Driving Ambulances Safely: Findings of Ten Years of Japanese Ambulance Crash Data

OBJECTIVE: Rules and regulations for ambulance operations differ across countries and regions, however, little is known about ambulance crashes outside of the United States. Japan is unique in several aspects, for example, routine use of lights and sirens during response and transport regardless of the urgency of the case and low speed limits for ambulances. The aim of this study was to describe the incidence and characteristics of ambulance crashes in Japan. METHODS: We retrospectively analyzed data from the Institute for Traffic Accident Research and Data Analysis (ITARDA) that include all traffic crashes resulting in injury or death in Japan. The study included all ambulance crashes from 2009 to 2018. We compared crashes that occurred during emergency operations with lights and sirens (i.e., when responding to a call or transporting a patient) to those that occurred during non-emergency operations without lights or sirens. We also used data on total number of ambulance dispatches from the Japanese Fire and Disaster Management Agency to calculate ambulance crash risk. RESULTS: During the 10-year period, we identified a total of 486 ambulance crashes out of 59,208,761 ambulance dispatches (0.82 in every 100,000 dispatches or one crash for every 121,829 dispatches) that included two fatal crashes. Among all ambulance crashes, 142 (29.2%) occurred during emergency operations. The incidence of ambulance crashes decreased significantly over the 10-year period. Ambulance crashes at an intersection occurred more frequently during emergency operations than during non-emergency operations (72.5% vs. 58.1%; 14.4% difference, 95% CI 5.0-22.9). CONCLUSIONS: Ambulance crashes occurred infrequently in Japan with crash rates much lower than previously reported crash rates in the United States. Ambulance crashes during emergency operations occurred more frequently at intersections compared to non-emergency operations. Further investigation of the low Japanese ambulance crash rates could provide opportunities to improve ambulance safety in other countries.