EMS Driver Error Caused 92.6% of All Fatal 2012-2018 Ambulance Crashes, Says NHTSA Report

EMS driver error was cited in almost all fatal U.S. ambulance crashes between 2012 and 2018. That’s one of the stunning conclusions made in the “Analysis of Ground Ambulance Crash Data From 2012 to 2018" report released by the National Highway Traffic Safety Administration (NHTSA).

“The SCI [the NHTSA’s Special Crash Investigations Unit] reports ... for 2012 to 2018 showed nearly all crashes (92.6%) involved ambulance operator/driver error,” said the NHTSA report. “Improper clearing of intersections, traveling against red lights, and operator fatigue were noted as factors in the crashes. Lights and sirens were active in 40.7 percent of the crashes. The expert reviewers noted that lights and sirens were often used in situations that were not recommended according to best-practice guidelines.”

As for the human toll from these errors? “Ambulance-involved fatal crashes remained relatively rare from 2012 to 2018 with a national average of 24.7 fatal crashes per year and 28.4 fatalities per year reported in FARS [the Fatality Analysis Reporting System],” the NHTSA report said. “Of the individuals killed, 40.2 percent were ambulance occupants (operators/drivers, front seat passengers, and clinicians or patients in the cabin), 52.3 percent were occupants of other vehicles involved in the crash, and 7.5 percent were non-occupants (e.g., pedestrians, bicyclists).”

Sobering Statistics

To put it mildly, these statistics disturb NHTSA EMS Specialist David Bryson. Most of all, “We need to reduce operator error because in 92.6% of the 27 SCI crashes investigated, ambulance operator error was a significant factor,” he told EMS World. “Improper clearing of intersections was a big one. Ambulances must come to a complete stop at red light and make sure the way is clear before they proceed. But many of these emergency vehicles did not stop completely before traveling through the intersection.” Other factors that contributed to these fatal crashes were speeding (14.8%), unbelted occupants (14.8%), driver fatigue (11.1%), impairment caused by alcohol or other drugs (3.7%), driver medical condition (3.7%), and driver distraction (e.g., GPS or cell phone use, (3.7%). 

Bryson is also concerned about this conclusion in the NHTSA report: “A key finding in the SCI crash reports was lack of proper restraint use by clinicians and patients,” it said. “Only 8.8 percent of clinicians in the patient compartment were properly restrained, and no occupants in the front passenger seat were properly restrained. While 95.7 percent of the patients were restrained in some manner, only 17.4 percent were properly restrained by both lateral belts and shoulder harnesses.” 

Given that EMS professionals attend crash scenes involving injured and deceased unrestrained drivers/passengers regularly, “we were concerned to see a rise in the number of EMS clinicians from the initial NHTSA 1992-2012 report to this 2012-2018 report that were not appropriately restrained in the back of ambulances during fatal crashes,” he said. “In the original report, about 84% of the EMS clinicians inside a fatal ambulance crash were not restrained. That number has gone up in this study. 92% of the EMS clinicians killed in a fatal ground crash during 2012-2018 were not restrained at all or properly restrained inside the ambulance.” 

Play it Safer 

The NHTSA report makes several recommendations aimed at reducing the number of fatal crashes and reducing the number of fatalities/injuries in those that do occur. They include requiring “all occupants to be properly restrained when the vehicle is [in] motion”; requiring “a full stop at all stop signs or red traffic signals before proceeding with caution when using lights and sirens”; and “no phone or other handheld electronic device used while the ambulance is in motion”.  

The NHTSA report also calls for EMS agencies to reduce driver error by requiring “all operators to complete an ambulance-focused emergency vehicle operator course (e.g., Emergency Vehicle Operators Course (Ambulance): National Standard Curriculum [NHTSA, 1995])”; creating a “Culture of Safety” by consistently enforcing safety procedures; and adopting new ambulance designs that improve safety for drivers, clinicians, and patients. 

All this being said, it is up to EMS drivers and their colleagues to put safety first during all aspects of the job. “I want people, especially our EMS clinicians, to understand how important it is for them to safely respond to any event or emergency,” said Bryson. “A big part of that is driving responsibly and always wearing their safety belts just in case something were to happen. We then need them to responsibly assess whether they need lights and sirens or not, and then safely transport their patient who is already sick or injured, and does not need to be involved in a crash going from the scene to definitive care.” 

As well, Bryson urged EMS personnel to think hard about the 27 fatal crashes that occurred between 2012-2018 and the fact that most of the deaths were preventable. “The victims were your peers, others just like you who are doing the same types of jobs you are doing and trying to protect themselves and the public,” he said. “I want people to take that to heart and to change their behaviors as much as possible so that we can eliminate ground ambulance crash fatalities.”