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DRIVE TO SURVIVE Part 3: AN EXCLUSIVE SUPPLEMENT Sponsored by: WHEELED COACH
Few areas of EMS are more important than vehicle safety. Many of you spend hours every day behind the wheel or in the back of a rig, treating and transporting, making your communities safer and better places to live. Your safety in that ambulance is a top concern for all of us. For vehicle designers and manufacturers, this means incorporating the latest and best features designed to protect their occupants. And for EMS providers, that means operating these vehicles with the proper training, equipment and attitude. In this special three-part supplement, we examine this equation in more depth. In Part 1, we looked at how agencies can create a "culture of vehicle safety." Part 2 reviewed what's new in terms of safety features in the back of the ambulance. This month, we consider the topic of driver training.
Previous installments of this special three-part supplement series covered important ground in the area of ambulance safety. The first examined the necessity of creating and maintaining an organizational "culture of safety" that breeds safe driving practices among every provider who ventures onto the road. The second described current efforts and ideas surrounding safety in the back of the rig, and looked briefly at what might be coming in the future.
As we've noted, though, restraints, air bags and padding can only accomplish so much. Perhaps the biggest factor that determines your safety on the road is the person behind the wheel. And no matter how much their organization might value and preach safety, that person needs certain knowledge and tools and resources to help them achieve it every day.
That's where driver training comes in. It is an inescapable part of the ambulance safety equation.
Training Today
You probably know that both the quantity and the quality of driver training received by EMS providers in America varies greatly. Some receive extensive instruction spanning days; others get virtually nothing. The good news is that more EMS drivers today seem to be getting some level of instruction than at any time in the past.
"We believe that today, there are more people in EMS and fire who get some type of emergency vehicle driver training than ever before," says Rick Patrick, director of EMS programs for Pennsylvania-based emergency-services insurer VFIS. "Depending on where you go, that can vary anywhere from an hour or two to a 40-hour program. The point is, there is more awareness now of the issues and characteristics surrounding the operation of emergency vehicles-of how ambulances and fire trucks are different in driving situations."
Many EMS driver-training programs are based on EVOC. EVOC is the Emergency Vehicle Operators Course, a generalized framework used for the instruction of those who operate emergency vehicles. It's not the only method by which to teach EMS drivers, but it is part of NHTSA's National Standard Curriculum for EMS, and variations of it are in broad use in communities across the U.S.
It's not the only option out there. Others get the National Safety Council's CEVO (Coaching the Emergency Vehicle Operator) course or one of any number of alternatives. They all cover many of the same things, and which one is best may boil down to things like individual instructors or personal preferences.
"I'm familiar with about half a dozen emergency vehicle driver training core curriculums," says Patrick, whose company also provides training services. "For the most part, they say similar stuff. Obviously, they each have their own model of presenting information, but I don't know of any that contradicts any of the others."
It is not possible, of course, to describe all the key elements a driver-training program should have in an article of reasonable length. But let's look at a few.
Naughty By Nature
One of the most important things a driver-training program should instill is overcoming the aggression that comes naturally to responding to an emergency call. Flashing lights and wailing sirens can give providers a sense of invulnerability that is most definitely, dangerously false.
"The two most dangerous things I've done in my career," says Dave Long, RN, EMT-P, who teaches driver training for North Memorial Ambulance Service in Robbinsdale, MN, as well as for hospital drivers from the associated North Memorial Medical Center, "are putting a tube in and not recognizing and verifying its proper location, and turning that button that says emergency mode. There is nothing more dangerous that we do. Once we turn the lights and siren on, there's an adrenaline rush, and we have to constantly check ourselves."
"The men and women who enter this profession are fairly aggressive by nature," agrees Bob Krause, EMT-P, who offers expertise in driver training and other areas through his Toledo-based Emergency Services Consultants. "They have that 'want to help, want to be there, want to get the job done' demeanor. And all too often, they believe the red lights and sirens are a free pass. That's definitely not the case."
Related to this is the danger of intersections. Danger lurks down every side street.
"Most of the collisions involving emergency-response vehicles occur in intersections," says Krause. "And that is because we push on through without ensuring that each lane has yielded to us. You cannot make that assumption. You have to treat each lane of traffic as a separate intersection, and you must be absolutely sure that every vehicle coming from 90 degrees recognizes you and is able to stop."
What all this amounts to is controlled driving-focusing on the task at hand, filtering out distractions and remaining attuned to the major dangers and the defensive approaches that keep you safe.
"Driving is the one thing the 9-1-1 professional does different from anybody else in the healthcare industry," says Long. "We load people into vehicles and take them to medical facilities. Other healthcare professionals don't do that. Because we do, we need to be more astute and attentive with what goes on behind the wheel. We can't focus on what's going on at home, what the dispatcher's saying, the child who's not breathing. We have to really focus on the job at hand: driving the vehicle."
Weight Watchers
That's all pretty standard stuff you're likely to get in even the most cursory training effort. Beyond that level lie additional components to safe driving that bear elaboration.
Let's start with the physics of operating those big, heavy, bulky emergency vehicles. Their characteristics differ substantially from those of any car you've driven.
"There are a number of things that have to be understood before we allow someone behind the wheel of a 30,000-pound ambulance or a 35,000-pound fire truck," says Krause, who instructs drivers with Toledo Fire Rescue. "That's a lot of weight that needs to be understood-the dynamics of the way the vehicle turns and moves. If you accelerate and figure you're going to spin it around in a J turn, well, that's not going to happen. It's basic physics. No matter how good a driver I am, I can't beat physics."
Ambulances in particular, with their high profile and squarish design, can be tricky. Cornering too fast in a top-heavy cube not only courts rollover, it doesn't exactly facilitate the delivery of care in the back.
The key is understanding weight distribution and how it shifts with the vehicle's motion.
"When you drive an ambulance, you're a weight manager," says Long. "You manage the weight between the four tires. But has anybody ever talked to you about over- and underinflated tires? Tire tread? Vertical load on the tires? If EMS drivers understood those concepts, they'd have less tendency to overdrive the vehicle."
For a sobering insight into the importance of weight-management and the forces that can skew it, consider exactly how much of your ambulance physically touches the ground. Your contact with the road basically boils down to a few square inches that must absorb all your turning, braking and acceleration forces.
"I've never seen a driving course that talked about the tire contact patch," notes Long. "When you drive an ambulance with six tires, the only thing between you and the road is a legal-pad-size contact patch where the tires meet the road. The more intact you keep that contact patch-and don't overdrive its limits-the better off you're going to be."
You're No. 1
While it's relatively rare for a civilian driver to encounter an emergency vehicle, it's extremely common for emergency-services drivers to encounter civilian vehicles. Therefore, the burden of safety in these encounters rests disproportionately on the emergency driver.
"It's more incumbent upon the emergency vehicle operator," says Krause, "to have a higher level of awareness and a greater commitment to safety, because the common driver is not used to seeing an emergency vehicle approaching them at a high rate of speed."
At this month's EMS EXPO, Long is teaming with racing veteran Jeff Payne, president of a company called Driver's Edge, to discuss the pitfalls of driving hot and offer some tips on doing it safely. With our emphasis thus far on driving slowly and in control, this might seem an odd pairing. But who better to share insights on controlling a vehicle in a fast-moving, unpredictable environment?
"It's opened our eyes to a lot of things we missed," Long says. "A lot of EMS people may say 'I don't need to be trained by a race car driver; they're just going to teach me to go fast.' But that's not it at all. It's about the limits of the vehicle, and knowing that driving is a mental exercise, a philosophy. If you don't focus on your attitude when you get behind the wheel, no matter what the call is, you're going to have a problem."
The bottom line is that safe driving isn't something that happens by itself, and isn't something that requires just a token commitment. It's an ongoing effort that requires the buy-in of an entire organization-that culture of safety we discussed when this series started. "Changing driving behavior isn't something that can occur overnight," says Patrick, whose company offers resources to help through its Operation Safe Arrival. "It could take years, if not decades, for a whole organizational culture to change. Chief officers need to have the tools they can use to effect behavior modification. Then you give people the knowledge and training, and then let them do the job and hold them accountable. If someone is really shown that their organization believes they're No. 1, and wants them to go home intact at the end of the day, they'll naturally start to treat safety as a high priority."
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