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Ambulance safety: The more things change...

The "good ol' days" of ambulance transport hold some fundamentally sound design concepts that can be applied to today's technology

You know you're old in EMS when one of the rigs you worked in as a 911 provider was an Oldsmobile high top ambulance, complete with fireball lights, mechanical wig-wag tunnel lights, and a mechanical siren that sat right over your head as you barreled down the highway.

In the back of the ambulance, the "ambulance attendant" sat in a low seat that basically had you on the floor, right next to the patient lying on the 2-man gurney. And yes, the ride was…smooth. It felt like you were floating as the rig was moving along at 70 mph.

Of course, it wasn't all that rosy. The hearse-like station wagon was as maneuverable as a lumbering big rig; it felt like a three ring circus when trying to execute a U-turn on a city street. Any turn faster than 20 miles per hour turned into a carnival ride.

Image Art HsiehAt EMS World Expo 2011, one apparatus builder had a proof of concept vehicle that has a passenger-vehicle-type-seat mounted on a rack that allowed the seat to pivot and roll alongside the patient.
Image Art HsiehAt EMS World Expo 2011, one apparatus builder had a proof of concept vehicle that has a passenger-vehicle-type-seat mounted on a rack that allowed the seat to pivot and roll alongside the patient.

There wasn't a lot of space back there, but back in the day you really didn't need it. There was the stretcher, the resuscitator, a couple of jump bags, splints, a backboard and canvas flat. Communication between the driver and the attendant was through the glass window that separated the two compartments.

Perhaps the greatest advantage about the configuration was that everything was within arm's reach. From the attendant seat you could easily monitor the patient, take vital signs, perform ongoing basic care, and notify the hospital of your impending arrival.

To be honest, I miss that level of convenience. Today I ride in the back of a standard type three modular ambulance, and while the amount of space has increased dramatically to accommodate the amount of equipment we carry, it certainly is not convenient. More often than not I find myself moving about the compartment reaching for this and that piece of equipment. I don't feel safe when I do that. I know that, in a crash or a sudden emergency move, my body will have no choice but to follow the laws of physics (remember your last trauma life support class?). Likewise, all of those items in the back with me will become lovely little missiles that will undoubtedly aim for my head.

You would think that ambulance manufacturers would take heed of this situation, and indeed they have. I recently attended a national trade conference where visited with a few ambulance builder representatives. We talked about safety concerns in the back of a rig. They pointed out an obvious fact that I had overlooked – ambulances are built the way they are today because of the government specifications ("KKK-specs") for Star of Life Ambulances, originally set in the 1970s. Requirements like bench seats created constraints that US ambulance manufacturers had to contend with. Fortunately, possible changes in these specifications may encourage builders to build safer patient compartments.

During my visit I was able to sit in several different compartment configurations that promoted better safety for the EMS provider and the patient. There were a couple of overarching themes:

1) Reduce provider movement. The less you need to move around in the unit to care for the patient, the more time you'll spend secured in your chair. Simple idea, but much harder to accomplish. One builder had a proof of concept vehicle that has a passenger vehicle type seat mounted on a rack that allowed the seat to pivot and roll alongside the patient. (See photo) The patient gurney is also fastened to a "floating" base that allows it to move when required, and helps with the loading and unloading of the patient. Patient care equipment is kept in a small cabinet is located right next to the EMS provider. When sitting in that compartment I felt like I could perform most of the tasks without having to get up, very encouraging indeed.

2) Critically look at current technologies. Seriously, lap belts went off automobiles back in the late 70s. So why are they still in use in the majority of patient compartments today? Oh, and by the way – most of us are sitting sideways on that bench seat. Is there any data to show how those belts will affect the body when the vehicle comes to a sudden stop? During the show I saw different types of harnesses being demonstrated. None of them were perfect, but they seemed better than what currently exists. In addition, side air curtains are appearing as well, as well as more secure compartments that will hold loose equipment in place during a crash. Not much of the equipment has been crash-tested, so it remains to be same if they really represent an improvement in safety, but it's a start.

To be fair, much of the "good ol' days" of ambulance transport now seems quaint and antiquated. Yet there are a couple of fundamentally sound concepts that can be applied in today's technology-driven world, producing a safer, friendlier environment that better protects both patient and provider. Now if they can just make a truck ride like a car….

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