A Portsmouth Ambulance crashed on US 23 North last Tuesday around 1:20 am. Why it happened is all too familiar in the ambulance industry. According to what the driver told the Ohio State Patrol, he fell asleep for a few seconds and the vehicle gradually left the road. When he woke up, it was too late to stop the vehicle from rolling over.
A fellow medic in the vehicle was injured so severely he required air ambulance transport to St. Mary’s Hospital in Huntington. The ambulance was responding to a call, so there was no patient inside.
EMS safety expert Jonathan Godfrey told me accidents like this are all too common in the EMS industry. But why? Let’s review in 4 slides.
According to the accident report provided by the Ohio State Highway Patrol, the driver told them he was near the end of a 24-hour shift. He’d just returned from a call from Kentucky and struggled to stay awake. He’d attempted to take a nap but was interrupted when the call came in.
The 22-year-old driver, who was cited for not maintaining control of a vehicle, told officers he should have “fatigued out” instead of taking the call. So why didn’t he?
I spoke to a former area ambulance driver who said he has suspicions. He told me the company he worked for offered ‘contract shifts.’ According to him, “You sign a contract and you agree to not refuse runs or fatigue out. If you do, you lose your contract and the high pay rate that comes with the contract.”
Appealing To Your Wallet
Jonathan Godfrey told me stories like that aren’t exactly unusual. “Private ambulance services are unique because its volume-driven and the profit margins are narrow. In smaller Mom and Pop operations, they don’t necessarily adhere to the community safety norms. It’s either to realize profits or because they are just barely getting by and trying to stay afloat.”
You hear wild stories that they are running their crews into the ground and making unheard of offers to pay you more. They appeal to your wallet and feeding your family and running to your limit.”
Easy To Manipulate
Godfrey, a transport nurse who helped design EMS safety protocols for a nationally-recognized hospital, said it’s easier to get EMS personnel to agree to work past the point of fatigue.
“Part of the mindset that you’re starting out with is that the demo is a little different than your average public. These are people that run into burning buildings. Other people would be incensed if they didn’t get a break. EMS workers think, ‘By golly, there’s somebody in need, I have a duty to help them out. It’s easy to manipulate a crew to consider going for long periods of time without a break or ignoring their own fatigue.”
‘We were needed’
The former local driver I spoke to agreed, “I worked 24-hour shifts and the dispatchers cared as they should, however, management prevented them from allowing crews a break. Numerous times I was on shift and caught myself falling asleep while driving. I expressed concern to my dispatcher and was told that we were the only ALS truck at that station tonight and were needed. We continually ran all night and when we attempted to “fatigue out” they still tried to give us more runs and then tried to do anything they could to get us to stay.”
Godfrey said that younger drivers are particularly easy to convince. “People can be young, not educated about it. They are not able to monitor their own fatigue levels to do a risk assessment. To think ‘risk vs. benefit, it’s not worthwhile for me to take this call’. If you go and narrowly avoid an accident and there’s no negative outcome and it reinforces the attitude that you will do it again and again and it becomes the norm because you see people doing it all along.”
No Safety Standards
Godfrey said the average ambulance isn’t a particularly safe vehicle under the best circumstances. The only part of the vehicle that’s been crash-tested in the two front seats of the original truck body. Everything from the original cab on back is fairly unregulated. In fact, he said a lot of ambulance bays are constructed out of particleboard.
Godfrey said that while children are expected to wear helmets with bikes and skateboards, “They put attendants in the back of an ambulance with the power of lights and sirens and go fast, and they aren’t required to wear any kind of protective equipment. They go screaming down the highway under the assumption that they are providing a public service and saving lives. Doesn’t seem a little bit silly to you?”
To the experienced transport nurse, it appears that society cares more about race drivers than EMS personnel. “NASCAR drivers have roll cages, head protection, fire retardant clothing, helmets, and a whole bunch of training. Ambulance drivers get the keys to the truck and told to turn on the lights and sirens. It’s little more than that in a lot of places. I’ve literally been on a call where I told the ambulance driver we needed to respond with lights and sirens and she said, ‘how do you do that?’
What needs to change to protect EMS personnel and their patients? We’ll look at solutions in part 2 of this series. Click here to read part 2