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Vehicle crashes and being struck by vehicles are the leading causes of death among police. The purpose of this paper is to identify risk factors for injury in police officer vehicle crashes in order to help determine the most effective approaches to improve officer vehicle safety.

The study entailed a cross-sectional survey of officer drivers involved in vehicle crashes from 16 local, county, and state law enforcement agencies across the USA over one year. The relative risk of injury for officers in crashes with a given characteristic relative comparison crashes without that characteristic was computed to determine which characteristics are more likely to be associated with injuries.

The survey yielded 854 crashes, 90 of which involved injuries to the officer driver. Crash characteristics associated with a statistically significant increase in the risk of injury include multiple vehicle collisions, collision direction, officer vehicle type, officer vehicle being stopped, driving under emergency conditions, conducting traffic control or assisting motorists, not wearing a seat belt, and others. Most findings hold for all crashes and when minor crashes are excluded from the analysis.

This study presents the first quantitative estimates of the risk factors for injury to law enforcement officers in vehicle crashes. Our findings indicate that seat belt use remains a critical safety intervention; driving under emergency conditions is high risk, though the reasons for this are unclear; better practices are needed to protect officers in stationary vehicles; agencies should carefully weigh the benefit of motorcycles against the vastly increased risk of injury they present; and that mobile data terminals are both a major distraction hazard and important source of injuries in crashes.

Traffic incidents vary considerably in their severity, and the dispatch categories assigned during emergency ambulance calls aim to identify those incidents in greatest need of a lights and sirens (L&S) response. The purpose of this study was to determine whether dispatch categories could discriminate between those traffic incidents that do/do not require an L&S response.

A retrospective cohort study of ambulance records was conducted. The predictor variable was the Traffic/Transportation dispatch categories assigned by call-takers. The outcome variable was whether each incident required an L&S response. Possible thresholds for identifying dispatch categories that require an L&S response were developed. Sensitivity and specificity were calculated for each threshold.

There were 17,099 patients in 13,325 traffic incidents dispatched as Traffic/Transportation over the study period. “Possible death at scene” ‘had the highest odds (OR 22.07, 95% CI 1.06–461.46) and “no injuries” the lowest odds (OR 0.28 95% CI 0.14–0.58) of requiring an L&S response compared to the referent group. The area under the ROC curve was 0.65, 95% CI [0.64, 0.67]. It was found that Traffic/Transportation dispatch categories allocated during emergency ambulance calls had limited ability to discriminate those incidents that do/do not require an L&S response to the scene of a crash.

This research makes a unique contribution, as it considers traffic incidents not as a single entity but rather as a number of dispatch categories which has practical implications for those emergency medical services dispatching ambulances to the scene.

The purpose of this paper is to investigate the role that agency culture, training, and supervision play in the rates of on-the-job seatbelt use among peace officers, as well as other officer safety-related driving concerns such as cell phone use, Mobile Data Terminal use, and other sources of distraction.

Based on semi-structured interviews with California peace officers.

This study found an array of agency culture issues related to on-duty collisions, including distraction, failure to follow policy or procedure, fatigue, self-selection processes among officers and agencies, supervision and field training processes, morale issues, and family/lifestyle issues.

To explain these agency culture findings, this paper introduces the concept of the “banality of risk” to understand why many officers choose not to use risk-attenuating equipment. The findings are suggestive of a set of best practices that agencies could consider regarding in-vehicle officer safety.

Accidents, injuries and fatalities resulting from state police pursuits conducted during the Michigan Emergency Response Study (MERS) were compared with non‐pursuit police accidents and three‐ and five‐year means of general population accidents to examine the relative dangerousness of the police pursuits under varying light conditions. The Michigan State Police troopers, who were asked to complete a survey instrument each time a pursuit was conducted during the survey period of June 1991 through May 1992, reported 197 pursuits, 65 accidents with 30 injuries and one fatality. Pursuit accidents were significantly more likely to occur during the hours of darkness than the three comparable groups; however, pursuit injury accidents were more likely to occur during daylight and darkness, but not so during the hours of dusk and dawn. Significant differences in fatalities were not found during daylight, dawn or dusk, but the pursuit fatality rate was higher during darkness when compared with the three groups. Examines accident, injury and fatality rates of previous studies in the review of the literature. Overall, several similarities existed among the studies regardless of the number of pursuits reported.

Examines a questionnaire returned by 188 Alabama police and sheriffs’ departments with regard to pursuit issues. Considers variables such as department size, current policy, officer judgment, forcible stop techniques and training. Finds that 80 per cent of these departments had an emergency response policy. Clearly shows that a majority of the respondents think their department’s policy is somewhat restrictive. Cautions that policy may not always be followed in practice. Finds that there is a comprehensive effort to promote safety for officers and all involved, notably in the fact that only 44 per cent of the responding departments allow the use of forcible stop techniques.

The purpose of this paper is to assess the performance measurement in the UK NHS ambulance service documenting various unintended consequences of the current performance framework and to suggest a future research agenda.

The paper reviews the literature on ambulance performance targets and documents several unintended consequences of the current performance system through an in‐depth case study analysis based on interviews with Trust staff and policy experts along with observation of performance review meetings in the chosen Trust. Ethical approval for the study was obtained from a local NHS research ethics committee.

Significant unintended consequences of the ambulance performance targets based on response times have been systematically documented, which are likely to put the target under spotlight, especially that of the eight‐minute response. The current policy focus to reform the eight‐minute target by making it more stringent has the potential of jeopardising the reform agenda based on developing clinical skills of the paramedics and introducing clinical management in the service.

The paper makes an objective assessment of the sustainability of the current policy framework and identifies future lines of enquiry for further research.

This paper makes an original contribution in identifying and documenting the disjuncture between stated and unintended consequences of ambulance performance measurement, which will be of value to academics, practitioners and policy makers.

Although adverse events are less studied in the prehospital setting, the evidence is beginning to paint an alarming picture. Consequently, improvements in Emergency Medical Services (EMS) demand a paradigm shift regarding the way care is conceptualized. The chapter aims to (1) support the dialogue on near-misses and adverse events as a learning opportunity and (2) to provide insights on applications of multiteam systems (MTSs).

To offer discussion on near-misses and adverse events and knowledge on how MTSs are applicable to emergency medical care, we review and dissect a complex patient case.

Throughout this case discussion, we uncover seven pertinent issues specific to this particular MTS: (1) misunderstanding with number of patients and their locations, (2a) lack of context to build a mental model, (2b) no time or resources to think, (3) expertise-facilitated diagnosis, (4) lack of communication contributing to a medication error, (5) treatment plan selection, (6) extended time on scene, and (7) organizational culture impacting treatment plan decisions.

By dissecting a patient case within the prehospital setting, we can highlight the value in engaging in dialogue regarding near-misses and adverse events. Further, we can demonstrate the need to expand the focus from simply teams to MTSs.

There is a growing academic interest in the examination and exploration of work intensification in a wide range of healthcare settings. The purpose of this paper is to explore the differing staff perceptions in emergency ambulance services in the UK. It provides evidence on the challenges for the paramedic professionalisation agenda and managing operational demands and work intensity in emotionally challenging circumstances, with significant implications for patient safety.

Drawing on the evidence from an empirical study in a large National Health Service ambulance trust in England, this paper examines the challenges and differing staff perceptions of the changing scope and practice of ambulance personnel in the UK. Amidst the progress on the professionalisation of the paramedic agenda, individual trusts are facing challenges in form of staff attitudes towards meeting performance targets, coupled with rising demand, fear of loss of contracts and private competition.

Research findings highlight differing perceptions from various sub-cultural groups and lack of clarity over the core values which are reinforced by cultural and management differences. Need for greater management to explore the relationship between high sickness levels and implications for patient safety including the need for policy and research attention follows from this study. The implications of work intensity on gender equality within the ambulance settings are also discussed.

Ambulance services around the world are witnessing a strain on their operational budgets with increasing demand for their services. Study evidence support inconclusive evidence for patent safety despite the growing specialist paramedic roles. Organisational implications of high staff sickness rates have been largely overlooked in the management literature. This study makes an original contribution while building upon the earlier conceptions of work intensification.

The study findings have significant implications for the ambulance services for better understanding of the staff perceptions on work intensity and implications for patient safety, high sickness absence rates amidst increasing ambulance demand. Study findings will help prepare the organisational policies and design appropriate response.

Societal understanding about the organisational implications of the work intensity in an important emergency response service will encourage further debate and discussion.

This study makes an original contribution by providing insights into the intra-organisational dynamics in an unusual organisational setting of the emergency ambulance services. Study findings have implications for further research inquiry into staff illness, patient safety and gender issues in ambulance services. Evidence cited in the paper has further relevance to ambulance services globally.