A Retrospective, Single-Agency Analysis of Ambulance Crashes during a 3-Year Period: Association with EMS Driver Characteristics and a Telematics-Measured Safe Driving Score.

BACKGROUND: Driver demographics and aggressive driving behavior are established risk factors for traffic accidents, yet their role in ambulance crashes remains poorly studied. We reviewed all ambulance crashes that occurred in our emergency medical services (EMS) agency during a 3-year period, and examined incidence rates (IR) by driver characteristics and telematics-measured driver behavior. METHODS: This retrospective study was conducted in a U.S. EMS agency that operates 75 Type III ambulances and requires personnel to document all ambulance collisions, regardless of severity. Crashes reported between September 2017 and August 2020 were reviewed, and established criteria were used to classify injury and vehicle damage severity. Serious crashes were defined as events with any injury and/or functional or disabling damage. A vehicle telematics system installed fleet-wide in 2017 continuously captures driver-specific data, including miles driven and indicators related to speeding, harsh cornering and braking, and seatbelt use. A composite score characterizes compliance with safe driving behaviors (1 = low compliance to 5 = high compliance). Crash IR per 100,000 miles, IR ratios (IRR), and Poisson regression were used in analysis. Driver sex, age, agency tenure, miles driven, and safe driving score were examined. RESULTS: Clinicians reported 214 crashes and the IR of any crash and serious crash were 2.1 and 0.63 per 100,000 miles, respectively. Injuries occurred in 8% of crashes and were all of low acuity. About one third of crashes produced functional (21%) or disabling (8%) vehicle damage, and the ambulance required towing in 10%. In a multivariate model, female sex (IRR = 1.50, 95%CI = 1.13-1.97), age 18-24 (IRR = 1.67, 95%CI = 1.06-2.66), and being in the lowest quartile of safe driving score (IRR = 1.51, 95%CI = 1.14-2.02) were EMS driver factors independently associated with an increased risk of any collision. CONCLUSION: Most ambulance crashes are minor events, but the proportion that result in injury and/or functional or disabling vehicle damage may be as high as one-third. Poor driver compliance with objectively measured safe driving behaviors may increase risk for collisions independent of driver sex and age. The EMS industry would benefit from additional studies that examine the full spectrum of ambulance crashes and expand understanding of EMS driver-related risk factors.

Evaluation of an EMS-Based Community Paramedic Pilot Program to Reduce Frequency of 9-1-1 Calls among High Utilizers.

BACKGROUND: Many community paramedic interventions aim to reduce unnecessary emergency department visits among high utilizers of acute care, but fewer focus specifically on reducing summons for emergency medical services (EMS). We implemented an EMS-based pilot program that identified high utilizers of 9-1-1 and facilitated community paramedic outreach encounters to understand and address potentially unnecessary 9-1-1 calls. This study compares the pre- and post-intervention incidence rate of 9-1-1 calls among program participants. METHODS: This retrospective evaluation was conducted using pilot data from a single U.S. EMS agency that responds to approximately 100,000 9-1-1 calls annually. High utilizers, defined as individuals with ≥3 9-1-1 calls in 90 days, were identified for recruitment between February 1, 2019 and December 31, 2019. Community paramedics recruited participants via phone and then conducted home visits to assist them with navigation away from unnecessary 9-1-1 use. Dispatch data from September 1, 2018 to December 31, 2019 were used to compute the incidence rate of 9-1-1 calls per 30 person-days of observation before and after the initial home visits. RESULTS: Data from 108 program participants were analyzed. The majority were over the age of 50 (79%), and 33% completed more than one visit. Median person-days of observation before and after the initial home visit were 354 days and 132 days, respectively. Participants called 9-1-1 an average of 0.68 times per 30 person-days prior to the community paramedic intervention, and 0.51 times per 30 person-days after the intervention, which represents an overall mean decrease in 9-1-1 utilization of 25% (p < 0.001). Although a decrease in 9-1-1 utilization was observed in the majority of participants, the 9-1-1 call rate increased in 29% of participants. No statistically significant changes in 9-1-1 use were observed in participants who received more than one home visit or who were in the highest quartile of 9-1-1 use prior to the intervention. CONCLUSION: This pilot work demonstrates the feasibility of an EMS-based, community paramedic-only intervention to reduce unnecessary 9-1-1 calls and suggests that some modest reductions in EMS use may be achievable by dispatching community paramedics to conduct home visits with frequent users of 9-1-1.