MINUTES OF THE AMBULANCE SAFETY SUBCOMMITTEE of the FEDERAL INTERAGENCY COMMITTEE ON EMERGENCY MEDICAL SERVICES (FICEMS) DATE AND TIME: June 5, 2003 at 2:30 p.m. LOCATION: National Emergency Training Center, Room J-107 16825 South Seton Avenue Emmitsburg, MD 21727 MEMBER AGENCY REPRESENTATION: Department of Homeland Security (DHS) Federal Emergency Management Agency (FEMA) Mr. William Troup Mr. John Brasko United States Fire Administration (USFA) Department of Agriculture No Representation Federal Communications Commission No Representation Department of Defense (DOD) No Representation General Services Administration (GSA) Mr. Mel Globerman, Engineering Director Department of Health and Human Services (DHHS) Ms. Nancy Romano, AS Subcommittee Chairperson National Institute for Occupational Safety and Health (NIOSH) Department of Interior No Representation Department of Transportation (DOT) No Representation Department of Veteran Affairs No Representation Federal Bureau of Investigation (FBI) No Representation Department of Labor No Representation OTHER FEDERAL ATTENDEES: Department of Commerce (DOC) No Representation Department of Justice (DOJ) No Representation National Park Service (NPS) No Representation OTHER ATTENDEES PRIVATE SECTOR: CFSI, VFIS Mr. Rick Patrick American Association of Safety Engineers Mr. Steve Pyle National Volunteer Fire Council Mr. Joseph Robison Fairfax County Fire and Rescue Captain Christine Woodward Centronia Ambulance Corps, Inc. Mr. Larry Wiersch NATEK Incorporated Ms. Sandy McMinn, EMS Specialist Ms. Sarah Oliver Ms. Susan Steinruck Mr. Stephen Homoki TELEPHONE CALL-IN ATTENDEES: American Ambulance Association (AAA) Mr. Kurt Krumperman MTIP Mr. Bill Leonard IFSTA Mr. Michael Wieder MWCOG Mr. Stephen Dickstein I. WELCOME Nancy Romano, Chairperson, welcomed the group. II. INTRODUCTIONS The meeting minutes from the last meeting were approved with no changes. III. DIRECTION OF THE SUBCOMMITTEE ON AMBULANCE SAFETY Meeting Time. Motion to change the meeting time to 9:30 a.m. Chairperson Nancy Romano suggested that the time for the AS Subcommittee explore the possibility of meeting before the main FICEMS meeting. This would allow some who have to leave before the AS Subcommittee has a chance to complete the processes. She moved that the next AS meeting should begin at 9:30 a.m. on the day of the regular quarterly meeting. Bill Troup – Suggested using another room so people coming to the FICEMS main meeting can come in early and talk. Some suggested to move FICEMS meeting to 10 a.m. but it was felt that would not afford enough time. Some were concerned that 10:00 a.m. may be too early for some members considering the distances traveled. The group decided to meet as Ms. Romano proposed. The meeting will be at 9:30 a.m. for 45 minutes and end no later than 10:15 a.m. IV. NEW AMBULANCE SAFETY ISSUES The round table discussion involved various topics intertwined. The topics included definitions, training, Subcommittee Outcomes, Vehicle Operations Courses, Information Sources, and NEMSIS. Driver Training. Mel Globerman – 80 to90% of accidents can be avoided by training good drivers and using simple safety features such as seatbelts. Apparently the latest accident involved people incapacitating themselves or making themselves accident prone by being under the influence of alcohol or other substance. Rick Patrick - Alcohol related issues are not unusual with the volunteer arena. Alcohol consumptions and problems with volunteers is a common issue. The human component is the issue – it is not the vehicle itself, it is the condition of the driver. There is also negligence at road intersections – drivers must ensure they understand their privileges to cross intersections against the light in emergency situations. It is also true that the public does not know what to do when approached by an emergency vehicle from any orientation. Mel Globerman – From an insurance point of view, they know what works and what does not. Drivers must know the law, and communities must train the drivers. The problem is how to deal with a patient losing life in the back of the ambulance, and the ambulance driver is panicked and loses focus on the road. There is a need to control the adrenaline of the situation and not have tunnel vision. By the same token, emergency responders must interact with the public and train them on what to do when approached by an emergency vehicle. Bill Leonard – A study of 911 responses shows that it is under 5% of calls that actually require emergency vehicles to respond in an extraordinary manner. This should be inculcated in our emergency responders. BFIS has a great training program, the problem is that most people have not driven an emergency vehicle before. Handling characteristics are very different from a normal truck. Mel Globerman – Agreed that drivers run lights and sirens when they do not need it when patients are stable, etc. Rick Patrick –Agreed that we need to do better training and change the mentality from training to EDUCATION and training. Training and Education should be done semi- annually. Nancy Romano –Asked whether emergency vehicle drivers should have a special drivers license? Rick Patrick – Added that increased call volume could be argued for the increase in incidents or accidents. He felt that we need to look at other risk control components since we cannot control the human component. Bill Leonard – education process about 911 is needed so the number of 911 calls is reduced and not as many vehicles need to respond. Behavior modification; learning how the vehicle acts/reacts in certain situations is necessary. The National Safety Council has developed a program that are good. Action item: Nancy Romano - Will contact Dr. Clauson to see if he would be willing to join the committee and maybe do a presentation. Bill Leonard and Rick Patrick will be assisting in contacting Dr. Clauson. Nancy Romano offered to extend an invitation to Dr. Clauson to address the committee. Mel Globerman – Volunteered that emergency vehicle dynamics are more complex, many drivers think that they are just a big car. Rick Leonard – Mentioned that there are some real good simulators. If communities could get moneys to do the virtual training simulation training that would be a good idea. He was not sure if there are simulators for ambulances, but there are simulators for fire apparatus. Crash Fire Rescue out of Dallas is one facility. Grady North is the person who coordinates that effort. Equipment can be seen at most trade shows. Bill Troup – The Fire Service Emergency Vehicle Safety Initiative is a partnership effort of the USFA and the U.S. Department of Transportation (DOT)/National Highway Traffic Safety Administration (NHSTA) and the DOT/ Intelligent Transportation Systems Joint Program Office. The long-term goal of this project is to reduce the number of firefighters killed responding to and returning from emergencies. Part of this initiative involves the evaluation of fire department that have best practices in various areas of emergency vehicle safety so that information on the guidelines, mitigation techniques, and technologies related to emergency vehicle operations evaluated, incorporating findings and information from these best practices evaluation sites, may be distributed to the appropriate audience of local-level fire departments and other organizations to facilitate the reduction of emergency vehicle crashes which represents the second leading cause of loss of life for firefighters. Further information on this project may be found on the following page of the USFA web site: http://www.usfa.fema.gov/inside- usfa/vehicle.cfm The FAAC, Inc. system is a portion of a real ambulance cab (a pick up truck cab cutaway) that FDNY uses for the ambulance driver simulator. Action item: Bill Troup – Will get contact information and identify a contact point for the ambulance driver simulator NYC. Action item: Susan McHenry - Share preemptive system information from NHTSA assisted by Rick Patrick. Mel Globerman – Wanted to know where we are we going with all this. Will we have immediate benefits, what about States and Users. Nancy Romano – USFA's driver course for emergency vehicles dates back to 1981. It would be best to update the course but we are unable because of cost. Mel Globerman – One area to explore is the military, they have many emergency vehicles and programs dealing with this problem. Referring to how to implement these initiatives said we must avoid duplication of effort, disseminate information, and let the people do their jobs. Bill Troup – There will be a meeting this summer which will take all these points and recommendations and put them in a report in August. All this discussion has contributed and he may have some preliminary information and feedback from this report at the September meeting. Mike Wieder – There will be a report ready for review by August. Larry Wiersch - Training is probably not the magic wand, we are jumping to the conclusion that training and education will fix our problem. We need to look at the root causes of the problems we have – it is related to the behaviors of the subjects. We need to look at the interview process, how we interact with our communities, whom we hire, how we train them, the policies of commercial companies and, finally, the undue pressure to be there within a certain time, to the scene, to the hospital, etc. We need to look at all the elements and put out a much broader paper including all these additional things combined – it is not just training. Bill Leonard – Training should not be the primary thing, whom we hire, etc., are just as important. Nancy Romano – The committee does not think training is the end all be all, it is just a step to help the problem, to see what is out there. Mel Globerman – There is no one solution, it is multifaceted. It has to be pulled together and getting the right policies and steps instituted. Larry Wiersch – Does this committee have access to information on crashes and contributing factors? Nancy Romano – In response to Larry Wiersch, we have a need for data, but we cannot find shared data or collected data. No entity will share that sort of data with us. We are not sure that the federal government has the data. Rick Patrick – Perhaps we need a university to take on this type of study knowing it is coming from a federal agency or our committee of federal agencies. You may get some insurance companies to release that data for a university study whereas not for a federal study. Larry Wiersch – We have a need to commission someone to collect this data. Bill Troup - Who would fund a study like this, the government needs to get clearance to do any kind of information gathering from OMB. Joe Robison – Stated sampling is the way to go not a survey. Bill Troup - How many states do you think do mandatory EMS reporting. Not many is the consensus. Bill Troup – Not many states have medical or psychological evaluations for emergency drivers. Usually, there is a physical at career entry. Action Item: Christine Woodward. Captain Woodward will look up to see how Virginia EMS accident reports are documented. NATEK will record the action items in a spreadsheet and send them out with the minutes. V. UPDATES FROM SUBCOMMITTEE MEMBERS Larry Wiersch's name was omitted from the approved minutes. This was a result of an oversight. Therefore, these minutes correct the oversight that Mr. Wiersch attended the last meeting via telephone. John Brasko – Felt it might be a good idea to have Dr. Claussen present to the whole group, not just the AS subcommittee. Mr. Brasko will talk to Jeff Dyar about putting him in the FICEMS main meeting agenda. Bill Leonard – Claussen's group will need at least 30 minutes for presentation and have a Q&A session. Nancy Romano – We were planning to do Dr. Claussen's presentation over the phone. Bill Troup – Anything over 10 -15 minutes need to be outside the FICEMS meeting because of time constraints. Also, because of the nature of the briefing, commercial presentations have historically been outside of the FICEMS meetings. Mel Globerman – Dr. Claussen is selling a product, therefore, FICEMS needs to be very careful about commercial speakers. We will have to let him know that his presentation should be conceptual. Phone – talk to Gordon about bringing in a commercial person Action Item: Let people know about upcoming meetings of interest. VI. ACTION ITEM REVIEW There are 6 main action items that came out of this meeting. Action Item: NATEK Incorporated. Draft a few paragraphs about the AS subcommittee for Mr. Globerman. He will be doing a presentation in Las Vegas. Mr. Globerman will send a copy of his briefing when it is ready so our input can be tailored to dovetail with his style. Action Item: NATEK Incorporated. Send out a list of action items and minutes to subcommittee by July 2 Action Item: Susan McHenry, NHTSA. Share NHTSA preemptive system information with committee. Action Item: Christine Woodward, Fairfax Fire Dept. Captain Woodward will look up to see how Virginia EMS accident reports are documented. Action item: Bill Troup, USFA. Will get information and contact point on the FAAC, Inc. system in NYC. Action item: Nancy Romano, NIOSH. Will contact Dr. Clauson to see if he would be willing to join the committee and maybe do a presentation. Bill Leonard and Rick Patrick will be assisting in contacting Dr. Clauson. Nancy Romano offered to extend an invitation to Dr. Clauson to address the committee. NATEK will record the action items in a spreadsheet and send them out with the minutes. Pictures of ambulance crashes will be exchanged between Rick Patrick, Bill Troup, and Larry Wiersch. The pictures will be sanitized with no identifiers. Bill Troup will email pictures to Nancy Romano for approval. VII. NEXT MEETING September 4, 2003, 9:30 a.m., NETC, Emmitsburg, Maryland VIII. ADJOURNMENT Ms. Romano again requested that if you know anyone who can contribute and wants to join the subcommittee, please let us know. Also, if you are aware some good EMS conferences or meetings, let her know so she can pass the word out. Motion to adjourn was passed at 3:50 p.m. 1