title: Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective analysis.
abstract: BACKGROUND
  Ambulance crashes have become an increasing source of public concern. Emergency medical services directors have little data to develop ambulance operation and risk management policies.
  
  
  OBJECTIVE
  To describe fatal ambulance crash characteristics, identifying those that differentiate emergency and nonemergency use crashes.
  
  
  METHODS
  This was a retrospective analysis of all fatal ambulance crashes on U.S. public roadways reported to the Fatality Analysis Reporting System (FARS) database from 1987 to 1997. Main outcome measures were 42 variables describing crash demographics, crash configuration, vehicle description, crash severity, and ambulance operator and vehicle occupant attributes.
  
  
  RESULTS
  Three hundred thirty-nine ambulance crashes caused 405 fatalities and 838 injuries. These crashes occurred more often between noon and 6 PM (39%), on improved (99%), straight (86%), dry roads (69%) during clear weather (77%), while going straight (80%), through an intersection (53%), and striking (81%) another vehicle (80%) at an angle (56%). Most crashes (202/339) and fatalities (233/405) occurred during emergency use. These crashes occurred significantly more often at intersections (p < 0.001), at an angle (p < 0.001), with another vehicle (p < 0.001). Most crashes resulted in one fatality, not in the ambulance. Thirty pedestrians and one bicyclist comprised 9% of all fatalities. In the ambulance, most serious and fatal injuries occurred in the rear (OR 2.7 vs front) and to improperly restrained occupants (OR 2.5 vs restrained). Sixteen percent of ambulance operators were cited; 41% had poor driving records.
  
  
  CONCLUSIONS
  Most crashes and fatalities occurred during emergency use and at intersections. The greater burden of injury fell upon persons not in the ambulance. Rear compartment occupants were more likely to be injured than those in the front. Crash and injury reduction programs should address improved intersection control, screening to identify high-risk drivers, appropriate restraint use, and design modifications to the rear compartment of the ambulance.
authors.affiliation: Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee 53226, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Kahn
authors.forename: R G
authors.initials: RG
authors.lastname: Pirrallo
authors.forename: E M
authors.initials: EM
authors.lastname: Kuhn
mesh_terms: D000062:Accidents, Occupational / Q000145:classification* / Q000401:mortality*; D000063:Accidents, Traffic / Q000145:classification* / Q000401:mortality* / Q000517:prevention & control; D000552:Ambulances / Q000706:statistics & numerical data*; D001334:Automobile Driving / Q000592:standards; D004634:Emergency Medical Technicians / Q000592:standards; D006801:Humans; D012189:Retrospective Studies; D012307:Risk Factors; D012309:Risk-Taking; D017751:Safety Management; D013997:Time Factors; D014481:United States / Q000453:epidemiology