The ambulance zigzagged across the highway and tipped onto its driver’s side.
The engine started smoking. The key wouldn’t turn to switch the engine off, and the passenger door and window wouldn’t open.
In the rear compartment, an EMT and a trainee had been helping a patient and weren’t belted in. When the ambulance crashed they were tossed around inside, one injuring his back, the other his arm. The patient was also hurt.
Other motorists stopped to help get everyone out of the ambulance before police arrived and closed the highway. Other ambulances arrived to take the injured to the hospital.
Those are the recollections of some of the people aboard an ambulance that crashed on Interstate 91 North in Whately about 9 a.m. on June 27, 2018. Each wrote a short narrative that was submitted to the state as it reviewed the accident.
Ambulances respond when people are hurt in traffic accidents or suffering from other medical problems. But ambulances are sometimes involved in crashes themselves.
Ambulance crashes reported in Massachusetts in recent years had a variety of causes, from EMT fatigue to the inattention of other drivers. Experts say a variety of factors contribute to ambulance crashes and more needs to be done to find ways to prevent them.
State regulations (105 CMR 170.350) require ambulance providers to report “serious incidents” including crashes to the Office of Emergency Medical Services, part of the state Department of Public Health.
In response to a public records request, DPH provided The Republican with a list indicating 66 ambulance crashes from Jan. 1, 2014, to Dec. 31, 2017. Based on media reports, The Republican identified an additional seven accidents in Massachusetts during that period, for a total of 73. Available data was incomplete, but indicated patients were aboard the ambulances in at least 37 of the crashes, and injuries were reported in 30 of them. Three of the crashes were fatal.
Those numbers compare to 5.2 million emergency and nonemergency runs reported by ambulance services to the Massachusetts Ambulance Trip Record Information System during the same four-year period.
Data from the National Highway Traffic Safety Administration indicates there were 20 fatal ambulance crashes in Massachusetts from 1982 to 2017, for an average of less than one a year. The nationwide average is 27 fatal crashes involving ambulances per year.
Chart by Greg Saulmon / The Republican • Source: National Highway Traffic Safety Administration / Fatality Analysis Reporting System
Use the toggle in the chart above to switch between data for Massachusetts and national data. The 2017 figures are provisional.
EMTs in Massachusetts are tested every two years on medical knowledge and skills in order to maintain certification. And while they must have valid driver’s licenses, the state does not require EMTs to go through emergency vehicle operator training.
Individual EMS agencies or municipalities can set their own driver training requirements, and classes are offered periodically by various agencies, said Deborah Clapp, executive director of the nonprofit coordinating agency Western Massachusetts Emergency Medical Services. One area ambulance company, for example, provides two days of driver training for its new recruits, including a daylong classroom session and one day spent on a “cone course” and driving in traffic with an instructor in the passenger seat.
“All EMTs, when they go through their basic training, they get some education about it, which is helpful,” Clapp said. “But it’s nothing compared to taking a class where you’re learning vehicle dynamics and all about a vehicle and its capabilities … emergency stopping, evasion … rollover awareness, those sorts of things.”
The National Highway Traffic Safety Administration began a survey of ambulance driver training programs in 2015 and results are expected in the next few months. Professor Brian J. Maguire, in a letter to the agency, agreed it’s important to gather the information, but argued more research is needed on the effectiveness of various training methods, as well as other potential contributors to ambulance crashes — particularly driver fatigue.
“We have anecdotal evidence that ambulance agencies schedule EMS personnel for very long hours, lots of anecdotal information that EMS providers work multiple jobs,” Maguire said in an interview.
EMTs may take short naps when they’re not on calls, and some research supports this as a way to stay alert, Clapp said. But some days there isn’t any downtime.
“There’s no requirements yet or best practices yet, but EMS fatigue is a very big issue,” she said.
A former paramedic and hospital administrator in New York City, Maguire is now an epidemiologist at the U.S. Naval Submarine Medical Research Laboratory in Groton, Connecticut. He also recently completed a teaching and research stint in Australia, where he said EMS personnel make significantly more money and tend to stay in the profession longer than their counterparts in the U.S.
Reducing the number of crashes and resulting injuries will take coordinated study of factors from driver training and fatigue to other potential contributors like distraction and diesel fumes, Maguire said.
“A couple of events occur and they say, Oh, now we have to address this,” he said. “And they do something, but then there’s no followup evaluation and nobody’s publishing the results. And so ambulance agencies again and again are kind of reinventing the wheel.”
The ambulance involved in the crash on I-91 in Whately last summer was transferring a patient from one medical facility to another. It wasn’t an emergency call and the ambulance’s lights and sirens weren’t activated. Police and DPH records indicate the ambulance was traveling at 65 mph, the posted speed limit, when it crashed near mile marker 32.5.
Records show all five people aboard — the patient, a patient aide, and three crew members — were injured and taken by other ambulances to Baystate Medical Center in Springfield. Information about the severity of their injuries was redacted in records provided by DPH, which cited medical privacy laws.
State police cited the ambulance driver, Megan LaJoie of Wilbraham, for a marked lanes violation. In the days that followed, she lost her job with National Ambulance of Springfield.
“Employee should have maintained a higher level of situational awareness and more attention to detail,” Stepfanie Cote, the company’s assistant operations manager, wrote in a report filed with the state.
For her own part, LaJoie wrote that she had just cleared a construction zone on the highway when a car cut her off as she tried to change from the left lane to the right lane. She swerved to avoid the car, went into the median, then back into the road. The ambulance rolled onto its side and came to a stop in the breakdown lane.
It was unclear whether LaJoie or other National Ambulance employees had taken part in emergency vehicle operator training. National Ambulance did not respond to a detailed list of questions and multiple requests for comment from The Republican.
The “Providers Plan of Correction” submitted by National Ambulance to the state Office of Emergency Medical Services listed four points: investigating the crash, notifying the service’s medical director and the state, removing the ambulance from service, and terminating LaJoie. In a subsequent letter to Manager Kirill Adzigirey, OEMS wrote, “We have carefully reviewed your submission materials and determined that the steps National Ambulance Service took for remediation and improvement in this case have adequately addressed the issue.”
There have been at least three fatal accidents involving ambulances in Massachusetts in the last five years. In each case, police determined the ambulance drivers were not at fault.
The most recent fatal crash, on the afternoon of April 23, 2016, involved a 2-year-old girl who police said ran in front of an EasCare ambulance leaving Tufts Medical Center in Boston’s Chinatown neighborhood. Media reports identified the girl as Isabella Wu.
The ambulance driver told police he was moving slowly down Nassau Street “because he knew this area has a lot of traffic and people moving around,” according to a police report provided by the Suffolk district attorney’s office. Investigators determined the ambulance was traveling at 8.28 mph. But even at that speed, police said, the driver didn’t have enough time to react when the girl appeared in his path. Investigators attributed the deadly crash to “pedestrian error” and deemed it “unavoidable.”
An EMT tending to a transfer patient in the back of the ambulance told police he “felt a thud on the wall of the truck and felt a speed bump type bump. He heard screaming and screamed for the driver, (redacted) to stop. He looked outside through the rear window and saw the child motionless on the ground.”
The EMT and the driver both rushed to aid the girl. There were at least two other ambulances parked nearby and their crews responded as well.
Police said the girl’s mother received a phone call and didn’t realize the girl had slipped away until it was too late.
On Sept. 22, 2014, at about 11:30 p.m., an ambulance T-boned a sedan at the intersection of Beacon and Fairfield streets in Boston’s Back Bay.
A police report indicates the Boston EMS ambulance had a green light and was passing through the intersection with its emergency lights flashing. The car slowed but failed to stop for a red light, police said. The sedan driver, whose name was blacked out in the police report, was ejected and pronounced dead at a hospital about 90 minutes later. There was no patient on board the ambulance.
The third crash involved a car that slammed into a Community EMS ambulance at an intersection, killing the patient inside. That happened at Route 140 and Green Street in Milford about 11:15 a.m. Jan. 21, 2014. The patient was identified in media reports as Karen Scott, 58, of Upton.
The driver of the car, Lisa Zemack, 61, of Framingham, went on to plead guilty to negligent operation of a motor vehicle, the Milford Daily News reported. She was sentenced to two years’ probation, had her license revoked for two years and was ordered to do community service and take a driver retraining course.
DPH records detail a handful of less serious incidents around Western Massachusetts, including some where the ambulance driver was deemed at fault. Road conditions and dark of night did not appear to be factors.
Oct. 8, 2018, 5:15 p.m.
An ambulance from National Ambulance scraped against a car in Greenfield on Route 10 near the intersection with Silver Street, ripping off one of the car’s tires in the process. The driver of the car refused medical attention. There was no patient aboard the ambulance. Police cited the ambulance driver, Nicole Brunetti, for a marked lanes violation.
May 9, 2018, 8 p.m.
An ambulance had a close call with a semi truck while merging in a construction zone on Interstate 91 north in Longmeadow around sunset. The ambulance was taking a patient to the emergency room. The truck was hauling a car carrier with one vehicle aboard. The two vehicles brushed against one another, resulting in scratches and a missing hubcap bolt. The ambulance driver reported traffic was heavy and he had nowhere to safely go to avoid the collision. There were no injuries, and a second ambulance completed the patient transport.
“We will be adding material to our annual training for all employees, as well as adding it to our NEOP (new hire program),” wrote Mark LaPrade, operations field supervisor for American Medical Response of Springfield, in a report to the state after the incident. “The focus of the training will be the safe operation of a vehicle within a construction zone and will be taught by EVOC (emergency vehicle operators course) instructors.”
April 25, 2018, time unknown
A driver from County Ambulance of Pittsfield ran a red light and collided with a car at the intersection of Main and Walter streets in Springfield. The driver said he was tired and didn’t notice the red light until he had already entered the intersection, at which point he “firmly applied the brakes.” There were no injuries. A patient on board the ambulance was being transferred from one hospital to another; a second ambulance completed the transfer.
Dec. 8, 2017, 12:06 p.m.
The top of a South County EMS ambulance struck a roof overhang at New England Health Center in Sunderland. Records say the ambulance, which was transporting a patient to the hospital, was moving 2-4 mph. The incident did not delay the patient transfer and caused only cosmetic damage to the ambulance and building.
April 24, 2015, 6 p.m.
An ambulance operated by MedCare was damaged in a chain-reaction crash involving four vehicles at Plainfield and West streets in Springfield, according to police. A driver of one of the other vehicles was taken to the hospital with minor injuries and was cited for failure to stop. The patient aboard the ambulance was taken by another ambulance to an emergency room as a precaution, DPH records indicate.