August 27, 2012 -NYC Paramedic David Restucciokilled BBaanngg ffoorr bbuucckk:: AAmmbbuullaannccee SSSSaaaaffffeeeettttyyyy,, SSSSttttaaaannnnddddaaaarrrrddddssss aaaannnndddd SSSSuuuurrrrvvvviiiivvvvaaaallll --WWhhaatt ddoo yyoouu nneeeedd ttoo kknnooww!!”” Nadine Levick, MD MPH Research Director, EMS Safety Foundation CEO, Objective Safety, New York, USA Chair, TRB, EMS Subcommittee, National Academies Friday September 7, 2012 What are we going to cover today? NYC (cid:131)Key principles of ambulance transport safety Funeral of (cid:131)Standards and Guidelines PPaarraammeeddiicc –NFPA 1917 perspective David Restuccio –NASEMSO MRAVD –MarynReport (cid:131)How to make your ambulance transport environment safer right now Goals and Learning Objectives Emergency Medical Services Emergency Medical Service (EMS) (cid:131)Educate on the risks to patients, transport and An important and unique transport (cid:131)What are the transport safety issues that emergency medical service providers and the public system pertain to this important public service and from ambulance transport adverse events public safety industry? (cid:131)Identify and explore factors related to ambulance ccrraasshheess aanndd iiddeennttiiffyy ppootteennttiiaall mmeecchhaanniissmmss ooff iinnjjuurryy ttoo (cid:131)PPuubblliicc ssaaffeettyy, ppuubblliicc hheeaalltthh (cid:131)What do we know of the risks and hazards and EMS transport providers, patients and the public and and emergency service how can we measure these ? expose safety myths (cid:131)How can the safety of this transport system be (cid:131)Instruct providers on strategies for enhancing (cid:131)Is there to save lives optimized? transport safety and reducing risk of injury to patients (cid:131)What can we learn from and share with our and providers and the public during transport international colleagues 1 Your electronic http://www.objectivesafety.net Your electronic Handout handout/resource card Your Handout and Additional Resources awaits you online at… (cid:131) www.objectivesafety.net Or if you are < 3300 yyeeaarrss TThhiiss WWIILLLL bbee FFAASSTT!!!! No need to take any notes –all text slides will be awaiting you in your online Handout How do you use an eTagfor the Your handouts etagpage Who am I? first time? Get Microsoft Tag App on your smartphone (cid:102)Nadine Levick MD, MPH (free from your App store, it reads ALL eTags) 11 (cid:102)Emergency Medicine Physician and Public open Tag App and scan the eTag Health Academic, (USA-Hopkins, Columbia 22 SUNY & Australia –Royal Melbourne, Royal ChildrensHospitals, Royal Australian Flying 3333 Doctor Service) (cid:102)Chair, National Academies Subcommittee TRB EMS Transport Safety, USA for those not of the Y or @ generation! (cid:102)Founder of EMS Safety Foundation -if you have a smart phone (cid:102)Recipient, International Society of Automotive -and you have downloaded free Tag Reader Engineers, Women’s Leadership Award for EMS www.objectivesafety.net/PDFHO.htm -point your phone and capture this etagto get today’s Safety form will open directly on your phone handout on your phone White House Safety Interdisciplinary Innovation Goals Data Palooza Consortium September 14, 2012 (cid:131)Cheaper (cid:131)(cid:131)BBeetttteerr (cid:131)Safer 2 EMS Transport Safety September 4, 2012-Las Vegas Things can go wrong – but when there are sound safety policies and technologies in place, and the system is well (cid:131)‘patient safety’ prepared, you can minimize harm AND also (cid:131)‘provider’ and ‘public safety’ Fatal injuries among EMTs and Balance of concerns and paramedics, 2003-2010* Science behind Policy risk during transport Other 11% Assaults and Aircraft incidents (cid:131)“For successful technology, reality must violent acts 8% 34% take precedence over public relations, Other transportation 7% for Nature cannot be fooled.” iinncciiddeennttss TToottaall = 9977 Struck by vehicle 7% Richard P. Feynman 1988 (cid:131) Response and transport time 32% (cid:131) Clinical care provision Highway incidents (cid:131) Occupant safety/protection * Data for 2010 are preliminary. Percents may not add to 100 due to rounding. Source: Bureau of Labor Statistics, Census of Fatal Occupational Injuries (cid:131) Public Safety the EMS transport process The Emergency Department (ED) Safety of the… (cid:131) communications/dispatch (cid:131) the patient T (cid:131) restraining device/seat I (cid:131)Provider (cid:131) transporting device/gurney M (cid:131)(cid:131)PPuubblliicc (cid:131)(cid:131) ppaartiaemnte mdiocsn/ittroarninsgp oerqtu nipumrseenst, doctors & family E (cid:131)Patient (cid:131)(cid:131) cplrionticeaclt ivcea reeq &u iipnmteervnetntions & (cid:131) the vehicle (cid:131) the driver/driving skill PLACE (cid:131) other road users (cid:131) the road 3 An ambulance is notan ED /ICU on Firstly! wheels (cid:131)An accident ? (cid:131)or a predictable and preventable event A tragic emergency health care intervention Negative impact on system A devastating tragedy… outcome performance… (cid:131)An ETT down the wrong hole (cid:131)BUT an EMS crash can kill all those may kill your patient and be a involved AND wipe out a rural EMS tteerrrriibbllee bbuurrddeenn ffoorr tthhee ppttss ffaammiillyy ssyysstteemm AANNDD nneeggaattiivveellyy iimmppaacctt aa and for the medic involved regions response capacity…… It does happen…. Ambulance Transport Safety Ground Ambulance Transport Safety IS Complex AND Multidisciplinary So (cid:131)Emergency care, public heath, public EDpaitdae Cmoiollleocgtiicoanl ManRagisekm ent SPaufbelitcy safety, and patient transportation. Ergonomic (cid:131)Important Principle: Research Transport TrPaonlsicpyort (cid:131)What’s important AAmmbbuullaannccee ttrraannssppoorrtt ssaaffeettyy iiss ppaarrtt ooff aa BBiioommeecchhaanniiccaall Safety system, the overall balance of risk Automotive Safety PPE (cid:131)What’s not important involves the safety of all occupants and BiohRaezsaeradr/Cchhem TDrariinveinrg the public (cid:131)All get home safely Comtemchunnoicloagtiyons TecShanfeotloy gy RegSutalantdioanrsd sand FlPeerot gSraafme ty 4 (cid:131)What’s going to save your life (cid:131)What’s going to hurt you (cid:131)What is factual (cid:131)What might take your life (cid:131)WWhhatt’’s goiing tto prottectt you (cid:131)(cid:131)WWhhaatt iiss ggaarrbbaaggee Letter to Abe Lincoln –1864 1864 Ambulance Design Patent re: safety of ambulance design and diagrams Almost 150 years ago (cid:131)What is new (cid:131)What is not new USA 1980’s Then…. USA 1980’s Then…. Equipment hard to reach And And 2012… NOW!… 5 Innovation Now… Real world answers to real world questions - (cid:131)What features will enhance safety of my new vehicle purchase? (cid:131)What we need to consider, where is the (cid:131)What color scheme do I want on my vehicle to make ‘bang for buck’ in ambulance transport it ssaafeesst? safetyy (cid:131)Do I need a helmet, and if so which one? (cid:131)Where is the low hanging fruit? (cid:131)What policies offer the safest system? (cid:131)How do I get my team to address safety issues? (cid:131)What data should I collect when something goes wrong, and how to analyze it? Ambulance Safety Research: We should use the best safety WE DO HAVE TECHNICAL No longer such a New Field practices demonstrated in engineering DATA!!! Dan Berry Transport Canada, Ministry of Health eeenprggidoinenemoemiroiinlcoggy NNEVHTTeSSOTtuwBS Care/Abl,de/ eAelln tu aelrbachSF aEuMBZRnAPSdieyveaswikrtrnroo,sa vr leilcot ,,a lBZPaiegcpgheeaBTerrastui a,laLel tlhylet, ,av Celitca kaELll leeW,MKPLe WFa,veet aiSlel riteacvhro iCaaskelinoclls g,edlPkoetw E MHSLLeraa eDetemula rvavtdn-g iSilit,tccuh iAnkki,rg FeLe,EMNC,etDDCe -avIDtMeeaTO lia rClc lWGolSekoHr Ra,Le ,BZLMeet evaeavilvelclilocei,kcsk reLek h rLe,etn, Letavj aHeiavli,RKc, tliJLDi c kg uaaoiok nhpylh wdLeLenanhetetdess aovav toGtellili nmccittl,kk NeaCe a, Le tdtlleBeh et aa wtuuav llalnlgllilclg,ak r d 1960non ‘70 ‘78 ‘86 ‘93 ‘95 ‘96‘982001‘02‘03‘04‘05‘06‘07‘08‘09‘11 issue ? safe safer and in ergonomics Range of reach.. This is a well ESV July 2009 defined technical science 6 Who writes vehicle and As well as epidemiological injury data August, 2011 occupant safety standards?? http://www.ncbi.nlm.nih.gov/pubmed/21834620 (cid:131) FMVSS (cid:131) SAE (cid:131) CEN (cid:131) ASA (cid:131)(cid:131) IISSOO (cid:131) KKK –only ambulances (cid:131) AMD –only ambulances (cid:131) ASTM –only ambulances (cid:131) NFPA –for fire trucks and now ambulances (cid:131) Health Care providers –MARYN report The 2012 TRB EMS Safety Summit 2012 EMS Safety Systems, print th(cid:131)is pOapgee &n iynogu rA sdmdarrte pshso:n eA w.iJll. pHlaey itghhe t8m saesnsions from the eTags! (even in B&W) Strategies and Solutions Summit (cid:131) Safety Developments Update –N. Levick (cid:131) Research needs assessment forms explained –E. Frazer (cid:131)One Day event, 30 presentations 1: Data and Recent Initiatives (cid:131)Held in Washington DC, Keck Center 2: Transport, Human Factors -Bridging Diverse Disciplines (cid:131)(cid:131)SSiimmuullccaasstt LLiivvee ttoo EEMMSS TTooddaayy 3: Testing and Standards 4: New systems safety technology solutions & telematics (cid:131)Live Webinar Access -globally 5: Fleet management strategies (cid:131)Over 100 participants live across 3 continents 6: Innovative Vehicle Design (cid:131)Greater that 10,000 downloads of handouts 7: OperationalizingSafety within the first week!! 8: Panel: How to optimize the safety of your existing fleet http://www.emssafetyfoundation.org/2012TRBSummitAgendawithLinks.pdf Wrap up –from Prof. Art Cooper The impaired/distracted Talking increases crash risk 5x The science of Stretcher driver Texting is lifting & loading (cid:131)Impairment COMPLETELY UNACCEPTABLE –Illness 23X increase in crash risk –Exhaustion –Substance –Emotion –Distraction •CELL PHONE !!!!! –(A MAJOR HAZARD) •Other technology 7 Size matters…. Less than 27 inches Stretcher Load -# 1 (CNLOAD01) And what is the loading will save your back!!!! height of your ambulance?? Course Design A lot is now possible and for less! (cid:131)One-day program EMS SAFETY (cid:131)Interactive lecture, discussion, group (cid:131)Driver behavior CCOOUURRSSEE activities (cid:131)Vehicle behavior (cid:131)Case studies using real incidents (cid:131)RRoaddsiidde IITTSS National Association of (cid:131)8 hours continuing education credit (cid:131)Fuel consumption/Economics Emergency Medical Technicians (CECBEMS) (cid:131)Resource modeling (cid:131)Presented in 8 modules Fleet Management technologies Spectrum of dimensions Telematics (cid:131)ACETech/Ferno (cid:131)CAD (cid:131)FleetEyes–Intermedix (cid:131)Resource allocation (cid:131)Zollrescuenetand roadsafetyfleet (cid:131)Fleet performance – managgement syystems –MMoonniittoorriinngg:: SSyysstteemm tthhaatt ggiivveess mmaannaaggeemmeenntt (cid:131)Marvlis data of vehicle efficiency and use (cid:131)Telematicus –Feedback: Directly to drivers at the wheel (cid:131)Optima (cid:131)Public Alerts (cid:131)Northrop Grumman 8 Its out there NOW March 2012 EMSSF TRB Synopsis Webinar USA Ambulance Standards & http://www.emssafetyfoundation.org/Recorded2012 March15ICTEPWebinarlogininfo.htm Testing (cid:131)TRB 2012 Summit –addressed the key and interdisciplinary applied solutions issues, in (cid:131) KKK A 1822F: Purchasing Guideline one day –please seek that information out. –“Minimum Specification and performance parameters” www.objectivesafety.net/TRBSummit2012.htm (cid:131) AMD-001-025: Manufacturing Guideline (cid:131)TThheerree hhaavvee bbeeeenn ttwwoo pprriioorr TTRRBB SSuummmmiittss hheelldd,, 2008, 2009 and both with vehicle engineering (cid:131) ASTM F2020-02a: Standard Practice and transportation systems technical expertise (cid:131)See www.trb.org, and for the Summit archives: (cid:131) NFPA 1917 Standard for Automotive Ambulances: www.objectivesafety.net/TRBSummit2008.htm 2013 Edition www.objectivesafety.net/TRBSummit2009.htm Click here www.youtube.com/watch?v=avFjl06bYcY or scan this eTagto see it on You Tube USA KKK ambulance purchase Ambulance Standards and Testing International Ambulance Design specifications NFPA 1917 Safety and Occupant Protection (cid:131)Interrelated –mostly Standard for Automotive Ambulances: GSA:KKK-A-1822F, Aug 2007 2013 Edition Standards paraphrasing each to retire October 2013 other’s requirements (cid:131)Specifications for purchase of Star of Life Ambulance In existence since 1999 (cid:131)Static Pull test (cid:131)(cid:131)SSeellff cceerrttiiffiieedd (cid:131)Australia –ASA (cid:131)(cid:131)22220000 LLbbss. ssttaattiicc ssttrreettcchheerr tteesstt iinn longitudinal, lateral & vertical (cid:131)Europe -CEN (cid:131)No dynamic test for vehicle, occupants or equipment (cid:131)No automotive test manikin (cid:131)Voluntary www.ntea.com/WorkArea/downloadasset.aspx?id=1352 USA Ambulance Manufacturing AMD ambulance ‘safety testing’ ? –Is NOT Yes a “nationally recognized testing lab” Division (AMD) consistent with accepted automotive safety –BUT -NOT an automotive/occupant practice… Ambulance Standards safety crash test lab!! –August 2007 (being integrated into NFPA 1917) (cid:131)No dynamic or impact test (cid:131)No automotive test manikin (cid:131)Mandates NO ‘crumple zone’ (cid:131)No impact tested anchorages for occupant restraint or equipment (cid:131)Internal, not independent & not a standardizing body http://www.ntea.com/WorkArea/showcontent.aspx?id=1350 9 The Laws of Physics Prevail.. No ‘a’… then NO ‘F’ !!!!! AMD 2007 -025 ‘static occupant safety testing’ -Compared with - (cid:131) F = ma Accepted automotive safety dynamic occupant testing where F –force m –mass a –acceleration PhilosophiæNaturalisPrincipia Mathematica, July 1687 NFPA 1917, August 2012 NFPA 1917 -Test Methods NFPA 1917 Testing Criteria (based on KKK, AMD) (cid:131)AMD Standards incorporated (cid:131)Side load testing types I and III (cid:131)(cid:131)AAllll aaddjjuussttaabbllee sseeaattss mmuusstt bbee dynamically tested to SAE J2917 (cid:131)Seat belts for side facing seats tested to FMVSS 210 SAE Ambulance Equipment NFPA -Key issues identified by mounting testing standards EMS Safety Foundation Frontal Impact SAE 2917, published May 2010 Side Impact SAE 2956, published June 2011 (cid:131)Key that meaningful safety data drive the process (cid:131)Need for ambulance safety, injury and fatality mechanism outcomes data be used (cid:131)Integration and collaboration with technical automotive occupant protection and crashworthiness expertise is paramount 10