Meet a Friendly Big Brother

Richmond Ambulance Authority was the first to receive accreditation from the Commission on the Accreditation of Ambulance Services (CAAS) in 1994. Some 10 years ago, despite the controversial nature of tracking technologies, the Virginia public utillity service also became one of the first to install Road Safety International's RS-3000 On-Board Computer System--the so-called "black box" recorder--into its vehicles to track driver safety. With data indicating that technology has drastically cut maintenance costs, the Authority has taken the next step and become the first to upgrade these monitors with In Motion Technology's onBoard Mobile Gateway (oMG 1000) equipment, which can transfer the data directly to the communication center's servers over a wireless network.

"What we originally hoped to accomplish was to drive more safely," says RAA Executive Director Jerry Overton. "What we did not anticipate was the box paying for itself by saved maintenance costs in less than two years. We were able to extend the useful life of the ambulances--which were designated at four years--to 4.5 years, then to five years, which was a tremendous savings to the Authority."

Upgrading, he says, will allow them to accomplish even more. "Before, we were having to download the information after each shift from the Box to a software program. And that was a time-consuming task." Plus there were times when the information got lost due to human error.

But now, with vehicle information instantly online, the potential is unlimited, says Overton. "For instance, because it taps into our electrical system, we've seen an electrical overload on an ambulance when it was driving around. Maintenance was then able to pull the vehicle in and take care of the issue before it became a problem.

"We're also getting ready to install electronic patient care report forms and we'll be able to download those through the application. We're going to have a seamless technological solution to all our EMS data needs," he says.

Controversial as potential "snooping devices," these monitors are not popular with everyone in the industry, upgraded or not, especially when used to supplant training. But Overton insists they enhance training in Richmond, offering instant feedback to drivers that reinforces training. That's because they don't just report acceleration and braking behavior, they provide an audible alarm to let drivers know when they are exceeding mandated parameters. This allows them to readjust.

By tying the system in with GPS tracking, HQ also can know if drivers are stopping at traffic signals as required when running lights and sirens.

"If they aren't, then we bring them right back in for retraining," Overton says. "So, the combination of the two provides a constant feedback mechanism...that directly leads to safety."

Overton acknowledges there was reluctance on the part of personnel to accept the system when it was first installed a decade ago.

"Until we had an incident," he adds. "We were involved in an intersection collision with an empty school bus while on an emergency response. The bus driver claimed we didn't come to a stop at the light and we didn't have our emergency equipment operating."

But the data would prove otherwise, and the bus driver relented.

"Now it's looked upon not necessarily as something punitive, but also as a positive. Because now we have the proof to back them up."

In fact, the industry as a whole is becoming more accepting of such monitoring equipment, as respected ambulance-safety experts like Nadine Levick, MD, find crash rates reduced by as much as 90%, as reported in the July 2005 issue of EMS Magazine. One critic, Platte Valley (CO) Quality Care Coordinator Thom Dick, says Levick's reports are even causing him to rethink the issue.

Richmond's data shows at least an 80% reduction in preventable incidents since installing the black boxes and Overton says there has been no resistance from personnel against the upgrade. On the contrary, he says drivers are happy to save time previously required for the download. "It's one more thing they don't have to worry about."

Richmond's recent request for proposals requires companies submitting a contract bid to not just address the use of the monitoring system, but maximizing its potential. "Richmond's always been looked at as a state-of-the-art system, in which we're always trying new things," he says. This is just one more.