Lifesaving Policy Solutions for EMS Motor Vehicle Collisions

Background: Emergency medical services (EMS) providers are first responders to motor vehicle collisions and other emergencies, transporting these patients to definitive care. Despite their critical role in society, transportation-related injuries and fatalities among EMS providers range from two to five times the general worker population. The majority of these fatal collisions involve the use of lights and sirens.

Objectives: The primary objective is to better understand the incidence and severity of EMS motor vehicle collisions. A secondary objective is to analyze potential policy interventions that address the problem of motor vehicle collisions. 

Methods: First, a literature review was conducted in order to synthesize current knowledge surrounding the statistics and epidemiology of this issue. Then policy solutions were explored that can address the problem of motor vehicle collisions in EMS. Finally a recommendation was proposed that incorporates regulatory and fiscal realities. 

Results: Lights and sirens usage quadruples the risk of motor vehicle fatality and injury. Research demonstrates that lights and sirens are almost always unnecessary and generally do not improve patient outcomes. EMS provider fatalities are on par with or higher than police, firefighters, and other public safety personnel. Fatal ambulance crashes disproportionately occur on rural roads and among volunteer EMS providers. Engineering controls are necessary given the lack of any federal ambulance safety equipment or chassis mandates. Administrative controls, through improved training and driving policies, may enhance EMS driving behavior. Safety culture is also an important mediator to address, as research demonstrates that EMS agencies with strong safety cultures have much lower injury and fatality rates. Personal accountability for seat belt usage and distracted driving may lead to a decrease in collisions without regulatory control.

Conclusions: Sufficient evidence is available to suggest that significant reductions in lights and sirens usage can lead to dramatic reductions in EMS motor vehicle collisions without negatively impacting health outcomes, yet this risky practice largely continues. Ambulance collisions are also underreported, which means the incidence is likely even higher. Simple regulatory changes to address lights and sirens utilization could yield positive benefits without any apparent unintended consequences.