Outline Objectives (cid:102)Review of the EMS fleet safety issues, risk (cid:102)Educate on the spectrum of hazard and risk 1stAnnual Resuscitation Conference management and economics related to fleet safety. Anchorage, Alaska, June 2nd, 2007 (cid:102)Comprehensive review of the new Z-15 ANSI/ASSE (cid:102)Explain the elements of the new Z-15 SSttrraatteeggiieess ffoorr MMaannaaggiinngg fleet safety standard and other guidelines ANSI/ASSE standard for fleet safety management AAmmbbuullaannccee FFlleeeett SSaaffeettyy IIssssuueess (cid:102)Update of the latest technology and other tools for optimizing fleet safety and a profile of safety (cid:102)Explore the implementation of new transport technologies under development. safety technologies and innovations NRaedseinaer cLhe Dviicrke,c tMorD, MPH (cid:102)Iimncpelnemtiveenst ianngd s satfreattye dgeievse linopvomlveendts i nto enhance (cid:102)Iennshtarunccti nogn fsletreatt esgafieesty a tnod m pionliimciiezse froisrk for EMS Safety Foundation & fleet safety patients, providers and the public CEO, Objective Safety New York, USA http://www.objectivesafety.net So… (cid:102)what policy changes could enhance transport safety? (cid:102)what do you see as obstacles to improving transport safety? (cid:102)what are ways to enhance awareness and understanding of transport safety issues? (cid:102)what devices could be considered to enhance transport safety? (cid:102)how is data on transport safety captured? (cid:102)how can you identify predictable and preventable risks during transport? What do ambulance crashes New paradigm -Integration of EMS really cost ? (cid:102)Loss of life and injury (cid:102)Negative impact on EMS system (cid:102)Public health departments (cid:102)Collisions are the largest liability cost and (cid:102)Social service agencies exceeds malpractice or negligence (cid:102)Besides the direct financial costs of replacing a (cid:102)Community outreach damaged ambulance and equipment, there are additional hidden costs incurred: (cid:102)Hospitals (cid:138)investigating the ambulance collision (cid:138)litigation /settlement/lawsuit (cid:102)Health care networks / Insurers (cid:138)medical/disability costs of injured EMTs (cid:102)Industry (cid:138)hiring of new employees to replace injured personnel (cid:138)retraining and psychological counseling of personnel involved and others (cid:138)increased insurance rates EMS Transport Safety Key Elements to Safety Data Capture (cid:102)Vehicles (cid:102)‘patient safety’ (cid:102)Data Capture (cid:138)Total number and type (cid:138)Total number of runs AND also (cid:102)Vehicle Biomechanics and (cid:138)Total number of miles traveled Crashworthiness (cid:102)Providers (cid:102)‘provider’and ‘public safety’ (cid:102)Ergonomics and Biohazards (cid:138)(cid:138)THootuarls n wumorbkeerd and type (cid:102)Transportation Environment (cid:102)Transportation adverse events, including mechanism –both injuries and fatalities (cid:102)Safety Management –evaluation and (cid:138)The vehicle analysis (cid:138)Patient (cid:138)Provider (cid:138)Public Vehicle Biomechanics & Ergonomics and Biohazards Transportation Environment Crashworthiness (cid:102)Integration with Highway Safety strategies (cid:138)Partnerships/collaboration and Information sharing (cid:102)PPE (cid:102)Intelligent Transportation System (ITS) (cid:138)Head protection Technologies (cid:102)Vehicle (cid:138)Protective Clothing (cid:138)Driver/vehicle performance monitoring & feedback (cid:138)Compact crashworthy vehicles (i.e., vans) (cid:138)Visibility devices (cid:138)Non-hostile interiors (cid:102)E(cid:138)qBuiiophmazeanrdt apnrodte Vcteiohnic le Layout and Design (cid:138)(cid:138)CSioglnlisali osny satveomidsance vehicle technologies (cid:138)Lock down positions for equipment (cid:102)Roadside safety design and planning technologies (cid:138)Equipment interface ergonomics (cid:138)Seat belts for all occupants (cid:138)Vehicle positioning and scene safety issues (cid:138)Vehicle interface ergonomics and human factors (cid:138)Over-shoulder harnesses for all patients on (cid:138)Vehicle visibility and appropriate warning signals (cid:138)Hospital ambulance bay access and egress the stretcher (cid:102)Fleet mix (cid:138)Rapid response vehicles (cid:138)Vans, Trucks, Motorcycles, other Best Practice…..? The technology A peer reviewed tragedy described in your junk mail is far more advanced than that used in EMS (cid:102)Persistent disconnect between automotive safety science and EMS transport safety approach (cid:102)Pre-hospital and Emergency Care 2004 (cid:138)“EMS vehicle drivers are advised to approach the intersection, slowing to ensure that traffic has stopped and making eye contact with other driversbefore entering the intersection.” (cid:102)In the modern era of road safety to suggest that a strategy of “eye contact”to be made at an intersection with a driver traveling at ~ 40mph in the hope that this would result in a safety intervention, is at best frightening http://www.usatoday.com/sports/graphics/car_of_tomorrow/flash.htm Risk Awareness before & after a Pennsylvania Code Guidelines –standards 1 hour presentation Pre % Post % P value (cid:102)Transport safety Perception of the rear compartment as 43 76 <.0001 a high risk for serious injury LikertScore* of 10, (10=highest) for 36 72 <.0001 (cid:102)Practice protocols tahmeb cuolnancceern for safety in the rear of the Self-report of always wearing a seat 14 19 NS belt (cid:102)Occupational Health and Safety Considering wearing a limited motion 81 97 <.0001 safety harness Wearing a helmet in the patient 31 81 <.0001 compartment * LikertScore for safety concern, increased from a median of 8 pre to 10 post, p<.0001 911 Call to Hospital/ED Definitive Care What’s missing Haddon/Baker/RunyanPhase-Factor Matrix as applied to EMS Safety* Time Intervals* 1. What data is collected nationally? EMS EMS EMS EMS arrives Hospital/ED (cid:138) We have no denominator data Emergency 911 vehicle arrives leaves at ED EMS definitive (cid:138) We have incomplete numerator data Occurs contacted dispatched on scene scene bay care 23.. AmAi1n+bbep ss2cuee ht+nna3ttn ps=ict orrspeu dsucualtautlttaraie ondnt tibrnaaansbesidplit onyr attatoito idonenas lsi giannfjeu atryny d ed neagvtaian loeurea ritnienj ugr y PHp(prAreeFS AcEerCvaeTsnOht)R adPbersaiiddppvru(iedilaahnnacermtogwgaidivs et sieerihtnnoo)rdig nasti,tdc, o / ry, anveatihv Vcl(oisooaceipclgldhelekiea ise wcnnibdoltcere)neaig, k hets,,(tpiieErhmornyeapm&svddlEi ieca s VrdmadrouOkilesrn/eiCsfpnrnmaie aggtcgtesenecudn,h l,at, toprSu(ysdoEa)bfcircMwslooiiocaSoom/rr pciiep emu Lna&n laer&t targsau umsSetrni, aoe)lnd,ic•••••••• aaECESECEScctoftfooohfhfccccesesieieiitcctccaapp ststbblltiti vvaeae eebnbnnnieielleeififttiissytytss *Not drawn to sdciasEtlipeMmaSetc h rethsepEtV oisMmenchSeseie nc elteo reElaMteStid ms tcereannes pEoMrthtrtS aiotm inssmescpe pei(tXonare)lt to EdDhefo iEtnsimMiptSiietv a e(blY /acE)yaD rt eo 45.. eWWffhhiciacath co yov reogrfsa iinngijhzuatr tyiis oi nnthtsee rwrveoe?unltdio dnest ermine policy? p(poo(csesrtvta e cesnrvhtae)snht)seastec umbhvsgneeeioedlrladutnreit,t sbdr yseruliea,yde, srfiasinee,tgt ytgreya ,ibnutermrexzesptoseiraetsniarcirtseraa a e& ibntdn i oatoetc g fsfnrdausi,egb mbsnriuipgcrlsnen scmtyorsrhaaloltsuanietyEsarmramisMddaogtawf ,Senesfq imamci cudsar paeeerleen ite,t y d , dreoahccahnoiuantadlbm dlpc ei dlapedciotnnetaaietn ottaasinot ino,n ••SSoocciieettaall nneeeedd Safety data on EMS transport A number of potential Some challenges and its oversight interventions to enhance safety (cid:102)No accepted national safety standards for - have been identified: (cid:138)EMS fleet management or safety practice (cid:102)EveMhSic vleeshicle crash rates are in excess of similar sized (cid:138)Ambulance vehicle rear compartment design (cid:102)EMS worker transport fatality rates are well above other (cid:102)Safety Policy and performance emergency services (cid:102)Safety performance standards (cid:138)Provider occupational injury protective (cid:102)Is exempt from Federal Motor Vehicle Safety Standards (cid:102)Vehicle crashworthiness equipment (FMVSS), and not covered by other national (cid:102)Vehicle interior ergonomics transportation system safety oversight (ie. FMCSA) (cid:102)Yet convincing data for injury risk and (cid:102)Almost non existent ergonomic research or data (cid:102)Personal Protective Equipment design hazard (cid:102)The findings of limited research conducted to date (cid:102)Driver selection, training and simulation (cid:102)Need for patient, provider and public safety suggest EMS transportation safety is in need of urgent (cid:102)Safety and risk awareness modification focus fsoacfeutsy .a nd has been left behind commercial truck and bus (cid:102)(cid:102)RInitsekll ibgeehnat vTiorarn mspoodriftiactaiotino nS ystems (ITS) This is happening out there Gregg TheunesAppeal to his NOW…. Senator, December 29, 2005 2007…. (cid:102)‘Pizza delivery truck’approach has got to go (cid:102)As do the religious ‘beliefs’about occupant protection (cid:102)Z15.1 –we must at least know what we are doing and have consistent and meaningful safety programs and practices Safety oversight of what and by The National Transportation …. whom Safety Board (NTSB) (cid:102)Vehicle Safety (cid:102)Vehicle Design (cid:102)Safety Equipment Design (cid:102)Vehicle and Safety Equipment Testing and Standard development (cid:102)Safety policies NTSB 1979 Accident Report NTSB: 1979 Recommendations neverimplemented Recommendations •EVOC •To NHTSA –Class II & III Priority Action •LICENSE RECORDS –E30x1te) ntod iFnecdluedrael aMmobtourl aVnecheisc laen Sda ofethtye rS etamnedragred?nsc (y2 2v0e,h 2ic2l1e,s –Extending FMVSS re: padding and restraints •To GSA –Class II Priority Action –Maintenance of handling –Loading instructions –Body structural integrity –Anchorage for all equipment –Occupant protection •To National Committee on Uniform Traffic Laws –Modify criteria What about FMCSA’sMission A very serious gap in data, Issues (cid:102)Office of Research and Analysis is committed to reducing performance and oversight the large truck-related fatality rate from 2.8 per 100 million (cid:102)Patient, provider and public safety truck-miles in 1996 to 1.65 by 2008. Mission (cid:102)FMCSA Truck safety goals – (cid:102)Key issues (cid:102)The mission of FMCSA'sOffice of Research and Analysis to decrease the fatality rate of 2.8 per (cid:138)Essential Emergency service is to reduce the number and severity of commercial motor vehicle (CMV) crashes and enhance the efficiency of CMV 100 million truck-miles in 1996 to 1.65 (cid:138)Low budget operations by: by 2008 (cid:138)All environments (cid:138)Conducting systematic studies directed toward fuller scientific discovery, knowledge, or understanding (cid:102)EMS crash fatality rate estimates are – (cid:138)Recruitment and retention issues (cid:138)Aanddo protiandgs, itdees tbinegs,t apnradc dtiecpelso yainndg tiencnhonvoaltoivgeie dsr iver, carrier, vehicle, 7.66 -41.93 fatalities per 100 million (cid:138)Technology dark ages (cid:138)By expanding the knowledge and portfolio of deployable ambulance-miles (cid:138)Communication, administrative, transportation technology, the research and technology program will help FMCSA reduce crashes, injuries, and fatalities and will deliver a program and health care data challenges that contributes to a safe and secure commercial transportation system. EMS is multidisciplinary Air EMS is a role model for safety initiatives and focus (cid:102)Did someone design this system as a (cid:102)Primary focus has been physician stationary one -that didn’t move?? driven -optimizing acute health care (cid:102)This IS acute health care, and practice communications AND transport (cid:102)But…. NOT optimizing (cid:138)Communications/data –administrative and health care (cid:138)Transportation aspects and safety Air and Ground EMS An Aviation Safety Plan Air Safety Approach (cid:102)Major differences in safety culture (cid:102)Safety Program Planning and approach (cid:102)Evaluating (cid:102)Dichotomy of Safety standards (cid:102)Analysis of Safety Performance (cid:102)Diverse safety oversight (cid:102)Analysis of Safety Information and (cid:102)Absent ground safety regulatory Data control (cid:102)Analysis of Risk Profiles and Plans Ground Transport Safety ? Unique workplace Safety process (cid:102)Identify hazards (cid:102)In vehicles (cid:102)Raise awareness of safety issues (cid:102)Create a safety attitude (cid:102)At roadside and other emergency (cid:102)Promote Teamwork scenes (cid:102)Provide motivation (cid:102)Accomplish established goals Safety Management Safety Plan Creating a Safety Culture (cid:102)Culture of Safety (cid:102)EMS Practice and Policy within a company must start with upper (cid:138)(cid:138)TSiaefree dd rdivisinpga tpcohlicy and practice (cid:102)A Safety Culture management’s commitment to safety (cid:138)Driver selection and training (cid:102)Protective Policies (cid:138)Seat belt use policy -for providers, patients and passengers (cid:102)Protective Devices (cid:102)Awareness (cid:138)Safety monitoring and feedback (cid:138)Stop at red lights and stop signs (cid:138)To prevent a crash (cid:102)Training (cid:138)(cid:138)ESmeceurrgee anlcl ye qVueihpimcleen Otperators Course (EVOC) (cid:138)In the event of a crash (cid:102)Incentive (cid:138)Use portable communications (cid:102)Monitoring and Analysis (cid:138)Notify driver if rear occupants are in vulnerable positions (cid:102)Continuous Education and Evaluation (cid:102)Fleet Management (cid:138)Fleet Safety program (cid:138)ANSI/ASSE Z.15 Safety leadership…from the EMS Transport Safety Strategies - Integration and Collaboration IAFC and USFA 2006-2007 New York State Strategic EMS Transport Safety Strategies -2006-2007 New York State Highway Safety Plan Strategic Highway Safety Plan (cid:102)EMERGENCY MEDICAL SERVICES DISPATCH SERVICES (cid:102)EMERGENCY MEDICAL SERVICES PARTNERSHIPS (cid:138)Increase the participation and role of Regional EMS Councils in local and regional highway traffic safety boards and/or organizations (cid:102)PRE-HOSPITAL TRAINING PROGRAMS (cid:138)Train EMS providers in the use of the new medical protocols; provide funds and/or other support to certified EMS Course Sponsors to train EMS providers in the use of these protocols; and collaborate with Regional EMS Councils and/or Regional Emergency Medical Advisory Committees (REMAC) on the development and implementation of training programs (cid:102)ROAD CONDITION AND INCIDENT RESPONSE (cid:138)Provide a placeholder for regional and/or county EMS representatives in municipal DOT emergency management plan development and implementation EMS Transport Safety Strategies - 2006-2007 New York State Strategic Risk Exposure Rates EMS Injuries* Highway Safety Plan Crashes per FARS 2003 DATA & Biggerset al 1994 (cid:102)Higher than the injury rate for any (cid:102)EMS RESPONDER CRASH PREVENTION 100 million miles private industry published by DOL (cid:138)Undertake a systematic review of other state actions and protocols othno asme bapuplarnocperi tartaef ffiocr stahfee tNye mwe Yaosrukr eSst attoe idpreen-thifoys apnitda lp sryiosrtietimze 3500 3,200 (cid:102)34.6 injuries/100 fulltime workers per (cid:138)Ionfc arpepasroep erdiautcea ttriaofnfi ca nsda fientvyo tlevcehmneiqnut eosf EMS providers in principles 23500000 Automobile year (cid:138)Dreegvioelnoapl aanndd ismerpvleicme elenvt ealmbulance traffic safety protocols at state, 2000 Light Truck (cid:102)1.5 x that of fire fighters (cid:138)Rmcreaavysi hecweos ntrtreiabtumtee ntot minojudraielisti eress aunltdin pgr ofrtoomco tlhs et oim idpeanctti foyf tahmosbeu ltahnacte 11050000 849 LMaortgoer cTyrculcek (cid:102)5.8 x that of health services personnel (cid:138)Isdeernvticifeys m oef tphroodtos ctool ps rtohvaitd een ihnacnenceti vtreasf ffiocr s aadfeotpytion by EMS 500 405 386 212 U(Bribgagne rAsm ebt ualla. n1c9e94) (cid:102)7 x the national average (cid:138)Pedaurtcnaetri owni tcha omrpgaainginzast itoon ism tphraotv per dorviivdeer pauwbalrice ndersivse or fa dwraivreenr ess and 0 type of vehicle * Maguire, Hunting, Guidotti& Smith, Occupational Injuries among Emergency rveeshpicolnessibility and appropriate response to approaching emergency Medical Services Personnel, Prehospitialand Emergency Care Oct/Dec 2005 Transport Safety Goals And the injury events.. Cultivating a Culture of Safety 30 (cid:102)At a Service level Percentage of cases %112205055 ltofairasfvaltslenisnarseugpxloterrttaiotinon (cid:138)(cid:138)(cid:138)(cid:138)CCERdoeogumllucamablatouteerna itceate (cid:102)(cid:102)(cid:102) SPDtraaatnacdbtiaacrsede psso ftlooicr dys ebamfaesoteynds torant eS coiuetnccoeme 0 cases LWD cases The first and only published scientific We’ve known for 10 years that red fire trucks Absence of standards and are twiceas likely as lime yellow trucks to text on ambulance crashes (1995) oversight …and by an optometrist crash at an intersection (cid:102)Challenges in identifying best practice (cid:102)Myriad of unregulated commercial products (cid:102)No safety performance standards (cid:102)Absent national safety oversight The “Black Box” The “Black Box”- Driver behavior monitoring and feedback device Purpose of ‘Black box’ A transportation safety monitoring and Program feedback device This technology is conceptually like a (cid:102)Enhance Safety vehicle safety ‘pulse oximeter’–that with (cid:102)Improve Driver Performance auditory feedback -can save your life, your coworkers life, your patients life, and (cid:102)Save Maintenance Dollars others on the road (cid:102)Aid Accident / Incident Investigation How the Device Works Monitoring and feedback devices (cid:102)Implementation well received by the (cid:102)Computerized monitoring device installed providers. Demonstrated Effectiveness on each vehicle to measure parameters (cid:102)Each driver has individual key “fob” (cid:102)20% cost saving in vehicle maintenance (cid:102)Data collected every second within 6 months. (cid:138)including: vehicle speed and (cid:102)No increase in response times performance, driver behaviors (cid:102)Fewer crashes and less severe crashes and emergency mode (cid:102)Auditory feedback of warning (cid:102)Sustained improvement in safety proxies, ‘growls’, and penalty tones with no inserviceor retraining after the (cid:102)Data downloaded automatically every day initial introduction period. Monthly Seat Belt 2003-2004 and Over Total Miles Driven Monthly 2003-2004 and A key to safe ambulance transport Speed Violation Trends 2003-2004 Average Between Count Miles 2003-2005 MEMS MONTHLY SEATBELT VIOLATION TREND 2003/2004 TOTAL MILES DRIVEN MONTHLY 1110242468III,,,,,,,0000000I I0000000– I00000000 –M–arIbc7hgu62il1dnirnAope1iri3lIddw8nI84e tdlM3insaI6yfa2I 4tiI&teiJafudn i2e,te6 odndJnuao ly2de0t agaAsugurt stOao4Sept weNcTmbO1earTl,6As LpOw cNtoOtb.e4M iOru1FtON oVhvrNIeOTemL bHAe r1T 4DIOecNeSmber8123456J000000a000000n,,,,,,u000000a000000r0000000y1M0aFrceIhbrua2r11y60A,9pr2ilM2aIrcI5h50,M23a5yI31AI7pr9iIl,762Ju12n,e07MM4aEy6MJulS1y, 6JM0u9nOeANu4guTs2tH85SLepYte Omb5eV4r7ERO ctSo4bPe,r0E4EM6NoDOve NmVTbIe2HOr07LDAecTeSmIeOberr4Ni0e7 sTJa1RnuaEry7N1D0Fe 2br0ua0r7y38/0200Ma4rc3h,069April1,004May1657Jun2e709 MILESIIII I– I1111111 –001122399–050505005b,,,,,,,,,000000000gu000000000il000000000dnirnAoepi9rIidd3lwn,4e 4tdl7M9insa9fay,I8 ti4&Itei1aJf1ud i0nI,tee6M I,o6dnOdI5n1NJ1ao u0Tlde8ytH ,6agaAs5u6grt 1uOao0sSt9ep ,wt4Nce216m0alb,2es r,p9wO8ct7t1oiub1et0Nr,hor2v1ee6 1m 0b 4eDr,e7c4Marche106I.01m180be,9rApril0J.I10aI167n1uMayIa00.rIT80y4I4,OF9e3.T5June8b8r5A6u1La0r 5.MJuly5y24,4I0L19M5.E811a4AugustSr32c0h,11September25.05319A1pr29.iOctober9l,48041November1M14.a802y3,1December1133.J412u91n2Januarye9.,30198M9February7.E24MSMarch9. 41AB6April.9C MMay8.39ileJunes9 .6P1eJuly2r.2 7MAugusto7.n57th4.September2899.2October71November7.431December5.251*January 20056.61February17.49March15.76April19.32May13.110511220505 Other monitoring devices Data, but is it generalizable The jury is out on (cid:102)Primarily to record events during and immediately preceding a crash (cid:102)Opticon (cid:102)Give no driver crash prevention feedback (cid:102)Simulators (cid:102)Administratively burdensome (cid:102)Intrusive (cid:102)Not demonstrated to be as effective in improving vehicle maintenance costs or as effective in modifying driver behavior long term EMS is emerging in the Being seated IN an automotive transport safety arena seat is what will protect you Safety for emergency (cid:102)First and only presentation of ambulance safety transport research at ESV Congress was 2001 (cid:102)Anything that allows or encourages you to (cid:102)SAE Toptecon Military and Emergency Vehicles, get up out of your seat will also encourage USA , September 2001 (cid:102)Emergency Vehicle Symposium, Australia, you to be injured or killed –it is potentially Policy that reflects Melbourne, May 2003 lethal to be out of your seat in any fashion (cid:102)Sporadic Ambulance safety research presented (cid:102)4 or 5 point harnesses for sidefacing SCIENCE at peer reviewed AAAM, ITMA, SAEM, Safe occupants are potentially lethal –and is in America, World Injury, Asia Pacific Injury Conferences 1999-2005 NO WAYSUPPORTED BY ANY DATA OR (cid:102)Next week at inaugural meeting at 2007 TRB AUTOMOTIVE SAFETY EXPERTISE Congress in DC EMS has unique head protection Role of a head protective device Problems needs –not well met by a ‘truncated’fire helmet… (cid:102)A simple, immediate and inexpensive adjunct – (cid:102)No Standards a protective device - ?! ?! (cid:102)Unique safety and hazard (cid:138)To protect occupants from hazardous interiors (cid:138)As vehicle crashworthiness design advances protection needs (cid:138)As driver training advances (cid:138)For when equipment becomes unsecured (cid:102)A number of less than (cid:138)As EMS Safety Standards are developed, for both appropriatedevices out there EMS vehicles and EMS occupational safety Awkward to use Gets caught and scratched Key Helmet Features New EMS helmet prototypes for 2006-2007 Securing equipment Safety saves time, lives AND money Very Scary insurance data The inevitable bottom line… Canada, Nova Scotia Year Payroll Modified Incurred Incurred Total (cid:102)Since 2000 working towards a goal of zero Premium Indemnity Medical Claims loss ratio with insurance provider $million $1,000 $1,000 $1,000 # (cid:102)10 million kilometers per year 2003 14.1 540 885 9,925 93 (cid:102)150 emergency response ambulance units 2002 12.6 547 266 255 78 (cid:102)Collision claim history measured in dollars 2001 11.3 454 88 128 55 per 100,000 kilometers traveled: 2000 10.6 420 63 194 89 (cid:138) 2000/2001 $ 1725.00 (cid:138) 2001/2002 $ 1049.00 1999 10.1 405 115 117 56 (cid:138) 2002/2003 $ 751.00 1998 9.6 411 13 30 51 (cid:138) 2003/2004 $ 416.00 Workers Compensation Rate increased by 26.5 % (cid:138) 2004/2005 $ 229.00 Was $5.86/$100 payroll in 2005-2006 Now it is $7.41 for 2006-2007