Beyond the sirens: A scoping review on paramedic safety during response and transportation

Background: Paramedic safety during response and transportation is a critical issue in emergency medical services, with direct implications for both paramedic well-being and patient care. Ambulance crashes, which average 24.7 fatal incidents per year in the U.S., pose significant risks, with 40.2% of fatalities involving ambulance occupants, including paramedics. Despite its importance, there is limited research addressing the unique risks paramedics face in this phase of their work. This scoping review aims to fill this gap by systematically evaluating the current literature, identifying key findings, and providing recommendations for future research. Methods: A scoping review was conducted using the JBI methodology, which involved a comprehensive search using three platforms: EBSCOhost (All databases), SCOPUS, and OVID. The search targeted articles published between 2000 and August 2024, focusing specifically on paramedic safety. The search terms included variations of paramedic, combined with keywords related to safety, danger, risks, and transport. Citations were imported in EndNote and reviewed by two authors. Articles primarily addressing patient safety and non-English publications were excluded. Thematic analysis was systematically performed using Braun & Clarke's method to manually extract and analyse key themes from the results. Results: 1354 publications were identified, with 1307 excluded due to lack of relevance or duplication. Forty-seven articles underwent further assessment, resulting in the exclusion of an additional twenty-four publications. Twenty-three articles met the final inclusion criteria. Thematic analysis revealed five core themes: (1) driver inattention and risky behaviours, (2) driver/pilot error, (3) seat belt use, (4) equipment and safety design, and (5) lights and sirens driving. Conclusions: This review underscores the potential role of paramedic behaviours in contributing to safety risks during the transportation phase and that this is key among a multitude of other factors influencing injuries and fatalities in this context. Despite its significance, research addressing these behaviours and risk mitigation strategies remains scarce. Future research must centre on understanding paramedic behaviour and implementing measures to address these critical safety concerns. Practical applications: The scoping review findings suggest actionable recommendations to enhance paramedic safety during transportation. Policy updates should mandate seat belt use, establish stricter guidelines for lights and sirens, and prioritize ambulance interior design for safety. This includes secure equipment storage, ergonomic seating, and advanced restraint systems. Additionally, training programmes should be enhanced to cover safe driving practices, risk management, and proper safety equipment use, while addressing cultural factors that may hinder adherence to safety protocols. These recommendations aim to guide policymakers, EMS providers, and equipment manufacturers in improving paramedic safety, ultimately leading to better health outcomes for both paramedics and patients.