Today I want to take a closer look at ambulance design and how it is contributing to needless injuries and fatalities. For the most part, since the Cadillac style of ambulances were phased out in the early 80’s, the interior design of Type I, II and III ambulances have seen little or no improvements in occupant safety. The patient compartment does not have to conform to the Federal Motor Vehicle Safety Standards (FMVSS), which if it did, I believe the injury and fatality rates for EMS workers would be substantially lower. So why was this overlooked when the U.S. General Services Administration developed the KKK-A-1822 specifications in 1976? How did ambulances get excluded? I’m betting it had to do with cost. If ambulances did have to conform to the FMVSS, I’m confident the prices of ambulances would be substantially higher. I’m also confident there would be more EMS providers alive today. Lower cost over life.... Criminal!
Ambulance manufactures for the most part have been enjoying a relatively unchanged design for decades. The chassis has seen many improvements in protecting the front occupants over this period, although in the “box” has certainly been void of substantial occupant protection. Some will argue the former pointing out the addition of safety nets, increased padding on walls and even air bags. What they are trying to do is soften the impact of a human projectile which may result in less injury. They are missing the point!
Findings from NTHTSA and NIOSH clearly indicate that riding in the patient compartment was associated with the highest risk for injury. For the high majority of clinicians in ambulances, the squad bench is the preferred seating position. Even though seat belts are provided in this position, research from the NREMT-LEADS survey revealed only a very small percentage wear lap belts while using the squad bench. Why? Seat belted in this position limits accessibility to the patient, medical equipment and controls. With this restriction to access, belts are not worn thereby gaining access with considerable risk. That false sense of security at the end of the bench, the safety net, is not going to protect you either.
In my opinion, squad benches should no longer be available in new ambulances for one reason and one reason only, safety. Forward facing seats with lap and shoulder belts is the preferred replacement. From there designers can start by placing lighting and environmental controls within arm’s reach of the clinician. Surprisingly these ambulances do exist and have been effectively treating patients for many years. Oslo University Hospital in Norway has been utilizing this interior design for their ambulances for many years. This safety centric provider prioritizes safety in their ambulance designs and their excellent record proves it works. In addition to improving safety, they also firmly believe this design has improved patient care and outcomes. For those providers in the US that still want the large Type I and III ambulances, this layout can be easily incorporated to your vehicles.
So why hasn’t this design been widely adopted in the US? Could it be a cost factor or a paradigm? Has the US ambulance manufactures become so complacent that they are unwilling to make safety a priority? Are EMS providers also culpable for not speaking up and demanding safety improvements? I understand the increased cost factor, but when it comes to protecting your employees, safety is one of the best investments you can make. This might sound cliché, although safety experts around the globe truly believe in this quote: “An ounce of prevention is worth a pound of cure.”
As the current KKK specifications are sun setting, I sincerely hope that those organizations which are developing new ambulance standards make safety a priority. Now’s the time to get it right and develop standards that protect EMS providers! How hard is that?