Lack of Protective Gear for EMTs Leads to Injuries, Survey Indicates
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President Cairns & Brother, Inc.
Emergency medical technicians are neither provided with, nor required to wear, adequate personal protective equipment for the hazards involved in rescue work during extreme emergency situations, according to a survey conducted by the research department at Cairns & Brother, Inc.
It was further learned that EMTs are being injured at an alarming rate during vehicle extrication procedures and fire rescues and in vehicular accidents while responding to calls and transporting patients. These injuries range from minor lacerations to serious burns and smoke inhalation.
As first responders, fire fighters arrive at an emergency scene fully clad in protective clothing including turnouts, helmets, boots, and gloves, EMTs, however, wear little, if any, protective equipment. For example, our study shows that less than 30 percent of the EMTs surveyed are provided with jumpsuits, turnouts, bumper caps, or helmets with eyeshield. Only 33 percent are provided with safety glasses and 58 percent are issued gloves.
Insjury risk increasing
As the emergency environment becomes more dangerous, the risk of serious injury to the EMT steadily increases.
While it is true that the EMT’s primary concern is the safety and welfare of the patient, his personal safety should not be a secondary consideration. An injured EMT is more than just an additional patient to be treated at the emergency scene. Emergency victims may very well be depending on the EMT’s welfare.
Over the past year, our conversations with EMTs alerted us to the fact that the issue of protective clothing was not receiving the attention it merits. In researching this issue, we contacted federal regulatory and safety commissions, but we were unable to obtain any evidence to support the concern of the EMTs in the field. In an attempt to independently gather such evidence, Cairns surveyed EMTs throughout the country on the need for personal protective equipment.
Questionnaires mailed
Last December, Cairns’ research department mailed 300 questionnaires to emergency medical technicians throughout the country who responded to an ad for a helmet. The survey was designed to ascertain the need for protective clothing for members of the emergency medical service. Questions covered the types of emergency situations in which EMTs are involved, rate of injury for EMTs, categories of protective clothing EMTs are provided with and are required to wear, and situations in which EMTs are injured. Those EMTs reporting injuries were asked to describe the injuries as well as the circumstances in which the injuries occurred.
The survey response rate was 52 percent. The total number of responses was compared to those from paid personnel to check for any significant differences between paid and volunteer groups. Of the respondents, 51 percent identified themselves as paid EMTs, 43 percent as volunteers, and 6 percent as either paid fire fighters or EMTs engaged in instructional or supervisory activities.
EMTs responding to the questionnaire described their EMT organization or ambulance company as follows: private, 22 percent; municipal, 42 percent; volunteer, 42 percent; and other, 3 percent. Significantly, 92.5 percent of the paid EMTs fell into the 301-call-plus category, compared to only 79.6 percent of the total number responding to the survey (fig. 1). These emergency calls involve fire, explosion, extrication, industrial accident and home accident.
Vehicle accident toll
A significant percentage of EMTs reported involvement in vehicular accidents while responding to emergency calls and while transporting patients from an emergency scene. Although the question pertaining to vehicular accidents did not ask specifically whether the EMT had been injured, most of the descriptions in the comment section of the questionnaire were of injuries resulting from vehicular accidents. Of all EMTs responding, 53 percent indicated that they or a member of their organization had been injured at an emergency scene. Responses were multiple, reflecting a variety of injury experiences.
The largest confirmed contributor to EMT injury was extrication. A total of 50 percent of all respondents and 91 percent of those who confirmed injury experience indicated extrication as the cause. Fire ranked second with 22 percent, and home accident third with 11 percent (fig. 2).
Of all EMTs reporting injuries, 13 percent indicated that they or the injured EMTs were prevented from treating the patient because of the injury. And 24 percent reported being incapacitated, either temporarily or permanently, as a result of the injury.
The survey indicates that 52 percent of the respondents have been involved in a vehicular accident or know of a member of their organization who has been involved in a vehicular accident while responding to a call or transporting patients to a hospital.
Compartment danger
Comments by respondents indicate that it is the EMT riding in the patient compartment of the ambulance who is most frequently injured. The driver is provided with a seat belt to prevent injury. However, the EMT in the back has no seat belt to provide restraint against being thrown in the event of a sudden stop or collision.
A majority of injuries mentioned in comments were contusions to the head. No statistics are available on whether the EMTs surveyed were wearing any protective headgear while responding to an emergency call, but the inferred rate of injury suggests that protective headgear was not being worn. Sixty percent of those surveyed are provided with, or provide themselves with, helmets with eyeshields, and 49 percent also have bumper caps.
EMTs indicated that their emergency calls more often than not involve extricating a patient from a wrecked vehicle. Of those responding to the question on extrication injuries, 50 percent reported injuries. The most frequently cited injuries were head and hand lacerations from contact with jagged metal and broken glass. Other injuries cited were contusions to the head, incurred while climbing in and out of the wrecked vehicle to reach the patient, and eye injuries, resulting from the use of extrication tools such as hydraulic jaws, saws, and air chisels.
Hand and head injuries
The majority of injuries sustained while treating a patient in an extrication involved two key areas, the hands and the head. However, not all the EMTs surveyed are provided with head and hand protection by their organization. In fact, only 25 percent always wear helmets with eyeshields during extrication, and only a few more always wear gloves.
The equipment worn by EMTs during an extrication is required for 27 percent and voluntary for 73 percent.
Of the EMTs responding to the question on fire-related injuries, 22 percent indicated that they or a member of their organization had been injured. EMTs reported that 93 percent of their fire-related calls more often than not involved treating a patient at the fire scene.
Fire-related injuries described by respondents ranged from burns to smoke inhalation to head lacerations. There is cause to believe that the injury rate is high due in part to the fact that protective equipment worn by EMTs at the fire scene is mandatory for only 32 percent of the respondents. And, in fact, they only sometimes or never wore a jumpsuit, while only about half wore a helmet with an eyeshield.
High injury rate
The research study has provided significant evidence that EMTs are being injured at an alarmingly high rate as a result of exposure at the emergency scene and in vehicular accidents while responding to an emergency.
The results of the study point to a 50 percent rate of injury during extrication, and 22 percent rate of injury at the fire scene. Based on comments from EMTs surveyed and the types of protective equipment they indicated wearing in these situations, it is apparent that, at best, EMTs are not adequately protected and, at worst, not adequately equipped.
Although vehicular accidents are not usually considered emergency-related, the fact that 52 percent of those surveyed reported accidents makes this a most significant category and statistic. Modern ambulances have been designed to provide EMTs with sufficient room to treat the injured patient, but the increased mobility area also increases the EMTs’ exposure to serious injury in the event of a vehicular accident.
Need for protection
We are now more convinced than ever that there is a real and present need to equip EMTs with more adequate protective gear and then train them in its proper use. We are not suggesting that an EMT be overburdened with protective equipment that overshoots the specific nature of an emergency situation, but, instead, suggest that two very important elements exist:
First, as things stand today, EMTs are provided with very little protective equipment. Most EMTs are buying their own equipment. Our survey base was drawn from EMTs responding to an advertisement for protective headgear, which naturally projects a pro-equipment bias into the study. It is also significant to note the very strong interest in a better-equipped and informed EMT force as indicated by the extraordinarily high response rate of 52 percent to the survey questionnaire.
All rescue vehicles and ambulances should be equipped with personal protection equipment and clothing adequate to cover 99 percent of all potential dangers. All EMTs, whether volunteer or paid, should and must be thoroughly trained in the identification and proper use of the protective equipment appropriate to the potential dangers of an emergency situation. And, most important, the use of that equipment must be made mandatory.
