Paramedic Paul Markinson remembers the exact instant he went from being a caregiver to a patient. It changed his life forever.
He and his partner were responding to the scene of a train collision. Two transit commuter trains had collided in Secaucus, N.J., killing three people and injuring 162. They were on the first BLS rig to respond when they were cut off by a truck and drove head on into a bus.
"The whole time I was sitting in the ambulance, I was thinking, I just created another MCI," Markinson said. "I could see the helicopters overhead."
Co-workers needed to "pop the door" on the ambulance to get his partner out, and Markinson suffered a broken right femur. One of his co-workers who responded to the scene kissed his forehead and said he'd be okay.
Markinson, now a paramedic with Trinitas Hospital in New Jersey, was lucky. He returned to work nine months later. Many ambulance collision victims never do.
Just a Fact
Each day there's seemingly a report or two of an ambulance being involved in a crash, sending EMS personnel to the hospital or killing them. The number of incidents shows just how fraught with danger riding in a speeding ambulance can be to those who choose this line of work.
Researchers have found that rear-riding ambulance occupants were more likely to be killed than those in the front. Also, a study at the Medical College of Wisconsin revealed that most ambulances crashes and occupant fatalities occurred while a vehicle was traveling to an emergency and at intersections.
Looking at crashes between 1987 and 1997, they also found that ambulance collisions frequently hurt others not on the ambulance. During that 10-year span, there were 339 crashes, killing 405 and injuring 838.(1) The National Highway Traffic Safety Administration Fatality Analysis Reporting System found that between 1991 and 2000, there were 300 fatal crashes, killing 82 people in ambulances and 275 others.(2)
Working after a Wreck
Often times, in the aftermath of a crash, the focus tends to be on how to make the rigs safer. Conversely, there tends to not be much focus on the emotional aspects of coming back after a wreck, which can be equally devastating to those involved, and even to the organizations where they work.
Rob Davis is one of those. He was severely injured in a crash, and when he went back to work, he just wasn't comfortable in the patient compartment of the ambulance anymore.
"I didn't like being back there," said Davis, who, like many involved in ambulance collisions, can recite the day and time of his crash. "I kept saying to myself, 'You're being silly. Why are you uncomfortable?'"
Davis, who was working in a rural system in Texas at the time, was traveling to the hospital with a cardiac patient. He was standing over the patient when, while going through an intersection, their ambulance was broadsided. He snapped his arm in several places, and later learned he had nerve damage in his neck.
After a long recovery, he was anxious to return to work. Soon, though, he realized something was wrong. "My Spidey senses told me something was just not right," he said. "It was only a couple of weeks' time before I realized I was missing a comfort level."
He was distracted to the point that it affected the quality of his patient care. "I did find myself missing things in assessments and things like that, not taking measures that you would have," he said. "Nothing life-threatening. Then, I started asking myself whether I was out of practice or just that distracted."
Eventually, he quit his career in EMS. "Not a day passes that I don't think about it," Davis said of the crash.
Markinson, too, said he had a bit of apprehension getting back in the rig after his incident.
The Psychology of It
EMS providers caught in crashes say they go through an emotional rollercoaster following an incident. Some, say there are feelings of guilt because now they_ve caused harm when they're used to being caregivers. Others talk about having to overcome their own injuries and the mental anguish that can come along with this type of incident.
Rob Stuck, general manager of the Hudson Valley (N.Y.) region for TransCare Ambulance, has seen a variety of those reactions in his day-to-day operations.
"A lot of the attitude is, it's never going to happen to me, and when it does, your mortality comes to the surface," said Stuck.
Besides pure health issues, there are the emotional concerns about being jobless down the road. Also, there's always the threat of a legal challenge, which can drag on for years and become a financial burden.
Stuck has been involved in the company's critical incident stress debriefing team and is well aware of how a crash changes people within theEMS community. "We've had those that have come back and are skittish," Stuck said. "They're definitely paying more caution to stuff they wouldn't have done on a regular basis."
The good news is, a majority do go back to work, Stuck said. "A lot of that is through debriefing and getting some kind of help so that you can talk about it," Stuck said. "Accidents happen. Our goal is to save lives. The reality is, whether it be an accident or we're trying to save them, it's sometimes hard to deal with it."
If there's an upside to being involved in a crash, it may be in that the people who return to work tend to become cheerleaders for safety measures.
"I'm a huge advocate for seat belts," said Kate Glaudemans.
Glaudemans was a teenage EMT when she was riding in the back of an ambulance responding to a code."It was the day after Friday the 13," she said. "I remember the date. We were going lights and sirens. We were going against the light. The driver stopped and did all the things that were required. And we were T-boned."
She broke her wrist. Now, she won't ride on the bench seat, nor will she ride without a seatbelt. "I'm a huge safety fan. I know a few people who don't like to wear the seat belts in the back. I'm also more aware of making sure the equipment is strapped down," said Glaudemans, now a member of the Rockville (Md.) Volunteer Fire Department. "I tell all the probies they'd better have their seatbelts on."
Another positive result is that ambulance crash victims can become better caregivers following the incident. Having been a patient, thoseEMS providers know what it's like to be injured and strapped to a cot or backboard.
"You see yourself on one side of it when you go from rescuer to the patient," Stuck said. "It gives you a new perspective. You start to realize everyone's human. Everyone has their own mortality."
Markinson is one of them. Being stuck in an ambulance with a broken femur has given him a new outlook on the Hare Traction Splint, which was used on him that day. "It's opened my eyes," Markinson said. "I was treated very well. I was treated by my co-workers. But it puts you in the patient's shoes. They were excellent with me, but I can see for the stranger what it's like."
"Even in my own car, just driving again," he added, "you realize you're not invincible. Everybody inEMS, police and fire has this untouchable thing, and then you realize you're not."
What's clear is that while mostEMS professionals take emergency driving serious, accidents still happen -- and often not the fault of the person in the ambulance. Still, long after the bones are repaired and fenders are straightened, the emotional impact of the accident has an effect on the professionals and should be an area of concern in every organization.
Richard Huff,EMT-B, is a journalist, author and chief of the Atlantic Highlands (N.J.) First Aid and Safety Squad. Huff can be reached atRichardmhuff@gmail.com.References
- Kahn CA, Pirrallo RG, Kuhn EM:" Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective analysis." Prehospital Emergency Care. 5(3):261-269, 2001.
- Proudfoot SL, Romano NT, Bobick TG, et al."Ambulance Crash-Related Injuries Among Emergency Medical Services Workers -- United States, 1991-2002." Morbidity and Mortality Weekly Report. 52(8):154-156, 2003.