ambulance drivers to complete a driver training course that is often derived from the NHTSA course. EVOC thus represents an important step toward ensuring ambulance safety on the roads. In addition to training improvements, technology has been developed that provides ambulance drivers with automatic, audible feedback when they are not driving according to standards. This technology uses sophisticated on-board computers that are able to monitor speed, revolutions per minute (RPMs), and braking. Other new capabilities, such as “drive cams” and intelligent transportation highway designs (e.g., lane-centering devices in blizzard conditions) can also have a significant impact on safety. The committee supports the exploration of additional technological applications to increase patient and provider safety in ambulances, including the Federal Highway Safety Intelligent Transportation System Public Safety initiative.

Finally, ambulance safety is being addressed through protocols that dictate whether lights and sirens are appropriate to use in given situations. Operating with lights and sirens (i.e., “running hot”) can be helpful in navigating through traffic, but numerous studies indicate that doing so leads to increased danger (NAEMSP and NASEMSD, 1994; Hunt et al., 1995; Lacher and Bausher, 1997; Overton, 2001). A central question, then, is whether the use of lights and sirens is justified given the health care needs of the patient. Hunt and colleagues (1995) determined that on average, the use of lights and sirens saved only 43.5 seconds in transporting patients from the scene of an emergency to the hospital. The authors argued that such a small improvement in transport time would be clinically meaningful only in very rare situations. Lacher and Bausher (1997) found that nearly 40 percent of pediatric 9-1-1 responders inappropriately used lights and sirens when the patient was stable. They concluded that limited use of lights and sirens, dictated by strong protocols, could reduce the dangers associated with inappropriate use (Lacher and Bausher, 1997).

Air Medical Services

Air medical operations, including those involving both rotor-wing helicopters and fixed-wing aircraft, have become an increasingly significant component of U.S. medical capabilities (Helicopter Association International, 2005). The air medical industry began in the United States in the early 1970s, following the Vietnam War (Blumen and UCAN Safety Committee, 2002). During the war, the U.S. military used helicopters to transport soldiers from the front lines to mobile army surgical hospitals. After soldiers had been stabilized, the military deployed fixed-wing aircraft to transport them home. In Vietnam, the time it took for soldiers to be transported from the combat theater to a stateside medical hospital averaged approximately 45 days. During the Afghanistan and Iraq wars, transport time for wounded

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