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Ground Versus Air: Which Mode of Emergency Medical Service Transportation Is More Likely to Crash?

Published:November 15, 2022DOI:https://doi.org/10.1016/j.amj.2022.10.014

      Abstract

      Objective

      We analyzed helicopter emergency medical services (HEMS) and ground emergency medical services (GEMS) crash data in the United States during 1983 to 2020 to compare incidences of total, fatal, and injury crashes.

      Methods

      HEMS and GEMS total, fatal, and injury crashes during 1983 to 2020 and 1988 to 2020, respectively, were analyzed in this retrospective study. Data were obtained from the National Transportation Safety Board and the National Highway Traffic Safety Administration. Additional data from the Federal Aviation Administration, the National Emergency Medical Services Information System, and prior literature were used for rate calculations. A Poisson regression model was used to determine rate ratios with 95% confidence intervals comparing total, fatal, and injury crash rates from 2016 to 2020.

      Results

      HEMS crash rates decreased since 1983. Total GEMS crashes have increased since 1988. Of the total crashes, 33% (HEMS) and 1% (GEMS) were fatal, and 20% (HEMS) and 31% (GEMS) resulted in injury. During 2016 to 2020, GEMS crash rates were 11.0 times higher than HEMS crash rates (95% confidence interval, 5.2-23.3; P < .0001).

      Conclusion

      HEMS has a lower crash probability than GEMS. The availability of data is a limitation of this study. National GEMS transportation data could be useful in studying this topic further.
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      References

        • Schneider AM
        • Ewing JA
        • Cull JD.
        Helicopter transport of trauma patients improves survival irrespective of transport time.
        Am Surg. 2021; 87: 538-542
        • Galvagno Jr, SM
        • Haut ER
        • Zafar SN
        • et al.
        Association between helicopter vs ground emergency medical services and survival for adults with major trauma.
        JAMA. 2012; 307: 1602-1610
        • Galvagno Jr, SM
        • Sikorski R
        • Hirshon JM
        • et al.
        Helicopter emergency medical services for adults with major trauma.
        Cochrane Database Syst Rev. 2015; 2015CD009228
        • Ruskin KJ.
        Helicopter air ambulance services.
        Curr Opin Anaesthesiol. 2019; 32: 252-256
        • Boyd DD
        • Macchiarella ND.
        Occupant injury severity and accident causes in helicopter emergency medical services (1983-2014).
        Aerosp Med Hum Perform. 2016; 87: 26-31
        • Baker SP
        • Grabowski JG
        • Dodd RS
        • Shanahan DF
        • Lamb MW
        • Li GH.
        EMS helicopter crashes: what influences fatal outcome?.
        Ann Emerg Med. 2006; 47: 351-356
      1. Improving EMS worker safety in the patient compartment. 2017. Available at: https://www.dhs.gov/sites/default/files/publications/R-Tech_Improving-EMS-Worker-Safety-Patient-Compartment_%20Sept2017-508.pdf. Accessed November 3, 2022.

        • Maguire BJ
        • Hunting KL
        • Smith GS
        • Levick NR.
        Occupational fatalities in emergency medical services: a hidden crisis.
        Ann Emerg Med. 2002; 40: 625-632
        • Reichard AA
        • Marsh SM
        • Moore PH.
        Fatal and nonfatal injuries among emergency medical technicians and paramedics.
        Prehosp Emerg Care. 2011; 15: 511-517
        • Bruhn JD
        • Williams KA
        • Aghababian R.
        True costs of air medical vs. ground ambulance systems.
        Air Med J. 1993; 12: 262-268
      2. 14 CFR Part 119, 121, 135 (2010).

      3. House of Representatives. FAA Modernization and Reform Act of 2012. Pub L No 95. 126 Stat. 11: 112th Congress; 2012.

        • Cash RE
        • Crowe RP
        • Rivard MK
        • et al.
        Seat belt use in the ambulance patient compartment by emergency medical services professionals is low regardless of patient presence, seating position, or patient acuity.
        J Safety Res. 2019; 71: 173-180
        • Auerbach PS
        • Morris Jr, JA
        • Phillips Jr, JB
        • Redlinger SR
        • Vaughn WK.
        An analysis of ambulance accidents in Tennessee.
        JAMA. 1987; 258: 1487-1490
      4. National Transportation Safety Board. Data from: CAROL Query. 1983-2020. Available at: https://data.ntsb.gov/carol-main-public/landing-pagelast. Accessed November 3, 2022.

        • Luipersbeck T.
        Helicopter air ambulance mandatory flight operations report.
        Helicopter Air Ambulance. 2021;
        • Blumen IJ
        • Lemkin DL
        • Scott GK
        • et al.
        A safety review and risk assessment in air medical transport.
        Air Med J. 2002; 21: 1-63
        • Aherne BB
        • Zhang C
        • Chen WS
        • Newman DG.
        Systems safety risk analysis of fatal night helicopter emergency medical service accidents.
        Aerosp Med Hum Perform. 2019; 90: 396-404
      5. National Highway Traffic Safety Administration. Motor vehicle traffic crashes involving an ambulance by year and crash severity. 1988-2020. Available at: https://cdan.nhtsa.gov/tsftables/tsfar.htm. Accessed March 24, 2022.

      6. National Emergency Medical Services Information System. EMS Data Cube. 2014-2020. Available at: https://nemsis.org/view-reports/public-reports/ems-data-cube/. Accessed September 10, 2022.

      7. Pt 830. Notification and Reporting of Aircraft Accidents or Incidents and Overdue Aircraft, and Preservation of Aircraft Wreckage, Mail, Cargo, and records. Title 49 Subtitle B Chapter VIII (1988).

      8. National Highway Traffic Safety Administration. General Estimates System. Available at: https://www.nhtsa.gov/national-automotive-sampling-system/nass-general-estimates-system. Accessed June 1, 2022.

      9. National Highway Traffic Safety Administration. Fatality Analysis Reporting System. Available at: https://www.nhtsa.gov/crash-data-systems/fatality-analysis-reporting-system. Accessed June 1, 2022.

      10. National Highway Traffic Safety Administration. Crash Report Sampling System. Available at: https://www.nhtsa.gov/crash-data-systems/crash-report-sampling-system. Accessed June 1, 2022.

        • Watanabe BL
        • Patterson GS
        • Kempema JM
        • Magallanes O
        • Brown LH.
        Is use of warning lights and sirens associated with increased risk of ambulance crashes? A contemporary analysis using National EMS Information System (NEMSIS) data.
        Ann Emerg Med. 2019; 74: 101-109
        • National Emergency Medical Services Information System
        National EMS Database: NEMSIS Public Release Research Data Set User Manual.
        NEMSIS, Salt Lake City, UT2020
      11. Levick, N. R. (2007). Emergency medical services: A transportation safety emergency. Paper presented at American Society of Safety Engineers’ Professional Development Conference, June 24-27, 2007; Orlando, FL. Available at https://www.objectivesafety.net/2007ASSE628Levick.pdf. Accessed November 4, 2022.

        • Becker LR
        • Zaloshnja E
        • Levick N
        • Li G
        • Miller TR.
        Relative risk of injury and death in ambulances and other emergency vehicles.
        Accid Anal Prev. 2003; 35: 941-948
        • Kahn CA
        • Pirrallo RG
        • Kuhn EM.
        Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective analysis.
        Prehosp Emerg Care. 2001; 5: 261-269
        • de Anda HH
        • Moy HP
        EMS Ground Transport Safety.
        StatPearls Publishing, Treasure Island, FL2022
        • Ray AF
        • Kupas DF.
        Comparison of crashes involving ambulances with those of similar-sized vehicles.
        Prehosp Emerg Care. 2005; 9: 412-415
        • Sanddal TL
        • Sanddal ND
        • Ward N
        • Stanley L.
        Ambulance crash characteristics in the US defined by the popular press: a retrospective analysis.
        Emerg Med Int. 2010; 2010525979
        • Saunders CE
        • Heye CJ.
        Ambulance collisions in an urban environment.
        Prehosp Disaster Med. 1994; 9: 118-124
        • Murray B
        • Kue R.
        The use of emergency lights and sirens by ambulances and their effect on patient outcomes and public safety: a comprehensive review of the literature.
        Prehosp Disaster Med. 2017; 32: 209-216
      12. Safety Study - Commercial Emergency Medical Service Helicopter Operations (National Transportation Safety Board) 1-132; 1988. Available at: https://libraryonline.erau.edu/online-full-text/ntsb/safety-studies/SS88-01.pdf. Accessed November 3, 2022.

      13. Special Investigation Report on Emergency Medical Services Operations. 2006. Available at: https://www.ntsb.gov/safety/safety-studies/Documents/SIR0601.pdfhttps://www.ntsb.gov/safety/safety-studies/Documents/SIR0601.pdf. Accessed November 3, 2022.

        • Habib FA
        • Shatz D
        • Habib AI
        • et al.
        Probable cause in helicopter emergency medical services crashes: what role does ownership play?.
        J Trauma Acute Care Surg. 2014; 77: 989-993
        • Nix S
        • Buckner S
        • Cercone R.
        A review of risk analysis and helicopter air ambulance accidents.
        Air Med J. 2014; 33: 218-221
      14. National Highway Traffic Safety Administration. Federal Motor Vehicle Safety Standards; Head Impact Protection. 49 CFR Parts 571, 572, 589.

        • Vogt F.
        Equipment: federal specification, ambulance KKK-A-1822.
        Emerg Med Serv. 1976; 5: 60-64
        • Technical Committee on Ambulances
        NFPA 1917 Standard for Automotive Ambulances.
        National Fire Protection Association, Quincy, MA2019
      15. Thomas FD, Graham LA, Wright TJ, Almeida R, Blomberg RD, Benlemlih M. Characterizing Ambulance Driver Training in EMS Systems (Report No. DOT HS 812 862). National Highway Traffic Safety Administration; 2019.

      16. Title 14 CFR Part 91. In: Aviation CoIC, editor. 14.

        • MacDonald E.
        More safety regulation on HEMS around the corner.
        Air Med J. 2010; 29: 108-109
      17. Centers for Disease Control and Prevention. NIOSH continues research to improve safety for ambulance service workers and EMS responders. 2011-190. August 2011. Available at: https://www.cdc.gov/niosh/docs/2011-190/. Accessed November 3, 2022.

      18. National Emergency Medical Services Assessment (National Association of State EMS Officials [NASEMSO]), 2020, 1\055234. Available at: https://nasemso.org/wp-content/uploads/2020-National-EMS-Assessment_Reduced-File-Size.pdf. Accessed November 3, 2022.

      19. 2011 National EMS Assessment (Federal Interagency Committee on Emergency Medical Services) 1-560 (2011). Available at: https://www.ems.gov/pdf/811723-national-ems-assessment-2011.pdf. Accessed November 3, 2022.

        • Brown LH
        • Whitney CL
        • Hunt RC
        • Addario M
        • Hogue T.
        Do warning lights and sirens reduce ambulance response times?.
        Prehosp Emerg Care. 2000; 4: 70-74
        • Hunt RC
        • Brown LH
        • Cabinum ES
        • et al.
        Is ambulance transport time with lights and siren faster than that without?.
        Ann Emerg Med. 1995; 25: 507-511
        • Marques-Baptista A
        • Ohman-Strickland P
        • Baldino KT
        • Prasto M
        • Merlin MA.
        Utilization of warning lights and siren based on hospital time-critical interventions.
        Prehosp Disaster Med. 2010; 25: 335-339
        • US Department of Transportation
        Safety Management System. Order 8000369C2020.
        Federal Aviation Administration, Washington, DC2016