Robert Davis media fellow
By Robert Davis
Reprinted with permission of USA Today
Denver paramedic Otis McKay Jr. saw the fear in the young woman’s eyes just before he mowed her down with his 5-ton ambulance.
The seasoned paramedic had seen people die before. But watching 19-year-old Virginia Magalhaes-Rosa trying in vain to outrun his out-of-control ambulance in December 2000 — seeing her disappear beneath the flashing lights in the grille of the rig — haunts him every time he turns on his siren.
”I’m still spooked when I drive Code 10 (Denver lingo for an emergency run),” McKay says. ”I see shadows, I see cats, I see birds, I see leaves falling from the trees. Any sudden move in the periphery. I don’t think you ever get over that.”
Paramedics toil to save lives. But those inside the breakneck world of emergency medical services have long known of a huge danger that is rarely acknowledged to outsiders: Ambulances are among the most dangerous vehicles on the road, involved in a disproportionate number of crashes.
Now, however, more experts are questioning publicly the time-honored belief that seconds, or even minutes, are crucial to survival when transporting a patient to an emergency room. There is, in fact, no scientific proof that ”running hot” — street slang for operating with lights and siren — saves lives.
”You can’t prove from the literature that EMS (emergency medical services) saves more lives than it takes,” says Jeff Clawson, chairman of the certification board for the National Academies of Emergency Dispatch based in Salt Lake City.
”Speed has never saved anybody’s life. Period,” says W.H. ”Bill” Leonard of Medical Transportation Insurance Professionals, one of the top insurance underwriters of ambulances across the nation.
Running hot doesn’t even shave off much time, according to previous studies. One found that lights and siren reduce response times by 106 seconds in big cities and by 43.5 seconds in rural areas.
Clawson says it’s a myth that the public expects a lights-and-siren response to every emergency. ”That’s not what the American public thinks,” he says. ”They want it to come out right and not kill people in crosswalks when they don’t need to.”
Yet, ambulances are 13 times more likely to be involved in an accident than other vehicles in terms of the number of accidents per miles driven, according to a study in Houston in 1993. That study found that ambulances also are five times more likely to be involved in a crash that causes an injury.
Worse, an ambulance is an unforgiving vehicle to collide with — especially on an emergency run.
In fatal, multi-vehicle ambulance crashes between 1980 and 2000, the number killed in the other vehicle was 21 times greater than the number of ambulance drivers who died, according to a USA TODAY analysis of National Highway Traffic Safety Administration data. More than three-fourths of the fatalities were people who were not in the ambulance.
But because there are relatively few fatalities each year — 33 in 2000 (the last year for which complete data were available) out of millions of ambulance calls — federal officials say there is no pattern that triggers any alarms.
”There is not a lot of data out there,” says Jeffrey Runge, a former street medic and emergency room doctor now heading the National Highway Traffic Safety Administration. His agency collects data on fatal accidents and sets response guidelines. ”It tells me there is not a huge safety problem.”
Many in the industry disagree. ”This is a very, very big problem,” Leonard says.
A need for ‘the growler’
By some estimates, there are 15,000 ambulance crashes a year, though nobody keeps a complete count. Medics often are cleared of wrongdoing even when they crash while running a red light because ”failure to yield to emergency vehicle” laws give the medics the upper hand legally.
Even so, across the nation both male and female medics have served time for killing others while running hot. In those cases, the medic was found guilty of crimes such as driving negligently or recklessly. And an ambulance accident can cost an emergency medical system millions of dollars.
In an effort to curb these crashes, there are two major strategies at work in some cities across the nation to make emergency medical response safer.
First, the same kind of ”black box” technology that has helped make passenger jets safer is now monitoring some ambulances.
Mounted under the ambulance’s front seat is the box that medics call ”the growler.” By measuring more than 25 parameters of the vehicle’s operation, such as acceleration, braking and the use of seat belts, lights and sirens, this black box gives medics — and their supervisors — a precise picture of their every move on the road.
The boxes give audible cues to drivers when they are nearing or exceeding predetermined parameters for accelerating, braking and turning. When a medic takes a turn too fast, the growler clicks like a Geiger counter. If the medic exceeds the preset limit for a full second, the tone changes and the driver knows he or she has just been hit with a computerized violation of the driving policy.
The boxes, installed on only a minority of the nation’s ambulances, appear to have corralled the driving behavior of nearly 300 medics in the Florida system in a matter of weeks.
”We’ve seen direct results from this,” says Scott Springstead, operations supervisor for Sunstar Emergency Medical Services of Pinellas County. ”We’ve seen a reduction of 20-to-1 in the severity of our crashes.”
Mirrors still get clipped and fenders get bent, but there have been no big accidents, he says.
Despite success, the boxes, also called ”Big Brother” and worse by some medics, aren’t always popular. They threaten one of the primary perks of the job: Running hot through crowded streets is a thrill.
”Our workforce is young, largely male, and we all drive with a little testosterone when we shouldn’t,” Springstead says. ”There was a little bit of that bravado, a little bit EMT and a little bit race-car driver. That’s a bad attitude to take in an ambulance with you.”
But he says he can still drive fast, observe the limits of the black boxes and be certain that his city will see no change in response times.
”The message is, we have a job where minutes matter and seconds matter, and we need to be aware of that,” Springstead says. ”But rather than just floor it and cross your fingers, there is a science to how you can navigate your vehicle. We have a responsibility to the safety of our citizens.”
More selective about response
Another method that some cities are using to reduce the number of fatal ambulance crashes is smarter dispatch. If medically trained dispatchers can determine that the person on the other end of the phone line does not need a crew to rush to the destination — the theory goes — accidents can be prevented and lives saved.
Though many crews in the nation’s fragmented and diverse emergency medical systems can recall emergencies where their fast action saved lives, those calls are rare. People who are choking, bleeding to death or in cardiac arrest are few and far between in the modern emergency medical system. And those cases are easy for medically trained dispatchers to identify on the phone. When the situation is desperate, help can be sent in a hurry, Clawson says.
But the more common calls to 911 come from people who are not suffering life-threatening problems. In big cities, routine cases — people who lack insurance, do not have a doctor and simply need access to basic health care — clog the system.
This creates a backlog of runs and adds a sense of urgency to the medically mundane.
”This keeps the ambulances stretched thin,” says Leonard, a former street medic. Paramedics may be tempted to use lights and siren to transport a patient from a nursing home to a hospital, he says, to get back in service faster to be available to help people who are more likely to be saved.
Many of the fatal accidents have occurred as ambulances raced to the hospital with patients on board who were relatively healthy and medically stable. Others have occurred when medics were rushing to the side of a person with a sprained ankle or other non-emergency, USA TODAY found.
Some emergency medical systems are making medical judgment calls in the dispatch center to reduce the number of times their ambulances respond with lights and siren. Medically trained dispatchers can be more selective about what gets a hot response.
In Virginia, the Richmond Ambulance Authority uses both the black box ”growler” in the rig and state-of-the-art emergency medical dispatching to sort through calls.
In a darkened room full of colorful computer terminals displaying maps with ambulances and people in need across the city, street medics are at the consoles working the radios and phones.
On a recent day, as one medic gathered information and gave advice to a person having an allergic reaction, another radioed a colleague in an ambulance to start driving toward the address.
The ambulance was rolling within seconds, but the medic who was still on the phone determined that the case of hives did not need a lights-and-siren response. There was no trouble breathing. There was no immediate threat to life.
The medic gave simple medical instructions, including advice to call back if anything changed before the ambulance arrived.
”The emphasis in emergency medicine,” says Jerry Overton, the system’s executive director, ”is right here in dispatch.”
Hurtling into a pedestrian
But even the emergency medical systems that take steps to reduce the risk of crashes can’t prevent every tragedy.
In Denver, where paramedics sort calls in the dispatch center and medics get advanced driver training, running hot is still a danger.
It was a cold evening in December 2000 as Otis McKay drove his ambulance past the Cathedral of the Immaculate Conception where people were out looking at Christmas lights.
Virginia Magalhaes-Rosa was walking with others near the majestic steps of the cathedral.
As McKay responded to a call for a man with chest pain, he had a green light at an intersection. A van in the left lane stopped at the green light, and McKay passed the van on its left, cruising by in the left turn lane at about 35 mph.
As the ambulance came up beside the van, the van’s driver, Jose Campos-Ortega, inexplicably turned toward the ambulance.
”My partner yelled, ‘Watch out! Here he comes!’ ” McKay says.
The van struck the ambulance near the front tire, damaging the brakes and steering system.
As the ambulance veered across two lanes, McKay saw that he was heading straight for pedestrians in front of the church. He tried to steer toward the stairs of the church. ”I’m thinking I’d rather hit the building than the pedestrians,” he says. ”I’m stomping on the brakes, and the vehicle is slowly coming to a stop.”
But when the rig hit the curb, the braking and steering systems failed completely.
”The force of the vehicle hitting the curb shot me from going left back onto the sidewalk,” he says. Magalhaes-Rosa, a Brazilian immigrant, had been running toward the church, ”but when she saw that I was steering toward the church, she changed her mind and ran on the sidewalk.
”She is literally running in front of me. It sounds like a horrible cartoon,” McKay says. ”She is trying to outrun the speed of the ambulance. I watched her go underneath the vehicle.”
When the rig stopped, McKay called for help on a police radio. His partner told the ambulance dispatcher to send one ambulance for the man with the chest pain and another for the woman.
McKay climbed beneath the ambulance, ”hoping she will roll over and call me names and scratch and kick me.” She only gazed and gasped a few times.
He pulled her out, snaked a breathing tube down her throat and into her trachea, started an intravenous line and loaded her into another ambulance that raced her to the nearby trauma center.
She died hours later.
Campos-Ortega pleaded guilty to careless driving resulting in death and received 18 months’ probation. He is still paying for Magalhaes-Rosa’s funeral as part of his restitution.
McKay was cleared, but he is forever changed. ”You cover it up and paint over it, but once a good guy kills a person, the only thing you can do is swallow it and go on the best you can,” he says.
also of interest
- Kaiser Family Foundation/New York Times/CBS News Non-Employed Poll
- Visualizing Health Policy: The Washington Post/Kaiser Family Foundation Survey of Iraq and Afghanistan Active Duty Soldiers and Veterans
- New York Times Upshot/Kaiser Family Foundation Polls in Four Southern States
- After the Wars: Survey of Iraq and Afghanistan Active Duty Soldiers and Veterans