The Need for Speed: Crash Investigations

IN THE EMERGENCY services world, speed is supposedly everything for promptly arriving at fires, emergency medical services (EMS), rescues, and other activities. “The faster we go, the better the outcomes” is a preconceived notion that no research has proven. I was a person who once believed that speed made a difference. In reality, speed did not make that much of a difference for EMS. For the firefighters out there disagreeing, the need to arrive at a location and rescue those trapped and at risk of dying remains crucial; speed is elemental in those rescues.

However, as we see, there are several accidents involving fire apparatus attributed to speed or a lack of seat belts that have killed or severely injured emergency responders. Patients with an abnormal respiratory rate on a Glasgow Coma Scale score of eight or less (hemo/pneumothorax) benefit from helicopter EMS transport despite ground EMS transport being faster. This is an example of how patients would primarily benefit from advanced airway and chest trauma management in helicopter transport rather than a faster ground transport to a trauma center.¹

The more advanced treatment we can provide in the field, the more successful the outcomes will be. The model of heading to the hospital for life-saving treatment following the proper speed limit and using lights and sirens will likely save more lives. The more action we take on the way to a medical facility, the more we can positively intervene in cardiac arrest with advanced techniques or strokes with field-applied medicine interventions, including blood transfusions. Immediate admission to the stroke center, catheterization laboratory, or trauma center improves outcomes after we arrive at the hospital.

It is common to think those in EMS or fire rescue are getting different messages related to speed and arrival times. Our job is to arrive safely at the scene and apply lifesaving rescue skills. Crashing our apparatus en route fails to accomplish that goal.

Turnout Time

Turnout time is vital to firefighters’ ability to provide life-saving services. It begins with a dispatch from a 911 call center. Dispatchers notify the responders, who prepare for the emergency by donning their protective equipment and boarding their emergency vehicles. The National Fire Protection Association (NFPA) recommends a two-minute turnout time, yet we do not always meet this guideline.² NFPA 1710, Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments, establishes a 90% benchmark time goal for turnout time at 80 seconds for fire responses and 60 seconds for EMS responses. This goal is part of a larger benchmark time goal of 560 seconds (nine minutes and 20 seconds) for deploying an initial full-alarm assignment at a fire suppression incident. This larger goal includes 480 seconds (eight minutes) for travel time and 15 seconds for alarm answering time. The standard also calls for the initial assignment to arrive within nine minutes of dispatch 90% of the time. This ensures that enough people and equipmentarrive to control the fire and that a rescue is performed before significant damage and occupant death occur.³ If we fail to accomplish that turnout time goal, we tend to compensate with speed, which proves unnecessary and dangerous.

Accidents and Rollovers

Motor vehicle accidents (MVAs) involving ambulances, engines, trucks, and tenders cause fatalities of civilians and emergency personnel. These vehicles contain heavy equipment and are unsafe to travel at any speed above the posted speed limit. Even by taking proper precautions, we still get into accidents, resulting in injuries and deaths.

Traveling at unsafe speeds contributed to the crash of a Fort Worth (TX) Fire Department engine that rolled as it turned from one street to another. Two members of its crew were critically injured. No other factors or conditions were found to cause the crash. The engine was responding to a house fire, and as it negotiated the turn, it rolled and stopped against a tree. The engine was the only vehicle involved.⁴ There are hundreds of similar events that can be prevented (photo 1).

1. Photo by Glen E. Ellman.

Understand Cause and Effect

We understand the cause and effect of speed and its dynamic effect on heavy equipment. Driver training on all types of apparatus is imperative for safe driving operations. Due to the sheer size and mass of fire vehicles, fire truck occupants typically face a very low risk of injury during typical multivehicle traffic crashes.

The most harmful event for approximately 75% of all fire truck crashes is a collision with another motor vehicle in transport. However, rollovers are the highest contributor to fatalities in crashes, accounting for nearly half of the most harmful fatal events. This indicates that firefighters are exposed to a greater risk of injury or fatality in a rollover crash compared to a nonrollover crash.⁵ Previous studies have found that fire truck crashes are most common near intersections, in the afternoon peak periods, and with high-risk behaviors like speeding and passing maneuvers.⁶

Fatal Crashes

Almost all (92.6%) of the 27 Special Crash Investigation (SCI) crashes reviewed involved ambulance operator/ driver error. This 2023 study reviewed ground ambulance crashes in the United States from 2012 to 2018. 45.7% of the fatal crashes occurred during emergency use of the ambulance, and 28% occurred when lights and sirens were active.

The study queried several national crash databases and reviewed the National Highway Traffic Safety Administration’s SCI reports on ambulance-involved crashes. Data in the Fatality Analysis Reporting System revealed that ambulance-involved fatal crashes remained relatively rare from 2012 to 2018, with a national average of 24.7 fatal crashes and 28.4 fatalities per year.

Of the individuals killed, 40.2% were occupants of the ambulance (i.e., operators/drivers, front seat passengers, clinicians, or patients in the cabin), 52.3% were occupants of other vehicles involved in the crash, and 7.5% were nonoccupants (i.e., pedestrians, bicyclists). Overall, 45.7% of the fatal crashes occurred during emergency use, and 28% occurred when lights and sirens were active.

Analyses of the National Automotive Sampling System, General Estimates System, and Crash Report Sampling System data indicated that approximately 36.2% of injury crashes occurred when the ambulance was reported to have lights and sirens active, and of those injured, 24.4% were occupants inside the ambulance.

Similarly, lights and sirens were active in 40.7 % of the SCI crashes. Almost all (92.6%) of the 27 SCI crashes reviewed involved ambulance operator or driver error. Improper clearing of intersections, traveling against red lights, and operator fatigue were also noted as contributing factors in SCI crashes. A key finding in SCI crashes related to injury and fatality was the lack of proper restraint use by both clinicians and patients.⁷

Here is a list of the most common causes of fire truck or ambulance collisions:

• Right-of-way: All vehicles are expected to give a fire truck the right-of-way when their lights are flashing en route to address a fire hazard. Drivers who fail to give way to the fire truck are a common cause of crashes.
• Speeding: The misleading concept that fire trucks must speed to rush to a destination or emergency often gives other motorists little time to react, thus causing an accident.
• Equipment: Improperly securing equipment on apparatus, such as ladders or hoses, has been linked to accidents.
• Failure to follow rules: Firefighters operating the trucks often fail to stop at red lights and stop signs, even though they are required to by law. When a driver speeds through an intersection, collisions may occur, causing firefighter and civilian injury and deaths.⁸

Buckle Up and Slow Down

Approximately 500 firefighters are involved in fatal fire truck crashes each year, and 1 out of 100 of these occupants die as a result of the crash. Despite changes in regulations that govern fire vehicle safety, the average fatality rate per year has remained relatively stagnant.

Rollovers are the most common crashes that result in firefighter deaths (66% of all fatal fire truck crashes), and most of those fatalities were unrestrained occupants. Redesigning and improving fire truck and ambulance restraint systems could reduce the number of injuries and fatalities in vehicle crashes. Still, the restraint systems will only be effective if firefighters buckle themselves in while riding in the apparatus.

For ambulance operators, the statistics of accidents, fatalities, or injuries all point to speed and a lack of restraining devices for the occupants. Training programs incorporating driver safety protocols have been shown to reduce fire truck and ambulance accidents by 25%. We must arrive safely to do our jobs and go home at the end of our shift.

ENDNOTES

1. Chen, Xilin, et al. “Speed is Not Everything: Identifying Patients Who May Benefit from Helicopter Transport Despite Faster Ground Transport.” Journal of Trauma and Acute Care Surgery, vol. 84, no. 4, Apr. 2018, pp. 549-557, bit.ly/3ZwTPaB
2. Industrial and Systems Engineering Conference. Institute of Industrial and Systems Engineers (IISE), 2017, bit.ly/4fgEH78.
3. “NFPA 1710: Standard for the Organization and Deployment of Fire Suppression Operations. Emergency Medical Operations and Special operations to the Public by career Fiew Departments”. NFPA, 2020, bit.ly/3ZgQAFa.
4. Clarridge, Emerson. “Unsafe Speed Contributed to Fort Worth Fire Engine Rollover Crash That Injured 4: Police.” Fort Worth Star-Telegram, 8 Apr. 2024, bit.ly/3DeFR5I.
5. Donoughe, Kelly, et al. “Analysis of Firetruck Crashes and Associated Firefighter Injuries in the United States.” Annals of Advances in Automotive Medicine, vol. 56, 2012, pp. 69-76, bit.ly/49DIoTd.
6. Savolainen, Peter, et al. “Investigation of Emergency Vehicle Crashes in the State of Michigan.” National Transportation Library’s Repository and Open Science Access Portal, 2009, bit.ly/3DgZ2fe.
7. Graham, Lindsey, et al. “Analysis of Ground Ambulance Crash Data From 2012 to 2018.” National Highway Traffic Safety Administration, 2023, bit.ly/3BBfsOQ.
8. “Fire Truck Accident Statistics.” World Metrics, bit.ly/4gCq9jj.

JOHN K. MURPHY has been a member of the career fire service since 1974, beginning his career as a firefighter and paramedic and retiring in 2007 as a deputy chief and chief training officer. He has been a licensed attorney in Washington State since 2002 and a licensed physician’s assistant since 1977. Murphy consults with fire departments and public and private entities on operational risk management, response litigation, employment policy and practices liability, personal management, labor contracts, internal investigations and discipline, and personal injury litigation. He serves as an expert witness involving fire department litigation and has been involved in numerous cases across the country. He is a legal and management educator, a frequent legal contributor to Fire Engineering, a participant in Fire Service Court Radio, a blogger, and a national speaker on fire service legal issues. He is a distance learning instructor with the University of Florida Fire and Emergency Services undergraduate program.