On May 15, 2001, a 26-year-old emergency medical technician (the victim) died when the ambulance she was working in was struck head-on by a motorist. The emergency medical technician (EMT) had been riding unrestrained in the ambulance patient compartment while attending an elderly patient during a nonemergency medical transport. As the ambulance was traveling along a two-lane rural highway at about 55 miles per hour (mph) a motorist operating a pickup truck left of the centerline in excess of 70 mph approached the ambulance head-on. The paramedic driving the ambulance attempted to avoid collision by turning left-of-center; however, the motorist's pickup struck the right side front quarter of the ambulance. During the collision, the EMT struck the front bulkhead of the patient compartment. The paramedic had been driving unrestrained and suffered severe injury. The motorist and elderly patient also suffered fatal injuries. The EMT and paramedic were airlifted to a local trauma center. The EMT died en route of blunt force trauma to the head and chest. The paramedic suffered multiple serious injuries including a broken leg and recovered after a stay in the hospital. NIOSH investigators concluded that, to help prevent similar occurrences, employers should: 1) ensure that emergency service workers use the patient compartment vehicle occupant restraints whenever possible; 2) consider equipping ambulances with patient cots that include upper body restraints, and; 3) ensure that drivers and front-seat passengers of emergency service vehicles use the vehicle occupant restraints provided. Ambulance manufacturers and emergency medical services should; 4) evaluate and develop occupant protection systems designed to increase the crash survivability of EMS workers in ambulance patient compartments.