Better Lucky Than Good?

Justin Koper, M.S., GSP, MTSP-C, FP-C

Safety Officer, HealthNet Aeromedical Services

While attending the Safety 2019 conference in New Orleans, I had the opportunity to interact with some of the nearly 6,000 safety professionals in attendance.  During all of the networking, I was asked about the type of industry I worked in, to which I replied “air and ground ambulance services”.  Predictably, everyone remarked about the precarious nature of air medical operations, but very few made remarks about the dangers of ground ambulance operations.  Unfortunately, I feel this is an all too common misnomer even among our own ranks.  Yes, the consequences of a helicopter related incident are far more severe than ground incidents, but thankfully air incidents are far less frequent.

During routine ground EMS operations, crews are exposed to a multitude of hazards not commonly present in the aviation industry such as distracted drivers, impaired drivers, road rage incidents, drivers violating traffic laws, and the list goes on and on.  Despite these external threats that come at us day in and day out, I still routinely see crew members partake in at-risk behavior such as speeding, use of a mobile device behind the wheel, not using seat belts, etc.  There is an adage from law enforcement which says that for a criminal to not be caught, he or she must be lucky every single time, whereas the officer only has to be lucky once. This mindset holds true with complacency and at-risk behavior where the complacent individual has to be lucky every single time they engage in at-risk behavior in order to avoid a bad outcome whereas the threat or hazard only has to be lucky once to get through all of our defenses to cause a bad outcome.

For EMS as a whole to move past a reactive safety mindset to one that is focused on prevention, each employee must have an appreciation of the problems and hazards we face. They must also reinvest themselves into their organization’s safety culture.

Since the beginning of 2018, HealthTeam Critical Care Transport has closely monitored any and all vehicle related incidents so we can carefully analyze trends within our organization. The data listed below shows the total number of at-fault incidents from January 1st 2018 to May 31st 2019.

Base At Fault Incidents
Beckley (Opened Nov. ’18) 0
Charleston 16
Martinsburg 3
Morgantown 6
Moundsville 2
Petersburg 1
Total 28

Just looking at total number of incidents does not truly paint a picture of where our opportunities for improvement are at. During this time frame our program’s ambulances have logged more than 2.7 million miles so just looking at sheer number of incidents makes it difficult to identify trends or problem areas. Listed below are each of the bases incident rates per 100,000 miles driven. Please note that even though Moundsville Ground has the highest incident rate, they had not yet accumulated 100,000 miles in this time period.

Base At Fault Incident Rate
Moundsville 2.02
Charleston 1.67
Petersburg 0.98
Morgantown 0.63
Martinsburg 0.53
Beckley 0.0
Company Average 1.02

With this data in mind, it is important to remember that each one of these incidents were preventable and many were the result of complacency.  Backing incidents, overhead strikes (driving under awnings) and sideswiping objects (cutting corners too close) accounted for 83% of our overall at-fault incidents.  It is also important to note that this data does not include the two at-fault collisions which occurred in July 2019.

What we have experienced within HealthTeam Critical Care Transport is like the rest of the EMS industry in terms of causal factors and preventability of incidents. According to NIOSH, backing incidents were the cause of 25% of all vehicle accidents even though we drive forwards 99% of the time.

Now that the extent of the problem is known, the next logical question is what we can do to make things better. Considering all the at-fault incidents were the result of unsafe actions or complacency, the answer is simply personal accountability. You have a responsibility to yourself and your partner to operate in accordance with the law and policy and failure to abide by them places everyone at an unacceptable level of risk. If you notice your partner taking unsafe actions, you need to hold them accountable in order to ensure everyone’s safety. We, as a program, have tried to instill the principle that safety is fundamental to our culture, but it only works when people are accountable for their actions and don’t rely on blind luck for a good outcome.