BY JEFF BURGESS AND DAVID BUI
Emergency service vehicle incidents (ESVIs), including road traffic collisions, rollovers, and on-scene struck-by incidents, are the second leading cause of fatalities among active duty United States firefighters, accounting for nearly a third of on-duty firefighter fatalities in 2016.
In 2015, there were 16,600 reported ESVIs involving emergency vehicles and 700 involving personally operated vehicles, resulting in a total of 1,200 reported injuries during that year—an 88 percent increase from 2014. Intersections are the most common site of ESVIs, and high speeds during emergency operations increase the risk of collision and rollover through reduced reaction times and stopping distances, weight shifts, and lane departures. The incidence of crash-related injuries and fatalities among fire personnel has not significantly improved over time.
Approaches to Preventing ESVIs
To better understand and prevent ESVIs, our research team partnered with four fire departments across the United States and conducted a three-year study to identify and evaluate approaches to reducing ESVIs in the fire service. We used the following strategies:
- Implement proactive risk management to identify unique risk factors for ESVIs and guide the implementation of tailored interventions at our partner fire departments.
- Explore the use of telematics driving data to monitor driver behaviors.
- Conduct a systematic review to find published articles and data on effective interventions previously employed.
Risk Management to Prevent ESVIs
Given the unique driving environments and operating conditions at every fire department, tailored approaches and interventions that address the actual and contextual needs of every department are necessary to effectively reduce ESVIs. Proactive risk management, which entails hazard scoping, risk assessment, implementation of interventions, and ongoing evaluation, has proven to be effective in managing and reducing occupational injuries and hazards across a broad spectrum of industries. The process allows organizations to consider the unique risks and hazards personnel face and to inform the selection and adoption of interventions that may be effective in reducing the specific risks and hazards for their employees, given their unique environment and context. Risk management may be particularly useful for addressing ESVIs, since fire departments work and drive in different geographies (e.g., urban and rural) and with different staffing structures (career and volunteer). Despite its widespread use in other countries, proactive risk management is still seldom used in most U.S. industries, including the fire service.
Between 2013 and 2017, we partnered with four U.S. fire departments in urban, suburban, and rural settings. Through a series of risk management meetings with personnel and staff at each fire department, we reviewed crash data to identify and prioritize specific hazards to each department and selected new interventions to reduce high-priority ESVIs at each department. Priorities differed by department based on geography and staffing.
For example, urban departments were more concerned with vehicle incidents occurring in traffic-congested areas and narrow streets, while rural and suburban departments prioritized weather conditions and animal collisions. One department instituted revised emergency response protocols for all vehicles, two implemented improved driver training programs, and three collected real-time vehicle operation data (vehicle data recorders) using wireless telematics in addition to a variety of other interventions.
All departments reported satisfaction with the implementation of the proactive risk management process. Two departments reduced their ESVIs by 10 percent and 26 percent, and one increased by eight percent, though the increase was not statistically significant. The fourth did not have any ESVIs before or after the interventions.
Using Telematics to Monitor Driver Behaviors
In addition to risk management, we also wanted to identify driver behaviors associated with ESVIs. In the general population, driver behaviors are a significant factor in most road traffic crashes. We know that factors such as a driver’s age, gender, driving experience, and education influence the risk of road traffic collisions. Further, among civilian drivers, certain driving behaviors such as hard braking are known to be associated with crashes; however, emergency responders operate large specialized vehicles under unique, fast-paced, and dangerous circumstances. Behaviors found to be predictive for crashing in general populations may not apply to the emergency services. We explored using telematics devices to monitor driving behaviors in a subset of emergency vehicle apparatus in our partner fire departments. The driving data were used to identify behaviors (e.g., speeding, hard braking, hard acceleration, etc.) associated with ESVIs and were used as training tools for department safety.
We analyzed the association between telematics driving data and ESVIs as well as the effect of enhanced driver training on improving driving behaviors as measured by telematics. The analysis of telematics data revealed that hard braking and speeding were associated with a twofold to threefold increase in the risk of ESVIs. We provided enhanced driver training with an emphasis on hands-on rodeo training and teaching to a set of drivers at one department. We found the training was associated with improved driving behaviors among trained drivers as measured by a reduction in unwanted driving behaviors in comparison to drivers who did not receive the training. The departments continue to use the telematics driving data in regular reports to inform personnel about driving trends and to promote driver safety awareness.
Reviewing the Evidence Base and Current Practice
Finally, we conducted a mixed method review, combining a literature review and key informant interviews with fire department representatives, to identify potentially effective interventions with supporting data or evidence. During this process, we reviewed 416 articles and found 67 that studied or discussed an intervention to prevent ESVIs. We completed 17 key informant interviews. Most articles we reviewed in the article search focused on vehicle engineering interventions (38 percent), followed by policy and administration interventions (27 percent), environmental engineering interventions (19 percent), and education or training (16 percent). Most key informants reported policy (49 percent) and training interventions (29 percent). Crash data provided by key informants revealed that programs such as enhanced driver training and risk management were associated with 19 to 50 percent and 19 to 58 percent reductions in ESVIs, respectively. Other engineering interventions like DriveCam, the use of black boxes, and backup cameras were reported to reduce ESVIs, but no data for their efficacy were found. In at least one department, the use of DriveCam was correlated with increases in small claim crashes.
Final Thoughts on What Works
A comprehensive risk management program, coupled with enhanced driver training and real-time driver data monitoring, can effectively reduce ESVIs. Enhanced driver training programs focusing on hands-on exercises such as rodeos and teach back improve vehicle operations and increase safety. Data and metrics should be used for monitoring driver behavior and ESVIs, and these data should be incorporated into a comprehensive safety program to further improve personnel safety.
JEFF BURGESS is the associate dean for research and professor at the University of Arizona Mel and Enid Zuckerman College of Public Health.
DAVID BUI is a PhD candidate in epidemiology at the University of Arizona Mel and Enid Zuckerman College of Public Health.