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EMERGENCY MEDICAL SERVICES WORKERS

Publications and Reports

General Information: Injury and Illnesses

Farm mapping to assist, protect and prepare emergency responders: Farm MAPPER
Journal of Agromedicine: June 2014 / 19(2): 90-95
This project performed usability tests on a Web-based farm-mapping application optimized for tablets and accessible via easily accessible on-site matrix barcodes, or quick response codes (QR codes), to provide emergency responders with hazard and resource information to agricultural operations.

Treating posttraumatic stress disorder in first responders: a systematic review
Clinical Psychology Review: July 2012 / 32(5): 370-380
This paper describes a systematic review of the PTSD treatment literature (English and non-English) in order to evaluate such treatment proposals based on what is known about treating PTSD in first responders.

Emergency Responder Health Monitoring and Surveillance System
U.S. National Response Team (NRT): January 26, 2012
The purpose of this document is to provide a recommended health monitoring and surveillance framework for emergency responders involved in disaster response. This guidance document builds on systems and practices currently in use, and should prove useful to persons or organizations who are responsible for, or design tools for, responder registration, credentialing, training, health screening, health monitoring, exposure assessment, safety, surveillance, and treatment.

Fatal and nonfatal injuries among emergency medical technicians and paramedics
Prehospital Emergency Care: October-December 2011 / 15(4): 511-517
This study described fatal and nonfatal injuries occurring to EMTs and paramedics. Data from the Bureau of Labor Statistics (BLS) Census of Fatal Occupational Injuries (CFOI) and the occupational supplement to the National Electronic Injury Surveillance System (NEISS-Work) were analyzed for the period 2003-2007.

Occupational injuries among emergency responders
American Journal of Industrial Medicine: January 2010 / 53(1):1-11
This study characterized injuries among emergency medical services, firefighting, and police occupations by using data from the National Electronic Injury Surveillance System - Occupational Supplement (NEISS-Work) for injuries treated in U.S. hospital emergency departments in 2000-2001.

Exposure and Personal Protective Equipment (PPE)

A story of impact: NIOSH research recommendations are incorporated into national standards to enhance protection for EMS responders
NIOSH Publication No. 2010-161: October 2010
Researchers at NIOSH, along with external partners, conducted a series of investigations as the basis for recommending specific mission-based criteria for protecting EMS responders during medical operations.

Management practices and risk of occupational blood exposure in U.S. paramedics: needlesticks
American Journal of Industrial Medicine: September 2010 / 53(9):866-874
The purpose of this study was to present risk estimates for needlesticks in U.S. paramedics and estimated risk ratios for selected management practices.

Preventing exposures to bloodborne pathogens among paramedics
NIOSH Publication No. 2010-139: April 2010
A national survey of 2,664 paramedics contributed new information about their risk of exposure to blood and identified opportunities to control exposures and prevent infections.

The national study to prevent blood exposure in paramedics: rates of exposure to blood
International Archives of Environmental and Occupational Health: February 2010 / 83(2):191-199
Data from a survey on blood exposure were analyzed to present incidence rates of exposure to blood among paramedics in the United States by selected variables and to compare all percutaneous exposure rates among different types of healthcare workers.

Management practices and risk of occupational blood exposure in U.S. paramedics: non-intact skin exposure
Annals of Epidemiology: December 2009 / 19(12):884-890
This study was conducted to estimate the risk of blood exposure to non-intact skin in U.S. paramedics and to estimate risk ratios for selected management practices.

Circumstances surrounding occupational blood exposure events in the National Study to Prevent Blood Exposure in Paramedics
Industrial Health: March 2009 / 47(2):139-144
A mail survey was conducted to describe blood exposure events among U.S. paramedics.

Provision and use of personal protective equipment and safety devices in the National Study to Prevent Blood Exposure in Paramedics
American Journal of Infection Control: December 2008 / 36(10):743-749
This study examined how often paramedics were provided with personal protective equipment (PPE), sharps containers, and selected safety devices by their employers; the frequency with which paramedics used sharps containers and these safety devices; and paramedics' attitudes regarding this equipment.

The national study to prevent blood exposure in paramedics: exposure reporting
American Journal of Industrial Medicine: March 2008 / 51(3):213-222
This survey was conducted to provide national incidence rates and risk factors for exposure to blood among paramedics. The analysis assessed reporting of exposures to EMS employers.

Blood exposure among paramedics: incidence rates from the national study to prevent blood exposure in paramedics
Annals of Epidemiology: September 2006 / 16(9):720-725
The aim of the study was to estimate incidence rates of occupational blood exposure by route of exposure (needlesticks; cuts from sharp objects; mucous membrane exposures to the eyes, nose, or mouth; bites; and blood contact with nonintact skin) in US and California paramedics.

Blood-borne pathogens among firefighters and emergency medical technicians
Prehospital Emergency Care: April-June 2005 / 9(2):236-247
The authors conducted a literature review of occupational blood exposures, the seroprevalence of blood-borne pathogens among firefighters and EMS workers, and the seroprevalence of blood-borne pathogens among the patients they serve.

Motor Vehicle Safety

NIOSH Continues Research to Improve Safety for Ambulance Service Workers and EMS Responders
NIOSH Publication No. 2011-190
Researchers at NIOSH set out to reduce ambulance crash–related injuries and deaths among EMS workers. Research addressed the layout and structural integrity of ambulance compartments, design of hardware, and occupant restraints. NIOSH researchers continue to work with the Ambulance Manufacturers Division of the National Truck Equipment Association, the General Services Administration, manufacturers, and federal agencies on other recommendations to improve occupational safety for EMS workers.

SAE Surface Vehicle Recommended Practice J2956 for Occupant Restraint and Equipment Mounting Integrity - Side Impact System-Level Ambulance Patient Compartment
SAE (2011)
This SAE Recommended Practice describes the test procedures side impact occupant restraint and equipment mounting integrity tests for ambulance patient compartment applications. Its purpose is to describe crash pulse characteristics and establish recommended test procedures that will standardize restraint system and equipment mounting testing for ambulances. Descriptions of the test set-up, test instrumentation, photographic/video coverage, and the test fixtures are included.

Assessing the performance of various restraints on ambulance patient compartment workers during crash events
International Journal of Crash worthiness: October 2010 / 15(5):517-541
The inability of emergency medical service (EMS) workers to remain safely restrained while treating patients in the patient compartment of a moving ambulance was identified as a key impediment to EMS worker safety in North America. Results indicated that the inclusion of restraint systems offering mobility have the potential to improve worker safety under many working conditions in this unique work environment.

SAE (2010). SAE Surface Vehicle Recommended Practice J2917 for Occupant Restraint and Equipment Mounting Integrity - Frontal Impact System-Level Ambulance Patient Compartment
This SAE Recommended Practice describes the test procedures for conducting frontal impact occupant restraint and equipment mounting integrity tests for ambulance patient compartment applications. Its purpose is to establish recommended test procedures that will standardize restraint system and equipment mounting testing for ambulances. Descriptions of the test set-up, test instrumentation, photographic/video coverage, and the test fixtures are included.

Crash testing of ambulance chassis cab vehicles
SAE 2007 Transactions Journal of Commercial Vehicles. Warrendale, PA: SAE International, 2008 Apr;1-19.
NIOSH, with partners, conducted a test program to evaluate the capability of mobile restraint systems to protect occupants in the patient compartment of an ambulance. This paper focused on the vehicle chassis behavior and acceleration pulses as seen in each test conducted to support the program.

Ambulance Crash-Related Injuries Among Emergency Medical Services Workers - United States, 1991-2002
Morbidity and Mortality Weekly Report: February 28, 2003 / 52(8): 154-156
EMS workers are most at risk when transporting patients, or responding to or returning from emergency calls. This report highlighted the risk of death or serious injury for EMS workers riding in ambulances.

Your Safety First: Railroad Crossing Safety for Emergency Responders
NIOSH Publication No. 2003-121
Reports fatalities of emergency responders struck and killed by trains at railroad grade crossings. Discusses safe driving at rail crossings, awareness of signs and warning devices, and how to react if a vehicle stalls on the tracks. Developed by NIOSH in cooperation with the Federal Railroad Administration and Operation Lifesaver, Inc.

Patient Handling

Identification of factors that affect the adoption of an ergonomic intervention among emergency service workers
Ergonomics: November 2012 / 55(11): 1362-1372
This study explored factors contributing to the adoption of a patient transfer-board (also known as a slide-board) that was designed to facilitate lateral transfers of patients to and from ambulance cots.

Designing ergonomic interventions for EMS workers: concept generation of patient-handling devices
Applied Ergonomics: November 2008 / 39(6):792-802
The purpose of this qualitative descriptive study was to generate ideas for the design of new EMS patient-handling devices that were framed within the contextual reality of the end user firefighter/paramedics. Guided by an ecological model of musculoskeletal injuries in the fire service, focus groups were conducted with 25 firefighter/paramedics from 13 suburban fire departments.

Designing ergonomic interventions for emergency medical services workers - part III: bed to stairchair transfers
Applied Ergonomics: September 2007 / 38(5):581-589
The objective of this work was to test interventions aimed at reducing the low-back musculoskeletal loads experienced by firefighters/paramedics providing emergency medical services that involve transferring a patient between a bed and a stairchair.

Designing ergonomic interventions for EMS workers - part II: lateral transfers
Applied Ergonomics: March 2007 / 38(2):227-236
The objective of this work was to test ergonomic interventions aimed at reducing the low back musculoskeletal loads experienced by firefighters/paramedics providing emergency medical services when performing lateral transfers between a bed and a stretcher or between a stretcher and a hospital gurney.

Designing ergonomic interventions for EMS workers, Part I: transporting patients down the stairs
Applied Ergonomics: January 2007 / 38(1):71-81
The objective of this work was to test ergonomic interventions aimed at reducing the magnitude of trunk muscle exertions in firefighters/paramedics providing emergency medical services when transporting patients down the stairs.

Monograph Series

Protecting emergency responders. Volume 4. Personal protective equipment guidelines for structural collapse events. (2006)
This monograph serves as a technical source for National Institute for Occupational Safety and Health incident commander guidelines for emergency response immediately following large structural collapse events. It characterizes response activities and expected hazards, and develops guidelines for selecting appropriate personal protective equipment.

Protecting emergency responders, Volume 3. Safety management in disaster and terrorism response. (2004)
During and after large scale disaster events, responders face the risk of physical injury, traumatic stress, and hazardous exposures. Effectively addressing such risks requires bringing together the capabilities of a range of response organizations from all levels of government, nongovernmental organizations, and the private sector. This study provides recommendations for preparing for response to such disasters and other large-scale incidents.

Protecting emergency responders, Volume 2. Community views of safety and health risks and personal protection needs. (2003)
The authors examined the hazards that emergency responders face and the personal protective technology needed to contend with those hazards. The findings are intended to help define the protective technology needs of emergency responders and develop a comprehensive personal protective technology research agenda for the nation.

Protecting Emergency Responders. Volume 1. Lessons learned from terrorist attacks.(2002)
This monograph was written following a December 2001 conference that discussed terrorist attacks and ways to improve the health and safety of emergency workers who respond to large-scale disasters. This book is intended to help managers and decision makers understand the unique working and safety environment associated with terrorist incidents, understand the equipment needs of emergency workers, and improve education and training programs and activities directed at the health and safety of emergency responders.

Fatality Investigations

To address the continuing problem of national occupational fire fighter fatalities, NIOSH conducts independent investigations of fire fighter line of duty deaths through its Fire Fighter Fatality Investigation and Prevention Program (FFFIPP). This includes investigations of fire fighters who were serving in the capacity of an EMS worker. It distinguishes between deaths related to cardiac events and deaths related to traumatic events. The FFFIPP web page provides access to NIOSH fire fighter investigation reports and other fire fighter safety resources.

Fire fighter/EMS worker deaths related to cardiac events
Report number Incident State Title*
F2012-02 TX Fire fighter-paramedic suffers on-duty cardiac death at fire station - Texas
F2011-06 OH Paramedic training instructor/coordinator found dead in his quarters - Ohio
F2011-03 NH Fire fighter-paramedic suffers sudden cardiac death during ice rescue training - New Hampshire
F2010-34 CA Fire fighter/paramedic suffers sudden cardiac death after rescue training - California
F2010-17 OH Fire fighter/paramedic dies from aortic dissection after three emergency responses - Ohio
F2010-12 UT Fire chief suffers sudden cardiac death during emergency medical response - Utah
F2008-23 MA Fire Fighter-Emergency Medical Technician Suffers Sudden Cardiac Death After Multiple Emergency Responses – Massachusetts
F2008-13 NY Fire fighter-emergency medical technician suffers sudden cardiac death during overhaul - New York
F2007-21 NV Fire fighter-emergency medical technician suffers sudden cardiac death during physical fitness training - Nevada
F2007-05 NY Volunteer fire fighter/emergency medical technician suffers sudden death 2 hours after completing vehicle extrication training - New York
F2006-18 SC Fire fighter/emergency medical technician (FF/EMT) suffers sudden death while on-duty - South Carolina
F2006-08 PA Fire fighter/emergency medical technician suffers an acute myocardial infarction and dies three days later - Pennsylvania
F2005-33 NY Captain suffers pulmonary embolism during response to a medical call and later dies - New York
F2004-22 SC Career fire fighter/emergency medical technician suffers sudden death 5 hours after participating in emergency response - South Carolina
F2004-12 FL Fire fighter-paramedic dies after performing physical fitness training - Florida
F2004-06 WA Fire fighter-paramedic suffers sudden cardiac death while performing physical fitness training - Washington
F2003-22 TX Volunteer fire fighter suffers sudden cardiac death after completing emergency medical technician (EMT) written examination - Texas
F2003-10 CA Fire fighter suffers sudden cardiac death during a medical emergency response - California

* The reports listed below were selected based on the identification of EMT, paramedic, or medical response in the report title.

Fire fighter/EMS worker deaths related to traumatic events
Report number Incident State Title*
F2011-21 LA Volunteer fire fighter dies in a single-motor-vehicle crash while responding to a medical assistance call - Louisiana
F2011-13 CA A career lieutenant and fire fighter/paramedic die in a hillside residential house fire - California
F2011-05 CA Career fire fighter/paramedic dies from injuries following an unexpected ceiling collapse - California
F2010-10 IL One career fire fighter/paramedic dies and a part-time fire fighter/paramedic is injured when caught in a residential structure flashover - Illinois
F2009-30 GA Career fire fighter/paramedic dies 2 days after being ejected during an ambulance rollover incident - Georgia
F2005-12 FL Career fire fighter/EMT dies in ambulance crash - Florida
F2004-11 KY Career lieutenant killed and fire fighter injured by gunfire while responding to medical assistance call - Kentucky
F2003-33 NE Career fire fighter/emergency medical technician dies and paramedic is injured in a three-vehicle collision - Nebraska
F2003-07 CA Career fire fighter/emergency medical technician dies from injuries sustained in fall from apparatus - California
F2003-05 TX Career fire fighter/emergency medical technician dies in ambulance crash - Texas
F2002-44 IN Parapet wall collapse at auto body shop claims life of career captain and injures career lieutenant and emergency medical technician - Indiana
F2002-42 NC Emergency medical technician killed in single-vehicle crash while responding to structure fire - North Carolina
99-F42 CA Fire fighters/emergency medical technician dies in apparatus incident at wildland fire - California
99-F29 MO Firefighter/paramedic drowns during an underwater scuba training drill - Missouri
98-F24 SC Emergency medical technician receives serious burns from an oxygen regulator flash fire - South Carolina
98-F08 CA Three fire department members (two fire fighter paramedics and one helicopter crewman) and an automobile crash victim die of injuries sustained in an air ambulance/helicopter crash - California

* The reports listed below were selected based on the identification of EMT, paramedic, or medical response in the report title.

Also, NIOSH has investigated deaths of emergency medical services workers involved in motor vehicle crashes through the Fatality Assessment and Control Evaluation (FACE) program. The purpose of these investigations is to better understand the circumstances that resulted in the EMS workers’ motor vehicle injury deaths. Each report includes a summary of the event resulting in the EMS worker’s death, and recommendations that employers and others can take to prevent future similar deaths.

Report number Incident State Title
2001-12 NY Emergency medical technician dies in ambulance crash - New York
2001-11 KY 26-year-old emergency medical technician dies in multiple fatality ambulance crash - Kentucky

Literature Search

NIOSHTIC-2 is a searchable bibliographic database of occupational safety and health publications, documents, grant reports, and journal articles supported in whole or in part by NIOSH.

NIOSHTIC-2 search results on Emergency Medical Service Workers are based on keywords related to EMS workers. FACE reports were removed from this unique search as all EMS worker specific reports in this program are listed in the Fatality Investigations section.

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