Organisational structural predictors of ambulance crashes: an analysis

Objective: This study investigated the association between three organisational structural factors—organisational type, organisation status (staffing model), and level of service—and ambulance crash rates. The null hypothesis was that there would be no difference in ambulance crash rates during response or transport between any of the three factors. Methods: A cross-sectional design with a sample drawn from the 2019 National Emergency Medical Services Information System dataset was used to examine the relationship between these systems-level factors and ambulance crashes. After applying inclusion criteria, a sample of 2207 cases was drawn and analysed using the χ2 test of association and multiple logistic regression. Results: There was a statistically significant but small association between level of service and ambulance crashes during transport, using the χ2 test of association (P<0.05). Emergency medical technician (EMT)-level services had lower crash rates and paramedic-level services had higher rates than expected. There was no statistically significant association between organisational type or organisational status and ambulance crashes during either the response or transport phase of an emergency medical service (EMS) call, using the χ2 test of association (P>0.05). Of the two logistic regression models performed, only EMT-level services had a statistically significant association with ambulance crashes during transport (P<0.05; OR 0.208 [0.050, 0.866]). Conclusion: The organisational structural factors examined in this study failed to explain most of the variance in ambulance crash rates. However, EMT-level services were associated with lower rates of ambulance crashes than paramedic level services. EMS healthcare administrators and researchers should continue to explore potentially modifiable factors to reduce the incidence of these events and promote positive social change by reducing the risk of injury to patients, EMS workers and the public at large.

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