Columns, Patient Care, Training

Enforce Practices that Keep Patients and Providers Safe

Issue 10 and Volume 39.

You place the patient in the back of the ambulance. His chest pain is relieved with one spray of nitroglycerin, but you also give him aspirin and establish an IV. The cardiac monitor shows no signs of ischemia and the patient remains pain free. You let your partner know you’re ready to transport.

You request a non-emergent transport to the local hospital because it’s close by. The back doors of the ambulance close.

You hear your partner climb into the driver’s seat, shut the door and put the ambulance in gear. You feel the ambulance move forward as you reach for the radio to notify the hospital of your arrival, but you’re suddenly thrown forward as you hear a crash.

You see the patient flail his arms and reach for something to hold on to as he’s bounced in the air and back onto the stretcher. You realize you’re upside down and there’s a burning sensation on the top of your head. Things are a bit fuzzy for a moment as your partner stands over you, saying, “I’m sorry!”

Collecting yourself, you move to evaluate your patient—he’s without complaint and is more concerned about you and the blood dripping into your eye. Your partner calls for additional ambulances, which take you and your patient to the ED.

So what happened? There were no other cars around and your partner had just turned out of the parking lot. There were no high-risk conditions, yet your ambulance crashed.

Discussion
To get to the hospital, the driver selected a route he drives daily on his way to work. The roadway selected, however, runs under a low-clearance bridge that’s high enough for passenger cars but not high enough for the ambulance, which was traveling about 25 mph when it struck the low overhang. The ambulance came to a complete stop in about four inches of roadway. The unrestrained provider in the back of the ambulance was immediately thrown off balance, went head first into the front cabinet and landed upside-down in the side entrance step-down.

Luckily, the patient wasn’t injured and his initial complaint of chest pain hadn’t worsened. The driver wasn’t hurt, and the thrown provider received several stitches but didn’t suffer any other injuries.

While there are several lessons to be learned from this collision, there was a lot that was also done correctly. The patient was restrained appropriately. Equipment in the back was secured. The driver was wearing his safety belts, obeying all traffic laws and taking the most direct route to the hospital. The provider in the back had completed much of the care prior to transport to avoid being up and about while the ambulance was in motion.

However, the mistakes could’ve resulted in devastating consequences. It’s important for providers and those operating emergency vehicles to be familiar with all aspects of their response area as well as the capabilities of the vehicles they’re driving. Providers in the back of a moving ambulance should be restrained. This is sometimes difficult to do—especially if the patient needs treatments during transport—but unrestrained providers can easily be thrown, causing injury to other providers, the patient and themselves.

Conclusion
It sometimes takes a case like this to make us sit back and critically evaluate our practices. It doesn’t take a high-speed collision involving multiple vehicles to cause significant injury. Low speed, quick stops and sharp turns coupled with unrestrained providers and equipment can all add up to injured providers and patients.

The phrase “Primum non nocere” (which means “first do no harm”) is commonly used to describe the ethical responsibility of medical providers to their patients. This concept can easily be applied in this case.

Delaying patient care, physically injuring the patient or exacerbating their original complaint are all potential consequences of even a low-speed accident. Take care of your patients and each other.