For years, our firm s attorneys have pointed out everywhere we go that ambulance accidents are the single biggest area of risk in EMS. The recent tragedy in Antwerp, Ohio, in which five — yes, five — people were killed, including two patients and three ambulance crew members, appears to be the single worst ambulance accident in modern EMS history. It s not a wake-up call we should get. But we did. And from the published reports quoting the police, this tragedy — in which an ambulance struck a tractor trailer broadside, bursting into flames upon impact — was easily preventable. (NOTE: There is a move to petition the National Transportation Safety Board (NTSB) to investigate this accident and other serious ambulance accidents so that a full professional expert investigative report may be issued, which would then be publicly accessible so that we can all learn from these tragic events.)

We need to slow down. We need to stop at all controlled intersections. We need at all times to operate our vehicles with due regard for our own safety and the safety of others.

Everyone needs to speak out on this subject at all levels if we are to reduce the terrible loss of life and serious injuries that occur when operating emergency vehicles in an unsafe manner. The solution is no doubt a multifaceted one. As an active driver/operator in a busy suburban fire/rescue department, I witness firsthand bad driving, excessive speed and overuse of lights and sirens. And we all see it. But the key question is what will each of us do about it?

I respectfully suggest that we can help cut down the number of tragic accidents if we totally commit to three basic actions:

  1. Put the right people behind the wheel in the first place;
  2. Monitor driver behavior closely and truly take the steps necessary to change behavior when problems occur; and
  3. If you can t change bad driving behavior, then get that driver the hell out of the driver s seat before someone gets killed.

There s way too much at stake here to do it any other way. Here are 10 additional comments as food for thought on this fundamental issue:

1. Screen Drivers: Do we carefully screen our drivers before we put them behind the wheel of an 8-ton missile (aka, an ambulance) or a 25-ton fire apparatus? Do we obtain detailed driver s license history reports on at least an annual basis? Some people just aren t good ambulance or apparatus drivers and lack the competency and skill sets needed to handle a large vehicle, especially in an emergency response mode. They simply shouldn t be there in the first place, and yes, we need to tell them that.

2. Assess Hands-On Driving Skills: Do we road-test our drivers on a regular basis? Let s face it. The standard EVOC course is essentially a parking test with some good didactic principles of safe driving thrown in. It shouldn t stand alone as the core driver-training program, as it does in many areas. We need to have approved driver instructors in our departments, and they need to regularly road-check our drivers on a one-on-one basis. And drivers should not be behind the wheel of an emergency vehicle unless they have been in that driver s seat on a regular basis. This is a particular concern in volunteer departments with low call volumes.

3. Teach the Mechanics of Operating Larger Vehicles: What about adding training for a commercial driver license (CDL) or other large vehicle? (It s a more relevant suggestion for larger apparatus drivers, naturally.) Pennsylvania doesn t require ambulance or fire apparatus operators to have a CDL, but my department is going to offer the essentials of the CDL program stopping short of requiring drivers to be licensed as commercial drivers. This training helps ensure coverage of such key principles as use of air brakes and the unique physical and operational characteristics of larger vehicles.

4. Add Electronic Vehicle Monitoring: Many of us used to think this was too much big brother watching, but now this is an absolutely essential element of a comprehensive accident risk-management program. And the technology has greatly advanced and has essentially evolved into a practical behavior modification program. All emergency vehicles should be equipped with vehicle-monitoring systems, such as devices developed by DriveCam, Road Safety and others. These systems provide either direct feedback to the driver or prompt feedback after an incident. All drivers can then learn from both bad and good driving events that can be shared throughout the department. These devices can be used as a positive tool and as a reward system. Some departments have done a great job in making these systems work well for positive behavioral change.

5. Consider Use of Computer Simulators: While I was at an EMS conference not long ago, I sat in one of those high-tech, video-game-type units in the exhibit hall. It threw all sorts of scenarios at me, including the school bus stop and the little old lady who jaywalks into the road. (Heck, I had so much fun, the folks behind me in line were telling me to leave and give them a turn!) These computer simulation units are rapidly evolving and can provide realistic simulation of the types of situations one might encounter operating an emergency vehicle, including those that aren t too common but can be killers unless the right split-second decision is made.

6. Set the Right Culture from the Top Down: Our EMS and fire service is in great part made up of us junkies of excitement. And with that addiction to excitement comes an addiction to speed — the fast-acting drug! Setting the right culture of safety requires a strong and visible commitment at the top, coupled with constant reminders and messages from the chief or director on down about why we need to slow down and drive more safely.

7. Don t Ignore Bad Behavior: This requires all officers and each of us as peers — to actually say something when someone s operating a vehicle unsafely or too fast. Far too often, we look the other way to avoid confronting a driver who is exhibiting bad driving behaviors. Lack of this essential confrontation is also a downside of our sometimes fraternal and close-knit culture. We need to make it OK in our department s culture to pull our brothers and sisters aside when they screw up and tell them about their behavior and the impact it can have on their own safety and the safety of others.

8. Limit the Number of Rescue Vehicles: Too many vehicles to the rescue is dangerous! In some areas of in the country, they send just about a full battalion to a vehicle accident with no known injuries along with numerous chief s cars and other vehicles. But 95% of the time, that level of response is simply not needed. The reason we send so many units may in part be due to low staffing levels, as many suburban and rural areas are volunteer. But as we all know, the greater the number of emergency vehicles that respond, , the greater the likelihood of one of them being in an accident. We need to critically ask ourselves, do we really need all this equipment? We need to promptly scrutinize the need for resources, and cancel or slow down units as soon as possible once a unit gets on scene and determines that the situation is not emergent or that not all the dispatched resources are needed.

9. Get the Job Done and Leave: Get out of the scene as quickly as possible. Keep things moving. Think ahead and anticipate the next task before you finish the one you re on. We know that standing around an accident scene isn t safe — even with those multicolor neon vests we now wear and good vehicle placement as barriers. Time isn t on our side when we re at an accident scene. Too many people get hurt or killed while operating on scene. Promptly getting our jobs done and clearing the scene reduces this risk tremendously.

10. Think Before You Respond: The following message is posted at my fire station for us drivers to see as we pull out. I m not sure where it came from, but it s an excellent reminder of the awesome responsibility we each have as a driver/operator of an ambulances or fire apparatus:

If you get to the scene 30 seconds later — safely — no one will remember that you were late. But if you try to get to the scene 30 seconds sooner and kill someone in the process, no one will ever forget it!

And I would be remiss in not mentioning the problems we have with ambulance design. As Nadine Levick, MD, MPH, says in her always dynamic and thought-provoking presentations, being in the back of many modern ambulances may be like being in a death vault. Too many people are seriously hurt in the back of an ambulance from getting thrown around, striking sharp objects or getting hit by a flying piece of equipment. (Visit Dr. Levick s Web site at Much more work needs to be done by manufacturers to make the back of our ambulances safer for both the patient and their noble caregivers.

We need to applaud those individuals who speak out on the need for change in our mindset about safety and join the chorus — people like Dr. Levick and our colleagues Chief Billy Goldfeder, Gordon Graham and many other strong voices. (Visit their sites at and We all need to be activists if we are to stop this unnecessary carnage we unfortunately create ourselves. We do too much good in other areas for this issue to cloud the public s perception of EMS and the fire service.

Steve Wirthis a founding partner of Page, Wolfberg & Wirth LLC, a national EMS industry law firm. He has been operating emergency vehicles since 1978 and is an active firefighter/EMT with the Hampden Township Volunteer Fire Company in Mechanicsburg, Pa. He can be contacted at [email protected].