Acil Sağlık Hizmetlerinde Proaktif İş Güvenliği Önlemlerinin Belirlenmesi

Year 2025, Volume: 9 Issue: 1, 96 - 118, 01.07.2025

Abdulkadir Bingölbali , Gerçek Budak

https://doi.org/10.56554/jtom.1595742

Abstract

Türkiye’de 2013-2022 yılları arasında yaşanan Ambulans Trafik Kazaları incelendiğinde, yerleşim yeri içerisinde, hava durumunun açık, yolun kaplamasının asfalt ve yüzeyinin kuru olduğu, düz ve eğimsiz cadde veya devlet yollarında gerçekleşen ambulans trafik kazalarında toplam 3058 yaralanma vakası belirlenmiştir. Ambulans trafik kazalarında en fazla yaralanma oranları yandan çarpma durumunda gerçekleşmiştir. Yandan çarpma trafik kaza durumu ile yaralanma sayısı arasında zayıf düzeyde pozitif ve anlamlı bir ilişki bulunmuştur. Ambulansların yandan çarpma trafik kaza ve bu kazalar sonucunda meydana gelen yaralanma nedenleri, paydaşlar ve uzman ekiple yapılan sosyal medya ve görüşmeler aracılığıyla belirlenmiştir. Sıralama metodlarından Borda Count Method (BCM) kullanılarak ambulansların yandan çarpma trafik kaza durumlarını ve bu kazalar sonucunda meydana gelen yaralanmaları azaltacak en iyi önlem alternatifleri sıralanmıştır. Ambulansların yandan çarpma trafik kazalarını önlemek için en etkili önlem, çarpışma öncesi uyarı ve otomatik frenleme mekanizmalarının entegre edildiği akıllı ambulans sistemleridir. Trafikte ambulansların fark edilmesini artırmak amacıyla siren ve ışıklandırma sistemlerinin kullanımı ise, ikinci en etkili önlem olarak belirlenmiştir. Ambulans araçlarının yandan çarpma trafik kaza durumlarının sebep olduğu yaralanmaların seviyesini düşürebilecek önlem alternatiflerinde; ambulanslara standart dışı yolcuların alınmaması en etkili önlem olarak belirlenmiştir. Trafik kazası sonrasında olay yerinin güvenliğinin sağlanması, kabin içi aktif ve pasif güvenlik önlemlerinin iyileştirilmesi ve ambulans kabin tasarımının iyileştirilmesi gibi önlemler de yüksek öncelikli tedbirler arasında yer almıştır. Literatür taramalarında örneği bulunmayan ve alanında öncü olma özelliği taşıyan bu çalışma; Türkiye’de yaşanan ambulans trafik kazalarını kaza oluş türlerine göre analiz ederek yeni bir perspektif sunmayı hedeflemektedir.

Keywords

İş Sağlığı ve Güvenliği, Ambulans, Borda Count Yöntemi, Trafik Kazaları, Acil Sağlık Hizmetleri

Ethical Statement

Çalışmanın tüm süreçlerinin araştırma ve yayın etiğine uygun olduğunu, etik kurallara ve bilimsel atıf gösterme ilkelerine uyduğumuzu beyan ederiz.

Thanks

Bu çalışmanın başarılı bir şekilde yürütülebilmesi için ambulans trafik kaza verilerini bizle paylaşan Türkiye Cumhuriyeti Emniyet Genel Müdürlüğü Trafik Başkanlığı’na teşekkürlerimizi bir borç biliriz.

Listing of Ambulance Traffic Accidents in Turkey Using the Borda Method and Activities to Prevent Injuries Due to Accidents

Abstract

When the Ambulance Traffic Accidents in Turkey between 2013 and 2022 were analyzed, a total of 3058 injury cases were identified in ambulance traffic accidents that took place on straight and uneven streets or state roads within the settlement, where the weather was clear, the road pavement was asphalt and the surface was dry. The highest number of injuries in ambulance traffic accidents occurred in the case of side impact. A weak positive and significant relationship was found between the number of injuries and side impact traffic accidents. The causes of side-impact traffic accidents of ambulances and injuries resulting from these accidents were determined through social media and interviews with stakeholders and the expert team. Using Borda Count Method (BCM), one of the ranking methods, the best precaution alternatives to reduce the number of side-impact traffic accidents of ambulances and the injuries resulting from these accidents were ranked. While the integration of smart ambulance systems, especially pre-collision warning and automatic braking mechanisms, was ranked as the most effective measure, the use of siren and lighting systems to increase the recognizability of ambulance vehicles in traffic ranked second. In the precautionary alternatives that can reduce the level of injuries caused by side impact traffic accidents of ambulance vehicles, not taking non-standard passengers in ambulances was determined as the most effective measure. Ensuring the safety of the scene after the traffic accident, improving active and passive safety measures in the cabin, and improving the ambulance cabin design were also among the high priority measures. To the best of our knowledge, this is the first study to analyze ambulance traffic accidents in Turkey according to accident types.

Keywords

Occupational Health and Safety, Ambulance, Borda Count Method, Traffic Accidents

References

• Akça, T., Sahingoz, O. K., Kocyigit, E., & Tozal, M. (2020). Intelligent ambulance management system in smart cities. In 2020 International Conference on Electrical Engineering (ICEE) (pp. 1–7). IEEE. https://doi.org/10.1109/ICEE49691.2020.9249959
• Alzu'bi, S., Siouf, S., Jamjoum, M., Abdelsalam, E., Salameh, T., & Swailmeen, Y. (2023). A smart ambulance escort drone. 2023 Advances in Science and Engineering Technology International Conferences (ASET), 1–4. https://doi.org/10.1109/ASET56582.2023.10180630
• Altındiş, S., Tok, Ş., Aslan, F. G., Pilavcı-Adıgül, M., Ekerbiçer, H. Ç., & Altındiş, M. (2017). Assessment of first aid knowledge level of university students. SMJ, 7, 125–130.
• Alsofayan, Y. M., Alhajjaj, F. S., Alowais, J. M., Alsuhaymi, F. S. M., Almutairi, A. A., Alsharef, M. K., Alenazi, S. A., Alsadan, Y. I. S., Alshangiti, S. A. M., & Albalawi, A. F. A. (2023). The epidemiology of prehospital ambulance crashes: A national experience across Saudi Red Crescent Authority. Cureus. https://doi.org/10.7759/cureus.42049
• Bair, S., Huang, R., & Wang, K. (2012). Can vehicle maintenance records predict automobile accidents? Property. https://doi.org/10.1111/j.1539-6975.2011.01433.x Bäumler, M., & Prokop, G. (2024). Predicting the Type of Road Traffic Accident for Test Scenario Generation. IEEE Access, 12, 28950-28971. https://doi.org/10.1109/ACCESS.2024.3367744
• Boland, L. L., LeVoir, M. W., Jin, D., Duren, J. L., Souchtchenko, S. S., & Stevens, A. C. (2023). A retrospective, single-agency analysis of ambulance crashes during a 3-year period: Association with EMS driver characteristics and a telematics-measured safe driving score. Prehospital Emergency Care, 27, 455–464. https://doi.org/10.1080/10903127.2022.2163327
• Boldt, J., Steinfort, F., Müller, M., Exadaktylos, A., & Klukowska-Roetzler, J. (2020). Online Newspaper Reports on Ambulance Accidents in Austria, Germany, and Switzerland: Retrospective Cross-sectional Review. JMIR Public Health and Surveillance, 7. https://doi.org/10.2196/25897.
• Borda, J.-C. de. (1781). Memoir on elections by ballot. History of the Royal Academy of Sciences, 102–111. Bozzini, S., Friedman, D., & Jimenez, J. (2013). A Study of Rollover Occupant Injury Mitigation Using Dynamic Testing To Evaluate Alternative Protection Systems. . https://doi.org/10.2118/165594-MS.
• Brorsson, B. (1989). The risk of accidents among older drivers. Scandinavian Journal of Public Health, 17, 253– 256. https://doi.org/10.1177/140349488901700306
• Bui, D.P., Hu, C., Jung, A.M., Porter, K.M.P., Griffin, S., French, D.D., Crothers, S., Burgess, J., (2018). Driving behaviors associated with emergency service vehicle crashes in the U.S. fire service. Traffic Injury Prevention 19, 849–855. https://doi.org/10.1080/15389588.2018.1508837
• Bulut, A., (2016). 112 Acil Durum Ambulanslarında İsg Risklerinin Tespiti ve İsg Rehberi. [Uzmanlık Tezi]. T.C. Çalışma ve Sosyal Güvenlik Bakanlığı İş Sağlığı ve Güvenliği Genel Müdürlüğü. https://www.csgb.gov.tr/Media/fvobcnnb/alpaybulut.pdf Byran, E., & Gilad, I. (2012). Design considerations to enhance the safety of patient compartments in ambulance transporters. International Journal of Occupational Safety and Ergonomics, 18, 221–231. https://doi.org/10.1080/10803548.2012.11076930
• Casado-Sanz, N., Guirao, B., & Attard, M. (2020). Analysis of the Risk Factors Affecting the Severity of Traffic Accidents on Spanish Crosstown Roads: The Driver’s Perspective. Sustainability, 12(6), 2237. https://doi.org/10.3390/su12062237
• Chew, K., & Low, M. (2022). Types and risk factors of ambulance accidents: A scoping review. The Medical Journal of Malaysia, 77(1), 60–70.
• Chiu, P.-W., Lin, C.-H., Wu, C.-L., Fang, P.-H., Lu, C.-H., Hsu, H.-C., & Chi, C.-H. (2018). Ambulance traffic accidents in Taiwan. Journal of the Formosan Medical Association, 117, 283–291. https://doi.org/10.1016/j.jfma.2018.01.014
• Claesson, A., Fredman, D., Svensson, L., Ringh, M., Hollenberg, J., Nordberg, P., Rosenqvist, M., Djärv, T., Österberg, S., Lennartsson, J., & Ban, Y. (2016). Unmanned aerial vehicles (drones) in out-of-hospital cardiac arrest. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 24. https://doi.org/10.1186/s13049-016-0313-5
• Delavary, M., Ghayeninezhad, Z., & Lavallière, M. (2023). Prevalence and characteristics of ambulance collisions: A systematic literature review. Safety. https://doi.org/10.3390/safety9020024
• Ekşi, A., Çelikli, S., & Catak, I. (2015). Effects of the institutional structure and legislative framework on ambulance accidents in developing emergency medical services systems. Turkish Journal of Emergency Medicine, 15, 126–130. https://doi.org/10.1016/j.tjem.2015.11.006
• Emerson, P. (2013). Original Board Count and Partial Voting. Social Choice and Welfare, 40, 353-358. https://doi.org/10.1007/S00355-011-0603-9.
• Ersoy, G., Ersoy, O., Yuksekbas, O., Kurnaz, G., Akyildiz, E. U., & Ekemen, S. (2012). Why did the patient die? The relationship between ambulance accidents and death of patients: Forensic medical issues. Journal of Forensic and Legal Medicine, 19(8), 474-479. https://doi.org/10.1016/j.jflm.2012.04.021
• Eygü, H. (2018). Trafik Kazalarını Etkileyen Faktörlerin Yapısal Eşitlik Modeli İle İncelenmesi. Elektronik Sosyal Bilimler Dergisi, 17(66), 837-850. https://doi.org/10.17755/esosder.391299
• Gańczak, M., Topczewska, K., & Korzeń, M. (2020). Risk factors for sharps injuries and the prevalence of blood borne infections among paramedics. European Journal of Public Health, 30. https://doi.org/10.1093/eurpub/ckaa166.718.
• Gökçedağ, Ş. Y., Başak, S., (2023). Ambulance Accidents Between 2016-2021 and Their Investigation in Terms of Occupational Health and Safety. Current Research in Health Sciences.
• Güler, R., & Ağaçayak, S. (2022). Maksillofasiyal kırığı olan 374 olgunun demografik özellikleri ve etiyolojik faktörleri: 11 yıllık retrospektif çalışma. Selçuk Dental Journal, 9(2), 417–422.
• Gülen, B., Serinken, M., Hatipoglu, C., Özaşır, D., Sönmez, E., Kaya, G., & Akpınar, G. (2016). Work-related injuries sustained by emergency medical technicians and paramedics in Turkey. Turkish Journal of Trauma and Emergency Surgery, 22, 145–149.
• Hareru, H., Negassa, B., Abebe, R., Ashenafi, E., Zenebe, G., Debela, B., Ashuro, Z., & Soboksa, N. (2022). The epidemiology of road traffic accidents and associated factors among drivers in Dilla Town, Southern Ethiopia. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.1007308
• Hakamies-Blomqvist, L. (1993). Fatal accidents of older drivers. Accident; Analysis and Prevention, 25(1), 19– 27. https://doi.org/10.1016/0001-4575(93)90093-C
• Ho, J., & Casey, B. (1998). Time saved with use of emergency warning lights and sirens during response to requests for emergency medical aid in an urban environment. Annals of Emergency Medicine, 32(5), 585–588. https://doi.org/10.1016/S0196-0644(98)70037-X
• Hudec, J., & Šarkan, B. (2022). Effect of periodic technical inspections of vehicles on traffic accidents in the Slovak Republic. Communications - Scientific Letters of t he University of Zilina. https://doi.org/10.26552/com.c.2022.3.a142-a159
• Høye, A. (2019). Vehicle registration year, age, and weight: Untangling the effects on crash risk. Accident; Analysis and Prevention, 123, 1–11. https://doi.org/10.1016/j.aap.2018.11.002
• Infante, P., Jacinto, G., Afonso, A., Rego, L., Nogueira, P., Silva, M., Nogueira, V., Saias, J., Quaresma, P., Santos, D., Góis, P., & Manuel, P. (2023). Factors That Influence the Type of Road Traffic Accidents: A Case Study in a District of Portugal. Sustainability. https://doi.org/10.3390/su15032352.
• Kahn, C., Pirrallo, R., & Kuhn, E. (2001). Characteristics of fatal ambulance crashes in the United States: An 11- year retrospective analysis. Prehospital Emergency Care, 5, 261–269. https://doi.org/10.1080/10903120190939751
• Kılıç, A. F. (2022). Değişkenlerin Kategori Sayılarının ve Dağılımlarının Korelasyon Katsayılarına Etkisi. Ege Eğitim Dergisi, 23(1), 50-80. https://doi.org/10.12984/egeefd.890104
• Klinjun, N., Kelly, M., Praditsathaporn, C., & Petsirasan, R. (2021). Identification of Factors Affecting Road Traffic Injuries Incidence and Severity in Southern Thailand Based on Accident Investigation Reports. Sustainability. https://doi.org/10.3390/su132212467.
• Kontek, K. ve Sosnowska, H. (2020). Jury Members' Particular Tastes or Cliques? How to Reduce Manipulation Levels in Group Decisions?. Group Decision and Negotiation , 29 , 1057 - 1084. https://doi.org/10.1007/s10726- 020-09694-y.
• Kulvatunyou, N. (2013). Association between side-impact airbag deployment and risk of injury: A matched cohort study using the CIREN and the NASS-CDS. The Journal of Trauma and Acute Care Surgery, 74(5), 1378–1379. https://doi.org/10.1097/TA.0b013e31828b7ad1
• Lacher, M., & Bausher, J. (1997). Lights and siren in pediatric 911 ambulance transports: Are they being misused? Annals of Emergency Medicine, 29(2), 223–227. https://doi.org/10.1016/S0196-0644(97)70272-5
• Lai, Y., Chou, Y., & Chang, L. (2017). An intelligent IoT emergency vehicle warning system using RFID and Wi- Fi technologies for emergency medical services. Technology and Health Care, 26(1), 43–55. https://doi.org/10.3233/THC-171405
• Lai, Y.-L., Chou, Y.-H., Chang, L.-C., (2018). An intelligent IoT emergency vehicle warning system using RFID and Wi-Fi technologies for emergency medical services. THC 26, 43–55. https://doi.org/10.3233/THC-171405
• Lee, W., & Chiu, C. (2020). Design and implementation of a smart traffic signal control system for smart city applications. Sensors (Basel, Switzerland), 20. https://doi.org/10.3390/s20020508
• Lee, J., Chae, J., Yoon, T., & Yang, H. (2018). Traffic accident severity analysis with rain-related factors using structural equation modeling - A case study of Seoul City.. Accident; analysis and prevention, 112, 1-10 . https://doi.org/10.1016/j.aap.2017.12.013.
• Maasalo, I., Lehtonen, E., & Summala, H. (2019). Drivers with child passengers: Distracted but cautious? Accident; Analysis and Prevention, 131, 25–32. https://doi.org/10.1016/j.aap.2019.06.004
• Maguire, B.J., & Smith, S. (2013). Injuries and fatalities among emergency medical technicians and paramedics in the United States. Prehospital Disaster Medicine, 28, 376-382.
• Maguire, B. J., & Smith, S. (2019). Ambulance crashes: Risk and prevention strategies. Journal of Emergency Medical Services, 44(3), 16–23.
• Makarova, I., Buyvol, P., Yakupova, G., Mukhametdinov, E., & Pashkevich, A. (2020). Identification for Factors and Causes Affecting the Traffic Accident Severity. 2020 XII International Science-Technical Conference AUTOMOTIVE SAFETY, 1-6. https://doi.org/10.1109/AUTOMOTIVESAFETY47494.2020.9293502
• Missikpode, C., Peek-Asa, C., Young, T. L., & Hamann, C. J. (2018). Does crash risk increase when emergency vehicles are driving with lights and sirens? Accident; Analysis and Prevention, 113, 257–262.
• Mostafanejad, R., Janati, A., Sadeghi-Bazargani, H., & Babaie, J. (2019). Challenges of scene management in road traffic accidents: A systematic literature review. Journal of Injury and Violence Research, 11. https://doi.org/10.5249/jivr.v11i2.1342
• Moussa, E. H., Kebir, S. T., & Amrouche, A. (2023). Intelligent transport system (ITS) for healthcare: Smart ambulance. In 2023 2nd International Conference on Electronics, Energy and Measurement (IC2EM), IEEE, Medea, Algeria, 1–6. https://doi.org/10.1109/IC2EM59347.2023.10419718
• Norii, T., Nakao, S., Miyoshi, T., Braude, D., Sklar, D., & Crandall, C. (2021). Driving Ambulances Safely: Findings of Ten Years of Japanese Ambulance Crash Data. Prehospital Emergency Care, 27, 94 - 100. https://doi.org/10.1080/10903127.2021.2015026.
• Norii, T., Nakao, S., Miyoshi, T., Hatanaka, T., Miyake, T., Okunaga, A., Albright, D., Braude, D., Sklar, D.P., Yang, M., Crandall, C., (2023). Ambulance Traffic Crashes in Japan: Characteristics of Casualties and Efforts to Improve Ambulance Safety. Prehospital Emergency Care 28, 598–608. https://doi.org/10.1080/10903127.2024.2315946
• Ommeren, J., Rietveld, P., Hop, J., & Sabir, M. (2013). Killing kilos in car accidents: Are external costs of car weight internalized? Economics of Transportation, 2, 86–93. https://doi.org/10.1016/J.ECOTRA.2013.06.001
• Orsi, C., Marchetti, P., Montomoli, C., & Morandi, A. (2013). Car crashes: The effect of passenger presence and other factors on driver outcome. Safety Science, 57, 35–43. https://doi.org/10.1016/J.SSCI.2013.01.017
• Parker, D., West, R., Stradling, S., & Manstead, A. S. R. (1995). Behavioural characteristics and involvement in different types of traffic accident. Accident Analysis & Prevention, 27(4), 571-581. https://doi.org/10.1016/0001- 4575(95)00005-K
• Pitta, L., Quintas, J., Trindade, I., Belchior, P., Gameiro, K., Gomes, C., Nóbrega, O., & Camargos, E. (2021). Older drivers are at increased risk of fatal crash involvement: Results of a systematic review and meta-analysis. Archives of Gerontology and Geriatrics, 95, 104414. https://doi.org/10.1016/j.archger.2021.104414
• Ray, A. M., & Kupas, D. F. (2005). Comparison of crashes involving ambulances with those of similar-sized vehicles. Prehospital Emergency Care, 9, 412–415.
• Saunders, C., & Heye, C. (1994). Ambulance collisions in an urban environment. Prehospital and Disaster Medicine, 9, 118–124. https://doi.org/10.1017/S1049023X00041017
• Selimoğlu, E. (2014). Trafik kazalarının nedenleri, sonuçları ve kazaların önlenmesine ilişkin öneriler. Ziraat Mühendisliği, 51, 54. Sosyal Güvenlik Kurumu. (2022). Trafik Kaza İstatistikleri.
• Tennyson, J., Maranda, L., & Darnobid, A. (2011). Knowledge and beliefs of EMS providers toward lights and siren transportation. Western Journal of Emergency Medicine, 16, 465–471. https://doi.org/10.5811/westjem.2015.2.24212
• Tennyson, J., Maranda, L., & Darnobid, A. (2015). Knowledge and beliefs of EMS providers toward lights and siren transportation. Western Journal of Emergency Medicine, 16, 465-471.
• Theofilatos, A., Ziakopoulos, A., Papadimitriou, E., & Yannis, G. (2018). How many crashes are caused by driver interaction with passengers? A meta-analysis approach. Journal of Safety Research, 65, 11–20. https://doi.org/10.1016/j.jsr.2018.02.001
• Tiwari, G. (2012). Traffic safety in selected countries: hospital-based evidence. International Journal of Injury Control and Safety Promotion, 19, 311 - 312. https://doi.org/10.1080/17457300.2012.748260.
• Turkdemir, Ahmet Haki & Aysun, Altuğ. (2003). Türkiye’de Ambulans Kazalarında Değişim. https://doi.org/10.13140/RG.2.1.1030.0409.
• Uthirasamy, R., Priyan, S., Abishek, S., & Akash, N. (2022). Automated UAV delivery system with medical emergency supplies. Proceedings of the International Conference on Intelligent Technologies in Security and Privacy for Wireless Communications (ITSPWC 2022), May 14–15, 2022, Karur, Tamilnadu, India. https://doi.org/10.4108/eai.14-5-2022.2318883
• White, W. (1986). Does periodic vehicle inspection prevent accidents? Accident; Analysis and Prevention, 18(1), 51–62. https://doi.org/10.1016/0001-4575(86)90036-9
• World Health Organization. (2023). Global status report on road safety 2023. WHO. https://www.who.int/publications/i/item/9789241565684
• Yaprak, Ş. (Ed.). (2017). 7. Karayolu Trafik Güvenliği Sempozyumu ve Sergisi Sunulan Bildiriler Kitabı. Emniyet Genel Müdürlüğü. https://www.trafik.gov.tr/kurumlar/trafik.gov.tr/06- Yayinlar/Sempozyum/KTGS/2016_Bildiriler.pdf
• Yaşar, M. (2010). Kolonoskopi sonuçlarımızın retrospektif analizi. Konuralp Medical Journal, 2(3), 6–9.
• Yazıcı, R., Bala, E. D., Güner, M., Kalafat, A. F. B., Kaya, H., Kalafat, U. M., Tapkan, R. B., Yeniyurt, B., & Doğan, S. (2024). Characteristics of ambulance crashes in Ankara: A retrospective analysis.
• Yıldırım, S. A., Mert, S., & Pekdemir, M. (2021). 5-year retrospective analysis of ambulance driving techniques training for paramedic students. Journal of Pre-Hospital, 6(1), 51–68.
• Young, H. P. (1974). An axiomatization of Borda’s rule. Journal of Economic Theory, 9(1), 43-52. https://doi.org/10.1016/0022-0531(74)90073-8
• Zhang, J., Fraser, S., Lindsay, J., Clarke, K., & Mao, Y. (1998). Age-specific patterns of factors related to fatal motor vehicle traffic crashes: Focus on young and elderly drivers. Public Health, 112(5), 289–295. https://doi.org/10.1038/SJ.PH.1900485
• Zhang, W., Xu, H., Wu, B., & Li, S. (2008). Safety management of traffic accident scenes based on system dynamics. 2008 International Conference on Intelligent Computation Technology and Automation (ICICTA), 2, 482–485. https://doi.org/10.1109/ICICTA.2008.83
• Zheng, C., Zhao, X., (2023). Analysis of the Relevance Degree of the Influencing Factors of Traffic Accidents, in: Proceedings of the 2023 3rd International Conference on Big Data, Artificial Intelligence and Risk Management, pp. 10–15. https://doi.org/10.1145/3656766.3656768
• Zou, Y., Zhang, Y., & Cheng, K. (2021). Exploring the Impact of Climate and Extreme Weather on Fatal Traffic Accidents. Sustainability, 13(1), 390. https://doi.org/10.3390/su13010390