Accidents and Incidents

September 9, 2021


Every day vehicular collisions, employee injuries and incidents happen.  Reports are complete, claims are filed, reserves are set, and life continues. Identifying the root cause of any incident and determining the best course of action is the responsibility of every owner,  manager, and safety supervisor.  In today’s insurance market for the NEMT company, it is very important to understand why an accident has occurred and how to prevent it from happening again in the future.

Root cause analysis helps the NEMT manager make a decision on taking corrective actions with the employee who is involved in an accident or incident.  It can be a waste of time and money to re-train an employee who has made a conscious decision to engage in risky behavior and put the company at risk. The chance of a repeat behavior is sometimes too great a challenge to undertake, and it is better to part ways with the employee. Conversely, if the employee simply did not have the knowledge or skills to safely perform the job, a letter of warning or other reprimands only is unacceptable and retraining and education are needed.

Defining the Accident & Incident

Accidents and incidents can be very unnerving for those involved, and needlessly expensive if handled improperly. Of vital importance is prompt medical attention for any injured persons, elimination, or minimization of further hazards to other traffic, protection of the accident/incident scene, complete and accurate recording of facts for further investigation, and protection of the company’s assets. This information and protocol described will ensure that an analysis of what occurred can take place with accuracy.

There are five basic rules that apply to accidents and incidents when they occur. They are:

  1. The first priority is to ensure that any injured persons are taken care of.
  2. Notify your dispatch and call 911 Emergency Services
  3. The vehicle involved must never be left unattended.
  4. If bad brakes are alleged, the vehicle must not be driven.
  5. Substance Abuse testing must be completed. (If you’re following DOT regulations and the circumstances for testing are met.)

NEMT Driver Responsibilities at the Scene of an Accident or Incident

There are 4 areas of responsibilities that drivers must know and should be taught during the initial training of drivers and reminded of. They are:

  1. Check for any injuries to passengers or other motorists.
  2. Notify Dispatch / Call 911 Emergency Services. Give exact location.
  3. Take Safety Precautions
  4. Place safety triangles or warning flares outside of the vehicle.
  5. Handle passengers courteously and give proper instructions. Where to stand outside the vehicle, proper evacuation if needed.
  6. Keep passengers safe, keep them off the street, highway, etc.
  7. Provide first aid if necessary.
  8. Observe and record all facts, begin completing the accident / incident information.
  9. Record exact time and place of accident
  10. Make a list of injure person(s). Name, Address, and Phone number
  11. Ascertain nature and extent of injuries as you know them as best as possible.
  12. Record the first aid that was given.
  13. Have the passengers sign a release form if no injuries are occurred.
  14. Document any witness names, address, and phone number if possible.
  15. Do not discuss the accident or incident with anyone except emergency personnel or company representatives.
  16. Cooperate with the police. Obtain name, badge number.
  17. Make no agreements, settlement offers, or commitments for the company or the driver.
  18. If media is present, refer them to company representative. Drivers should not be making statements for the company.
  19. A proper report must be completing giving information on what occurred, how it occurred, the drivers’ actions prior to the accident or incident, and direction of travel. Any other pertinent information must be gained for example: pictures, types of vehicles, weather conditions, direction of travel, roadway, etc. A driver’s statement and drawing of what happened is very important to determine the root cause. This report should be completed as soon as possible after the accident or incident occurs, before the driver returns their home. When writing the report, the drivers should use their own words and sign the document.

Company Responsibilities at the Scene

The NEMT company should be prepared to respond to an accident or incident when it occurs. Who responds is a company decision that should be made in advance and the person who responds needs to be trained on what to do at the scene. Below is a listing of the requirements.

Emergency Response Kit should be assembled and ready to go when needed. This kit should have the following as a minimum:

  1. Accident / incident Reporting Documents from the company.
  2. Writing utensils.
  3. Paper
  4. Clip Board
  5. A Camera, or if using a cell phone, make sure that the company has access to it. Remember that pictures are property of the company and should be printed and deleted from the personal cell phones if that was used. Also, if a cell phone is used, the pictures should be printed and saved to a company PC file, and the pictures deleted off the cell phone.  If you use a camera, make sure that the camera has fresh film and batteries.
  6. Tape Measure, preferably a 50-foot tape.
  7. Flashlight with extra batteries.
  8. Safety Triangles, Safety Vest (reflective type)
  9. Rain gear or  adverse weather gear.
  10. A Radio to communicate with the NEMT Company. Cell phones can be used, and the responding individual should make sure that the phone is kept on, and that it is answered.

When Arriving at the Scene the following procedures should take place:

  1. Approach the NEMT Driver, Identify yourself,  and check for injuries.
  2. If injuries are present or complaints are given, make sure that EMS is on the way and assist any injured when possible.
  3. Obtain investigating police officer and badge number.
  4. Cooperate fully with investigators.
  5. Assist driver with gathering information.
  6. Take pictures of the scene. (Take the picture of 12 views, using a clock reference)
  7. Make a sketch of the scene.
  8. Make notes of any skid marks, debris, or any other pertinent evidence of the accident or incident.
  9. Make sure all accident procedures have been followed.
  10. Make sure that all injuries or alleged injuries have been recorded.
  11. Determine if Substance Abuse Testing is required.
  12. Do not make an on-scene determination of whether the accident or incident was Preventable or Non-Preventable.


It is important to the determination of root cause of the accident or incident the proper documentation has or will occur. Those who respond to accidents or incidents must understand the process.

  1. Complete the investigation and secure all reports and paperwork generated at the scene.
  2. Make sure that all pictures are clear and if need be, retake any pictures or add to the documentary.  

Determination / Root Cause

Careful accident and incident analysis is essential to NEMT safety. Failure to learn what caused an accident or incident increases the chance of a similar accident or incident in the future. Taken individually, some contributing factors may appear relatively inconsequential.  For instance, a driver who doesn’t adequately compensate for view obstructions by “rocking and rolling” may get away with this bad behavior for years, until an accident or incident occurs. The investigator should investigate every part of the accident or incident by asking questions, reviewing the at scene documents and interview with the driver involved to understand their written statement and drawing of what happened. Comparing these questions and answers against the teachings of training given to the driver, and what they learned.  Asking probing questions will support any decision that is made regarding the outcome of the decision. Based on the facts of the accident or incident that are developed a question should be asked “did the driver do everything possible to avoid the accident or incident” if the answer is no, then your decision will be preventable.

There may be times when an accident or incident is clearly the other driver’s fault, but your driver may be charged with a Preventable accident. For example, your vehicle may be hit in the rear by Veh 2, but your driver is charged with a Preventable accident due to his stopping at an unauthorized stop. 

In Summary

Remember that one of the largest expenses for a NEMT company is their premiums for liability insurance. Controlling these costs begins with a good training program that teaches foundational driving skills and defensive driving techniques. When a collision occurs, an investigation should take place based on the information gathered at the scene by the driver and the company representative. Reviewing the information and determining the root cause of an accident or incident, if it is Preventable, will help you understand why an accident or incident has occurred and how to prevent it from happening again in the future.  

Thanks, and See You Next Time!

Frank J. Ciccarella

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