Systematic Review

Driving simulators may be used to supplement hands on driving. Specific scenarios/situations may be drilled with simulators. To increase use of simulators, certain techniques can be applied to reduce simulator sickness.

• FDNY reported that all accidents (firefighter vehicle) were reduced by 12% and intersection collisions by 38%. (Raheb, 2005).
• California Commission on Peace Officer Standards and Training reported that blended training (hands on and simulator training) resulted in fewest collisions for peace officers; though no data are available to substantiate this claim (Trench, 2010).
• Gradual exposure (acclimation) to simulator training shown to reduce self-reported simulator sickness symptoms (N=120) (Domeyer, 2013).
• Use of optical corrective lenses (to correct the discrepancy between virtual distance and actual screen distance) shown to reduce simulator sickness symptoms when compared to controls and placebo (non-corrective lenses) (Bridgeman, 2014)
• Use of ‘relaxing music’ reduced the severity of reported simulator sickness (N=93); simulation was a bicycle video and may not be applicable to driving (Keshavarz, 2014). 
• Use of pleasant odors (e.g. rose) may reduce severity of reported simulator sickness (N=42) (Keshavarz, 2015) 
• Simulator sickness symptoms may occur after simulator use (delayed onset) and could pose a risk to actual driving (Brooks, 2010).
• Study conducted by The California Commission on Peace Officer Standards and Training (POST) found that use of computer simulators results in the fewest collisions.
• Miami-Dade Fire Department reportedly has reduced simulator sickness to ~3% of trainees.

Pre-emption systems utilize on-vehicle signal emitters that trigger receivers built into traffic signals to switch the traffic light in the direction of travel to green while switching opposing and cross-traffic lights red, permitting priority passage of the emergency vehicle and stopping cross traffic.

According to FHWA studies, implementation of Opticom systems:

• Reduce intersection crash rates by up to 70% (this is for all emergency vehicle crashes)].
• Improve response times by up to 25%.
• Eliminate priority conflict
• Receive data reports logging vehicles and preemption activity
  City of St. Paul Minnesota saw emergency vehicle accidents at intersections drop by 70.8% after using Opticom since 1969. (Hudson, 2003)
• Data from PWC suggests Opticom had minimal if any effect on reducing crashes, though call volume/mileage could not be estimated.

Zoll Road Safety Systems use audible warnings to modify driver behaviors. The audible warnings increase in intensity based on the level of driver violation (i.e. sound gets louder the longer someone speeds). System also includes GPS tracking and reporting of violations. Primarily used in ambulances.

According to Zoll: 

• 87% decrease in preventable accidents (emergency vehicle accidents)
• 3 million miles without an injury accident (emergency vehicle accidents)
• 60% reduction in collisions (emergency vehicle (related) collisions

NFPA 1002 identified minimum job performance requirements for drivers and vehicle operators. Improving drivers training is prioritized and should contribute to safer vehicle operations. 

According to NIOSH’s Fire Fighter Fatality Investigation and Prevention Program (FFFIPP):

• 29.3%of fire departments provide training to firefighters as per FFFIPP recommendations.
• 78.8% of fire departments have Standard Operating Procedures (SOPs) in place consistent with the FFFIPP recommendations.
• The FFFIPP study found that departments which have experienced fatality are more eager to train firefighters and develop SOPs.
• In civilian drivers (N=309,624) there is little evidence to suggest, post-license driver training (remedial and advanced training) alone may reduce crash or injury rates; but training may reduce the rate of traffic offenses (Ker, 2003).

Seatbelt use is mandated in all departments, but compliance is generally low due to large turnout gear making buckling in difficult. Products like ReadyReach place buckles in easy to reach locations and extend seatbelt stalks for ease of access in large turnout gear. Bright orange webbing makes seatbelts easy to see. (IMMI, 2015)

• Although 84% of fire departments require firefighters to wear seat belts while in emergency vehicles, 16% of fire departments do not require seat belt usage according to NIOSH’s Fire Fighter Fatality Investigation and Prevention Program (FFFIPP). The investigation found that fire departments which have had fire fighter fatality are more likely to require seat belt use. Fire departments in the Midwest are the least likely to comply with seat belt recommendations while fire departments in the western region of the nation have shown the greatest compliance in requiring the use of seat belts.
• The entire FDNY fleet is outfitted with IMMI’s ReadyReach though no effectiveness data are available (IMMI, 2015)
• Multi-pronged approaches to seatbelt compliance are most effective, and the use of incentives (cash or otherwise) and obtrusive observations and feedback in occupational settings have been shown to increase seat belt usage 50-100% (Segui-Gomez, 2000).
• According to the the “Emergency Service Vehicle Safety Initiative” by FEMA, vehicle occupant fatalities during the daytime decreased from 57% in 1994 to 44% in 2009. 
• Five-point harness seat restraints have been used in apparatuses and ambulances to improve mobility while seated and increase vehicle restraint use. 
  • Articles reviewed did not evaluate usage or other outcomes, but noted enthusiasm and high acceptability among emergency services personnel. 
• Several articles discussed the use of seatbelt pledges to increase seatbelt compliance in the fire service. 
  • No formal evaluations or outcomes found. None of the articles reviewed reported any changes to seatbelt compliance or use. 

• Proactive risk management utilizes a formalized procedure of identifying, evaluating and ranking risks, and implementing controls. This has been implemented in various industries to prevent and reduce occupational risks and hazards. Some departments also use formal and informal risk assessment to identify root causes of collisions. 
• Several departments have reported using crash review boards as a component of their safety programs. The review board members generally use sessions to identify causes of crashes and make recommendations for remedial training or discipline. 

It has been identified that certain calls (e.g. reset fire alarms, invalid assists) may not require emergency (i.e. lights and sirens, or code 3) responses. Reducing the amount of emergency response calls may reduce exposure to high risk driving conditions and lower crash rates.

• The St. Louis Fire Department saw a 35% reduction in ESVCs after implementation of an “On the Quiet” program aimed to reduce siren use and consequently vehicular speeds for non-emergency calls, and Salt Lake City also saw a 78% reduction in ESVCs after implementation of a similar policy (Williams, 2005)

The Fire Service Vehicle Operator course is designed for Firefighters or Engineers who are assigned, or may be assigned, to operate fire department apparatus safely in the normal course of their duties. This course covers common driving hazards, vehicle maintenance and inspections, and driver’s training (Illinois Fire Service Institute, 2015).

• No information on program effectiveness can be found. However, driver training is emphasized by NFPA and FEMA vehicle safety standards.
• The online FSVO program trains to NFPA standards 1002, 1142, 1451 (Illinois Fire Service institute, 2015)

These systems track vehicle movement and engine data, but do not have a video or audio recording component. Some have audible in-cab alerts to alert drivers to speeding or harsh braking. The most basic systems simply track driving data that can be reviewed by safety managers. Some systems are designed to include metrics for monitoring vehicle issues and scheduling regular maintenance and repairs. VDRs are required for heavy fire service vehicles to meet the NFPA 1901 Standard.

• In an occupational setting of technical service truck drivers (N=191), the use of VDRs (tracking driver behaviors and providing feedback) has been shown to reduce all crashes by 38% and at fault crashes by 5%, 7 months after implementation; no data on long term effects (Toledo, 2008).
• Non-randomized, matched control, trial (N=840) showed a 20% reduction in crash rates (range = -31% to -12%) over a one year period on a broad range of vehicles used in occupational settings (light passenger taxis to heavy transport trucks—no emergency vehicles); again, long term benefits are unknown (Wouters, 2000).

Rear facing cameras used to display a live image of potential hazards and objects to the rear of a vehicle. Some advanced systems include sonar/radar to alert drivers of potential objects with audible distance indicators.

• In non-randomized controlled trial (N=46; civilians), 88% of test group did not have crash, while 100% of controls crashed; actual use of cameras (looking at screen) was low among test group (about 20%), though use of an audible back up alarm may help increase more consistent use (Hurwitz, 2010)
• Insurance Institute for Highway Safety (IIHS) saw a 43% reduction in pedestrian backing crashes (dummy pedestrian) in volunteer SUV drivers (N=111); backing sensors (alone or with cameras) were not more effective than cameras alone (Kidd, 2014).
• Back up cameras reduce rear blind zones (area not visible with side mirrors) by up to 90% in passenger vehicles (Kidd, 2014b)
• NHTSA has mandated that all new passenger vehicles to be equipped with rear view cameras by 2018
• Departments interviewed estimated a <10% reduction in backing incidents after installing backup cameras in department vehicles. 

Primarily used for hearing protection and increased on scene communications. May be used to enhance communication between drivers and spotters.

• The use of both wired and wireless headsets for spotter-to-driver communication is often recommended. 
  • No evaluations or outcomes were found.  

These systems provide audible warnings to drivers approaching foreign objects while backing.

• Backing sensor alarms alone were found to be less effective than back up cameras alone; backup cameras plus sensor systems were less effective than back up cameras alone (Kidd, 2014).

Reflective markings on apparatuses increase vehicle conspicuity and may reduce roadside collisions.

• 15% reduction in accidents for trucks with retro reflectors, versus those without. (Olson et al., 1992)
• 1999 United Kingdom study found that fully outlining (large) vehicles with contour markings increased surrounding drivers’ ability to detect them both day and night, as well as judge their size and distance.

Various policies and procedures have been outlined for effective on scene blocking to reduce on-scene roadside collisions. Examples of policies include always dispatching two vehicles and using one for blocking, assigning spotters to watch and direct oncoming traffic, and deploying roadside flares.  

• NIOSH recommends that more detailed blocking SOPs be implemented to reduce emergency vehicle accidents.
• SOPs enable agencies and their personnel to operate in an efficient and constructive manner. Enforcing and developing SOPs related to roadway incident scene operations as well as emergency vehicle response procedures reduce the risk of collisions.

DriveCam is an on-board event recording system which has been implemented in ambulances in several departments. The DriveCam system captures 12 second video clips of the inner vehicle cabin and forward street view when there is a sudden and significant change in longitudinal or latitudinal g-force (e.g., hard braking, hard acceleration, hard cornering or collision). Video clips are reviewed by trained analysts for driving issues.  

These systems focus on increasing the time to saliency (noticeability) of emergency service vehicles operating with lights and sirens among civilian drivers. Studies included advanced warnings to identify optimal timing of alerts and one study was a pilot demonstration. 

• One study evaluated various light bar configurations (frequency and flash patterns) to identify optimal settings for vehicle conspicuity and saliency. One study evaluated siren frequencies to identify optimal frequencies.
  • 4 Hz frequencies were rated more urgent than 1 Hz. The siren study reported significant reductions in transportation times when using the experimental siren. 
• Several articles and departments reported the use of policies to modify Code 3 response protocols to reduce the use of unnecessary emergency lights and sirens when crash risk is generally elevated.
  • A modified Code 3 SOP at FDNY resulted in a reported 32% reduction in crashes. Similar results were found in other departments, with reductions between 10-78% reductions in crashes reported.
• One study reported the development of an algorithm using field indicators to determine if a lights and siren dispatch was warranted for vehicle crash incidents. 
  • The dispatch algorithm was 97% sensitive and 33% specific in identifying incidents where patients required prompt trauma care. 

CRM was developed in the 1970s by NASA to reduce human error and increase safety during flight operations. One of the core tenets of the system is redundant and multi-person verification of critical actions to catch and reduce the risk of errors. This can be applied in emergency vehicle operations by having both driver and officer verbally verify intersection cross traffic is clear or not.

• Though not formally evaluated, there are near miss case reports demonstrating the use of CRM in preventing imminent collisions in fire apparatuses.

Several articles cited lack of accountability and discipline for driving SOP violations as contributing to lax safety cultures and recommended strict enforcement of disciplinary policies as a countermeasure. Some articles recommended holding both driver and officer accountable for all vehicle incidents with discipline including suspension, remedial training, termination or fines. One key informant implemented a seatbelt policy with clearly defined disciplinary measures for non-compliance.

• No evidence was found that increased discipline and accountability reduced crash risks. The one department that implemented a seatbelt policy with discipline reported (but did not provide data) an over 50% increase in seatbelt usage.