A prospective study was conducted to determine if emergency vehicle driver risk behavior could be improved with an onboard computer-monitoring device, with real time auditory feedback. Data were collected over 18 months from 36 vehicles in a metropolitan EMS group, with >250 drivers. In >1.9 million recorded miles, performance improved from a baseline low of 0.018 miles between penalty counts to a high of 15.8 miles between counts. Seatbelt violations dropped from 13,500 to 4. There was a 20% saving in vehicle maintenance costs within 6 months. This technology demonstrated sustained cost savings in regards to vehicle maintenance as well as minimal retraining of drivers.