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CASE REVIEW Hospital Course En route to the hospital, the patient receives ongoing cardiac compres- sions, and EtCO 2 monitoring shows values in the range of 28–32 mmHg. The cardiac team is brought into the ED, and they direct the patient to the cardiac intervention lab. He has a cardiac catheterization performed and an assist device implanted. After about 65 minutes of cardiac arrest, he has return of spontaneous circulation. He undergoes therapeutic hypothermia. After three days he awakens with a complete recovery of neurologic status. A defbrillator in his chest, he returns to work. The EMT who was pinned between the vehicles does not wish to be evalu- ated at a hospital. He has some bruises on his legs but remains on duty. The ambulance operator asks to remain out of his position for the shift. He attends a vehicle operations safety course before returning to his role as a vehicle operator. The crews complete a "near miss" report, and the incident is reviewed at a safety meeting several weeks later. The next week the depart- ment conducts a retraining on vehicle backing operations. Safety in Practice Vehicle operations in roadways have an inherent set of risks, particularly at higher speeds and when operating in lights-and-siren mode. Training for vehicle operation is part of an overall EMS safety management program. All EMS personnel must be involved in scene operation safety. Even at low speeds, vehicles may be moving in forward and backward directions, between people, objects and surfaces that create diffculties for the operator. There are often issues of lighting and darkness and additional law enforce- ment and fre personnel moving around, as well as actions being taken in transition to care that will take place in the vehicle. The driver alone cannot be responsible for safe movement. Many agencies require backing be done with a spotter. Many ambulances now have rear-view cameras, but those alone do not manage all the risks of backing operations. Spotters are a safety practice that takes a little extra time, but promotes the highest level of safety in vehicle operation. The spotter provides a dedicated set of eyes at the back of the ambulance, controls pedestrian movement in the area and identifes any hazards to the driver and others. James J. Augustine, MD, FACEP, is an emergency physician and the direc- tor of clinical operations at EMP in Canton, OH. For More Information Circle 15 on Reader Service Card Copyright granted for this article for department use only up to 20 copies. 22 APRIL 2014 | EMSWORLD.com EMS_18-23_CaseReview0414.indd 22 3/13/14 2:32 PM