse disciplinesFocus on technically robust information

One Day event, 30 presentationsHeld in Washington DC, Keck CenterSimulcast Live to EMS Today

2012 EMS Safety Systems, Strategies and Solutions Summit

Simulcast Live to EMS TodayLive Webinar Access - globallyOver 100 participants live across 3 continentsGreater that 10,000 downloads of handouts within the first week!!

Opening Address: A.J. HeightmanSafety Developments Update – N. Levick Research needs assessment forms explained – E. Frazer1: Data and Recent Initiatives

2: Transport, Human Factors - Bridging Diverse Disciplines

3: Testing and Standards

The 2012 TRB EMS Safety Summitprint this page & your smart phone will play the 8 sessions from the eTags! (even in B&W)

4: New systems safety technology solutions & telematics

5: Fleet management strategies

6: Innovative Vehicle Design

7: Operationalizing Safety

8: Panel: How to optimize the safety of your existing fleet Wrap up – from Prof. Art Cooper

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The 2012 TRB Safety Systems, Strategies and Solutions Summit

a GRATIS resource for anyone, anywhere in world,

and also via your smartphone

4:New systems safety technology solutions & telematics

http://www.emssafetyfoundation.org/2012TRBSummitAgendawithLinks.pdf

TRB 2012 Summit – addressed the key and interdisciplinary applied solutions issues, in one day – please seek that information out. www.objectivesafety.net/TRBSummit2012.htmThere have been two prior TRB Summits held,

Its out there NOW

There have been two prior TRB Summits held, 2008, 2009 and both with vehicle engineering and transportation systems technical expertise See www.trb.org, and for the Summit archives: www.objectivesafety.net/TRBSummit2008.htmwww.objectivesafety.net/TRBSummit2009.htm

Safe Practices for Motor Vehicle Operations

ASSE/ANSI Z15.1 2012https://www.asse.org/cartpage.php?link=Z15_1_2012&utm_source=ASSE

+Members&utm_campaign=b4472c203c-Z15_5_12_125_11_2012&utm_medium=email

ANSI/ASSE Z15.1-2012 Revised Standard is now available. “ Safe Practices for Motor Vehicle Operations“

Newly Revised ANSI/ASSE Z15.1-2012 Standard is now

available.

pThese practices are designed for use by those having the responsibility for the administration and operation of motor vehicles as a part of organizational operations.

Z15.1 Technical Briefhttp://asse.us2.list-

manage.com/track/click?u=c607f19210bc178f7ceb6d716&id=a311862ffc&e=8007d740a6

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What Z15 encompassesSafety ProgramSafety PolicyResponsibilities and AccountabilitiesDriver Recruitment, Selection and AssessmentOrganizational Safety RulesOrientation and TrainingReporting Rates and Major Incidents to ExecutivesOversight

Telematics

Communication Technology trends Smartphone navigation devices

A lot is now possible and for less!

Driver behaviorVehicle behaviorR d id ITSRoadside ITSFuel consumption/EconomicsResource modeling

How?

Deployment technology toolsInvehicle telematicsSmartphone telematicsSmartphone telematics

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Since 2009New perspectivesNew technologiesNew generations focusNew vehiclesNew vehiclesNew platformsNew policies/standardsNew international models

Rules/Policies Addressing Known Hazards

Federal Motor Carrier Safety Ad i i t ti (FMCSA)Administration (FMCSA)–Cell phone use – November 2011–Hours of Service – December 2011

Federal Motor Carrier Safety Administration - FMCSA

http://www.fmcsa.dot.gov/

Nov 2011, Hand Held Cell Phone Banhttp://www.fmcsa.dot.gov/about/news/news-releases/2011/Secretary-LaHood-Announces-Step-towards-Safer-Highways.aspx

Dec 2011, New FMCSA Hours of Servicehttp://www.fmcsa.dot.gov/rules-regulations/topics/hos/index.htm

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DOT HOS Rules Limits established for on-duty hoursEstablishes minimum levels of off-duty time-8 hours if on duty less than 12 hours FRA or if over 12 hours then 10 hour off-duty timeCommercial airline pilot can fly up to 100 hrs/monthAdopts 60/70 hour weekly maximum for truck drivers, 10 hour off-duty time

What are your policies???– If your patient is pink, warm and talking?– Are you required to notify the driver if you

When is it safe to do what… ?

Are you required to notify the driver if you are out of your seat belt?

– Are ‘routine procedures’ putting you at risk?

Policies to protect you too!Policy makes a difference…

DOH NYS, 2012 Advisory on patient care in a moving ambulance

www.EMSSafetyFoundation.org/2012-04_NYSAdvisory_on_Patient_Care_in_a _Moving_Ambulance.pdf

EMS VEHICLE OPERATIONS/SAFETY EMMCO WEST REGIONAL PROTOCOL

Pennsylvania Department of Health Operations 123– BLS– Adult/PedsEffective 07/01/11 Protocol 123

Criteria: A. All EMS operations, including incident responses and patient transports.

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Balance of concerns and risk during transport

Response and transport time

Clinical care provision

Occupant safety/protection

Public Safety

Communicating risk

LivesTime

Safety is a tool to save

Money

must be evidenced based

What is your transport safety record in your service?How can you improve if you don’t have a meaningful measure of safety

Data…

a meaningful measure of safety performance?Transport safety is not guesswork, it is a science

What we need to consider, where is the ‘bang for buck’ in ambulance transport safetyyWhere is the low hanging fruit?

Whats out there?

Integrated systems with mapping, safety and economyDeployment systemsDeployment systemsDriver management systemsIntelligent transport system

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Fleet Management technologiesACETech/FernoFleetEyes – IntermedixZoll rescuenet and roadsafety fleet management systemsg yMarvlisTelematicusOptimaNorthrop Grummen

ACETech/Ferno

ACETECHTM Web

Mapping, reports, alerts, hotspots, vehicle data

Fleet eyes

ZOLL systems Telematicus

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Fleet Management capability

Vehicle database• Individual vehicle/ data• Fleet mileage collection/Checklists• Link to other systems (SAP, Fleet)

Maintenance & Service Plans

Telematicus

Maintenance & Service Plans• Repair history & Scheduling • Action planning

Reporting• Export to Excel for manipulation• Scorecards views, Crystal Reports reporting•Direct Feedback

Optima: Demand/Resource analysis and modeling and base location planning

Northrop Grumman Marvlis

•• The dashboard The dashboard calculates:calculates:•• current percent of current percent of

demand coveragedemand coverage•• three closest vehiclethree closest vehicle

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•• three closest vehiclethree closest vehiclerecommendations recommendations for recent incidentsfor recent incidents

•• realistic travel timerealistic travel timeestimates for eachestimates for eachpossible responderpossible responder

Marvlis

•• The web The web interface:interface:•• individual choice of individual choice of

reference mapsreference maps•• integration of AVL/ARL integration of AVL/ARL

and other live feedsand other live feeds

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and other live feedsand other live feeds•• native Android clientnative Android client•• creation/update of creation/update of

spatial data direct to spatial data direct to ArcGIS ServerArcGIS Server

•• customization options customization options to extend functionalityto extend functionality

Priority Dispatch

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SAABOverview of these fleet

management approaches

Driver Training

Cost Savings Real-time Feedback

How How

ZOLL systems

Reward and Coach

Data Upload and Reporting

Immediate Improvements

Benchmark Drivers

Event Analysis

Road Road Safety Safety WorksWorks

Data Collection & Driver Feedback System

Onboard computer installed in each vehicle to assess driving performance

A dibl f db k t d i i

ZOLL systems

Audible feedback puts drivers in control of performance

Audio Speaker

Onboard Computer

Data Upload and ReportingData collected onboard is transferred via wireless data

hub to ZOLL online for reporting and analytics.

ZOLL systems5% of Drivers Cause 95% of Problems

Identify safe,

efficient drivers and

provide additional incentives

and

ZOLL systems

and rewards.

Identify and manage

the exceptions.

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ABC’s of Safe Driving

Driver grading system– Average miles

ZOLL systems

– Between– Counts (violations)

Other events and behaviors monitored

Braking, acceleration and side/sway forcesEmergency lights and sirensEngine RPM

ZOLL systems

Engine RPMEngine idle time (indicates wasted fuel)Distance drivenTurn signalsNumerous others—what’s important to you?

The “Feedback box”Driver behavior monitoring and feedback device

Extensive Indirect cost savingsFewer out of service vehiclesImproved transport timesDecreased administrative lost in

ZOLL systems

Decreased administrative lost in managing unsafe behaviorsDecreased legal burdenAutomatic system wide dataInsurance benefits

Demonstrated EffectivenessMEMS MONTHLY OVER SPEED VIOLATION TREND 2003/2004

216,922

550,353

2,074 1,609285 547

4,046

207 407 710 7803,069

1,004 1657 2709

179,721

0

100,000

200,000

300,000

400,000

500,000

600,000

Series1

March April MayJu

neJuly

August

September

October

Novembe r

December

January

February

MarchApril May

June

MONTHI II III

I – blind data, no growls

II – growls & tones ON unidentified data capture

III – identified data 0.04

4

0.01

7

0.01

8

3.88

6 5.24

415

.843

12.0

599.

9414

.823

13.4

299.

319

7.24

9.41

6.9 8.39

9.61

2.27

7.57

4.28

99.

2717

.43

15.2

5 16.6

117

.49

15.7

619

.32

13.1

1

0

5

10

15

20

25

Mar

chA

pril

May

June July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

rD

ecem

ber

Janu

ary

Febr

uary

Mar

chA

pril

May

June July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

rD

ecem

ber

*Jan

uary

200

5Fe

brua

ryM

arch

Apr

ilM

ay

MEMS ABC Miles Per Month

Unit 302 Accident

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Monitoring and feedback devices

Implementation well received by the providers. 20% cost saving in vehicle maintenance within 6 months.

ZOLL systems

No increase in response times Fewer crashes and less severe crashes Sustained improvement in safety proxies, with no inservice or retraining after the initial introduction period.

safety environmentefficiency

Telematicus

Global Green Drivers“Low Cost Safe Driving Platform”

The smartphone is capable of detecting:– Vehicle motion and speed via both the

accelerometer and changes in GPS and GPRS l ti

Smart phone Data terminal featuresTelematicus

location– Has the capacity to identify harsh braking – Software configuration can also disable the use

of texting and non-emergency calls whilst the vehicle is in motion.

Telematicus

GPS and GPRS status

GGD viewsA smart phone App that is a safety tool

Telematicus

Driver and vehicle ids

“Convergence?”

DriverTechnology

Handheld device collects and communicates key data‐ Speed‐ Braking & Acceleration‐ Time & Location‐ Pictures & Video

More information via Bluetooth OBDII, Black Boxes• More refined braking• Specific data e.g. Seat Belts• Tracking of vehicle.

Telematicus

AftermarketTechnology

OEMTechnology

Connected vehicle becomes an IP point, data access

Installation to vehicle 

Slide 84

AMD1 A core part of the OEM technology is Infotainment where there are opportunities for advertising and payfor media (music, video) services.

Given a lead in this area and openness (points of integration) for other categories of application including social media, travel, insurance/safety/risk management the Smart Phone becomes a useful platform for user interaction removing the costs of display in lower value marques. It will be resisted or dismissed by the more expensive marques e.g. Mercedes.DoreA, 11/9/2011

AMD2 For safety simply adding OBDII with minimal cost of install provides "high resolution" acceleration analysis.DoreA, 11/9/2011

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Fleet Management capability

Vehicle database• Individual vehicle/ data• Fleet mileage collection/Checklists• Link to other systems (SAP, Fleet)

Maintenance & Service Plans

Telematicus

Maintenance & Service Plans• Repair history & Scheduling • Action planning

Reporting• Export to Excel for manipulation• Scorecards views, Crystal Reports reporting•Direct Feedback

Safety Capability

Driver Alarm• Instant SMS & Email location

Driver Risks• Scorecards and Graphs• Automated Messages

Telematicus

•Training 

Trip playback•Speed, Braking, Acceleration

Incident Recording•Accident/Breakdown •Photographs 

0.002.004.006.008.00

10.0012.0014.00

Incident Reporting

GGD Data Capture• Real time• Key details• Photographs• Details on application 

Business System 

Telematicus

y• Individual records linked to drivers and vehicles• Action planning and assignment• Attachments e.g. photos

Reports• Launch accident reporting process• Export to Excel for manipulation• Scorecard or crystal reporting

• Capability

• Computing Power

So WhatTelematicus

• Convergence

• Costs

“Capabilities”

Duty of Incl Driver

On Line

Mobile/ Driver

Telematicus

LicenceCheck

On line Passive

Risk Assess

Duty of Care Low

Resolution Accel/

Braking GPSAlarm

Incl.Data

AnalysisAction

FeedbackReports

Driver Safety

MessageAccidentReport

TrainingGPS

OBDIIFault

Codes* With

handheld device

Black BoxHigh

ResolutionAccel/

BrakingGPS

CANbusFleet MgtSpeed,IdlingSeat Belts

per driver/vehicle per month from low to high cost

Driver Focus

Fixed/ Vehicle Install

Integrated business system

Organisation Hierarchy

Telematicus

Outlook view on home pagewith GGD modules included

List of Drivers within the system with key details, easy access to sorting information.

Slide 89

AMD3 ODBII is not really a fixed install. It's a bit of a hybrid but does give "high resolution" acceleration data.

I think the duty of care picture needs to show Smart Phone as well as handheld.. This leads to £5 + £2 (OBD11) giving £7 as good competitor for £13 black box. Otherwise the £13 black box seems to offer good value for money. Plus the accelormeter in the Smart Phone offers the potential for accident detection just like the black box. An area yet to be explored.DoreA, 11/9/2011

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Emergency Vehicle Intelligence with

The ACETECH System provides system wide, on‐board intelligence that improves the efficiency and safety of your emergency vehicles 

and staff, while reducing your operating costs.

Four Modular Functions

1. Vehicle operations center– Driver & vehicle operations

2. Patient Compartment– Mobile trauma bay environment; passive supportMobile trauma bay environment; passive support– Communication, temperature, lighting,

securement & access, storage, & overall interiorly & exterior safety

3. Medic platform – work environment & safety– Seating, operating areas, reach & access

4. Patient platform – care & safety focused– Cot & restraint system, patient care accessories

1. Integrated/Modular Solution2. ROI 3. Vehicle Performance4 U P

ACETECH Core Benefit

4. User Power5. Service– Affordability– Excellent warranty– Reliable– Modular design– Forward thinking– Product/OEM Support

ACETECHTM ECO-RunThis graph indicates battery drain when engine is off and on- scene lighting was

active. Auxiliary battery dropped to 11.5 volts (pre-programmed ECO-RUN start) in approximately 2.7 hours.

Voltage vs Time

13

14

ge

10

11

12

Enginerunning/

idling

Enginestopped

1h 2h 3h 4h 5h 6h 7h 8h

Time

Volta

g

Main Battery

Comms Battery

Aux Battery

Eco Run

ACETECHTM WebMapping, reports, alerts, hotspots, vehicle data

ACETECHTM Safety System Benefits ROIThe following is a partial list of benefits that may be realized through a properly managed vehicle safety program.• Fewer collisions• Fewer collision/near collision related injuries• Reduced insurance premiums• Fewer lawsuits• Reduced repair costs• Fewer towing bills• Reduced light duty• Increased vehicle life• Less time spent investigating incidents- more time for beneficial activities• Improved image• Improved financial performance

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ACETECHTM Geo FencingSet boundaries for vehicle travel and to receive automaticnotification when a vehicle leaves this boundaryImportant in theft control. Maintain vehicles at expected locations thereby p yreducing response times, speeding events and fuel expense.

ACETECHTM in the FutureAdvanced camera systems. Use of cameras to improve safety and security is not new. Camera systems include:

Rear viewSide ViewFront view

Cameras may also be used to provide real time consult with on-line medical control.

Niagara Region Demographics

Population: 430,000 (12 Municipalities)

Niagara region: 1850 square km

Ambulance call volume: 75,000 (annually)

Mileage: 2,000,000 km driven annually

26 Peak Vehicles

Acetech Integrated Vehicle Intelligence System

Fully integrated, vehicle performance monitoring and control system with on-board intelligence.

Safety Systems Eco Run Module BenefitsEco-Run Module BenefitsAsset Protection Benefits

Safety System (Integrated into AVI)Speeding infractions, Unbelted, Unsecured occupants Lights and siren complianceC t D i S f t R t idCreate Driver Safety Reports- provide feedback to employees Set pre-defined speed limiters

Niagara EMS Decrease in Speeding Infractions

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Optimize your fuel efficiency and reduce your carbon footprint

Reduce idle times by as much as 40% to lower your fuel consumption and costs

Reduce carbon emissions and contribute to a greener environment

Prevent flat batteries

Reduce engine wear and reduce maintenance costs while extending vehicle & engine life

Monitor driver behaviour to reduce excessive rpm for additional reduction of fuel consumption

Report Generated for One Week of Excessive Idling and Potential Savings on 5 vehicles

Niagara SummaryAutomatic Vehicle Informatics (AVI) Benefits

Protect assets with theft protection and geo-fencingReduce engine wear and reduce maintenance costs while extending vehicle & engine lifeModify driving behaviors with real time dashboard and full featured reports andModify driving behaviors with real time dashboard and full featured reports, and automatic updates on driving violationsImprove fleet efficiency and operations with remote vehicle diagnostics & real time Fleet Management Track information through web based interface or integration with established dispatch software

Safety TechnologySunstar: A System Perspective

Presented by Charlene CobbSunstar Paramedics

Pinellas County, Florida

Marvlis SystemOverview

Front End Technology

Marvlis at SunstarPrior to Marvlis: We used history and geography

Since Marvlis: WeSince Marvlis: We have data based on Year, week, day minute (17 years)

We now weather the “storms” with more efficiency

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Utilization of Marvlis

Improved response timesHelps determine post plansForecasts Routes

Dynamic Service AreaBlue overlay shows us what parts of the county arecounty are coveredTakes into account dead ends, traffic, geography water ways

Fleet EyesOverview

Back End TechnologyFleet Eyes Functionality

WeatherTrafficRoutingSpeedTrackingArea Resources

Fleet Eyes/Geo-FencingRoute Review

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Real Time Tracking Call Details

Road SafetyOverview

Retrospect Technology

Road Safety Provides Data for Incident Investigation

• Text to address outline• Ideally less than 24 words per slide

Monthly Driver Reports

•Identifies high risk behaviors

P id l ti•Provides real time feedback to driver

•Provides reports for employee evaluation

Measuring Our Success at Sunstar Paramedics

5 Year Road Safety Report - Unsafe Reverses

100001200014000

rses

02000400060008000

10000

Jan-06 Jan-11

Years

Uns

afe

Reve

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Sunstar Summary

Through these technologies:

Realized dramatic change in our drivers attitude toward safety

Have evidence based data to use for individual driver training and refresher courses

Are able to identify drivers that fail to align themselves with our mission of safety

Ambulance Safety InnovationDesign Module 1.0

www.INDEMO.infothe future you can have right

now!!!now!!!Better, safer and cheaper

INDEMO @ MedStartr -http://www.medstartr.com/ small changes can make a

BIG DIFFERENCE

PREPARE – TEACH – REACH – RESPOND– Look at your own safety record– Teach safety and hazard awareness– Reach out with safety information to all your EMS

providers– Respond with the best safety practices

PREDICTABLEPREVENTABLE

andNO ACCIDENT

ConclusionEMS transport has serious hazards and safety issuesMajor advances in EMS safety research, technology infrastructure and practice over the past 5 yearsDevelopment of substantive EMS safety standards is a necessity and a realityMultidisciplinary safety issues that EMS cannot solve internallyinternallyNew tech tools can increase fleet safety managementFailure to transfer knowledge from transportation, automotive safety and new technology is unacceptable and dangerous EMS is still way behind the state of the art in vehicle, transportation, new technologies and occupational safety

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Your electronic handout/resource link

Or if you are > 30 years

www.objectivesafety.net/PDFHO.htm

Thank you! Any Questions??

Electronic handout and resources available onlinehttp://www.objectivesafety.net