Improving Ambulance Safety for Patients, EMS Clinicians

By Dirk Hoffman

Rebeka Stephen, DO, was awarded the Best Clinical Research award at the 2025 International Scientific EMS Symposium held at the EMS World Expo Oct. 20-24 in Indianapolis for her study titled “Relative Risk of Death in the Rear Compartment in Fatal Ambulance Collisions.”

Using data from the National Transportation Safety Board’s Fatality Analysis Reporting System (FARS), the study described the association between the position of EMS clinicians and patients in an ambulance and the risk of death during a fatal ambulance collision.

“The purpose of our study was to improve safety for both EMS clinicians and patients during ambulance transport,” Stephen says. “Many studies have shown that being in the rear compartment of the ambulance has high risk in a crash, but it hasn’t specified whether it’s the patient or EMS clinician who had a higher risk.”

The study found that the non-EMS individual (usually the patient) in the rear compartment had a 2.9 times higher risk of fatality when involved in a fatal ambulance crash, but Stephen cautions the study included only four years of data, so more validation needs to be done. 

“This project speaks to UB’s commitment to research that enhances the safety of EMS clinicians and their patient,” says Brian Clemency, DO, MBA, professor of emergency medicine, and senior author on the study.

Stephen says the study is tied into national efforts to reduce the use of lights and sirens on ambulance calls.

“There’s still a great deal of research needed on ambulance crash safety and occupant protection. A lot of important work is already happening around lights and sirens use and the risks of being unrestrained,” she says. “Our data echoed what previous studies have shown: using lights and sirens and riding unrestrained significantly increases risk.”

Stephen says it will also be interesting to look at how many states currently rely on voluntary safety guidelines for ambulances, like those developed by the Society of Automotive Engineers.

“I’m curious how these voluntary standards reduce injury in severe crashes. Because these safety guidelines aren’t mandatory, strong data could help support policy changes to improve safety standards.”

Stephen also says one of the co-authors on the study who works as a paramedic raised concerns about transporting lights and sirens in an ambulance appears to increase risk for everyone involved, while not improving patient outcomes.

“We explored this through another dataset and presented a separate abstract at EMS World that looked at whether patients transported with lights and sirens were ultimately admitted to the hospital,” she says. “This helped us look at how prehospital urgency correlates with final patient disposition from the ER.”

This study was conducted during the Prehospital Care Research Forum (PCRF) hosted at the Jacobs School in June 2025. It brought EMS researchers and EMS clinicians from across the country to leverage existing datasets with a focus on improving EMS systems and prehospital clinical interventions for transportation emergencies. 

The PCRF was supported by UCLA, the National Emergency Medical Services Information System and the New York State Department of Health. 

“The work they do truly cannot be overstated. They bring together individuals from all levels of involvement in EMS, some with concrete ideas, many just curious and ready to put in the work to advance EMS with evidence-based medicine,” Stephen says.

“PCRF provided the expert support in the form of statisticians and faculty mentors and guided its participants through an intense three-day process,” she adds. “By the end, you leave with an abstract and solid set of research skills. It makes the research process far less intimidating and much more accessible, which is incredibly important in the world of prehospital care.”

Stephen says her career goal is to balance emergency medicine practice while also working toward evidence-based systemic improvements in EMS through different avenues.

“I want to continue EMS research that can influence local protocols and patient outcomes and eventually contribute to shaping national policies,” she says. “My long-term passion project is to use my skills internationally for systems development in regions where EM and EMS are in its early stages.”

The EMS fellowship at the Jacobs School has been exceptional in showing the value of combining medical direction with operational experience, Stephen says.

Stephen’s training experiences include:

• performing associate medical director duties for a high-volume EMS agency and a helicopter EMS agency with regular flight shifts as well as training with search-and-rescue teams
• learning directly from seasoned paramedics and providing on-call online medical direction while maintaining an active field response role on the physician response truck with full Advanced Life Support and expanded physician-level equipment (thoracostomy, field amputation and ultrasound)
• responding to mass casualty incidents like major fires, entrapments and airport alerts
• providing event medicine coverage for mass gatherings such as Buffalo Bills games
• participating in EMS research, education and resident scholarly track mentorship

“These experiences ensure I stay grounded in the realities of field operations so we can adequately support the work done by EMS clinicians,” Stephen says. “This program has integrated academic learning, operational exposure, and clinical practice in a way that is shaping me to be the kind of EMS physician I want to become.”

Other co-authors on the study are from:

• Limmer Education  
• Quality Rescue Services Training, LLC
• UT Health San Antonio Department of Emergency Health Sciences
• University of Utah Data Coordinating Center