Seat belt use in the ambulance patient compartment by emergency medical services professionals is low regardless of patient presence, seating position, or patient acuity

Ambulance Traffic Crashes in Japan: Characteristics of Casualties and Efforts to Improve Ambulance Safety

BACKGROUND

An ambulance traffic crash not only leads to injuries among emergency medical service (EMS) professionals but also injures patients or their companions during transportation. We aimed to describe the incidence of ambulance crashes, seating location, seatbelt use for casualties (ie, both fatal and nonfatal injuries), ambulance safety efforts, and to identify factors affecting the number of ambulance crashes in Japan.

METHODS

We conducted a nationwide survey of all fire departments in Japan. The survey queried each fire department about the number of ambulance crashes between January 1, 2017, and December 31, 2019, the number of casualties, their locations, and seatbelt usage. Additionally, the survey collected information on fire department characteristics, including the number of ambulance dispatches, and their safety efforts including emergency vehicle operation training and seatbelt policies. We used regression methods including a zero-inflated negative binomial model to identify factors associated with the number of crashes.

RESULTS

Among the 726 fire departments in Japan, 553 (76.2%) responded to the survey, reporting a total of 11,901,210 ambulance dispatches with 1,659 ambulance crashes (13.9 for every 100,000 ambulance dispatches) that resulted in a total of 130 casualties during the 3-year study period (1.1 in every 100,000 dispatches). Among the rear cabin occupants, seatbelt use was limited for both EMS professionals (n = 3/29, 10.3%) and patients/companions (n = 3/26, 11.5%). Only 46.7% of the fire departments had an internal policy regarding seatbelt use. About three-fourths of fire departments (76.3%) conducted emergency vehicle operation training internally. The output of the regression model revealed that fire departments that conduct internal emergency vehicle operation training had fewer ambulance crashes compared to those that do not (odds of being an excessive zero -2.20, 95% CI: -3.6 to -0.8).

CONCLUSION

Two-thirds of fire departments experienced at least one crash during the study period. The majority of rear cabin occupants who were injured in ambulance crashes were not wearing a seatbelt. Although efforts to ascertain seatbelt compliance were limited, Japanese fire departments have attempted a variety of methods to reduce ambulance crashes including internal emergency vehicle operation training, which was associated with fewer ambulance crashes.

Ambulance personnel use of coercion and use of safety belts in Norway

BACKGROUND

Providing health care in a moving vehicle requires different considerations regarding safety than in other settings. Use of seatbelts are mandatory, and during ambulance transport patients are fastened to the stretcher with safety straps. However, patients who wriggle out of, or unfasten, their safety straps pose a threat to him/herself and escorting personnel in the ambulance compartment in case of an accident. To prevent harm, ambulance personnel sometimes restrain the patient or unfasten their own seatbelts to keep the patient safe on the stretcher. The prevalence of coercive measures, and the relationship between the use of mechanical restraints comparable to coercion and seatbelt use, are scarcely investigated. Use of coercion normally requires a specific statutory basis. However, coercive measures needed to ensure safety in a moving vehicle while providing healthcare is hardly discussed in the literature. The aim of this study is to explore the use of coercion in ambulance services, the use of safety belts among escorts in situations where they need to keep the patient calm during transportation, and to analyse the relationship between safety belt non-compliance and coercion in these situations.

METHODS

This is a retrospective, cross-sectional study using a self-administered, online survey aiming to investigate the use of coercion and use of seatbelts during ambulance transport. Approximately 3,400 ambulance personnel from all 18 Health Trusts in Norway were invited to participate between Oct 2021 and Nov 2022. Descriptive analyses were used to describe the sample and the prevalence of findings, while multiple linear regressions were used to investigate associations.

RESULTS

Altogether, 681 (20%) ambulance personnel completed the survey where 488 (72.4%) stated that they had used coercion during the last six months and 375 (55.7%) had experienced ambulance personnel or escorting personnel working with unfastened seatbelts during transport. The majority of respondents experienced coercion as being unpleasant and more negative feelings were associated with less use of seatbelts.

CONCLUSIONS

Coercion seems to be used by ambulance personnel frequently. For the study participants, keeping the patient securely fastened was prioritized above escorting personnel's traffic safety, despite feeling uncomfortable doing so. Because coercive measures have negative consequences for patients, is associated with negative feelings for health personnel, and is not discussed ethically and legally in relation to the prehospital context, there is an urgent need for more research on the topic, and for legal preparatory work to address the unique perspectives of the prehospital context in which traffic safety also is an important factor.

Ground Versus Air: Which Mode of Emergency Medical Service Transportation Is More Likely to Crash?

OBJECTIVE

We analyzed helicopter emergency medical services (HEMS) and ground emergency medical services (GEMS) crash data in the United States during 1983 to 2020 to compare incidences of total, fatal, and injury crashes.

METHODS

HEMS and GEMS total, fatal, and injury crashes during 1983 to 2020 and 1988 to 2020, respectively, were analyzed in this retrospective study. Data were obtained from the National Transportation Safety Board and the National Highway Traffic Safety Administration. Additional data from the Federal Aviation Administration, the National Emergency Medical Services Information System, and prior literature were used for rate calculations. A Poisson regression model was used to determine rate ratios with 95% confidence intervals comparing total, fatal, and injury crash rates from 2016 to 2020.

RESULTS

HEMS crash rates decreased since 1983. Total GEMS crashes have increased since 1988. Of the total crashes, 33% (HEMS) and 1% (GEMS) were fatal, and 20% (HEMS) and 31% (GEMS) resulted in injury. During 2016 to 2020, GEMS crash rates were 11.0 times higher than HEMS crash rates (95% confidence interval, 5.2-23.3; P < .0001).

CONCLUSION

HEMS has a lower crash probability than GEMS. The availability of data is a limitation of this study. National GEMS transportation data could be useful in studying this topic further.

Perceived occupational stressors among emergency medical service providers: a qualitative study

Introduction

Emergency medical services (EMS) providers are at continuous exposure to occupational stressors which negatively affect their health and professional practice. This study explored perceived occupational stressors among EMS providers.

Methods

This qualitative study was conducted from December 2019 to April 2020 using conventional content analysis. Sixteen EMS providers were purposively selected from EMS stations in Hamadan, Iran. Semi-structured interviews (with length of 45–60 min) were held for data collection. Data were analyzed through Graneheim and Lundman’s conventional content analysis approach.

Findings

Data analysis resulted in the development of two themes, namely critical conditions of EMS provision, and personal and professional conflicts. The six categories of these two themes were complexity of patients’ clinical conditions, interruption of EMS provision, health hazards, interpersonal problems, interprofessional interactions, and legal conflicts.

Conclusion

Besides the stress associated with emergency patient care, EMS providers face many different occupational stressors. EMS managers can use the findings of the present study to develop strategies for reducing occupational stress among EMS providers and thereby, improve their health and care quality.