In the U.S. there are on average more than 6500 ambulance crashes each year. The occupational motor vehicle fatality rate for emergency medical personnel is four times the U.S. average for other occupations. Rural ambulance crashes in particular are of great concern, in part because they are usually much more severe than urban crashes. Ambulance crashes occurring on rural roadways are more likely to result in death to emergency medical personnel, the patient and occupants of other vehicles. Several factors may contribute to the increased risk of ambulance crashes generally, and rural ambulance crashes specifically. In rural areas the preponderance of the emergency medical services is based on a volunteer workforce… The volunteer status may result in infrequent and irregular exposure to operating the ambulance, and therefore limited opportunity to gain experience and sustain skills. The National Highway Traffic Safety Administration’s Office of Emergency Medical Services recently convened a group of industry experts to address issues in ground ambulance safety. Through this project, WTI and the Critical Illness and Trauma Foundation (Bozeman, Montana) will develop a research agenda to pursue the safety strategies identified by the NHTSA. Specifically, this project focuses on the feasibility of (a) gathering baseline data on EMS driving behaviors associated with rural ambulance crashes as well as (b) measuring the potential safety benefits of an onboard driving (QFS) within a rural ambulance fleet. Strategically, it is expected that this proposal will also support several future research paths in the areas of EMS safety and naturalistic study capabilities