commentary FossilMedic on 14 Aug 2007 08:00 am
EMS Health and Safety
For the last decade, Brian Maguire, Dr. PH, has been studying occupational and health issues as they affect emergency medical service providers. He has been the primary author of two important publications in peer-reviewed professional journals. I attended his presentation at the Pinnacle 2007 EMS Leadership and Management conference last week….FossilMedic
HOW EMTs AND PARAMEDICS DIE
One of the first obstacles Dr. Maguire encountered was that there was no single repository of occupational health information on ems providers. His first study was on occupational fatalities. Analysis was conducted by using data from three independent fatality databases: the Census of Fatal Occupational Injuries (1992 to 1997), the National EMS Memorial Service (1992 to 1997), and the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System (1994 to 1997).
“Using the highest cause-specific count from each of the databases, we estimate that there were at least 67 ground transportation-related fatalities, 19 air ambulance crash fatalities, 13 deaths resulting from cardiovascular incidents, 10 homicides, and 5 other causes, resulting in 114 EMS worker fatalities during these 6 years. We estimated a rate of 12.7 fatalities per 100,000 EMS workers annually, which compares with 14.2 for police, 16.5 for firefighters, and a national average of 5.0 during the same time period”.
CONCLUSION: This study identifies an occupational fatality rate for EMS workers that exceeds that of the general population and is comparable with that of other emergency public service workers.
You can download “Occupational fatalities in emergency medical services: a hidden crisis.” Ann Emerg Med. 2002 Dec;40(6):625-32, here: http://home.gwu.edu/~mikeward/Maguire_OccupationalFatalities.pdf
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The biggest on-duty killer for EMS providers is traffic collisions. Nadine Levick, MD, MPH, is the executive director of Objective Safety. http://www.objectivesafety.net A primary message from her Pinnacle 2007 presentation is that ambulance safety efforts are ineffective and made in a vacuum. The EMS industry did not use the considerable resources of the automotive and industrial safety community. Ambulances are specialty vehicles, with NO requirements to provide collision safety provisions beyond the first two feet of the “box.”
She provided many examples of utter destruction of the patient care compartment and too many examples of relatively low speed accidents where the belted driver survived but the patient and ems caregiver in the box died. She estimates about 5000 ambulance crashes a year, with one fatality every week. Two-thirds of the dead are pedestrians or occupants of other car. About four children die in ambulance accidents each year. There are ten serious injuries every day.
Levick destroys most of the safety practices that you would read in an EMS textbook, see at a trade show or learn in an emergency vehicle operator course. According to her, “It’s rubbish!” It is more than her opinion. She is a prolific researcher within the medical and engineering professional communities. She has implored, cajoled and embarrassed federal agencies to add ambulance safety to their missions, pointing out that the federal government has spent more money analyzing road kill than ambulance safety.
Until there is a central database of information about ambulance transportation accidents , http://www.objectivesafety.net is the best source of information. By the way, one nugget from Maguire is that a higher percentage of females die in EMS, as compared to males in per capita rates. This is different from most other public safety or outdoor skilled labor occupations.
Meanwhile:
1) Wear your seat belt.
2) Come to a complete stop at every red light and stop sign intersection.
MOST INJURED PUBLIC SAFETY EMPLOYEE
While the fatality rate puts ems personnel on par with firefighters and law enforcement, Maguire’s second research effort provides a much more troubling result.
“Four hundred eighty nine cases met the DOL inclusion criteria. The overall injury rate was 34.6 per 100 full-time (FT) workers per year. “Sprains, strains, and tears” was the leading category of injury; the back was the body part most often injured. Of the 489 cases, 277 (57%) resulted in lost workdays, resulting in a rate of 19.6 per 100 FT workers; in comparison, the relative risks for EMS workers were 1.5 compared with firefighters, 5.8 compared with health services personnel, and 7.0 compared with the national average.” That means EMS workers are getting hurt at rates 50% higher than firefighters. Most of these injuries came from moving patients down stairs.
You can download “Occupational Injuries Among EMS Personnel” Prehospital Emergency Care 2005;9:405–411 here: http://home.gwu.edu/~mikeward/Maguire_Occupational%20Injuries.pdf
Firefighters have the highest injury rates of all municipal employees When fossilmedic prepared the annual fire department budget, it was clear that the municipality’s payment to the state worker compensation board was much higher for firefighters than other occupational groups. Maguire said last week that he has seen no interest from the worker compensation or insurance organizations.
