By Jim Love
EMSafety.net
Several years ago a group of EMS industry leaders met in Washington, DC, as part of the American Ambulance Association’s Mobile Medical and Transportation Safety (MMTS) group. The purpose of the meeting was to discuss vehicle safety and to identify ways to improve safety of responders. It was a diverse group including physicians, PhDs, ambulance manufacturers, insurers, departments within the federal government and, lastly, ambulance providers, which I was a part of.
Throughout the day there were many presentations and thoughtful discussions. Different groups were formed, which included “human factors” and “ambulance design.” I left this first meeting feeling good, as though something was going to get done and things were going to change.
More than a year later, in my opinion, there had been no real action. A discussion took place and a decision was made between American Medical Response (AMR) and American Emergency Vehicles (AEV) to take action and build the first Safety Concept Vehicle. I was fortunate enough to be able to again participate in the design and build discussions. Others from MMTS also participated, a much smaller number, not only to discuss but to build.
Not Seated = Not Safe
The first Safety Concept Vehicle (C1) was a type 2 Ford ambulance. From the very beginning we wanted to build a vehicle that would allow, much more often than not, care providers to be able to remain in a secured, seated position. We looked at reasons why medics/caregivers left a seated position and sought to eliminate as many of these reasons as possible. In C1, the bench seat became a ¾ seat with a fully swiveled racing seat at the front. The seat could face the front and lock into position or it could face the patient. It could also turn and face aft and hold the head end of the backboard so as to still be able to transport two patients.
The question of whether ambulances today really need to carry two patients was of itself an interesting learning experience. AEV’s President Mark Van Arnum and I toured many ambulance operations and asked several questions in order to understand the perceptions and needs of field providers. These visits with crews and providers led to many of the changes seen in all the concept vehicles.
One of the questions we asked was how often they needed to carry multiple patients. At one of our stops in Miami, the answer was resounding — it happens all the time and needed to continue. Some 40 miles up the road in Ft. Lauderdale, they never did it and couldn’t see why or when they would.
These interviews also revealed that many of the reasons that caregivers left the seat had nothing to do with direct patient care. Across the ambulance and out of arm’s reach from the bench seat were the light switches, the AC controls and the med radio. As a result, additional switches and controllers were placed in C1 and eliminated many of the reasons why medics got up.
Bad fit
Another reason medics stated they did not stay seated or use the lap belt was the perception that the bench seat offered little in the way of safety anyway. The common lap belt did not fit properly, riding high up on the waist and prevented access to the patient. It was not perceived that the lap belt would offer much protection in any event.
So C1 had a racing seat with harness. It was a proper seat and harness and, when facing front, offered a big advantage over the bench seat and lap belt — or so it was hoped. There was a problem, however, with the original seat. There are not many wider-bottomed race car drivers out there —but it’s an affliction EMTs and medics can suffer from. Some could hardly get in the seat and found it incredibly uncomfortable. In fact, it was useless to many. The ¾ bench seat also eliminated some storage. This was not widely appreciated either especially in a Type 2 vehicles where storage is at a premium to begin with.
Finally, C1 had the most horrendous interior color scheme imaginable: gold and bright blue. The colors drew people in like moths to a flame. Many stood and stared in disbelief when it was first displayed, shaking their heads. Few were shy about telling us what they really thought about the colors, and about the seat and bench seat.
However, while they were telling us, they also got to listen to our story, what we were tying to accomplish, what we had learned from our discussions with field crews. Many left the display area with a newfound respect for what we were trying to accomplish — though of course still shaking their heads over our dumb design or color scheme.
In the end we realized that we were 110 percent successful in accomplishing our primary goal to get people talking. And not just a few — an entire industry was talking and thinking about how ambulances could be designed and made better.
In the second article of this three-part series, I will focus on Safety Concept Vehicle 2 (C2).
Jim Love began his EMS career in 1974. Since that time he has worked providing direct patient care, and has been an FTO. He transitioned to management and has held many positions over the years including operations and later focusing on training, safety and risk management. His most recent position was National Director of Safety and Risk for AMR. Prior to that, he was the Regional Director of Safety and Risk, CES and Fleet Services, also for AMR. He worked extensively on the development of all three Safety Concept Vehicles co-built by AMR and AEV. He maintains an EMS Safety site and blog, EMSafety.net, and can be contacted at drjlove007@gmail.com.