Be the Safe Ambulance Operator


CarolinaFireJournal - By Jonathan Olson
By Jonathan Olson
10/26/2015 -

In May of 1976, the folks at Twentieth Century Fox released the EMS cult classic film “Mother, Jugs, and Speed.”  The storyline focused on the operation of two Los Angeles private ambulance companies, F&B and Unity, and their competitive nature in seeing who could get to the scene of a call the quickest. For in the story, whoever arrived first got the patient and therefore the business.  Needless to say speed was the only thing that mattered to them.  In today’s world of EMS, we know that it’s what we do, and not so much how fast we do it — especially driving — that results in positive clinical outcomes for patients.

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Safety is all that matters.  None of us want to be the headline.  The one that reads, there was needless death or injury as a result of a collision with an ambulance.

While teaching Emergency Vehicle Driver recently to a group of employees, there were a number of good discussions within the class that focused on practices while operating emergency vehicles and in particular, things that we can and should do to enhance safety for everyone involved. In this article, I want to share some of those discussion topics to better illustrate some things that should be adopted as best practice for everyone that drives ambulances.

Safety is all that matters.  None of us want to be the headline.  The one that reads, “there was needless death or injury as a result of a collision with an ambulance.” You have seen those headlines and they are not pleasant.  Events like this permeate our agencies, our systems and our communities.  Remember that safety is all that matters.  We each are responsible for the safety of ourselves first and foremost.  And in emergency vehicle operation that starts with seatbelts.  Whether it’s in the cab when responding, in the rear when transporting, or securing the patient to the stretcher with all the provided cot straps, the data is clear that they do make a difference and they will save your life, and the life of your patient. Each and every time you leave the station, your objective should be to make it right back there without sustaining injury or damage. 

All ambulances are different. It is rare in today’s times that an agency can replace all their units in close proximity to maintain a consistent assortment of chassis and module configurations across their fleet.  There are commonly two or three different chassis being used, either in make and model or just age. Different trends have led to changes in module design over the years and you are likely to have a mix of new and remounted bodies in the fleet. The challenge lies in that regardless of your fleet, in many ways, no two ambulances are alike.  It is essential that you as the driver of a vehicle get to know that vehicle thoroughly as there will be characteristics of it that you will need to know in order to operate it safely and to make sure that it gets you back to the station after each and every call.  It may be a difference in the steering characteristics, whether it tends to be very responsive to the wheel or requires more effort to make a turn.  It may be how the weight of the vehicle acts when making turns or braking.  It may be the braking system and how well it is geared to the utilization of the vehicle and how well it has been maintained.  Regardless of the characteristic, understanding the specifics of the vehicle you are assigned to is essential to ensuring the safety of yourself, your crew and your patients.

Four eyes are better than two.  Every ambulance that I have seen in my career had at least two seats in the cab.  With a person in both seats actively engaged in what is going on, we have the ability to see twice as much than if just the driver is paying attention.  A number of agencies have adopted the “co-driver” practice whereby the responsibility for the safe and effective response of the vehicle is shared between those in the cab.  This practice means that for the passenger, they should be equally as intent as the driver on scanning the road for hazards, monitoring the following distance from traffic ahead of the vehicle, and constantly communicating with the driver on situational awareness and safe tactics for navigating and clearing intersections.  The co-driver also serves to monitor the person behind the wheel to ensure that his or her personal safety is being taken into consideration as the vehicle is being driven.  My safety matters as much as our safety matters.  This means that the passenger/co-driver shouldn’t be working on a laptop, texting, or talking on the phone — all of the distracting behaviors that we prohibit our drivers from doing.  They should be equally as focused with what is going on while the vehicle is moving and contributing to the safe operation of the ambulance, even in the absence of a brake pedal and a steering wheel.

Make your right foot the right foot.  Slowing down is the successful answer to nearly every scenario where the ambulance was or was nearly out of control.  While the laws of the state may grant you exemptions to posted speed limits in time of emergency, the law does not grant you to act in a reckless and dangerous manner.   There is a legal standard that is often applied in the context of operating an emergency vehicle and that is due regard.  Due regard is defined as “giving fair consideration to and sufficient attention to all the facts.”  In layman’s terms, it means that you have to ensure that everything you do as the operator of the emergency vehicle is done for your safety and for the safety of others.  It means that you stop at all controlled intersections to ensure that other motorists have properly yielded to you before proceeding. It means that you don’t assume that just because you are displaying a wide array of the latest in technology warning lights and sirens that others have seen you and will respond properly, and it doesn’t mean that you have to drive faster to make a difference.  Are you operating with due regard for your partner if you are going to the hospital 90 plus miles per hour on the highway while he or she moves about in the module of the ambulance attending to patient care?  Are you operating with due regard if you are driving at night in the rain like you would in the dry daylight?  Are you operating with due regard while allowing yourself to be needlessly distracted by something in the cab of the vehicle?  Operating with due regard is not a difficult standard to achieve 100 percent of the time, you just have to focus on all aspects of your driving to ensure that it is achieved.

Be prepared.  Driving an emergency vehicle can be a stressful occupation.  It requires total concentration both physically and mentally.  Are you prepared every time you get behind the wheel?  Fatigue can be an immense issue in EMS — and not just in a busy urban area.  Having the necessary rest to endure a long shift is essential to your safety and that of others on your vehicle.  And while a caffeinated drink may pep you up, it is not a substitute for meaningful rest.  As a patient, I would not want my caregiver dozing in and out of sleep while going to the hospital, but I’d take it seven days a week compared to the driver dozing in and out due to fatigue.  Injuries can also be a factor in our ability to physically operate an emergency vehicle.  Sore shoulders, strained backs, and aching knees will all impact your reaction time when the brake has to be pressed or the steering wheel turned to take an evasive maneuver while operating an emergency vehicle.  If you are physically unable to meet the expectations, you probably don’t need to be behind the wheel.

Just as important as your physical preparedness is your mental preparedness.  Your attitude at a given time will surely be reflected in how you operate the vehicle.  It’s okay to be ticked about the call 15 minutes before shift change, it’s just not okay to reflect that attitude in how you are operating the ambulance.  The driver of the car you strike while responding on that call is unlikely to be the least bit compassionate about your situation.  To perform appropriately behind the wheel, one must be mentally fit for the job.  Personnel are exposed to many emotions during a shift of answering calls and that emotional response must not be allowed to impact one’s judgment behind the wheel.  You must be the defensive, calculated driver operating with due regard for others at all times.   If you are mentally unable to meet these expectations, you probably don’t need to be behind the wheel.

The citizens that we respond to assist have expectations.  They expect a prompt response, they expect good customer service, they expect the finest of clinical care — and they expect to not be in a collision with or while riding in an ambulance.  We don’t live in the world of “Mother, Jugs, and Speed” — we live in the world of accountability, safety and due regard.  Be safe and wear your seatbelt.

Jonathan Olson is the chief of operations for Wake County Emergency Medical Services and assistant fire chief with the Wendell Fire Department. He is a graduate of the NFA Executive Fire Officer program, has over 25 years of experience in EMS and fire operations, and is a co-author of “Management of Ambulance Services” by NEMSMA.
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