EMS Innovations

This page is dedicated to some enhancements or modifications of EMS systems and equipment that I advocate.

Back to the Drawing Board: Ambulance Design

From the first day of EMT class, I remember being told “Your personal safety is the priority.” Yet, we accept mediocrity in regard to domestic ambulance design. Take a look over the water to see some proven, ergonomically ingenious, safe European specifications that make me think we have become satisfied with anything better than a horse and buggy. Topping the list of pointless, status quo features is the traditional perpendicular bench seat. Multiple restraint devices on the torso will not prevent lateral cervical movement. European ambulances have included forward facing attendant seats for quite some time. Not only does this allow for proper restraint during a collision, but it also promotes more effective patient care. The paramedic can achieve better therapeutic communication and physical assessment by being closer to the patient.

I’ve heard the argument that governing agencies still mandate the transport of two supine patients. One would think that this anachronistic requirement would have been abolished shortly after HIPAA demanded patient privacy. While I feel a more contemporary ambulance specification is warranted, profit oriented agencies (both public and private) are not likely to advocate a change to cut potential revenue during a single transport in half – despite the huge liability associated with current operations. So, the argument has merit (for now) and we must incorporate a safe way to transport two patients simultaneously. This creates another challenge since the traditional approach to moving a second patient has been securing them to the bench seat. Many ambulance incorporate “the net” to prevent forward movement during a frontal impact. Does this safety device get disconnected when we need to transport a secondary supine patient? If so, we now also compromise patient safety by removing any frontal impact restraint devices.

Other safety considerations include minimizing the need to access anything on the ‘streetside’ of the vehicle, minimizing the equipment carried, using a smaller vehicle designed to secure this specific equipment, placing everything typically used within seated, restrained reach of a paramedic, and providing a “buffer zone” for side impacts by moving passengers to the center of the vehicle. The following photos are a drafted solution to current safety issues using a Sprinter chassis. This is conceptual and not to scale, but enough to provide an idea.

The left exterior of a safety-first designed ambulance.

The left exterior of a safety-first designed ambulance. Access on this “streetside” of the ambulance should be limited to restocking or maintenance. 

The right interior of a safety-first designed ambulance.

The right interior of a safety-first designed ambulance. The primary attendant seat would be near the stretcher to allow for assessment and provide a “buffer” in case of lateral intrusion from a collision. The “airway” attendant seat would rotate with airway supply/ equipment cabinets on either side; also to promote seated, restrained care.

The rear of a safety-first designed ambulance. The larger loading door would permit loading of two patients, as well as access to backboards.

The rear of a safety-first designed ambulance. The larger left loading door would permit loading of two patients, as well as access to backboards.

The left interior view of the patient compartment. The "action area" would include rollers and a loading system, along with a harness and restraints   for securing a second patient.

The left interior view of the patient compartment. The “action area” would include rollers and a loading system, along with a harness and restraints for securing a second patient.

The right exterior of a safety-first designed ambulance. Main equipment bags stored in the right rear cabinet will be accessible from both the interior and exterior.

The right exterior of a safety-first designed ambulance. Main equipment bags stored in the right rear cabinet will be accessible from both the interior and exterior.

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