Occupational fatalities in emergency medical services: A hidden crisis

doi:10.1067/mem.2002.128681

Annals of Emergency Medicine

Volume 40, Issue 6, December 2002, Pages 625-632

Presented at the National Occupational Injury Research Symposium, Pittsburgh, PA, October 2000, and the New York State Vital Signs Conference, Albany, NY, October 2001.

https://doi.org/10.1067/mem.2002.128681 Get rights and content

Abstract

Study objective: We estimate the occupational fatality rate among emergency medical services (EMS) personnel in the United States. Methods: We undertook descriptive epidemiology of occupational fatalities among EMS providers. Analysis was conducted by using data from 3 independent fatality databases: the Census of Fatal Occupational Injuries (1992 to 1997), the National EMS Memorial Service (1992 to 1997), and the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (1994 to 1997). These rates were compared with the occupational fatality rates of police and firefighters and with the rate of all employed persons in the United States. Results: The Census of Fatal Occupational Injuries database documented 91 EMS provider occupational fatalities. The National EMS Memorial Service database contained 70 fatalities, and the Fatality Analysis Reporting System identified 8 ground-transportation EMS occupational fatalities. There was also wide variation in fatality counts by cause of injury. Using the highest cause-specific count from each of the databases, we estimate that there were at least 67 ground transportation-related fatalities, 19 air ambulance crash fatalities, 13 deaths resulting from cardiovascular incidents, 10 homicides, and 5 other causes, resulting in 114 EMS worker fatalities during these 6 years. We estimated a rate of 12.7 fatalities per 100,000 EMS workers annually, which compares with 14.2 for police, 16.5 for firefighters, and a national average of 5.0 during the same time period. Conclusion: This study identifies an occupational fatality rate for EMS workers that exceeds that of the general population and is comparable with that of other emergency public service workers. [Ann Emerg Med. 2002;40:625-632.]

Introduction

Emergency medical services (EMS) personnel are exposed to a wide variety of occupational hazards, including ambulance crashes, assaults, infectious disease, hearing loss, lower back injury, hazardous materials exposure, stress, extended work hours, and exposure to temperature extremes. These emergency medical technicians (EMTs) and paramedics respond to automobile crashes, shootings, medical emergencies, hazardous material incidents, and large-scale disasters. However, little is known regarding the risks associated with this occupation.

Because EMS personnel were not defined by a unique industry or occupational code, published data from the Bureau of Labor Statistics (BLS) cannot be routinely used to describe the risk of occupational illness or injury to these personnel. Therefore, the only information available were obtained from record reviews or surveys of EMS populations. It is also difficult to get a comprehensive injury profile from the published studies because the authors use different definitions of “injury” and use different denominators for their calculation of rates.

To date, few data are available to quantify the injury risk to EMS workers, in part because of a lack of specific codes to identify more workers in standard databases. This research was conducted to quantify the risk of fatality among providers of out-of-hospital care in the United States by combining data from 3 independent existing sources of data.

Section snippets

Materials and methods

The Census of Fatal Occupational Injuries (CFOI) is the central repository for information on fatal occupational injuries in the United States; occupational fatalities for particular groups can be identified by specific occupational codes. However, there is no specific occupational code used for EMS workers. Rather, EMS workers are mixed in with other occupational groups. We used CFOI to identify probable EMS injury fatalities from within 5 other occupational groups by using the methods

Results

For CFOI, 67 (74%) of the 91 probable EMS fatalities resulted from crashes. Ten (11%) fatalities were caused by assaults. In 7 of the 10 assault cases, the decedent was shot. The majority of these 10 victims were women. The 14 cases listed as “other” included cardiovascular incidents, air ambulance crashes, smoke inhalation, electrocution, falls, suicide, needle sticks, drowning, and injuries from other causes. These 14 cases are classified for this analysis as “other” because CFOI regulations

Discussion

Little is known to date about the injury risks of EMS personnel. Only 4 studies have evaluated a broad spectrum of injuries. Gershon et al¹⁰ evaluated injuries among EMS workers in Baltimore, MD, and found 226 occupational injuries per 197 employees per year. At face value, this equals a rate of 115 injuries per 100 full-time employees per year. However, the authors specified neither the definition of “injury” nor whether the denominator was based on full-time equivalent employment. By

Acknowledgements

We thank Tee Guidotti, MD, MPH, and Jim Weeks, PhD, for their critical review of the manuscript, Dante Verme, PhD, and Earl Pollack, PhD, for statistical advice, and Jim Weeks, PhD, for his assistance with the CFOI data. We extend our thanks to Peter McIntyre, Nabil Ali, and Aaron Patterson for their help with the initial data collection. We also appreciate the assistance and support from representatives of the Bureau of Labor Statistics, particularly Eric Sygnatur.

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^*: Address for reprints: Brian J. Maguire, MSA, EMT-P, Department of Emergency Health Services, University of Maryland, Baltimore County, 1000 Hilltop Circle, Baltimore, MD 21250; 410-455-3778,fax 410-455-3045; E-mail [email protected]

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Emergency Medical Services/Original ResearchOccupational fatalities in emergency medical services: A hidden crisis*

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgements

Am J Emerg Med

Ann Emerg Med

J Emerg Nurs

J Emerg Med

J Emerg Med

Ann Emerg Med

Ann Emerg Med

Am J Emerg Med

Ann Emerg Med

Census of Fatal Occupational Injuries

Census of Fatal Occupational Injuries, CFOI Research

Fatality Analysis Reporting System (FARS)

Bureau of Labor Statistics Occupational Outlook Handbook

EMS workforce

J Emerg Med Serv JEMS

Fatalities to law enforcement officers and firefighters, 1992-97

Compensation and Working Conditions

National census of fatal occupational injuries, 1995

Compensation and Working Conditions

Workplace-related homicide among health care workers in the United States, 1980 through 1990

JAMA

Review of accidents/injuries among emergency medical services workers in Baltimore, Maryland

Prehosp Disaster Med

News of labor

Disabling job injuries among urban EMS providers

Prehosp Disaster Med

Emergency Medical Services/Original Research
Occupational fatalities in emergency medical services: A hidden crisis*