It's time to get real about safe ambulances

Imagine how ambulance design and safety can improve when motivation and the desire to do the right thing come together to drive change

This feature is part of our Paramedic Chief Digital Edition, a regular supplement to that brings a sharpened focus to some of the most challenging topics facing paramedic chiefs and EMS leaders everywhere. To read all of the articles included in the Winter 2016 issue, click here.

By Art Hsieh

The typical EMS provider workspace is rather unique. In the small confines of an ambulance, we have to provide a comfortable ride for our patients, carry enough supplies to rival a small clinic and render care quickly and effectively while traveling at highway speeds. Within the confines of our rolling offices, it's easy to imagine that we are performing our jobs safely as well.

Sadly, we work in a ticking time bomb when it comes to our safety.

Research shows just how dangerous it is to work inside ambulances.
Research shows just how dangerous it is to work inside ambulances. (Photo/Greg Friese)

Disagree? Look around your ambulance's patient compartment the next time you step into your unit. Look at every piece of equipment and disposable supply that isn't tethered in place during transport.

Now imagine what all of those devices and bags will do in a very sudden stop, a crash or rollover. A 20-pound defibrillator may suddenly feel like a 120-pound blunt trauma projectile in a 30 mph crash. Cabinets fly open, oxygen tanks become airborne; it doesn't take much imagination to understand and predict the blunt trauma injury patterns that will happen to anyone — patient or EMS provider — traveling in the back of the unit.

And seriously, how many of us continue to not wear seat belts while in the patient compartment? I doubt that many paramedics and EMTs wear a seat belt all the time on every transport.

Too often seat belt use is simply impractical. Taking a patient's blood pressure while buckled on the bench seat? Good luck with that. Reaching for some supplies from the cabinet? Maybe if you have the wingspan of an NBA power forward. Trying to administer medication by slow IV push over five to 10 minutes? Well, you get the picture.

What about the "walls" that make up the patient compartment? If you think the side walls of a big box patient compartment are designed to withstand any forceful side impact like a typical automobile's steel reinforced door, you are mistaken.

Research shows just how dangerous it is to work inside ambulances. A National Institute for Occupational Safety and Health report indicates that the risk of death to EMS providers is more than double the national average of American workers dying in a transportation incident.

Our EMS work environment has its origins in the military ambulances of the 1970s. How many other types of vehicles from that era continue to look and operate like they did 40 years ago?

While the specifications of new ambulance construction are changing, it's been a slow, tortuous process. To compound the issue, there are potentially competing standards for how ambulances should be built.

Meanwhile, an EMS service in Minnesota has taken upon itself to improve the safety and protection of its personnel after an ambulance crash nearly killed two of them in 2014. Recently, the service developed an ambulance unit that will better protect both patient and provider during transport.  

While not perfect, the ambulance is an example of what can happen when motivation and the desire to do the right thing come together to drive change. Moreover, it appears that these safety features are not coming at an additional cost either.

Meanwhile, the rest of the industry continues to slog along with little or no change in ambulance safety. For those of us who are trying to stay healthy while working in this industry, it's critical that the standards for better ambulance design be finalized so that manufacturers can get to work in making safer, more efficient offices for us to provide care to our patients. Field providers also need to call on their leaders to provide a safer office with significant safety improvements.

New ambulances look great with increased fuel economy, more ergonomic features and more reliable electrical systems. Let’s add the phrase “the safest for patients and providers alike” to the list of improvements and innovations that keep us safe while at work.

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