Characterizing Ambulance Driver Training in EMS Systems

Thomas, Dennis; Graham, Lindsey A.; Wright, Timothy J.; Almeida, Raul; Blomberg, Richard D.; Benlemlih, Melynda · 2019 · ROSA P / United States. National Highway Traffic Safety Administration. Office of Behavioral Safety Research

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Summary

This study addresses the lack of comprehensive data regarding ambulance operator training in the United States, motivated by the National Highway Traffic Safety Administration’s (NHTSA) priority to reduce ambulance crashes caused by human error. While NHTSA has promoted a standard Emergency Vehicle Operator Course (EVOC) curriculum since 1995, the actual implementation, content, and quality of training across the country remained poorly characterized. The research aimed to document current practices at both state and local levels to identify gaps in oversight, training duration, and instructional methods. The researchers employed a mixed-methods approach involving three primary data collection activities. First, they conducted discussions and email exchanges with personnel in State EMS offices across 38 jurisdictions to determine state-level policies, licensing requirements, and oversight mechanisms. Second, they administered an internet-based survey to local EMS agencies, receiving responses from 2,102 agencies that operate ground ambulances. This survey detailed agency-specific training requirements, content, instructor qualifications, and supervision practices. Third, a team of three subject matter experts (SMEs) with decades of experience reviewed four widely used ambulance-specific EVOC programs and two law enforcement EVOC programs. The SMEs evaluated these programs against the 1995 NHTSA standards and current best practices to assess content consistency and quality. The findings reveal significant inconsistencies in training and oversight. At the state level, while all 38 participating states regulate ambulance agencies, very few provide direct oversight of individual operator training or licensing. Only one state required an ambulance-specific license with testing, and while 17 states mandated EVOC, enforcement was often delegated to local agencies with limited verification. At the local level, approximately 74% of responding agencies required EVOC, and another 13% reported that operators typically completed it voluntarily. However, the quality and depth of this training varied widely. Just under 50% of agencies based their programs on the NHTSA standard curriculum. Training duration was often brief, with 40% of courses lasting under 10 hours and only 20% exceeding 20 hours. Instructional methods relied heavily on classroom instruction (over 80%) and behind-the-wheel training (about 70%), while simulators were used by less than 5% of agencies. Furthermore, standardized testing was rare, and only about 55% of agencies conducted "check rides" to evaluate driving skills, primarily focusing on basic maneuvers rather than comprehensive safety performance. The study concludes that while most ambulance operators receive some form of training, the current system is insufficient for maximizing safety performance due to a lack of standardized content, inadequate duration, and minimal state-level oversight. The absence of universal performance criteria and documentation limits the ability to verify operator competency. The authors imply that without more rigorous, standardized, and monitored training programs, the goal of reducing operator-error-related crashes will remain unmet. The findings highlight the need for improved regulatory frameworks and evidence-based training standards to ensure ambulance operators are adequately prepared for the complex demands of emergency transport.

Key finding

Approximately 74 percent of surveyed local EMS agencies required their ambulance operators to complete some form of EVOC, yet less than 5 percent reported using simulators and only about 20 percent of courses exceeded 20 hours in duration.

Methodology

mixed_methods

Sample size: 2102

Provenance

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Summary generated by qwen3.6-27b-prismaquant on 2026-06-10; verification: verified.

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• licensing policy