Risk management of emergency service vehicle crashes in the United States fire service: process, outputs, and recommendations

Background Emergency service vehicle crashes (ESVCs) are a leading cause of death in the United States fire service. Risk management (RM) is a proactive process for identifying occupational risks and reducing hazards and unwanted events through an iterative process of scoping hazards, risk assessment, and implementing controls. We describe the process, outputs, and lessons learned from the application of a proactive RM process to reduce ESVCs in US fire departments. Methods Three fire departments representative of urban, suburban, and rural geographies, participated in a facilitated RM process delivered through focus groups and stakeholder discussion. Crash reports from department databases were reviewed to characterize the context, circumstances, hazards and risks of ESVCs. Identified risks were ranked using a risk matrix that considered risk likelihood and severity. Department-specific control measures were selected based on group consensus. Interviews, and focus groups were used to assess acceptability and utility of the RM process and perceived facilitators and barriers of implementation. Results Three to six RM meetings were conducted at each fire department. There were 7.4 crashes per 100 personnel in the urban department and 10.5 per 100 personnel in the suburban department; the rural department experienced zero crashes. All departments identified emergency response, backing, on scene struck by, driver distraction, vehicle/road visibility, and driver training as high or medium concerns. Additional high priority risks varied by department; the urban department prioritized turning and rear ending crashes; the suburban firefighters prioritized inclement weather/road environment and low visibility related crashes; and the rural volunteer fire department prioritized exiting station, vehicle failure, and inclement weather/road environment related incidents. Selected controls included new policies and standard operating procedures to reduce emergency response, cameras to enhance driver visibility while backing, and increased training frequency and enhanced training. The RM process was generally acceptable to department participants and considered useful. All departments reported that the focused and systematic analysis of crashes was particularly helpful. Implementation of controls was a commonly cited challenge. Conclusions Proactive RM of ESVCs in three US fire departments was positively received and supported the establishment of interventions tailored to each department’s needs and priorities. Electronic supplementary material The online version of this article (doi: 10.1186/s12889-017-4894-3) contains supplementary material, which is available to authorized users.


Introduction
Hello. My name is [interviewer] and I am [include affiliation]. I am working with the University of Arizona Team on this research.
The purpose of our discussion today is to hear from you how the risk management process was implemented; how its working, challenges that were encountered, and lessons learned. Our discussion is very important since it will generate information to guide future replication of this intervention strategy.
As a reminder, your participation is voluntary. And since you are volunteering to be here, I ask that you are candid and that you view this as a discussion. I will not record your names, and things that you say will not be tied to your name in the products that we create based on this work. I will summarize what you say with the other groups and individuals that I am speaking with, and report the common themes. Similar to the other sessions, with your permission, I will be recording this session; thus, please remember to speak loud and clear, and one person at a time.
Does anyone have any questions? Then let's begin.

Let's talk about your thoughts on risk management process thus far:
What are your thoughts about the risk management process that was used to develop the interventions that were implemented?

Probe, as needed:
Was it a useful approach for preventing injuries? What were some of the challenges with this approach? What were some of the strengths of this approach? Is there another approach to improve injury that you would have rather tried instead?

What do you predict will happen to the interventions once the research study is complete?
What have you learned from the implementation of this policy that would be helpful to others who are interested in preventing injuries using the risk management approach?

Reinforcing Behavior
What could the fire department do as an organization to reinforce the safety behaviors learned through the risk management process?
Do you see a role for incentives to motivate departmental safety behavior?
If yes, what are some possible motivators that might reinforce behavior? If no, why not?
What about peer leaders? Why or why not?

Now that you have completed the risk management process, I want to hear your thoughts on injury prevention. (These are for the original participants)
Do you believe that all injuries during firefighting are preventable?
Do you believe that getting injured during firefighting activities is simply "part of the job"? Do you believe that you have control over your own risk of sustaining an injury while working as a firefighter?
Do you feel that the risk management approach was a good way to identify all of the risks? If so, then why? If not, then why not?
Do you think that control strategies that were implemented through the risk management process created a safer work environment for all of those who are part of the fire department? Probe, as needed: Why? Or Why not? If yes, then try to get to the how, how did it create a safer environment.

Replication and Sustainability
If we were going to try this same process with another fire department, in your opinion, what do they need to know about this process?
If the fire department were to adopt this "bottom up," risk management process, what other operations/job tasks do you feel are appropriate for developing injury control strategies (e.g., drilling/training, technical rescues, etc)?
Do you believe the involvement of university/outside experts in setting up and evaluating the risk management process was helpful or necessary?
Do you feel the process can now continue without them?

Conclusions
Is there anything else that you want to tell me about this process?
Thank you for speaking with me.