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Home > EMS Products > Ambulances
February 06, 2014

Crash tests to shape ambulances of future

With the 2015 retirement of the KKK specifications, companies are using safety crash tests and ergonomic studies to develop new standards and designs

By Cate Lecuyer, EMS1 Editor

WASHINGTON — From Wisconsin to Virginia, experts are loading dummies into ambulances, and driving them into walls.

For the first time, the same safety methods that are a staple for passenger vehicles are being applied to EMS, and the data collected from crash tests will greatly shape new ambulance standards when the federal KKK specifications are retired in 2015.

"This is probably the best and most real science we've had in our industry," said Mark Van Arnam, president of American Emergency Vehicles. "Ever." Van Arnam was one of the presenters at EMS Today's seminar "National Ambulance Standards: What's Ahead"

The work being done by the National Association of State EMS Officials includes extensive research to develop new standards that include body integrity, litter design, lighting, rigid cot restraint, equipment mounting and more.

One study explored arm, leg and head movement in an accident to determine how far away to place equipment so it won't become a hazard.

New territiory

Researchers are also studying EMS workers themselves. They're determining the sizes, shapes and movements of EMTs and medics, and using computer modeling to see how bodies relate to ambulance design.

"This is brand-new territory these guys are plowing," Arnam said.

Future ambulance designs will also consider ergonomics and functionality for workers.

Ron Thackery, senior vice president of professional services and integration at American Medical Response, showed a photo of a particularly messy rig that included repurposing a seatbelt to attach a trash can to the wall. This, he said, demonstrates need.

"Here's a crew that said 'here are all the things I need around me as I care for a patient. Find a place for me to put them,'" he said

The new standards will aim to do just that. Minimal cabinet space, for instance, is on the horizon. Instead of storing supplies behind closed doors, they'll be rolled up in a soft bag that attaches and locks to the wall, ensuring materials are restrained but also making sure they're accessible.

Medic safety

A lot of work is also going into seatbelts — and why EMTs and medics in the back of the ambulance tend to not use them. Seventy-five percent of industry deaths in ambulance collisions occur when EMTs and medics don't use the restraint, Thackery said.

"How do we convince people to buckle up?" he asked.

The future of ambulance design also extends beyond standards, and will start to incorporate some of the latest safety technology.

Mercedes-Benz, for instance, uses Collision Prevention Assist, where sensors measure the space between your vehicle and the one in front of you. If that space shortens, but you continue at the same speed, it will automatically apply the brakes. This feature is making its way into the rescue industry, and is available on the 2014 Sprinter.

Conceptual designs of new ambulances will be based on incorporating new technology and the new standards developed through research. When it comes time to applying them, EMS agencies will have to make a decision as to what they choose to adhere to.

"Certainly," Thackery said, "at the end of the day it's up to the states."

Comments
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Sean Brierley Sean Brierley Thursday, February 06, 2014 2:23:19 PM How do you buckle up and work with a patient? My arms aren't long enough, especially in type I and III vehicles. Also, what I need is over here, over there, the patient wants a blanket and it is in that compartment, and now he's going to vomit and that is in the other cabinet .... And that's not even a messy trauma or CPR. CPR is lots of seat swapping, compressor gets tired, bagger has to swap with the medic who's started an IO in the leg and now needs to intubate ... or vice versa .... Make the seats too close to the patient and you cannot move around the patient to get stuff or exit. And cabinet space, consider what the state requires ... we have stuff on our ambulances that are required to be there by the state but that our protocols won't let us use .... Not a solution, just a set of challenges.
Andy Monce Andy Monce Friday, February 07, 2014 5:08:52 PM hey Europe only did it 10 + years ago. but whos counting
Andrea Weinberg Andrea Weinberg Friday, February 07, 2014 5:55:35 PM I have been in 2 ambulance accidents both times I was the treating EMT, leaning over my pt and assessing vitals. I always sit on the bench seat when treating my pt. The first MVC we were stopped at a light and a person went around stopped traffic and struck us @ the drivers side front quarter panel/tire area, I was thrown off of the bench seat and landed on the floor area behind the stretcher (Box not van) The second MVC was a mutual fault with both vehicles entering a nearly blind intersection at the same time and meeting in the middle. I had just sat up from being bent over assessing a BP when the impact happened. This time my butt stayed planted on the bench but my weight shifted right and my right side face hit the safety wall at the end of the bench, bending my neck to the left. I was fortunately not severely hurt either time but have been seriously contemplating a more user friendly safety restraint for EMS personnel. It would be nice to have some type of quick connect harnesses or something that could be worn as part of uniform (non cumbersome/ not bulky of course) . A restraint device that would be easy to click in and out of the seat so to allow almost free movement when needed but instant restraint (barring you click yourself back in). Not that it would solve every injury/death in Ambulance MVCs but maybe cut down on them and ease of use may encourage use of it by EMS. On a side note Im a firm believer in everyone (meaning civilians) taking a drivers ED refresher course and test every 5 years. (If you fail you dont get a license back until you improve and pass) Driving is a talent and a practiced skill and too many people suck at it lol.
Jennifer Carty Jennifer Carty Friday, February 07, 2014 6:29:18 PM That accident sucked!!
Micky Finn Micky Finn Tuesday, February 18, 2014 3:56:38 PM Ok, been in this game for 32 years, and went from Cadillacs, Olds, and Pontiacs, to Vans and Modulars. No simple answer. Again, always the change EMS and change FIRE, but its the public who runs into us, fights us, shoots us, and yet we bow down?? Don't buy the hype. I was there when they swore up and down we were saving lives with BLS, yet see if thats still the word! Please, its nonsense. Low pay, never change that do they? Referendums always fail, and now kill EMS so you guys think beofre you say I'm worng, because Ive been through all the "Changes"
Brendan McStay Brendan McStay Tuesday, February 18, 2014 7:12:07 PM I guess you could ask yourself why we transport with CPR in progress despite all available evidence showing it accomplishes nothing. Failing that, get a LUCAS or AutoPulse. No more need to stand up or move.
Sean Brierley Sean Brierley Tuesday, February 18, 2014 7:35:58 PM Guidelines are 20 mins of CPR on scene, but I have not seen any reports that saying stopping CPR for a 30-min trip to the hospital is as effective as continuing CPR in transport. Links?
Brendan McStay Brendan McStay Tuesday, February 18, 2014 7:41:47 PM *facepalm* I'm not talking about stopping CPR for the transport. I'm talking about not transporting.
Sean Brierley Sean Brierley Tuesday, February 18, 2014 7:51:48 PM You said, "ask yourself why we transport with CPR in progress." Just saying. Anyway, links? Take a look at this data, http://www.bbc.co.uk/news/health-26229072 http://www.bbc.com/future/story/20140217-does-cpr-usually-work.
Brendan McStay Brendan McStay Tuesday, February 18, 2014 7:59:41 PM I didn't think I had to spell it out, but I forgot I was on EMS1. I have no idea what those BBC articles have to do with the fact that transporting cardiac arrests is inconsistent with cardiac arrest survival. There is no evidence to support it. If the patient doesn't have a pulse when you leave the scene they will not survive the event. It's an exercise in futility that does nothing except risk the lives of everyone involved who isn't dead already.
Sean Brierley Sean Brierley Tuesday, February 18, 2014 8:12:34 PM Clear documentation is a key part of what we do. "[A]sk yourself why we transport with CPR in progress" makes it seem like you are giving me two choices, transport with CPR in progress and transport without CPR in progress. The BBC articles are just ones recently on success rates that I thought were interesting. I see what you are saying. I know of one instance where CPR was started on scene and a pulse gotten back in the ambulance and the patient left the hospital a week later with no deficit. But, aside from that, the other instances of pulse recovery during transport did not have positive outcomes. That being said, do you have some links to support your assertion that we should not transport if we cannot recover a pulse on scene? I am not in disagreement, just looking for supporting documentation.
Brendan McStay Brendan McStay Tuesday, February 18, 2014 8:40:39 PM AHA 2010 Guidelines. Page 24, "Ethical issues" http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317350.pdf Right here at EMS1: http://www.ems1.com/columnists/kenny-navarro/articles/1432503-Prove-it-Transporting-patients-in-cardiac-arrest-improves-outcome/ (There are over a dozen studies provided in the footnotes of the EMS1 article.)
Sean Brierley Sean Brierley Tuesday, February 18, 2014 8:43:06 PM Thanks. Looks like great reading! On the issue of restraints in the back of the bus, what do you think of going with a Sprinter-style, maybe a bungee tether to a harness worn by the tech? If the pt is belted on a secured stretcher, the pt should be okay aside from unsecured objects in the pt compartment....
Sean Brierley Sean Brierley Tuesday, February 18, 2014 9:14:47 PM Good question. Are the lives of those 6 patients worth the risk of the response? "A Houston study involving 1461 patients who suffered an out-of-hospital cardiac arrest found that 952 did not achieve ROSC at the scene and only 6 (0.6%) survived to hospital discharge (Bonnin, Pepe, Kimball, & Clark, 1993)."
Dallas Bond Dallas Bond Tuesday, February 18, 2014 9:25:42 PM Someone did a bungee tether in Arizona. I want to say it was Phoenix 12 to 14 years ago. They spent a lot of time and money on a good theory. It was presented in JEMS as the wave of the future like a lot of "new" ideas are. It was a bit premature as there was only a short usage time to review, no suggestions for compliance, and (other than load testing of the system to assure minimum breaking strengths) there was no crash testing to see what happens to 180 pounds of life saver on a short leash being swung around the interior of a metal box. It ultimately went nowhere but remained a valid concept in need of refinement. Later studies have shown that the safest method was to restrain the care giver with everything within reach. The recommendations by the seat manufacturers (the ones with the largest liability concerns) suggest a 6 point harness for lateral seating and a 5 point harness for forward or rearward facing seating. Plus they are also working on compliance by developing interlinks that not only warn the vehicle operator of an unrestrained crew member but actually will shut the rig down.
Shawn Noyes Shawn Noyes Monday, February 24, 2014 4:52:43 AM I agree with no transport with no pulse. That is what we do where I work, but patient's code and or re code in transport. You can't slam on the brakes and stop instantly. There is still potential for needing to do CPR while traveling even a short distance and everyone knows that you can get hit just sitting still at a light, parking lot, or (even more dangerous) on the side of the road/freeway. No way around it. Throw your statistcs out about tranporting a code all you want because you are right about it's effectiveness but your to focused on one issue in a topic that is about a huge number of variables.
Tony Smith Tony Smith Thursday, February 27, 2014 4:41:12 PM "experts are loading dummies into ambulances, and driving them into walls" Yup. That's EMS.
Sonny Dove Sonny Dove Wednesday, March 12, 2014 10:54:12 AM 1988 I was granted a US Patent for a restraining harness system for the rear of ambulances. Since then I have tried finding a manufacture that would be willing to develop this concept. I to have been thrown around inside the patient compartment of a ambulance. As for those seat belts you can only treat one side and that is limited as well.