Tradition in EMS is Impacting Responder Safety

By P.J. Norwood

How far would you go for your safety? To what lengths are you willing to go for the safety of your employees?  What steps are you willing to take that will increase your chances to return home to your family each day while at the same time not limiting your ability to provide patient care?

Nineteen years ago I was working part time for a fire department as a paramedic. My partner and I loaded a patient into the back of an ambulance who was having a cardiac emergency. We had approximately a 20-minute transport to the emergency room. I told my partner, “I am all set; I will perform all ALS en route.” As I began to gather the necessary items, he made his way to the driver seat. On this specific day, I had a very good partner, someone who was an experienced, capable driver. I was never concerned with his driving ability! As he slowly pulled away from the curb, moving less than five miles per hour, a car cut him off and, by instinct, he hit the brakes. I recall hearing a noise and then I heard the patient saying, “Sir…sir…are you okay?” When the driver hit the brakes, I was thrown forward. I struck my head on something and was knocked out cold. 

Could this happen to you? Absolutely. Working in the back of an ambulance offers many challenges and dangers to us. Any good, proactive system requires the use of a restraint system in the back of the ambulance during transport. Reality tells me few comply. I understand, I get it–I still work in the back and it’s not easy to take care of patients while restrained. In some ambulances and on some calls, it’s near impossible. 

Let’s take my firsthand experience and break it down. What would have prevented me from getting a concussion? 

  1. A better driver? No, not at all. He was a solid driver, moving less than five miles per hour and was cut off. He took an appropriate defensive action to prevent a collision.
  2. Wearing a restraints system? Yes, absolutely. However there were items (Life Pak 10, oxygen cylinder etc.) not secured that could have become projectiles. We could have ended up with same result.
  3. Engineered patient compartment? Yes, this could have helped, depending where and on what I stuck my head on.
  4. Netting at end of the bench? Possibly would have caught me sliding forward. 
  5. A head protection (helmet) absolutely would have made a difference. A protection device that meets the ANSI standard would have prevented a head injury in this low-speed impact scenario. 

We cannot engineer all risk out of our jobs. We work in a high-risk, dynamic environment where there will always be risk involved. In this type of profession, it is not possible to engineer every risk when we don’t know each and every risk we will encounter. When we look at the industry as a whole, we have made great progress in engineering a safer environment for us to work within. 

The downside with some of the engineering controls is us! Seatbelts have been on the back of the ambulance for many years but their acceptance and use is limited. Reality is seatbelts are difficult to wear while providing patient care.

There are new industry rumors that there are restraint systems that promise to fix the problem. Similar to the success of some risk-reduction models where providers wear a harness in the back of an ambulance that is tethered to the ceiling or side wall.

INSERT PHOTO #1 obtained from internet at

This past year at the Fire Departments Instructors Conference (FDIC) International, I briefly looked at almost 20 different brand new ambulances that offered the “newest, latest, greatest options” on the market. Not one of these show models had any “new” restraints system in place. There were some that offered rear-facing seats only, but no tether or other restraint systems.

When the industry “rumors” do become reality, there will still be many roadblocks before the majority of us see this technology in the streets.

So what can you do today? What can to do today to reduce your risk and reduce your employee risks of a head injury?

As a parent, I require my daughter to wear a helmet every time she rides her bike and I won’t ride a bike without one. We use helmets while riding motor cycles, all-terrain vehicles, and snowmobiles, and some states have helmet laws in place. There are many emergency medical services (EMS) agencies that already issue helmets and require helmet compliance. Some agencies require the use of a helmet while on the scene of a variety of calls, such as fires, motor vehicle accidents, etc. All these incident types have a low risk of a head injury. So why do we not wear a helmet in the back of the ambulance, where the risk is much higher?

Here are some of the reasons I have been told by current providers why they don’t wear a helmet:

  • I don’t have one issued.
  • My fire helmet is too big, heavy, and cumbersome.
  • It will impact my ability to treat a patient.
  • How could I explain it to the patient?
  • I have never hit my head before.
  • Are you crazy! I can’t wear that, can you imagine what they will say?
  • If we get into a high-speed accident, a helmet is not going to save my life

The stigma of wearing a helmet is the number one underlying reason. The EMS culture must change, and it starts with you!

The fire and EMS service is filled with tradition that has carried us through and helped us through some of the most difficult times. Keeping some old traditions is not always in the best interest of our personal safety–especially when it comes to your health and safety. 

One young fire medic told me: “Chief, you are right! I should wear a helmet. But man, the guys will make so much fun of me.” I asked him how often those who make fun of him will come visit you when he is bed confined with a brain injury two years after the incident. Or how often will your family visit? I owe it to my family to take steps to provide as much safety as I can. They clearly understand there are dangers I cannot change, but there are things that I can do and should be doing.

I would rather be made fun of every day for wearing a helmet than have my wife and daughter have to visit me is a rehabilitation center and not even be able to communicate to them. And all because I was too concerned about being made fun of.

I have found and begun using a helmet every time I work in the back of an ambulance. I have also issued a helmet to each paramedic who works for me. I am providing them with an opportunity to continue to provide high-quality patient care and enhance their safety. I cannot prevent or reduce all injuries. But, as a leader, it is my responsibility to take necessary steps to reduce all injuries to my providers.

INSERT PHOTO #2, & #5 Caption – The KASK HI VIS Helmet increases provider safety and does not impact their ability to provide high level of patient care.

When I first presented the helmet theory to my providers, I received all the expected negative feedback. This negative feedback was based on assumptions and not facts. Once I placed the helmet in their hands and they tried it on, their opinion quickly changed. Once they stepped outside of tradition and tried to wear it while working in the back of an ambulance I received nothing but positive feedback.

It’s lightweight, not cumbersome, does not impact or impede patient care. Most importantly, it protects them!

INSERT PHOTO #3. Caption – You can also add eye protection to each helmet to further enhance safety.

There are a couple different helmets and considerations. We looked at two different types and chose the KASK HI-VIS Super Plasma helmet. It is extremely important to look at the options available to you and obtain buy-in from the providers who will be wearing the helmets. If there is no buy-in and a level of comfort to the helmet, they will never be worn. The KASK helmet offered the ability for our paramedics to wear lightweight head protection that would not impair their ability to treat patients. We found what we were looking for in the KASK helmet. You must look at your options and apply protective equipment that meets the needs of your responders.

You owe it to yourself, your family, and–if you are a leader or supervisor of any organization–you owe it to your employees to begin looking at the options available. It’s time to stop paying lip service to safety items and begin taking action to protect our most valuable resource, our employees!

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