What EMS Should Take from the NTSB Wish List

The National Transportation Safety Board (NTSB) recently published its “2016 Most Wanted List,” which represents the agency’s strategic goals and objectives for the upcoming year.  

Some of the items on this wish list are issues EMS systems should also be addressing.

Reduction of fatigue-related accidents

Time and again we hear of EMS providers working long hours, overtime and more than one job and being so exhausted that they make a critical error or fall asleep on duty. Nearly 20% of the 182 major NTSB investigations completed between Jan. 1, 2001, and Dec. 31, 2012, identified fatigue as a probable cause, contributing factor or a finding.

Forward-thinking EMS systems should have policies in place that address over-tiredness and its impact on patient care and personal safety. Additional information on fatigue and EMS can be found in the National EMS Advisory Council (NEMSAC) position paper published on this subject. The National Highway Traffic Safety Administration (NHTSA), in collaboration with the National Association of State EMS Officials (NASEMSO), is also working to develop voluntary fatigue risk management guidance specific to EMS.

Disconnect from deadly distraction

There is no excuse for EMS providers to be using smartphones while in transit, yet it happens. Since 2003, the NTSB has found Personal Electronic Device distraction as a cause or contributing factor in 11 accidents that killed 50 people and injured 259, and the NTSB does not even investigate the majority of highway crashes.

According to NHTSA, 3,179 people died in 2014 in vehicle accidents where the driver was distracted.  Many of those victims were the drivers themselves. NHTSA also reports that drivers engaging in visual-manual tasks, such as dialing or texting, triple their risk of a crash.

Strengthen occupant protection

Having worked in both volunteer and career EMS systems, I can attest to a lack of seatbelt utilization in ambulances, both in the cab and patient comportments. I have also seen what happens to EMS providers when their vehicles get involved in accidents.

The NTSB reports that, in cars, restraint use has been required in most states for more than 20 years. Yet, in 2013, nearly 50%of the more than 20,000 fatally injured vehicle occupants were found to be unrestrained. While the daytime seat belt use rate for front seat occupants in the United States is 87%, seat belt use is significantly lower in states without primary enforcement laws and for back seat passengers.

Recent NTSB investigations have also highlighted the importance of proper seat belt use and readily accessible and identifiable evacuation routes on larger passenger vehicles, such as school buses, motorcoaches, and other commercial vehicles. Clearly this has implications for ambulances as well.

Require medical fitness for duty

There has long been talk in the EMS management community about better codification of fitness for duty standards and how the standards that are present are typically agency dependent. Although the NTSB recommendations are specific to what they term safety-critical personnel, there are some good areas for EMS managers to pay attention to as they develop policies for their systems. These include:

• A complete medical history of the applicant, taken at prescribed intervals, that includes medications, conditions, treatments and a physical examination;
• Specific historical questions and physical examination procedures to identify applicants at high risk for sleep disorders;
• Identification of specific conditions, treatments, and medications that initially disqualify applicants for duty, with certification contingent on further testing (specific to each condition);
• Explicit and uniform processes and criteria for determining when the applicant has a treated, but otherwise disqualifying, condition
• Guidance for medical providers that should be used when the provider believes a medical condition disqualifies an individual for duty.

The NTSB has compiled a document that is filled with best practices related to safety. Provider and patient safety are primary concerns for EMS and will remain so as we continue to move forward as profession. It is incumbent upon EMS system leaders to take these safety-based best practices and make them their own.