Aerials, Pumpers, Rescues

Reducing Emergency Service Vehicle Crashes: What Really Works?

Issue 10 and Volume 23.

Emergency service vehicle incidents (ESVIs), including crashes, rollovers, and roadside struck-by incidents, are leading causes of occupational fatality and injury among firefighters and other emergency responders. Between 1994 and 2012, 390 United States firefighters were killed in ESVIs, and approximately 1,100 firefighters are injured in ESVIs every year.

ESVIs are also a danger to civilians, given emergency vehicles’ large sizes and high-speed operations. Between 1997 and 2006, 94 of 107 fatalities from collisions involving a fire service vehicle during emergency response were occupants of the other vehicle, pedestrians, or bicyclists.

Recently, a multidisciplinary team of researchers and fire service partners, led by researchers from the University of Arizona, completed the first comprehensive review of interventions designed to reduce or prevent ESVIs. For this review, researchers gathered articles published in the past decade featuring ESVI interventions and interviewed key informants (chiefs, captains, and lieutenants) from fire departments serving major metropolitan areas. These key informants were from departments found in the reviewed articles or referred by chiefs from the International Association of Fire Chiefs and National Fire Protection Association Metropolitan Fire Chiefs. The team reviewed more than 400 published articles and interviewed 17 fire departments across the United States and United Kingdom (UK). They identified several effective and promising evidence-based interventions currently available to fire and emergency services. Interventions identified included additions or modifications to the emergency vehicle, modifications to the environment (including roads and stations), policy and administration interventions, and education and training programs.

Of the interventions reviewed, proactive risk management and enhanced driver training/refresher training had data available showing proof of ESVI reduction. Proactive risk management uses a formalized procedure of identifying, evaluating, and ranking risks and implementing controls. It has been used in various industries, including mining and automotive manufacturing, to prevent and reduce occupational risks and hazards, and several fire departments are already doing this with great results. Rockland County (NY) Paramedic Services reported a 58 percent reduction in ESVIs, 54 percent reduction in related costs, and 36 percent reduction in crash-related injuries. Crash data from the London Fire Brigade in the UK revealed a 19 percent reduction in overall crash rates.

Enhanced driver training and refresher training programs were found to be particularly effective. These programs typically increase the amount of hands-on field training and vehicle-specific operation training and include closed-course evolutions and scenarios. Data from several departments showed significant reductions in ESVIs attributable to enhanced training. After implementing a comprehensive driver training program in 2008, the Seattle (WA) Fire Department reduced its average crash rate by 19 percent. The Sacramento (CA) Fire Department had an immediate 26 percent reduction in crashes one year after implementing a comprehensive emergency vehicle operator course, including annual refresher training. Its crash rates continued to decline, resulting in an overall 50 percent reduction in crashes that reportedly saved the city an average of $3 to $4 million annually from avoided vehicle collisions.

Not all interventions identified in the review could be evaluated for how effectively they reduced ESVIs. These interventions included driver mentoring programs, emergency vehicle traffic signal preemption systems, in-vehicle advanced warning alert systems for civilians, backing cameras, and policies that modify code 3 response protocols to reduce the use of lights and sirens. Preliminary studies and reports from fire departments suggest that these interventions have potential benefits, but there are limited crash data being gathered and reported by departments making the evaluation of these interventions difficult. Further evaluation is necessary, and a commitment to gathering and analyzing crash data is absolutely critical to finding out what really works.

Despite numerous strategies and interventions, such as education and apparatus design, that have been developed to prevent ESVIs and address personnel safety, ESVIs remain a key cause of firefighter and first responder fatalities, and the frequency of ESVIs has remained unchanged for more than 20 years. As this review highlights, there are many interventions, but there are limited data available that show how effective these interventions actually are. However, this review has demonstrated that comprehensive driver training and risk management can be effective approaches for departments to mitigate ESVIs and associated financial burdens.

This study was funded by an Assistance to Firefighters Grant awarded by FEMA. Read the full review here: https://doi.org/10.1016/j.aap.2018.01.006 and learn more about the research grant at https://vrm.arizona.edu/.


ALESIA JUNG is a PhD student studying epidemiology at the University of Arizona Mel and Enid Zuckerman College of Public Health. She is currently participating in research to understand epigenetic changes in firefighters associated with occupational exposures and to develop and test a framework to study cancer over time in the fire service.

DAVID BUI is a research epidemiologist. His research focuses on evaluating policy, education, and technology approaches for reducing fire service vehicle crashes.

JEFF BURGESS is the associate dean for research and a professor at the University of Arizona Mel and Enid Zuckerman College of Public Health. His research to improve occupational health and safety has a special focus on working with firefighters, other public safety personnel, and miners.