Are You Driving in a Sterile Cockpit?

The tones just went off for a multi-vehicle accident with possible entrapment. You slide into the driver’s seat, click your seat belt, call en route and…turn on the music? Send a text message? Perhaps grab a few bites of the sandwich you just ordered? More than many of us care to admit, responding crews multitask to acquire more information, communicate or satisfy hunger while driving at high speeds to get to calls. While all this multitasking might make you more productive or enhance your communication, it also puts you, your partner, your patients and the public at tremendous risk.

Sterile Cockpit

In 1981 the Federal Aviation Administration enacted two policies, FAR 121.542 and FAR 135.100, to help curb the number of accidents from distracted pilots. Commonly known as the “sterile cockpit” rules, these regulations specifically prohibit crew member performance of non-essential duties or activities while the aircraft is involved in taxi, takeoff, landing and all other flight operations. This includes music, visitors or extemporaneous conversation. Departments or individuals might want to consider this “sterile cockpit” concept while responding in ambulances, so that with the exception of the dispatch radio, other distracting behaviors are not taking place. The California Department of Motor Vehicles defines distracted driving as anything that takes your eyes off the road, ears off the sounds of the road, mind off the road or hands off the steering wheel.

Listening to Music

According to several research articles, many emergency vehicles operators already drive too fast. Research shows that mere seconds are saved by driving the ambulance over the speed limit on emergency responses, especially in urban areas. These seconds certainly are not enough to warrant the greater speed and exponential risk increase of an accident. Alex Zozula, an EMT with Princeton (NJ) First Aid and Rescue, suggests music not be played at all in the ambulance: “Listening to loud, fast and/or aggressive music will increase the adrenaline rush and make an already dangerous activity that much more dangerous,” he says.

Sgt. Christopher Strattner, JD, EMT-P, of the Orangetown (NY) Police Department agrees that music can be an unwelcome distraction. “If you are picking your way through traffic, you want to be a bit calmer—there's plenty of adrenaline available for a near crash or two, and the sound of the siren gives you all the extra juice you need. And you definitely don’t want to have the radio cranked up so loud you miss the fire truck responding to the same job but coming through your intersection from a different angle,” Strattner says.

In addition to being a distraction, listening to music is also unprofessional. Deborah Herr, public information officer for the West Orange (NJ) First Aid Squad, believes the patient should be receiving “100% of our attention.”

Chris Stellatella, FF/EMT with the New Brunswick (NJ) Fire Department, also feels it is unprofessional to listen to music en route. “You should be focusing on the call at hand. Regardless if the call is fire-, EMS- or law enforcement-related, your focus should be the patient, structure/occupants and/or nature of call. There are many things that can be prepared for en route if you’re not distracted by outside sources,” Stellatella explains.

Rachelle Burk, an EMT with the East Brunswick (NJ) Rescue Squad, agrees: “Music is entertainment, and therefore doesn’t feel appropriate when a patient is in the rig. I wouldn’t have music on in a business meeting or other professional settings, so why would I do so while tending to a patient?”

Step one to a “sterile cockpit”: Turn off the music.

Texting

Many EMS organizations use a text message alert system as a backup to radio dispatch or even as the primary dispatch. While this was designed to ensure accurate addresses and dispatch times, it also unwittingly creates another distraction to Code 3 driving, especially when responding to a text message on an agency-issued or personal device. This also applies to dashboard computers, GPS units and mobile data terminals (MDTs).

As reported in the New York Times in April 2008, an EMT in West Nyack, NY, looked at his GPS screen, swerved and hit a parked flatbed truck. The crash sheared off the side of the ambulance and left his partner, who was in the passenger seat, paralyzed. In June 2007, a sheriff’s deputy in St. Clair County, IL, was driving 35 miles an hour when a dispatcher radioed with an assignment. He entered the address into the mapping system and then looked up, too late to avoid hitting a sedan stopped in traffic. The sedan’s driver was seriously injured.

According to the National Highway Transportation Safety Administration, drivers who text create a crash risk 23 times worse than driving while not distracted. This is painfully evident in the death toll: 3,042 people were killed in the United States in 2010 due to distracted driving with text messages.

Step two to a “sterile cockpit”: Don’t let your fingers do the talking while you drive.

Cell Phones

With the days of the Biophone and APCOR radio long gone, most ALS services use cell phones to give patient reports or get orders. Though work related, talking on the cell phone is yet another distraction, even while using a hands-free device. According to a 2009 Harvard study, 570,000 motor vehicle crashes caused by cellular phone distractions occur each year; 2,600 of these lead to fatalities.

A 2006 University of Illinois study found there are incredibly high levels of distraction for drivers involved in cell phone conversations. Specifically, they found a decrease in reaction time, keeping in lane and brain processing speed. This was true for both hands-on and hands-free devices.

Step three to a “sterile cockpit”: Save the calls for before or after you start driving, even with a hands-free device.

Eating

EMS is a profession that doesn’t have a built-in meal break. All of us have had meals interrupted by the tones at some time or another. However, as much as your hunger needs to be satisfied, eating while driving is yet another distraction. Besides the physical act of chewing your food, opening wrappers, spilling food or sipping drinks means you are focusing on your food and not on the road. Further, while a “sterile cockpit” sounds good for distractions, ambulances are anything but sterile when it comes to germs. Eating in the ambulance increases your infection risk.

Step four to a “sterile cockpit”: Eat when the call is done.

Final Thoughts

Driving an emergency vehicle is risky business. We already know accident risk rises exponentially when we respond Code 3; we should not add to that risk through distracting behaviors. Talk with your partner and establish the desire to maintain a “sterile cockpit” in your vehicle before the shift begins and before each response. It takes discipline and cooperation, but with practice it can become habitual. By minimizing distractions, you increase your chance of a safe response toward the ultimate goal of providing outstanding patient care.

Bibliography

Becker L, Zaloshnja E, Levick N, Li G, Miller T. Relative risk of injury and death in ambulances and other emergency vehicles. Accident Analysis and Prevention 2003; V. 35(6): 941–948.

Elling R. Dispelling myths on ambulance accidents. J Emerg Med Serv July 1989.

Horrey WJ, Wickens CD. Examining the impact of cell phone conversations on driving using meta-analytic techniques. Human Factors 2006: 48:196–205.

Petz K, Petz J, Jansson J, Nordsrom, G. Time saved with high speed driving of ambulances. Accident Analysis and Prevention 2011; 43(3): 818–822.

Richtel M. Gadgets in emergency vehicles seen as peril. New York Times, March 10, 2010.

Richtel M. Promoting the car phone, despite risks. New York Times, December 9, 2009.

Sumwalt RL. The sterile cockpit. ASRS Directline, June 1993.

Barry Bachenheimer, EdD, EMT-B, FF-II, has more than 25 years' experience in fire and EMS as an ALS and BLS provider in paid and volunteer roles. He currently works with West Orange (NJ) EMS, East Brunswick (NJ) EMS and the Roseland (NJ) Fire Department.