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EMS provider helmet use and safety

EMS Provider Helmet Use During Patient Transport

The following information was published by the Center for Disease Control/ National Institute for Occupational Safety and Health.

May 2001: An EMT died as a result of blunt force trauma to the head and chest incurred in an ambulance vehicle collision. The EMT was caring for a patient in the rear patient compartment when the incident occurred. The EMT was unrestrained and struck the front bulkhead of the patient compartment.

July 2001: An EMT died in an ambulance vehicle collision after striking the front bulkhead of the patient compartment. The EMT was unrestrained.

March 2002: A paramedic was seriously injured after striking the interior cabinets of the patient compartment in an ambulance vehicle collision.

According to the National Highway Traffic Safety Administration, 300 fatal crashes involving ambulances occurred between 1991 and 2000. Data published in the Fatal Analysis Reporting System indicated that 27 EMS personnel fatalities occurred as a result of these collisions. (1)

Recently the National Fire Protection Agency published an initial draft for the NFPA 1917 standard: Ambulance Vehicle Safety. The new standard defines the requirements for new automotive ambulances to be used to provide medical treatment and transportation of sick or injured people to appropriate medical facilities. The purpose of this document is to set the highest standard of safety specifications for the ambulance manufacturing industry. Advances in safety engineering for ambulances are long overdue. Every year, several pre-hospital healthcare providers are injured, in many cases fatally, in ambulance vehicle collisions. Head injuries are the most common injuries incurred. Healthcare providers engaged in patient care in the rear patient compartment are subject to striking the bulkhead or being struck by a flying object during the course of an ambulance vehicle collision. In many cases, serious injuries can be prevented by actions on the part of the EMS provider. Securing equipment, specifically equipment that has the potential to seriously injure the EMS provider or patient, should be of primary importance. Cardiac monitors, laptop computers, and oxygen cylinders should be properly secured with specialized brackets or straps. The EMS provider should make every effort to be restrained properly with a seat belt of safety harness. Patients should always be properly restrained to the ambulance gurney or bench seat during transport. In addition to these standard safety measures, EMS providers should consider wearing a helmet during patient transport. The use of helmets would greatly reduce the incidence of EMS provider head injuries sustained in ambulance vehicle collisions. Unfortunately, this alternative has not been widely realized and placed into standard operating guidelines. The standard firefighting helmet would not be a practical alternative for the EMS provider engaged in patient care during ambulance transport. The weight and shape of a firefighting helmet would be restrictive and cumbersome and an impedance to patient care. A lighter helmet, such as a helmet utilized in swift water or rope rescue would be a more practical alternative. When the rescuer or firefighter is engaged in fire suppression or rescue activities, a helmet is a standard requirement in accordance with the highest level of safety. Wearing a properly designed helmet while providing patient care in a moving ambulance should be considered as a standard requirement as well. In the interest of safety, EMS providers should considering donning a helmet while caring for a patient in the rear patient compartment.

(1) SL Proudfoot, NT Romano, TG Bobick, PH Moore
Division of Safety Research
National Institute for Occupational Safety and Health, Center for Disease Control

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Permalink Reply by Roland O'Leary on April 4, 2012 at 2:30am

My history... 30 years in EMS and Fire Services. Currently work full time for an ambulance service doing interfacility transfers regionally, part time for a combination 911 ambulance service, and a volunteer fire department.

For years I have sat on the side lines quietly watching the debate over the need for helmets in ambulances. I have even looked at a few and thought it might not be a bad idea, especially in bad weather. This past December or January I actually went in search of a special helmet that I had seen at a conference several years ago, that was made just for EMTS. I was thinking I might get one. That helmet, the AVC is no longer available I found. I had given up on the idea until this past weekend after reading a vehicle accident report. Mine.

Recently my partner and I were involved in a multi-vehicle crash involving our ambulance. I was the unrestrained attendant sitting (I believe) on the squad bench. I sustained a serious concusion, a large laceration to the head, a broken jaw, and a very badly bruised back, chest, and side. Our ambulance impacted another vehicle, causing the subsequent 90 degree rotation of our unit, and ending in 1 1/4 rollover. I also sustained a memory loss of all the incident and rest the day, with the exception of about 15 seconds involving about 4 snippits of time following the incident. My partner says he found me unconscious with snoring respirations, and responsive to verbal stimuli, total down time unknown... He was too busy trying to manage our patient, to worry a whole lot about me (I'm good with that). I did regain conscousness on my own and was able to assist him and an off duty nurse in attempting to stabilize our patient until additional resources arrived.

Recovery has been slow, and still continues. I hope to be cleared to full duty in about 30 more days. But this incident along with a conversation I had with another medic a week or two before our incident got me thinking. What if I was on a transfer in the middle of no where (yes we travel through there several times a month) and my partner swerves to miss a deer, cow, debris, or has to brake hard while I am moving about the box and I smack my head against the bulkhead or a cabinet resulting in unconsciousness....How long is it before he/she notices? What is he/she going to do if we are in the middle of no where with no radio, no cell service and no one for 40 miles in any direction to come assist? What then? Who takes care of my patient? Who takes care of me? If my partner does, then who is going to drive? How do we get help?

Something for everyone to ponder. Obviously in the case of our crash, a helmet would have lessened my injuries, and I could have been a whole lot more help to my partner and our patient following the crash. Being in a lap belt on the squad bench, not so sure if I would have been better or worse off. But these instances, thankfully, are more rare than ambulances having to make evasive manuvers involving swerving and hard braking. These evasive manuvers (hard braking and swerving), I would guess, are occuring several times a day, exposing the unrestrained attendant to the potiential for a head injury, and our patients to compromised care. It is for this reason that I am seriously looking at a helmet for the back of the ambulance. I figure the odds are greater of this happening, than being involved in another rollover crash (quick somebody hand me a piece of wood). I am also going to work on doing better planning for my patients needs during transports, so that I am unrestrained less during transports. Lastly securing loose equipment should be something that we all can do to lessen our danger.

I hope this has been thought provoking. I don't know that we need more rules to keep us safe? I think we just need to spend a little more time and put a little more thought into our safety. For me, the wearing of a helmet in the back of the ambulance seems like a step in the right direction.

Stay Safe...

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Permalink Reply by Clarence T(Tom) Bragg on April 4, 2012 at 2:21pm

Tried googling for EMS Helmet found many EMS helmmets in a variety of styles. I personally like this style from PACIFIC:

http://www.rescuetech1.com/usaremshelmet.aspx

Many other styles are shown, this style protects the side of the head.

Tom Bragg

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