The retrieval of critically ill patients is frequently done in difficult circumstances and often under considerable time pressures. These adverse conditions have a finite risk of serious injury or death. The level of risk is poorly described in the literature and reliable data on accident rates are hard to find. Most of the information comes from North America. There are no clear published statistics for the UK. We report for the first time data on accidents and casualties involving vehicles classified as having an ambulance body type and air ambulances within Great Britain between 1999 and 2004.
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Accidents involving emergency vehicles are rare but have resulted in serious injury or death. Most available data come from emergency medical services in the USA where the majority of teams are primary responders.1 Accidents occur most frequently during ambulance transports when “lights and sirens” are being used.2 The collision rate for road transportation is 5/10 000 responses. The death rate among emergency medical personnel is 12.7/100 000 workers, 14.2/100 000 for the police and 16.5/100 000 for fire fighters.3
Statistics regarding accidents in Great Britain are available,4 5 but there is no central register for emergency vehicle accidents. In January 2002 the then Secretary of State for Health admitted in her written answer to the House of Commons that “… information on … and details of how many ambulance vehicles have been involved in road accidents is not collected centrally by the Department”.6
For aeromedical helicopter flight transports between 1992 and 2002 the death rate in Australia was reported as 1.46/100 000 flight hours7 and in the USA as 1.69/100 000 flight hours.8 Hence, the largest contributor to the death rate would appear to be vehicle accidents.
A study was undertaken to investigate the incidence of accidents and deaths during ambulance and flight retrievals in Great Britain. The definition of retrieval included both primary transports when injured patients are moved from the site of injury to an emergency facility and secondary transports from an emergency facility to a secondary site for further management. We also wanted to try to determine how many deaths and injuries were caused by ambulances.
Data were obtained from the Department for Transport, Road Statistics for the number of road accidents in which an ambulance body type was involved and the number of casualties from accidents involving ambulances between 1999 and 2004. Median (range) values are presented. Data for accident rates of air ambulances within Great Britain were obtained from the Civil Aviation Authority, Aviation Safety Review.9
Road data for Great Britain (excluding Northern Ireland)
Annual rates for the number of accidents and casualties involving vehicles classified as having an ambulance body type in Great Britain defined as slight, serious or fatal between 1999 and 2004 are shown in tables 1 and 2. The annual rates of casualty data include pedestrians or other vehicle occupants and thus are larger than the number of accidents for the same year.
Air ambulance data for Great Britain and Northern Ireland
Data were obtained from the Civil Aviation Authority and the Air Accidents Investigation Branch and are split into fixed wing aircraft (<5700 kg maximum take-off weight) and helicopters. For fixed wing aircraft there were five deaths between 1999 and 2004 in a single accident involving a medical student, doctor, nurse and two crew members. There were no deaths during helicopter transport in the same period. Although aeromedical transport occurs less frequently than road transport, the total numbers of hours flown by air ambulances are not available to the Civil Aviation Authority. The general risk of death during non-medical flights (1995–2004) on the types of aircraft used by retrieval services is shown in table 3. Reporting errors of highest significance and occurrence reports (1998–2004) are useful surrogate markers of critical incidents. Helicopter flights appear to have more risk but fewer fatalities.
Undertaking retrieval can be dangerous for healthcare workers and also the general public. This is the first report that gives an indication of the size of the problem in Great Britain. The report is limited by the data recorded by government bodies and hence precise figures cannot be given. Data regarding total hours driven and flown are obviously needed to give a better estimate of the overall risk. However, there is no registry of how many hours are spent on retrieval. The majority of fatalities involved road journeys. In 2005, 671 pedestrians were killed in road accidents in Great Britain, which represents 21% of all deaths from road accidents. The total number of deaths in road accidents was 3201.10 Given the small number of aeromedical retrievals within Great Britain, there should have been no fatalities within the study period. This makes us concerned that flight retrieval might be a greater risk than is generally appreciated. Risk factors for flight transport include bad weather and night flying,6 7 but use of maintained landing sites, two flight crew members and operating under instrument flight rules mitigate some of these risks.
The numbers of fatalities per year during retrievals are small. However, each death is a disaster and every attempt needs to be made to reduce the incidence to zero.
Competing interests: None.