EMERGENCY MEDICAL SERVICES WORKERS
Publications and Reports
Workers’ compensation injury claims among workers in the private ambulance services industry – Ohio, 2001-2011
American Journal of Industrial Medicine: December 2018 / 61(12):986-996
This study described Ohio workers’ compensation claims among state-insured ambulance service workers working for private employers from 2001 to 2011.
EMS Provider Infographicpdf icon
EMS providers are critical to public health and safety. They are also at high risk for injuries and exposures at work. This NIOSH resource, co-branded with the National Highway Traffic Administration (NHTSA), recommends ways EMS providers can protect themselves from injuries.
Emergency Medical Services Workers: How Employers Can Prevent Injuries and Exposures
NIOSH Publication No. 2017-194
Employers need to understand why injuries occur in order to prevent them. Fewer injuries can result in a healthier workforce and decreased costs to the agency. This fact sheet highlights results from a four-year study capturing data from EMS workers treated in emergency departments and provides recommendations for prevention.
Occupational injuries and exposures among emergency medical services workers
Prehospital Emergency Care: July-August 2017 / 21(4):420-431
This study used emergency department surveillance data to identify injured EMS workers and telephone interviews to collect additional details on the worker demographics, employment, and injury event circumstances.
The association between weekly work hours, crew familiarity, and occupational injury and illness in emergency medical services workers
American Journal of Industrial Medicine: December 2015 / 58(12):1270-1277
This retrospective cohort study used historical shift schedules and occupational injury and illness reports to assess the influence of extended weekly work hours on injuries and illnesses.
An observational study of shift length, crew familiarity, and occupational injury and illness in emergency medical services workers
Occupational and Environmental Medicine: November 2015 / 72(11):798-804
This study examined the relationship between shift length and occupational injury while controlling for relevant shift work and teamwork factors.
Teammate familiarity and risk of injury in emergency medical services
Emergency Medicine Journal: November 2015 / 33(4):280-285
This study investigated the association between teammate familiarity and workplace injury in the emergency medical services setting.
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.
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.
Post-9/11 peripheral neuropathy symptoms among World Trade Center-exposed firefighters and emergency medical services workers
International Journal of Environmental Research and Public Health: May 2019 / 16(10):1727
This study analyzed questionnaire data from 239 Fire Department of the City of New York World Trade Center (WTC)-exposed firefighters and EMS workers to evaluate the association between work at the WTC site and subsequent peripheral neuropathy symptoms using the validated Diabetic Neuropathy Symptom (DNS) score. This study suggests that symptoms of peripheral neuropathy and paresthesias are common and are associated with WTC-exposure intensity.
Persistent self-reported ear and hearing problems among World Trade Center-exposed firefighters and emergency medical service workers, 2001-2017 – a longitudinal cohort analysis
American Journal of Industrial Medicine: January 2019 / 62(1):43-49
The goal of this study was to estimate the impact of exposure to the World Trade Center (WTC) site on annual and persistent rates of otalgia and hearing impairment among Fire Department of the City of New York Firefighters and EMS workers. Findings demonstrated that the odds of long-term ear symptoms were significantly associated with the intensity of WTC exposure.
Post-9/11 sarcoidosis in WTC-exposed firefighters and emergency medical service workers
Respiratory Medicine: November 2017 / 132:232-237
This study estimated the incidence of post-9/11 sarcoidosis in approximately 13,000 male firefighters and EMS workers enrolled in The Fire Department of the City of New York (FDNY) World Trade Center (WTC) Health Program; compared FDNY incidence to rates from unexposed, demographically similar men; and examined rates by level of WTC exposure.
Emergency Responder Health Monitoring and Surveillance Systempdf iconexternal icon
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.
World Trade Center-related physical and mental health burden among New York City Fire Department emergency medical service workers
Occupational and Environmental Medicine: January 2016 / 73(1):13-20
This observational cohort study described the health burden among Fire Department of the City of New York (FDNY) emergency medical service (EMS) workers and examined its association with work at the World Trade Center (WTC) disaster site.
Post-September 11, 2001, incidence of systemic autoimmune diseases in World Trade Center-exposed firefighters and emergency medical service workers
Mayo Clinic Proceedings: January 2016 / 91(1):23-32
This study estimated the incidence of selected systemic autoimmune diseases (SAIDs) in approximately 14,000 male rescue/recovery workers enrolled in the Fire Department of the City of New York (FDNY) World Trade Center (WTC) Health Program and compared FDNY incidence to rates from demographically similar men in the Rochester Epidemiology Project (REP), a population-based database in Olmsted County, Minnesota.
Evaluation of occupational exposures to illicit drugs during a law enforcement and emergency medical services response
Health Hazard Evaluation (HHE) 2018-0083-3332: November 2018
This health hazard evaluation (HHE) concerns unintentional potential exposure to illicit drugs during a joint law enforcement and fire and rescue response to a drug overdose at a private residence. Nine responders developed adverse health effects during the incident.
Evaluation of occupational exposures to opioid drugs during an emergency medical services response (interim report)
Health Hazard Evaluation (HHE) 2018-0083: March 2018
This health hazard evaluation (HHE) concerns possible exposure to opioids (including fentanyl or its analogues) after a fire fighter-EMS responder developed symptoms during an EMS response to a drug overdose in January 2018.
Ambulance disinfection using ultraviolet germicidal irradiation (UVGI): Effects of fixture location and surface reflectivity
Journal of Occupational and Environmental Hygiene: January 2018 / 15(1):1-12
The objectives of this study were to investigate the efficacy of a UVGI system in an ambulance patient compartment and to examine the impact of UVGI fixture position and the UV reflectivity of interior surfaces on the time required for disinfection.
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.
Preventing emergency vehicle crashes: status and challenges of human factors issues
Human Factors: November 2018 / 60(7):1048-1072
This study reports current status of knowledge and challenges associated with the emergency vehicle (police car, fire truck, and ambulance) crashes, with respect to the major contributing risk factors.
Ambulance Crash Test Methods: Keeping Emergency Medical Services Workers Safe on the Job pdf icon[PDF – 637 KB]
NIOSH and the Department of Homeland Security’s Science and Technology Directorate partnered with other federal agencies and the ambulance manufacturing industry to conduct ambulance crash testing to reduce and eliminate crash-related injuries and deaths to EMS workers in the patient compartment. This infographic highlights ten published crash test methods, and includes a link to a 7-part video series.
SAE Surface Vehicle Recommended Practice J2956 for Occupant Restraint and Equipment Mounting Integrity – Side Impact System-Level Ambulance Patient Compartmentexternal icon
SAE (2011 – Revised 8-23-2016)
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.
SAE Surface Vehicle Recommended Practice J2917 for Occupant Restraint and Equipment Mounting Integrity – Frontal Impact System-Level Ambulance Patient Compartmentexternal icon
SAE (2010 – Revised 8-17-2016)
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.
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.
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.
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.
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.
Protecting emergency responders. Volume 4. Personal protective equipment guidelines for structural collapse events. (2006)external icon
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)external icon
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)external icon
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)external icon
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.
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.
|Report number||Incident State||Title*|
|F2014-23||TX||Pump Operator/Paramedic Suffers Sudden Cardiac Death After Physical Fitness Training – Texas|
|F2014-16||WA||Firefighter Suffers Fatal Heart Attack While Providing Emergency Medical Services – Washington|
|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.
|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.
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.