Designing for Safety

HUDSON AREA AMBULANCE
     In May 2007, Hudson Area Ambulance of Hudson, MI, put into service a 2007 medium-duty C4500 Chevy chassis rig, which was custom-built by Marque Inc., out of Elkhart, IN, and was designed with safety in mind. The design includes two captain seats that can face forward and lock with three-point belts while allowing enough space to transport a second patient. All necessary supplies are within arms' reach.

     The curbside entry door has been moved all the way forward for added privacy, with the ALS cabinet with inside access only blocking sight into the patient compartment. There are only two outside compartments: one for backboards, KEDs, traction splints, etc., and the other for miscellaneous equipment, including fire extinguishers and road flares. The unit is equipped with LED warning, brake, tail and turn lights. We also added a second light bar, which is halogen, to the roof of the cab. Regular floodlights on each box side with high-intensity lights provide on-scene lighting.

     Inside the unit, we have an Apollo Road Runner camera system with two cameras in place that feed to a 250Gb hard drive. One camera is mounted inside the patient compartment with the other facing forward from inside the passenger compartment. Viewing this footage, which shows vehicle speed, GPS, right turn, left turn, brake application, as well as warning light and siren activation, can be done on a separate CPU.

     There are two EVS captain-style seats with three-point belts that swivel to forward face. One seat on the curb side of the box allows facing forward, as well as being able to provide patient care while belted. The second is positioned at the head of the cot. From this seat, we can provide airway maintenance, along with suction, while still being belted. The bench seat has been moved to the street side; therefore, two-patient transport is still possible. The suction unit is recessed under the bench with a three-way switch to activate it from either side of the unit.

     With one of the captain seats placed on the curb side, we have also moved all radios, light switches, thermostat, inverter panel, O2 and monitor brackets to the curb side, which are all accessible while facing forward and remaining belted without hindering patient care. To be belted and forward facing while still being able to provide patient care is a huge improvement in vehicle safety.

     Brad Vanderlooven is a paramedic for Hudson Area Ambulance in Hudson, MI.

     By Andrew Isaacs

WINTER PARK FIRE-RESCUE
     The idea for occupant safety started while I worked as a firefighter/paramedic and we responded to a vehicle overturned with entrapment. Upon arrival, we found an unconscious female and an ambulatory male. The male, calm and uninjured at the time, requested to ride with his girlfriend to the hospital. During transport, he suddenly became violent and started punching the ambulance's dash and screaming for us to go faster. I called for police to intercept the ambulance. Within a few minutes, there was a highway patrol car behind us. As I yelled for my driver to stop, I went flying from the back of the ambulance head- first into the curb side stepwell. That's when the Action Safe design was born.

     Years later, a promotion landed me with an ambulance manufacturer. As an EMS supervisor, I was tasked with ordering two new rescue/ambulances. While walking through the plant, I noticed that the ambulances were basically all designed the same, and I thought we must be able to make these units safer and better organized.

     I started to pose some questions. Since most ambulances are built with the lighting and climate controls, as well as the radio, at the action area—the seat at the head of the patient—and no one sits here, what would happen if we moved all the controls over to where we really sit? Could we have an actual seat belt here, so if there was an accident we wouldn't be thrown against the wall? And could we move all the equipment storage here, as well, giving the crews no reason to stand up and letting them remain belted? The rest of the finished product was a joint effort with the Winter Park Fire Department, Medtec Ambulance, EVS and Schroth Safety.

     We believed that allowing our paramedics to treat patients in the back of a moving vehicle while unrestrained was unacceptable. Working with the manufacturer, we created a harnessed seating configuration on the curb side wall of the patient compartment. We looked at how patients are transported to the hospital, and, more important, at where the paramedic sits during a transport, which is on the bench seat next to the patient. This is the only place where the paramedic can sit and talk with the patient and attend to the patient's needs. The bench seats on most ambulances have only a lap belt restraint system. We felt this had to change.

     Much fanfare followed the redesign. We called a press conference, and the local newspaper and news channels did a story on our ambulances. There were magazine and Internet articles, and the trucks were featured at national conferences. Chiefs and supervisors from all over North America contacted us daily. Some even flew to Orlando to see the truck and test its function.

     So is the redesign functional? The trucks have been in service for over a year now, and our crews have transported thousands of patients. I recently asked our crews for a candid assessment of the redesign. I wasn't surprised with their responses.

     Engineer/paramedic Jeff Spinelli is a veteran of many ambulance designs. He has close to a decade of EMS experience and had this to say: "Being assigned to the unit at its inception, I can honestly say that it has truly changed the way we work. I now feel out of my element when not 'harnessed' in. Yes, there are times when it cannot be worn for the duration of the call, but those are the rare exception. The design has forever changed EMS in the city of Winter Park."

     Firefighter/paramedic Richard Ribar is also a veteran of public and private ambulance designs. His response: "I have enjoyed the safety upgrades of the new system. It truly works well with our stable or non-acute patients. With that said, I can wear this harness for approximately 90% of our calls."

     I had been striving for 50% compliance. We now have crew members who were basically 100% noncompliant seat belt users who have improved to 90% seat belt compliance. That is quite an accomplishment.

     Brenden Ankeny (pictured above), who is fresh out of paramedic training, wrote: "This system of being strapped in and all of your equipment being stored in specially designed compartments sounds restricting, like it would interfere negatively with patient care. In my opinion, it's quite the opposite. I feel I can now focus more on the patients and their needs because I'm not worrying so much about my safety when I'm sitting in the action area. You are still able to interact and assess your patient right there from the seat."

     If you are tasked with ordering ambulances for your agency, you don't have to order the status quo. This is one of the few times where thinking inside the box is best.

Andrew Isaacs is a lieutenant/EMS supervisor with the city of Winter Park, FL.