Will Helmets Make Headway in EMS?

     EMS providers should wear helmets in the ambulance, says EMS safety advocate Nadine Levick, MD, MPH, CEO of New York, NY-based Objective Safety LLC, an organization dedicated to improving ambulance safety. She believes that ambulances in the U.S. are unsafe--and until they are built safer, believes providers should wear head protection.

     Levick has conducted several studies on ambulance safety. "Plenty of scenarios have occurred where medics have been struck by a piece of equipment and had serious or life-threatening injuries," warns Levick. She sees helmets as a quick way to provide safety.

     Levick says for a helmet to be successful, it has to weigh less than 1.2 kilograms and be engineered for the types of forces commonly seen in vehicle accidents. "Climbing helmets won't work," she says, "because they are only engineered to protect against one G (force)."

     She envisions helmets being a multi-hazard protection device, with built-in communications and goggles for eye protection.

     That doesn't mean prehospital providers actually want to wear helmets. Paul Angelo is a 12-year paramedic in Northern California who works on a ground ambulance. His reaction to the idea of wearing helmets is typical of most of the prehospital providers Levick is trying to convince.

     Angelo wants to see some other steps before he puts a helmet on his head. "A lot of stuff is not being done as far as our safety, and suddenly we need helmets?" he says.

     In presentations to prehospital providers around the country, Levick cites some scary statistics. She says more than 74% of EMS fatalities are from vehicle crashes, and more than 64% of those result from serious head injuries.

     Angelo's not convinced. "If you show enough people in nasty car accidents, you start to believe it's extremely common," he says. "You've got to do the research to find out how big of a problem this is. What percentage of providers on the road every day are actually getting hurt?"

     Levick can't answer that. She says the exact numbers aren't out there.

     "How many medics have suffered a head injury at work? I'd love to know. Compared to police and firefighters," she says, "the data is difficult to get hold of. There's no database for EMS injuries."

     As a medic in the field, Angelo believes safer ambulances should be the first priority. "We should design a safe ambulance to fit what we do, rather than conform to an unsafe vehicle."

     Levick agrees, and she says the lack of specific EMS statistics doesn't mean there aren't some indicators to get designers started. Levick says automotive safety engineering studies provide a great starting point. Levick says any type of redesign needs to include professional vehicle safety engineering. She says an automobile seat itself is a safety feature, and one that automobile safety experts spend a lot of time and effort perfecting. Levick says seats need to be much more than a cushion from an RV.

     Until redesigns happen, Levick says keeping everything in the back of the ambulance secure--equipment, providers, and patients--is probably the most important aspect of safety.

     "I spent some time in the outback with an organization called the Royal Australian Flying Doctor Service, a fixed-wing patient transport service," Levick says. "It was clear to me that the safety requirements in the air were different from the safety practices on the ground."

     Levick points out how air ambulance caregivers will announce to the pilot when they are not secured in their seats, in order for the pilot to be extra careful. And flight crews only unbuckle in severe cases that require immediate attention. She contrasts that with ground ambulances. "In an ambulance," she says, "when you're out of your seat, you go faster. If you're doing CPR in the back, you should be going 25 miles per hour."

     Seatbelts, says Levick, are intended to keep drivers and passengers secured to a properly engineered automotive rear- or forward-facing seat. Anything else, she says, that lets a provider get out of his or her seat--even while still buckled--is dangerous.

     Levick would like to see standardized testing of ambulances and driver feedback/monitoring devices--known as "black boxes"--in every ambulance. However, redesign is slow and expensive, so for now, Levick wants to protect EMS crews with helmets and action.

     "Securing equipment and restraining all occupants is extremely important," she says. "Those things you can achieve without changing any design features whatsoever."

Rod Brouhard is a paramedic for American Medical Response in Modesto, CA, and former director of the EMS program at Modesto Junior College.