Adverse Conditions

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Adverse Conditions Crashing (Doing it right)

• Collision Avoidance

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Adverse Conditions

• Most ambulance crashes happen on bright sunny
  days. Clear skies, dry roads
• EMS Drivers get overconfident
• Let their guard down
• Drivers dont see lights in daylight
• With windows up, radio on, and AC blowing, may
  not hear sirens
• Just not expecting to see you

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      Murphy Law

• Anybody who drives will drive in adverse
  conditions
• EMS people are guaranteed to get stuck in them,
  often!!!
• With experience and confidence
• Only another professional challenge
• Challenge is in tackling a dangerous situation,
  Mountain climber, skydiver
• Can be rewarding

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Before entering into the dark and stormy night 

• Do everything to keep the odds in your favor
• Windshield - clean, Inside and Out
• Washer fluid
• Rain X, etc.
• Wipers - Get what you pay for
• Will wear out with ice, snow and heat

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Before entering into the dark and stormy night

• Defogger / Air conditioner
• A/C in humid weather
• Bug Screens
• ECNALUBMA sign
• Headlights
• Mud collectors (Clean em)

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OK, NOW GET READY TO ENTER THE AFOREMENTIONED
NIGHT     
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Check yourself out, NOT LIKE THAT!!!  

• Are you overtired, drunk, healthy, rested?
• Are you relaxed?
• Nervous drivers will pull themselves close to the
  steering wheel
• Relax, smoother movements and better control
• Light grip on the wheel
• Speed easier to control and not get
  disillusioned.
• Visual Habits will be consistent

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Now the DARK part of that stormy night.

• 30 of crashes happen at night, 47 of fatal
  crashes at night
• The EYE
• 2 receptors
• RODS - night vision, shades of gray, periphery of
  the retina
• CONES daylight, centrally located, color
  sensitive,
• Vitamin A trivia ( RODS are made up of Vit A
  attached to protein. Light source will cause the
  2 to separate and a period of blindness. Vitamin
  A is metabolized in the Liver, same as Alcohol.
  Liver likes booze more than it likes Vitamins.
  If drunk, more susceptible at night to being
  almost completely blind among other things.

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Guidelines for night driving

• Keep in mind the principle of the eye
• Many people who use good visual habits during the
  daytime do not at night
• Not as stimulated, will stare straight ahead
  instead of scanning
• Blind spots may be right in front of you
• Continuously scan, looking for variations of gray

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Guidelines for night driving

• Be resourceful
• Look beyond your headlights for shades.
• Use front vehicles headlights, illuminating the
  roadway further ahead
• Light doesnt bend
• Curves more hazardous at night.
• Depth perception is distorted
• Truck pulling out will be difficult to judge
  speed and distance

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To Maintain Night Vision

• One bright light might take 30 minutes to recover
  from
• Avoid looking at bright lights
• Driver ed recovery test
• Look at the white line on road edge
• City intersections on mostly dark roads trash
  night vision
• Dashboard lights, Interior lights
• Red light discussion

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To Maintain Night Vision

• May need to FLASH high beams to get oncoming
  driver to lower theirs
• 500 feet oncoming, 300 feet behind
• Dim high beams before a right hand turn
• DO NOT RETURN FIRE
• Lights in the trees, or on the road edge,
  guardrails

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Dangers of Twilight

• 1/3 MVCs occur from 4-8 pm
• 1/4 off all fatalities
• 1/3 of all pedestrian accidents
• Children are twice as likely to be hit during
  twilight
• 24-30 minutes of twilight twice a day
• Morning, vision is continuously improving
• Evening much worse, eyes are switching from cones
  to rods

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Dangers of Twilight

• Not going gently into that good night
• Eyes cannot adjust as fast as the conditions are
  changing
• Highways are most crowded
• Drivers tired, anxious to get home and visibility
  at its worst
• Become irritated and make rash decisions
• Known as Twilight Narcosis

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Driving in twilight   

• Use sun visor as much as possible
• Angle towards the windshield, in the event of a
  crash
• Sunglasses
• Dont forget to take them off
• Headlights
• Parking lights only forget to turn on the
  headlights later
• Highbeams will not help and will hurt others

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Fog

• Magnifying effect on objects
• Objects at 15 yards appeared to be 30 yards
• Slow down
• Use low beams only
• No headlights if fog lights are properly
  positioned
• Amber fog lights, reflects less

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Fog

• Emergency lights and sirens will only be
  confusing and nauseating
• Reflects back and will cause vertigo for the
  people in front
• The siren will be refracted in all directions

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Impaired traction

• Rain, so common, most dont give it respect it
  deserves
• 6 times as many people killed on rain slicked
  streets than on snow and ice
• Most dangerous immediately after rain starts
• Oils rise to the surface and are not washed away
  yet

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Standing water review

• Puddles
• If both front tires hit, entire vehicle will
  shift off crown of the road
• Only one side hits, vehicle pulled in that
  direction

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Brakes

• Soaked brakes have to be dried to work well
• One side gets wet, vehicle will pull to the dry
  side
• Left foot on brake while driving to dry them

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Leaves

• Avoid them
• Slippery
• May be hiding kids toys, sometimes kids

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Ice

• Can increase stopping distance X three, really
  mess up cornering
• Shaded areas highly suspect
• Movements deliberate and slow
• Gentle acceleration, deceleration
• Release gas pedal slowly
• Disengage transmission while coming to a stop
• This will keep the front brakes and the rear
  tires from fighting
• Hills
• Dont stop if at all possible

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Maximizing Traction

• Full tank of gas (weight)
• Sand and salt thrown to the side
• Drive slightly off center
• E-brake when pulling away from a stop
• Limited slip differentials
• Neutral while stopped at a light.

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StatisticsAmerican Ambulance Association reports

• Common causes of Ambulance crashes
• Following too closely
• Failure to use siren and/or lights appropriately
• Failure to use care in intersections
• Driving left of center line without reasonable
  notice to other traffic
• Driving too fast for conditions
• Improper backing or parking
• Failure to set parking brake at scene
• Improper passing technique
• U-turns
• Emergency braking and acceleration

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Get Ready to Crash

• Pre-crash planning
• Always lock the doors, will withstand much more
  strain
• Keep equipment secured
• Oxygen bottles
• Lifepack secured to counter top
• Suction device
• Backboards
• Med bags/boxes
• Cabinets, closed latched
• Fire extinguishers

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Get Ready to Crash

• What do you hear? Find it and fix it!!!
• Patients properly secured to gurney
• Family members belted in front
• EMT fastened in, if possible

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Practice Crash Planning and Develop Crash Habits

• You should have a plan (SIPDE) (Scan, Identify,
  Predict, Decide, Execute)
• Includes the best way to crash
• Knowing how to crash will minimize property loss
  and injury
• What will I do if????
• Keep track of escape routes

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Actions to Avoid a Collision

• Braking
• Most commonly used
• Driver Ed train track story
• Not always the best option
• Proper braking must be used
• Locking brakes will increase stopping distance
• Most trucks have ABS
• Maximum braking must be practiced in a controlled
  setting to get good at it

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Actions to Avoid a Collision

• Acceleration
• Person on a collision course for you!
• Braking might be the wrong action
• Steering away and accelerating might avoid the
  collision

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Actions We Can Take to Avoid a Collision

• Steering Away
• Bend the vehicle from its original path.
• Many are afraid to make quick moves
• The inability of many drivers to swerve is the
  cause of many accidents
• Braking is instinctive, it will cause problems.
• Upsets the weight distribution balance and
  stability
• Look away from the collision and look where you
  want to go.

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Off the Roadway Is an Option

• Path of least resistance
• Getting the ambulance dirty and stuck in the mud
  is far better than a collision.
• Drive all the way to a stop.
• No hands in the air
• No eyes closed
• No paralysis
• Loss of bladder and bowel function, BAD

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Off the Roadway Is an Option

• If off of the road towards an embankment
• Do not drive on an embankment, likely to lead to
  a rollover
• Turn more and point the front of the vehicle down
  the hill

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When a Collision Is Unavoidable

• Choose the best angle to hit
• A head-on collision must be avoided!!!
• 2 vehicles going 55mph 110 mph
• Certain recipe for death
• If driver is in your lane
• Take the open oncoming lane, or
• If/when the oncoming driver realizes they are in
  the wrong lane, they will abruptly jerk back into
  their lane
• Depends on the condition of the road, shoulder,
  visibility, obstacles

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When a Collision Is Unavoidable

• Identify objects that are impact absorbing
• Concrete bridge abutments are BAD
• Buildings are BAD
• Big trees are BAD
• Power poles are bad too, better than a tree of
  the same diameter
• If you must hit, try to sideswipe instead of
  ramming, it will certainly win

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Standing Outside of the Smoldering Wreckage

• Post crash
• OUT OF SERVICE
• 2nd unit dispatched to your initial call
• Request police
• Check all ambulance occupants
• Now in triage mode
• All involved must have a primary survey before
  treatment begins
• Request additional units

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Standing Outside of the Smoldering Wreckage

• Non medical responsibilities
• Warning flares or triangles
• Driver license information
• Registration numbers
• Insurance info
• Assess vehicle damages
• Never admit fault or apologize
• Police and accident investigators determine fault
• May have been circumstances you didnt know
• Make comments only to officer in charge
• Identify witness
• Names, numbers and comments on what they saw
• Diagram the scene

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Standing Outside of the Smoldering Wreckage

• Agency will typically do a case review of there
  own
• Some units have tachographs
• Review board will meet
• Be ready for court

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Vehicle Malfunction

• Even with careful inspections and routine
  maintenance
• Stuff happens
• Tire blowout
• Not as common anymore to have a blowout (flats
  more common and slower process)
• Hold wheel firmly, minimal steering, just
  maintain lane position, let vehicle slow itself,
  stay off brakes

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Vehicle Malfunction

• Brake failure
• Pump brakes a few times
• Downshift
• E-brake is not hydraulic
• Not as efficient, will take longer to slow
• Steering failure
• Usually result of engine stalling
• Can usually still turn wheel, slower with more
  effort
• Hood flies up
• Look through gap in windshield
• Lean head out window, maneuver to road edge

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Case reviews
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THE END