Work Related Injuries Among Prehospital Emergency Medical Staff, an Observational Study

Ambulance personnel often work in a dangerous environment and work related injuries of emergency medical staff have repeatedly been documented. However, only case reports are published and no data exist about the incidence and type of work related injuries of ambulance personnel.

Aims:

The primary aim of the study is to assess the incidence (number of new injuries per 100'000 emergency missions or per 1'000 flying hours) and type of work related injuries among prehospital emergency personal. The secondary aims are to identify risk factors associated with work related injuries and to compare the risk of injury to other groups of professionals such as hospital nurses, policemen or fire-fighters.

Background

Background:

Staff of emergency medical missions is at high risk of work-related injuries. Over 8 % of emergency medical staff have been reported to be victims of work-related injuries, leading to a time away from work of 9.4 %. Others have reported a rate of 5 - 25 accidents per 100'000 flight hours or 55 per 100'000 road ambulance transports. A ten year retrospective analysis of US public roadways identified 331 accidents with 405 fatalities and 838 injuries. Speed of work, unknown work surroundings, difficult working conditions such as poor lighting and tight work environment may all contribute to injuries. While mishaps and unintentional injuries cause most incidents, frank assaults pose additional threats to medical staff. In the US the injury rate for EMS workers are higher than rates reported by the department of labour for any other industry. Most commonly reported injuries include strains and sprains, however, permanent disabilities and fatal injuries have been reported. Even though the medical profession's first duty is to do no harm, innocent bystanders have repeatedly been victims of ambulance crashes. In fact, one study reported a greater burden of injury on persons not in the ambulance. While emergency medical work pose some intrinsic risks to patients and workers, several risk factors have been identified which are associated with increased risk of incapacitating or fatal injuries, e.g., positioning in the rear of an ambulance or improper restrains, younger EMS professionals and sleeping problems and while on non-emergency travels. Inadequate restrains pose a particular risk in paediatric emergency transport.

No data for work-related injuries have been reported for prehospital medical crew in Europe.

Aims:

The primary aim of the study is to assess the incidence (number of new injuries per 100'000 emergency missions or per 1'000 flying hours) and type of work related injuries among prehospital emergency personal. The secondary aims are to identify risk factors associated with work related injuries and to compare the risk of injury to other groups of professionals such as hospital nurses, policemen or fire-fighters.

Setting:

Prehospital emergency medical services (EMS) in Switzerland, including ground, air and water-related ambulance services. All certified ambulance services for air, traffic and water accidents are eligible for participation and will be contacted and invited to participate. Additional supporting rescue companies such as rescue squad of the Swiss Alpine Club or of a ski resort as well as lay rescuers will not be included in the analysis. All accidents on medical missions of a prolonged period are analysed. Depending on the available data in the different ambulance services, the study period may extend from at least one year up to a maximum of 10 years.

Methods:

Incidents are defined as:

* an unintentional (i.e. accident) or intentional (i.e. assault) injury during an emergency medical mission leading to leave from work, including:

  * EMS personal,
  * innocent bystanders or
  * additional injuries to patients transported;
* a needle stick injury, even if it will not lead to a leave from work;
* a leave from work due to a severe psychological distress during an emergency mission, e.g. death of a child

Medical reasons (e.g. common flu, chronic back pain) resulting in leave from work are not considered as incidents and will not be included.

Severity of injury will be stratified according to the KABCO classification as suggested previously (K: killed, A: incapacitating injury, B: non-incapacitating injury, C: possible injury, O: no apparent injury).

Incidents will be analysed according to parameters related to an ambulance organisation, type of emergency mission and injuries to patients, EMS personal and innocent bystanders. Since the prevalence of accidents or near misses is expected to be low, a large number of emergency missions of a large time span must be investigated. To allow a timely analysis, data will be gathered retrospectively. The data of the victims (cases, i.e. ambulance worker) will be collected anonymously. Cases will be identified using the accident number (Schadennummer) and the UVG (Unfallversicherungsgesetz) insurer. Personal data will thus be anonymous at the study centre in Bern.

Data evaluation and statistics:

In a first step the total incidence of work-related injuries (number of new injuries divided by number of missions or divided by number of flying hours) will be determined as primary endpoint among street, air and sea ambulance services in Switzerland. Descriptive statistics will be used.

Risk factors, i.e. secondary endpoints, will be analyzed using univariable and multivariable multilevel linear regression models with three levels: 1. ambulance organization, 2. ambulance mission and 3. victim. Possible risk factors may include for:

* ambulance organization:

  * type of ambulance organization, (ground, air, sea)
  * geographical region of the ambulance organization (German, French, Italian-romansch speaking region of Switzerland)
  * rural - urban setting
  * hospital association of ambulance service
  * number of collaborators at ambulance service
  * number of missions per year
* mission:

  * time of day
  * weekday
  * time of year
  * weather conditions
  * duration of mission
  * type of accident (unintentional accident, assault, psychological "injury")
  * phase of mission (during approach, on site of accident, on way to hospital, during hand-over / on hospital ground, on way home)
  * type of mission (primary mission, i.e. direct approach to accident, secondary mission (interhospital transfer).
  * with / without special signal, i.e. signal and lights
* Victim associated:

  * Age at the time of accident
  * gender
  * years of on the job experience
  * role during the accident-related rescue mission (driver, paramedic, pilot,...), position at time of accident (driver compartment, patient compartment,...)
  * part-time, fulltime employment
  * number of mission per collaborator and per year
  * patient characteristics (patient to be transported suffered additional injury, patient escort e.g. parent of child-patient, member of rescue team, bystander)
  * degree of injury (deceased, permanent injury, non-permanent injury, possible injury, uninjured)
  * duration of leave from work
  * position at the time of accident (driver compartment, patient compartment, outside vehicle, in / on other vehicle)
  * innocent bystander
  * patient to be transported

In a second step the comparison with other professional groups, e.g. hospital nurses, policemen or fire-fighters will be performed. The data of the first step will allow to perform a sample size calculation for future research.

Objective

Aims:

The primary aim of the study is to assess the incidence (number of new injuries per 100'000 emergency missions or per 1'000 flying hours) and type of work related injuries among prehospital emergency personal. The secondary aims are to identify risk factors associated with work related injuries and to compare the risk of injury to other groups of professionals such as hospital nurses, policemen or fire-fighters.

Methods

Prehospital emergency medical services (EMS) in Switzerland. All certified ambulance services for air, traffic and water accidents are eligible for participation and will be contacted and invited to participate. All accidents on medical missions of a prolonged period are analysed.

Incidents are defined as:

* an unintentional (i.e. accident) or intentional (i.e. assault) injury during an emergency medical mission leading to leave from work, including:

  * EMS personal,
  * innocent bystanders or
  * additional injuries to patients transported;
* a needle stick injury, even if it will not lead to a leave from work;
* a leave from work due to a severe psychological distress during an emergency mission

Eligibility Criteria:
Inclusion Criteria:

* human
* leave from work
* work related mortality
* work related injury
* needle stick injury
* psychological distress
* innocent bystander
* unintentional injury
* intentional injury
* emergency mission

Exclusion Criteria

* medical reason
* chronic illness
* non-work related injury
* non-work related mortality