Safety evaluation of a medic's work environment during rural emergency response

Abstract

The purpose of this study was to gain a better understanding of emergency medical service working conditions, and to develop recommendations to aid in minimizing harmful actions and behaviors inherent in EMS work. The naturalistic data collected in this study allowed researchers to perform analysis in a rural emergency driving environment to identify contributing factors to attending medic behavior, severity of biomechanical forces experienced in the driver and patient compartment, and an evaluation of emergency medical response safety culture. Based upon research findings, the project includes development of a series of environmental, ergonomic, policy, or training recommendations to mitigate circumstances that cause potentially unsafe operations in the driver's and patient's compartment of the ambulance. This study used naturalistic data and video, survey responses, focus groups, and agency patient care records to analyze the rural medics' working environment during emergency patient transportation. Accelerometer data was analyzed for 102 separate emergency transports to provide descriptive statistics relevant to whole-body vibration experienced by the medics during patient care. Five years of patient care records were analyzed to identify specific patient illnesses and medical procedures associated with traveling in emergency response mode. Restraint compliance rates were collected for both self-reported (21.5% restrained) and observed (2.6% restrained) data collection methods. Focus groups identified factors influencing medics' choice to be unrestrained, characterized by a reduced ability to provide patient care, the belief that restraint devices will cause harm to the medics, and the belief that the restraint devices are ineffective in a crash situation. Finally, reach analysis was conducted to highlight the procedures and equipment retrieval which require the medics to assume positions resulting in awkward and unstable postures during transport. The results of this study will add to the growing body of knowledge surrounding the behaviors of EMS workers in a real work setting, will aid in understanding the complexities of EMS safety culture, and can be applied toward different aspects of EMS work such as driver or medic training.