We’ve all seen an ambulance racing down the street, sirens blaring, weaving in and out of traffic. But sometimes in the rush to get to the hospital in the fastest way possible another tragedy can strike.
In 2010, a medic, patient and passenger all died when the ambulance driver lost control on an icy road and rolled the ambulance. While the EMT driver survived, those in the patient compartment did not. The accident occurred in Texas, but it could have happened anywhere.
When James Green, an engineer with the National Institute for Occupational Safety and Health (NIOSH), heard the story in Texas he knew he had to make it safer for anyone in the back of an ambulance. He set out to reduce the hazards.
Green spent years building partnerships with ambulance manufacturers to crash-test their products and devise improvements. His work with the public–private team has led him to propose 10 crash safety standards or recommended practices for ambulances and their equipment. The proposals have already triggered some safety reforms within the ambulance manufacturing industry and are under consideration by National Association of State EMS Officials.
For his work, Green has been nominated for a Service to America Medal (Sammies), the Oscars for federal employees. Green told Chris Dorobek on the DorobekINSIDER program that these ambulance accidents that the government as safety regulators are duty bound to make riding to the hospital safer.
“Historically, ambulances have been designed, built and sold without crash certification testing, and most fall under state rather than federal regulatory authority,” said a Sammies press release. Although they often travel at high speeds, a lot of their equipment isn’t bolted down, and patients and emergency crew are on cots and seating that don’t meet automotive crash-testing requirements.
“The challenge for the ambulance community is they don’t have a set of guidelines, standards or federal regulations, to use to design a safer seats or the patient cot. I’ve worked with the ambulance industry to try and change that paradigm, and together we’ve created a family of standards that will move the back of the ambulance to that same level of crash safety as we all enjoy in our cars, SUV’s and vans,” said Green.
Green’s interest in the safety project was spurred in part by Bureau of Labor Statistics data that showed EMS personnel involved in crashes had a fatality rate more than twice the national average for all workers. NIOSH also knew from its own earlier testing that ambulances’ structural integrity was compromised in crashes at 30 miles per hour.
“We saw workers sitting on a bench seat parallel to the patient, and largely working without any seatbelt on. Now there are belts on the seat, but to be able to do their job, to reach the patient, to reach the radio to communicate with the hospital, they had to move from their seat. So they were into this mode of working unrestrained in the back of an ambulance. It was a difficult challenge,” said Green.
"Green initially drew restraint system manufacturers to the table with a fairly modest goal—to learn from what the military had done to protect personnel transported in helicopters. “I had come from a Navy side where we had workers in the back of helicopters standing up. They used a restraint that allowed them to sit or stand,” he said.
“Green decided to figure out how to make the back compartment of an ambulance stronger. NIOSH began crash-testing to learn what happened when equipment and crash dummies were subjected to rear, side, front and rollover accident forces. Green, meanwhile, continued to add new players to his team, drawing in more than a dozen commercial interests with a stake in the ambulance industry,” said a Sammies press release.
“We’ve written partnerships with the seating manufacturers, and we’ve tested over 150 seats and restraint systems, and we’ve written a new standard for those as well. We published those standards, and now they’re being referenced by national bodies for ambulance builders,” said Green.
Green and his team have instituted a lot of changes in a quick amount of time, but so far he hasn’t received any push-back from EMT’s in the field.
“That’s been the most rewarding piece, we haven’t received as much pushback as the world might think. Instead, what we found was a very receptive audience that recognized they had problems. And when we first started, we didn’t know where we were going long term.”
One of the ways Green was able to be successful was to focus on building partnerships. For Green, the secret to success is building trust. “The industry was already regulating itself, and I use the word regulate very loosely. The federal government regulates. NIOSH for the most part is a research institute that does very little regulation; we provide information. So when I went into industry, the first thing they’re going to worry about is the federal government going to regulate. That wasn’t the case with me. Instead I was tryin’ to partner with them to encourage them to improve their own standards. They knew that there were places that they could improve, whether it was a seat or a cot an equipment mount, and they were happy to have the support, but it came from building trust.”
Making major changes in government can be tricky and often bureaucratic, but Green said he was impressed by the number of motivated feds who were willing to help. “You have so many motivated people who see opportunity, and to me that’s what the federal government offers, are opportunities. And you have to seize those. You have to look, you have to question, and you have to try and built a, build a career, because you are self-motivated; you can’t wait for somebody else,” said Green.
You can find all our Sammies interviews here.
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