On April 3, 2009, an ambulance from Virginia's Carilion Clinic Patient Transportation was involved in a collision on Interstate 81 outside Lexington. Though the incident revealed some opportunities for improvement, the agency's overall culture of safety helped minimize what could have been far more serious consequences. Here service leaders review what went right and some lessons learned.

   The evening began like any other: in at 8 p.m. for a 12-hour shift. The crew checked and readied their unit for the night in a mixed 9-1-1 EMS and ALS ground transport base. Just before 6 a.m., they responded to a local tertiary care hospital to transport a patient with facial fractures and an intracranial bleed to the University of Virginia Medical Center for definitive care. The ambulance's occupants included the driver, the attendant in charge (AIC), the patient and the patient's brother, who was sitting in the front passenger seat. It would be a 2½-hour transport by ground.

   For the first 80 miles, the transport was uneventful. The weather was moderate, and traffic light. Suddenly, crew members found themselves in a downpour, and the driver noticed traffic beginning to stop ahead of him secondary to an MVC. The ambulance was in the left-hand passing lane on a moderate uphill grade. There was a tractor-trailer in front of it, and another one next to that. To avoid striking the truck in his lane, the driver began braking and attempted to merge to an open area on the right shoulder. However, as he transitioned across the right-hand lane, the ambulance began to hydroplane, then struck the rear of the tractor-trailer in that lane. The impact caused a significant crushing deformation to the front, causing both air bags to deploy.

   Belted in the rear-facing captain's seat, the AIC was uninjured. The patient, restrained with the typical three cross-belts plus two shoulder straps, remained secured to the stretcher. The stretcher, however, dislodged from its brackets and became airborne. It landed at a 45-degree angle facing the bench seat, with the patient landing on his left side.

   The AIC checked the patient first and determined there were no new injuries sustained during the accident. He then spoke to the front-seat passenger, who had been properly belted and was uninjured as well. Next the AIC checked the driver. He, too, had been properly restrained, but his left leg was pinned underneath the dashboard, and he could not move.