Nobody should ever be in a position where they’re driving a vehicle and they haven’t had training. This statement is especially true when it comes to driving an ambulance, which doesn’t handle like your 3,010-pound Toyota Prius.

The mission when operating an ambulance is often urgent, responding to potentially critically ill or injured patients with limited dispatch information and then transporting those patients to a hospital emergency department for additional life-saving care.

Let’s look at today’s standards of emergency vehicle operational safety training and then explore how to shore up standards nationwide.

A Curriculum is Developed, But Updates are Scarce

In the mid-1990’s the National Highway Traffic Safety Administration (NHTSA) developed a training curriculum for emergency vehicle operators focused on ambulance driving. The emergency vehicle operator course, or EVOC, hasn’t been updated since its inception in 1995. Most states that recommend this training allow updated courses as long as they’re based on emergency vehicle operation concepts or standards.

Data from a 20-year study released by NHTSA in 2015 paints the following picture: In a typical year there was an average of 4,500 ambulance crashes. This typical year would include 33 fatalities of which 4 percent were ambulance drivers, 21 percent were ambulance passengers, and 75 percent were occupants and non-occupants of the other vehicles.

It was clear then that a dedicated training course was desperately needed.

In 2017, we recognized the deficiencies of existing emergency vehicle operator training. At that time, we developed the textbook EMS Vehicle Operator Safety (EVOS). Next, with input from the NAEMT EMS Safety Committee, and Jones and Bartlett Learning, EVOS was turned into an 8 hour (didactic) or 16 hour (didactic and skills) course recognized as one of the series of continuing education courses for EMS practitioners offered through NAEMTs training network. 

As we think through current and future course material, below are the key issues we are focused on when it comes to emergency vehicle operation:

• Lights and Siren Use: The Lights and Siren paradigm is rapidly changing. With an average of 58 percent of the ambulance fatalities occurring during L&S emergency use most would question the risk is not worth the very limited clinical benefit to the patient. Arriving at the emergency room 2 to 3 minutes earlier only to sit in the hallway waiting to be seen or waiting for a life-saving procedure to be scheduled just does not make sense. In February of 2022 a Joint Statement on L&S Vehicle Operation on EMS Responses was issued by the National Association of EMS Physicians and 12 other leading associations. This statement will be the tipping point changing the previous behavior of racing to the scene with L&S on every call to a less risky patient clinical condition centered approach and emergency medical dispatch (EMD) assigned priority based on medically reviewed algorithms when responding.
• The Golden Hour Re-imagined: We are currently rethinking the “golden hour” concept - the idea that a trauma victim needs care within an hour of an incident or their chance of survival decreases dramatically. It is not that emergency vehicle operators shouldn't be expedient. We want emergency vehicle operators to have a full understanding of how little time is actually saved on the road, the increased risk of rushing, and we are considering better ways to save time. For example: calling ahead and receiving physician permission to bypass the emergency department and take the cardiac patient directly to the cath lab.
• Securing the Scene: The scene is never safe, especially on a highway. Traffic Incident Management is essential, must be preplanned and coordinated with other emergency response agencies, and practiced often to reduce the number injuries and fatalities occurring at the scene of a highway incident. As we note in the text, “We cannot simply rely on a state’s "Move Over" Law or the Visible Vests to prevent secondary crashes from occurring.”
• Addressing Fatigue: Fatigue is the emergency vehicle operator's enemy. Studies have shown that work-related fatigue affects greater than half of EMS personnel. The odds of injury, medical error, patient adverse events, and safety compromising behavior are higher among fatigued EMS personnel than non-fatigued personnel. All EMS agencies and practitioners must begin to deal with this risky behavior.

Additionally, it is very important to stress the need for all emergency vehicle operators to be trained by qualified Field Training Officers familiar with all the concepts discussed in the EVOS course.  

How Trainers Can Get the EVOS Course

Currently, EVOS is made available by the National Association of Emergency Medical Technicians (NAEMT) and offered through Public Safety Group. Public Safety Group invites qualified instructors to request a sample chapter of EVOS in consideration of course adoption.

Request a Sample Chapter

About the authors:
Bob Elling, MPA, EMT-P has been involved in EMS since 1975. He is a paramedic with the Town of Colonie EMS Department, Times Union Center, and Whiteface Mountain Medical Services. He is a retired clinical instructor from Albany Medical Center and worked in the Hudson Valley Community College Paramedic Program. He has served as National and Regional Faculty for the American Heart Association (AHA), and as Regional Faculty for the New York State Bureau of EMS. He was also a paramedic and lieutenant for New York City EMS, paramedic program director and associate director of the New York State EMS Bureau, and an education coordinator for PULSE: Emergency Medical Update.

 

Robert Raheb, AS, EMT-P, has been in the EMS field for over 30 years and has had a leadership role in the Emergency Vehicle Operator course program. He achieved a high degree of success after adapting the New York City Fire Department Bureau of EMS curriculum to include simulation training, resulting in a 50 percent reduction in intersection collisions. Robert also writes for national publications and conducts several speaking presentations each year.