Number 326 May 2007

Traffic Safety Facts

Traffic Tech – Technology Transfer Series

Feasibility for an EMS Workforce Safety and 

Health Surveillance System

U.S. Department of Transportation 1200 New Jersey Ave. SE., Washington, DC 20590

National Highway Traffic Safety Administration

Emergency Medical Services (EMS) personnel treat an estimated 22 million patients a year (Maguire and Walz, 2004).

While on duty, EMS workers frequently encounter two

work-related risks: injury and illness. Current research on

EMS workforce injury is unsettling and limited compared to

research on EMS workforce illness. In 2000, the occupational

injury rate was the highest for EMS workers compared to

other industries (Maguire et al., 2005). Another study found

that the occupational fatality rate for EMS workers was more

than twice the national average (Maguire et al., 2002). Yet,

even though the extent of EMS workforce occupational illness is better understood, it is still largely limited to infectious disease report analyses mandated by law and the respiratory illness plaguing World Trade Center rescuers.

Certain factors have also made the surveillance of injury and

illness in the EMS workforce difficult, such as the unknown 

size of the EMS workforce. Since emergency medical technicians (EMTs) are housed under a variety of organizations,

such as career and volunteer fire departments, commercial 

ambulance services, third-service public utilities, and rescue

squads, this obscures the dimensions of the EMS workforce.

Thus, the goal of this project was to assess the feasibility of

conducting occupational injury and illness surveillance for

the EMS workforce by: (1) examining the extent of on-the-job

injuries and illness among EMS personnel; (2) determining

essential characteristics and elements of an EMS workforce

illness and injury surveillance system; and (3) assessing the

utility of existing data systems.

Extent of Occupational Injuries and Illness 

To examine the circumstances, characteristics, and extent of

occupational injuries among EMS personnel, a systematic review of the existing literature was conducted. The literature

review examined occupational injuries and illness among

EMS personnel related to: (1) firefighter fatalities; (2) nonfatal 

illness, injury, and infectious disease exposure of firefighters; (3) coronary artery disease and cardiovascular health;

(4) EMS workforce illness and injury (general perspective);

(5) motor vehicle crash injury and fatalities; (6) violence and

assault; (7) infectious disease: needlestick injury, hepatitis B,

hepatitis C, HIV/AIDS; (8) stress and mental health: job

stress and burnout, post-traumatic stress disorder; and (9) occupational illness and injury of rescuers at the World Trade

Center in 2001.

One of the literature review findings was that musculoskeletal injuries, as a result of overexertion lifting, are one of

the common injuries in the EMS workforce. The literature

review also found that in crash conditions, the rear compartment in an ambulance is a dangerous place to be; rear occupants are significantly more likely to be killed than front 

occupants. Additionally, seat belt use in the EMS workforce

is low according to a survey conducted by the National Registry for EMTs.

Method

To determine the essential characteristics and elements of

an EMS workforce illness and injury surveillance system,

and assess the utility of existing data systems, two groups

were created: (1) a steering committee, composed of knowledgeable experts in occupational injury and illness surveillance and EMS operations; and (2) a consensus panel,

drawn from officials of EMS stakeholder organizations in 

the United States, representatives of data collecting or managing entities, and university-based experts in EMS and

occupational injury.

Characteristics of an Illness and Injury 

Surveillance System and Utility of Existing 

Data Systems

The steering committee came up with a list of 32 ideal characteristics/elements of an EMS workforce illness and injury

surveillance system and rated them in order of importance.

The committee also reviewed 14 data systems/sources, classifying their suitability related to: (1) integration orlinkage with

existing data systems; (2) use of denominator data to facilitate

rate calculation; (3) specific elements for capturing contributing factors and EMS events underway when illness or injury

occurred; (4) “user friendliness” of resulting data products;

(5) utility for evaluation of prevention efforts; and (6) inclusion of provisions for evaluation of the surveillance system.
TRAFFIC TECH is a publication to disseminate information about

traffic safety programs, including evaluations, innovative programs, and new publications. Feel free to copy it as you wish. If

you would like to receive a copy, contact Melissa Cheung, MPH,

Editor, fax 202-366-7096, e-mail: traffic.tech@dot.gov.

The committee classified seven systems as being of medium 

suitability and classified the remaining seven systems as being of low suitability. No data system received a rating of

high suitability. Systems were classified as “medium suitability” for: (1) their accessibility of data for an important

component of EMS workforce illness and injury; (2) their

current or future potential for providing information on

broad sectors of the EMS workforce; or (3) their capacity as

a census-­sample-based system. Whereas, the systems that

were rated as “low suitability” were limited in their scope

of surveillance or spectrum of the EMS workforce for which

they provided surveillance coverage.

Based on the steering committee’s findings, the consensus 

panel agreed that the most effective approach to surveillance

of EMS workforce illness and injury was to draw upon several existing systems. Thus, the consensus panel adopted the

language “Surveillance Program” instead of “Surveillance

System.” The consensus panel also came into agreement

upon the essential and desirable elements and characteristics

of an EMS workforce illness and injury surveillance program

(see table below).

Characteristics and Elements of an EMS Workforce Illness 

and Injury Surveillance Program

Characteristics/Elements

Consensus 

Rating

1.	 Capture information from a variety of available data

sources orcreate new data sources

Essential

2.	Capture information regarding the injury or illness

event (including specific EMS activity) at the time of

the injury or illness

Essential

3.	Capture denominator data Desirable

4.	Standardized coding schemes Essential

5.	Facilitate systematic analysis Essential

6.	Generate technical and non-technical output that

is user friendly

Essential

7.	 Include ongoing planning and evaluation Essential

8.	Provide outputs useful for evaluation of

preventive measures

Essential

9.	Be responsive to the needs of the EMS community at the

local, State, and national levels

Essential

Based on the work done in reaching a consensus on surveillance and prioritizing surveillance characteristics,the consensus panel developed a conceptual model for EMS workforce

illness and injury surveillance. The model describes the pathway of data collection, analysis and dissemination of results,

the use of data in developing preventive interventions and

program evaluation, and surveillance program evaluation.

Conclusions

The consensus panel concluded that currently in the United

States, no single data system satisfies the diverse requirements of a comprehensive surveillance data source for EMS

workforce illness and injury. However, the panel did note

that some existing systems (e.g., CFOI, FARS, and NEISSWork) already contribute to or show potential in increasing our understanding of EMS workforce illness and injury.

Thus, the panel found thatratherthan creating a new system,

the best approach is an integration of data systems.

The panel suggested that those who manage data systems

should consider sharing systems, and data owners and

other data providers should be encouraged to explore new

approaches to data aggregation to address EMS issues. The

panel agreed that EMS stakeholders should work together

with data holders/owners to encourage analysis and dissemination of information on EMS workforce illness and injury.

Lastly, the panel stressed that a national EMS workforce injury and illness surveillance program should be established,

spanning surveillance to prevention because, ultimately, the

goal of the program is to improve the health and safety of

EMS workers.

How to Order

To order Feasibility for an EMS Workforce Safety and Health 

Surveillance System (55 pages plus appendices), prepared by

Bedford Research and the Pacific Institute for Research and 

Evaluation, write to the Office of Behavioral Safety Research, 

NHTSA, NTI-130, 400 Seventh Street SW., Washington, DC

20590, fax 202-366-7096, or download from www.nhtsa.dot.

gov. Melissa Cheung, MPH, was the Contracting Officer’s 

Technical Representative for this project.

1200 New Jersey Ave. SE., NTI-130

Washington, DC 20590