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Driver Training in EMS??? (Where have all the good discussions gone???)
OK, nobody was interested in talking about violence. Something else?
I'm continuing on my crusade to heighten awareness of "holes" in our pre-service and in-service educational programs. I hope that with increased awareness we will see some movement toward filling them. Maybe not, but I can hope.
So....EMS schools and agency trainers.....before driving your ambulances on emergency calls, what do your drivers get in the way of training?
Vehicle handling training using the SKIDCAR or similar systems? Check out http://www.skidcar.com/skidcar-system/skidvan.php
Vehicle handling training using a high-fidelity simulator? It's good enough for the Ice Road Truckers - how about your ambulance operators? Good enough for Lisa Kelly? Good enough for me! http://www.orionps.co.uk/simulator-W21page-21-
At least 8 hours of on-road driving, including dropping wheels off the pavement?
Just a cone course in a closed lot?
Just a lecuture course?
WHY? WHY NOT? Driving - both hot and cold - occurs on almost every call. And driving is where we kill an awful lot of EMS medics. So how do you, my EMS thought leader friends, feel about our approach to training emergency vehicle operators and transporters of precious cargo?
In case you're wondering, I think what happens in most places today is woefully inadequate.
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Replies to This Discussion
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Permalink Reply by Neil White on -
On this side of the pond our Driving Qualification is provided by Pearson which is a US company
http://www.edexcel.com/quals/ihcd/Documents/IHCD%20Ambulance%20Driv...
It is a 3 week full time programme of study. Agency Instructors must be qualified government Driving Instructors and Fleet Driving Instructors. This course also meets the requirements for professional drivers to complete the DriverCPC programme mandatory for all professional heavy good vehicle drivers in the UK.
Emergency Service Vehicle driving is much more regulated in the UK because of the exemption on the regulations governing the time lengths that professional drivers of large vehicles must undertake and as a result the required rest periods. This exemption is very flakey indeed and is likely to be removed in the future.
Driving hours of goods vehicles over 3.5 tonnes and some passenger vehicles are regulated by European Community rules. These set limits on driver’s hours:
- Daily driving limit: 9 hours*
- Maximum driving limit: 4 ½ hours
- Daily rest period: 11 hours
- Weekly driving limit: 56 hours
- Fortnightly driving limit: 90 hours
- Weekly rest period: 45 consecutive hours**
* Can be extended to 10 hours no more than twice a week.
** May be reduced to 36 hours if taken at normal base, or 24 hours if taken elsewhere.Drivers operating within the UK exempt from European law will be subject to the Transport Act 1968, which lays down the following limits:
- Daily driving: 10 hours maximum
- Daily duty: 11 hours maximum
The contention lies in the word "driving" for goods drivers, this time includes any waiting periods for loading and unloading, because at any time they could be required to move or reposition the vehicle. Thus the same argument is made for EMS.
Stobart Group in the UK have a 40ft Truck Simulator which all of its drivers are now trained on before going on to the road. We find that as university's in the UK bid for students for the very over scribed paramedic courses teaching tools will increase as a result. One university has installed an actual fully working bus in its classroom http://news.bbc.co.uk/1/hi/england/8568272.stm
Whilst I feel technology and practical skills are there, i do believe there is a lot of work to be done on the mindset and emotional responses whilst driving. I also believe that there is work to be done on creating a silent cab to minimise distractions both not taught in our current programs.
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Permalink Reply by Rob Harrison on -
We don't drive ambulances, but in our district, which includes driving fire trucks as well as ambulance sized rigs that transport our marine division equipment and our rehab unit, any member of the district has to take the written course every other year, and a driving obstacle course as well to be qualified to then get the chance to have the station Captain take you out in every vehicle in the station to which you can respond and drive in our local area until he is satisfied you can not only handle the truck, but the equipment on it. We also have SOPs for operating the vehicles, which include our Medical Emergency Response Vehicles, which are Hondas filled with EMT gear.
I didn't see the discussion about violence. I would have pitched in.
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Permalink Reply by Skip Kirkwood on
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Permalink Reply by dr-exmedic on -
The agency I worked for longest required a lecture-and-cones course (originally 8 hours, now 16) before getting in the driver's seat for employees, with more non-emergency driving experience for volunteers (but no specific amount). Certainly nothing unusual.
Simulators are expensive to buy but apparently there are companies that will rent them for a couple days--a friend of mine got to do that recently, but her department only sprang for 30 min per employee. Don't know if that's going to be an annual thing, though.
Neil White said:On this side of the pond our Driving Qualification is provided by Pearson which is a US company
Ah, yes, Pearson. I know them all too well...having forked over a good $2000 (1300GBP) and counting for tests I've taken with them....
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Permalink Reply by Bob Sullivan on -
Going back to school's my excuse for being out of discussions, but I'm on break now.
I've been allowed to drive at every EMS workplace without demonstrating competence in it. My last two required me to have a 16 hour EVOC class (videos and a cone course), which I had, but told them I lost my certificate (which I did), and that was good enough for them.
My first time driving hot with a patient in the back was on my first Saturday night in the big city of Buffalo. It was me, an EMT-I, and paramedic. The EMT-I told me I'd be up front by myself because he wanted to play paramedic in the back, so I was on my own. I got a tongue lashing on the ramp at ECMC from them afterwords (apparently my driving made her miss an IV) and almost quit. I'm glad I didn't.
How many hours do police officers get with driving? We don't chase people, but I would argue that our cargo is more precious than theirs.
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Permalink Reply by Skip Kirkwood on
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Oh I'd agree! The cops appear to spend 40-80 hours on driving in pre-service training, and I don't know about others but while I was a deputy we did some driving every year - one year a speed course, another year the skid-car course, another year the PIT technique - always something new, but always reinforcing the fundamentals too.
Guess what - most police agencies don't chase any more, or they have severely limited who gets to chase and how that is done, but they haven't removed driving from the curriculum.....
And in Buffalo no less....you should have had advanced training in pothole navigation and bullet-dodging before being turned loose on the streets of the Niagara Frontier! Never mind "How to do skids and drifts on frozen, unplowed streets!"
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Permalink Reply by Wil Bard on -
I'd like to say we have a great driving program, but we don't. When I started it was something like this is the ambulance go and drive it. I drove a full size van so the regular driving was pretty much the same. I got training driving lights and sirens by being coached while doing it by an experienced partner. Today it's much different, a training book that has to be completed requiring three different senior EMT's to go over all exercises and questions. Then just none emergency driving until it is felt by both new EMT and trainers that they are ready. I know it's not very high tech, but it seems to work...so far.
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Permalink Reply by Neil White on
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How many hours do police officers get with driving? We don't chase people, but I would argue that our cargo is more precious than theirs.
Its interesting here, Pursuits have to be authorised by the senior officer on duty in the dispatch and in the UK we see helicopters being used more and officers driving far back in the distance.
Emergency vehicles in the UK are involved in something like 27,000 accidents a year. Given that there is 7ish million emergency calls across all the services, you could argue the percentage is small. However, 100% of the accidents are caused by driver error, things like overconfidence or claiming exemptions that were not safe - Crossing Red Traffic Lights being the biggest.
The question I'd like to pose if what is the opinion of a situation where an emergency driver is facing prosecution due to a driving accident. His defence is naturally operating within the confines of very controversial laws governing exemptions. Is the Emergency Driver automatically at fault for an accident whilst on lights and sirens?
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Permalink Reply by Skip Kirkwood on
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In most US states, not "automatically." Our laws allow you to violate a variety of rules (speed, red lights, etc.), provided that you exercise "due care."
However, it is very easy for someone (bosses, jury, police) to conclude that you hit something, therefore you were not exercising due care. Ergo, liability. If you were exercising due care, you wouldn't have been there.
We are fortunate in that we get a lot of "professional courtesy" from the police - who face the same concerns that we do. If they can do so with a straight face (and they're not mad at EMS for something), they will often ticket the other driver for 'failure to yield to a emergency vehicle,' which (at least informally) takes the medic off the hook.
Sometimes it helps to be lucky if you aren't very good......
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Permalink Reply by Michael Stern on -
The two agencies I was most recently with both required a classroom and cone course/precepted road time approach (based on the NHTSA EVOC curriculum) prior to being alone in the driver's seat. Both also attempted to send everyone (at some point) to Bridgestone's Winter Driving School, due to the routine winter driving condition in their Rocky Mountain jurisdictions.
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Permalink Reply by Charlie Wright on -
I am a VFIS Driving Instructor, and using the course in the class room as well as driving the course laid out I feel teaches the "new" operators a lot in being aware of what they are driving. The most important thing that I tell them all is even though you get out of the patient compartment and move into the drivers seat PATIENT CARE DOES NOT STOP! You will still give that person the BEST driving that you can do. Being in EMS for over 28 years now I started out in a Cadillac (yes it was an old hearse), moved to a van then the modular. It doesn't matter what is driven, what matters is that YOU your partner, the patient, and any family, that are being transported arrives SAFE!
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Permalink Reply by Neil White on
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So what would a fit for purpose driving programme look like....
1 week, 2 or more
With patient actors on board or without? Would technology help?
And the big question here, requalification - how often should drivers revisit training? We're moving to every 5 years.
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