Restrained Behavior

     Ambulance crashes cause significant injury and disability to providers and the patients we care for. Bryce McCormick, a paramedic in Meredosia, IL, recently shared a close call on this topic.

     "It is infrequent that we take a patient past our community hospital and on to one in Springfield, but on this call we were. I work part-time as a medic in Springfield, but my driver had never driven there in an emergency vehicle. About five miles from the city limits, the patient's SaO₂ had dropped into the low 80s, even though she was on 15L O₂ via NRB. I had the driver upgrade to lights and sirens. As we entered the city, I told him he needed to stop at every stop sign and light, because this was a lot different than driving in our small town of 1,000.

     "Due to road construction, we had to take a different route, and the driver was concentrating on what street he was on and traffic. I was getting up to cross the patient compartment and saw we were slowing for a stop sign before crossing a four-lane one-way street. We'd started to accelerate again when I was suddenly knocked to the stairwell, striking my head on the cabinets. Somehow our stretcher came out of the restraint, and my knee and ankle were hyperextended when I was pinned under it when it came back down. I realized we'd been hit in the driver's side of the ambulance."

     Most can relate to that sinking feeling of realizing we've been involved in a crash. The amount of force transmitted into the patient compartment and to the occupants can be staggering. In this case, there were a few noteworthy factors that may have predisposed the crash to occur.

     First, there was the driver's lack of familiarity with the route and a detour on the way to the hospital. Distractions like these can play a part in crashes (whether or not they did in this case). It was noted in a review of cruise ship and tanker collisions and groundings that distractions on the bridge were the most common and preventable cause. Simulator training for ship captains now involves intentional distractions aimed at sharpening their concentration. Could the same concept be employed in EMS driver training?

     This crew made a solid choice in traveling without lights and siren for most of the call. Traveling "on the red" may increase the risk of collision, especially at intersections. Use lights and siren only when necessary.

     The location of the crash—at an intersection—is the most predictable part of this story. Many, if not most, emergency vehicle collisions occur at intersections. In fact, the terminology used to describe crashes has gone from accident to collision to connote the preventable nature of these incidents. While we typically have a right of way and may be in the clear legally after a crash, many agencies are also investigating how preventable collisions are. If you haven't stopped at an intersection before proceeding, for example, you may fail the preventability test.

     Bryce continues: "Anyone who's been in the back of an ambulance knows it would be nice to always be belted, but when taking care of a patient, it isn't always possible. The reason I think this accident is important to share is what happened to the patient. The patient was fully restrained with leg, waist, chest and shoulder straps. After the stretcher locked back into the restraint (with my leg under it), the patient never came off or out of the stretcher. Everything worked as it was designed to (for the patient, anyway). However, our defibrillator came off the counter and struck the patient. I remember the patient screaming after being hit. The monitor hit her in the arm and chest. Her IV was pulled out, and she was bleeding through the new opening in her forearm. Luckily my partner wasn't injured; the car struck just behind the O₂ compartment."

     The days of loose equipment on the counters are over. Be sure all equipment is secured. Patients should also be fully secured—with over-the-shoulder harness-type straps—anytime they're on the stretcher. Bryce noted that it's impossible for providers to be secured all the time. For now, that may be true. But there are an increasing number of restraint systems available that are likely to improve with time.

     In addition to being treated for her initial complaint, the patient in this case had a possible fractured wrist and collarbone from the monitor.

     Bryce concludes: "This was a close call for my driver and me, our patient and the driver of the other vehicle. I had the patient fully secured per protocol, and my driver slowed when going through the stop sign. However, I am pushing for our system to make a restraint system for monitors mandatory on all ALS ambulances… I feel as though keeping a heavy object like the monitor from flying about in an MVC is as important as restraining the patient. I am thankful no one was seriously hurt, and that the monitor did not hit the patient in the face or neck."

     Bryce, his partner and their patient are indeed fortunate he is contributing to the Close Calls column rather than reporting (or becoming) a fatality. The recipe was right for tragedy: unsecured provider, unsecured equipment and an intersection. We thank Bryce for sharing his story and send our best wishes for speedy recoveries to all. For additional information on ambulance collisions and provider safety, visit www.objectivesafety.net.

Daniel D. Limmer, AS, EMT-P, is a paramedic with Kennebunk Fire-Rescue in Kennebunk, ME.

Note: It is not the intent or policy of the Close Calls column, the author or EMS Magazine to determine or imply fault in any situation. By writing to discuss potential issues and contributing factors, those who share their stories do so to help others.

To submit a case for review, e-mail nancy.perry@cygnusb2b.com.