What changes to ambulances would make it safer?

July 26, 2007

So based on Doc's post. What changes would you like to see

implemented or at least tested to improve safty?

Has a study been done to see if it is safer to transport patients

head first rather than feet first?

Renny Spencer

EMT-B (still waiting on the state to send my EMT-I)

>

> Nadine Levick and I spoke about this last week before this horrible

tragedy.

> There is about as much pseudoscience in ambulance design as there

is in many

> EMS practices. Ambulances are motor vehicles and more similar to

cars than

> rocket ships or salamanders. Why then do we not look at the auto

safety

> literature and follow their tenets (ambulance manufacturers are

largely

> removed from the automotive industry in terms of design)?

>

> Several things have to occur:

>

> 1. We need to totally redesign our ambulances from the wheels up

using

> safety standards and practices from the international automotive

industry.

>

> 2. Ambulances should be tested and achieve similar safety ratings

to my

> 2007 Acura MDX.

>

> 3. Ambulances may need to be smaller with a lower center of

gravity.

>

> 4. Ambulances need to carry less junk.

>

> 5. Lights and siren responses must be extremely limited and almost

> non-existent. Only patient condition should drive use of lights and

sirens

> and nothing else (including some PUM at LEVEL 0).

>

> 6. Improve driver education. We take the youngest, least

experienced

> person (usually an EMT in their twenties) and ask them to drive a

> Freightliner in an emergency with their catecholamines and hormones

raging.

> Perhaps we need " ambulance drivers " whose sole job is to safely

operate the

> ambulance.

>

> 7. We need to look at integrated warning systems that will

override the

> sound systems in cars to alert people to the ambulance/fire truck.

>

> 8. All intersections need a system to change the lights from red

to green

> for the approaching emergency vehicle EVEN when not responding with

lights

> and sirens.

>

> 9. Do away with dispatch categorization. Ask a few questions to

determine

> what type of response is needed and that is it. The first priority

should be

> to dispatch the ambulance.

>

> 10. Assure personnel on duty have adequate rest.

>

> 11. Keep people with problem driving records from

driving.

>

> 12. Use dash cams and low energy driving techniques.

>

> 13. Periodically practice emergency driving (skids,

emergency

> braking, turns) so that personnel are familiar with the operating

> capabilities of the ambulance.

>

> 14. Like it or not, an ambulance such as the MB

Sprinter is

> probably in EMS' future.

>

> http://commons.wikimedia.org/wiki/Image:Ambulance_Germany.jpg

>

> BTW, those squad bench safety restraint systems are custom made for

inducing

> a spinal injury in the provider-mark my words.

>

> And now, back to your regularly scheduled dribble.

>

> BEB

>

July 26, 2007

In a message dated 7/26/2007 10:56:18 A.M. Central Daylight Time,

spenair@... writes:

So based on Doc's post. What changes would you like to see

implemented or at least tested to improve safty?

Has a study been done to see if it is safer to transport patients

head first rather than feet first?

Renny Spencer

EMT-B (still waiting on the state to send my EMT-I)

Great to the point question Renny!

First and foremost while I will respond to the Doc's post directly on this

let me recant what I did in my last job as a training Officer for a service.

1) We took the time (and money) to train in-house VFIS EVOC & NSC CEVO I &

II instructors. We chose five folks from our in house staff to make EVOC

Instructors and Mentors. The ones we chose were those that we knew were safe

and

experienced EVO's and we were able to make use of the resources that were

availed to us via the National Safety Council (CEVO I and II) as well as

through

VFIS Insurance since they offered their insured's a behind the wheel EVOC and

EVOC Instructor Course. While we were not insured by them my volunteer vire

department was and we were able to access that resource in that way (a double

benifti for the VFD as well I might add).

We had those 5 folks and myself take all the base courses at locations other

then our home area (a new Instructor and fresh view was the purpose of

that), we then took each of the respective instructor courses. Once we did that

we

brainstormed and created a " hybrid version " of a behind the wheel EVOC that

we then required our folks to all take upon hiring. We ran them on Friday

night, Saturday, and Sunday in a 20 hour course format with classes no lager

then

15 Students with 2-3 Instructors and at least one Type 1, II and III rig

(we ran all 3) as well as one of our Command SUV's and our one Crown Vic.

We ran these at least once a month when we had new hires, it was mandatory

that they sit for this course BEFORE they drove our units of any kind. We paid

them to be there and we even fed them. All of our on the books folks came to

one within 8 months of the implementation of this (80 folks or so on the job

when we did this).

We also would post on all training boards at our stations articles and news

clippings and the like about ambulance or other related crashes. We tried to

make the idea of behind the wheel safety a part of the " company culture " I

think we did a decent job in that. We never had a lot of " crashes " but we had

our sharing of backing incidents and the like while it's been 5 years since I

left that job and came to Texas I speak with them a lot and their accidents

are down.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Owner and President of LNM Emergency Services Consulting Services (LNMECS)

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

(Home Phone)

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July 26, 2007

I'll bite this one:

First, some facts for everyone:?

A) There is approximately 5,000 ambulance crashes a year in the US (helicopters

are unsafe?);

There is approximately 1 fatality a week on average (52 a year)

C)? Our fatality rate in EMS is about 12.7/100,000 workers...lower than LEO and

FF...but when you look at transportation deaths we are at approx 9.5/100,000

while LEO is 6/100,000 and FF is 5.5/100,000....we are killing ourselves with

our driving....74% of EMS on the job fatalities are transportation related

D)? 82% of rear occupants killed in ambulance accidents were unrestrained

E)? >65% of ambulance accident fatalities had serious head injuries

F) Over 70% of fatal ambulance accidents occur while using the lights and sirens

Changes I would advocate TODAY (most a low if any cost)

1.? ALL patients transported should be transported head first, sitting up as

much as clinically possible with FIVE straps securing them...legs, pelvis, chest

and 2 should straps securely fastened.? The patient's only chance of survival is

to remain secured to the stretcher...flat without shoulder straps creates a

missile into the bulkhead wall.

2.? All care providers should be strapped into a seat or on the squadbench with

whatever straps are available.? Even the lap belt works...wear the seatbelts!

3.? All equipment in the back of the ambulance should be secured so that it

CANNOT move around while anyone is back there.? A cellphone at 40mph to the head

can be lethal.

4.? Red lights and sirens should not be used UNLESS absolutely necessary.? I

would even suggest NEVER when a patient is on board.? We do not use priority

dispatch methodology in our agency yet...but we do not respond emergency to any

type of standby, to any call where we have a report from the scene that there is

no critical situation (1st responder or LEO), and, after this accident in Ohio,

we will soon no longer be responding emergency to any call we will have to stage

on.? In addition, our transport emergency priority has fallen to way less than

5% of our transports (and for those interested this is trauma alerts as

well...we use helicopters on 0.5% of our transports).? In our research in our

agency, the quickest time an ambulance transporting emergency ever beat a

vehicle following traffic laws was 45 seconds.? None of my 35 people are worth

45 seconds of standing in an ED waiting on a bed...

5.? Examine different vehicle designs.? Ideally, we should be able to be seated,

secured and able to reach the equipment we need to care for the majority of our

patients.? We are able to accomplish this in aircraft...why shouldn't we be able

to do so in an ambulance?? Think outside the box on this one.

6.? We should all start wearing helmets in the rear compartment of the ambulance

while it is in motion.?

7.? Anytime we are operating outside the vehicle on a street crews should be

wearing reflective vests with 5 point break away velcro (both sides of torso,

front of body, tops of both shoulders).

8.? Ambulances should come with black-box vehicle monitoring and driver feedback

systems installed in them that encourage and promote low forces driving

9.? Agencies must write policy requiring their vehicles, when using lights and

sirens,?to come to complete stops at all stop signs, red-lights, and

uncontrolled intersections...COMPLETE STOPS...and then enforce it (All the city

department heads and city councils we service have my cell number on a card to

report this to me personally if they ever see it in their city)

10.? Low force driver training must be provided annually.?

11.? Efforts must be made to develop and mandate appropriate ambulance operator

driving courses...just because it works in a cop car or fire truck doesn't mean

it will work in an ambulance.

12.? Agencies must start rewarding calm, cool collected decision making that