Simplicity in Form and Function

If the design and layout of ambulances isn’t exactly safe, part of the reason is because ambulance design hasn’t fundamentally changed in 50 years. Safety measures have improved significantly during that span for other vehicles, but ambulance design has remained largely stuck in the past. It’s like the difference between an Etch A Sketch, one of the most popular toys of 1960, and an iPad. Luckily, things are changing.

Several years ago a team of technical experts led by the EMS Safety Foundation went about combining the safest aspects of ambulances the world over into one vehicle. Those ambulances were rolled out in the U.S. at Dallas-area service CareFlite and in Oslo, Norway.

In Norway, the process began even earlier, around 2003, when the Scandinavian country’s two biggest ambulance services merged, says Ronald Rolfsen, a paramedic and advisor to the Oslo University Hospital ambulance service. “The first thing we did after the merger was to make a common equipment list so we had the same equipment in the vehicles, as well as common standard operating procedures, uniforms, etc.,” Rolfsen says. 

Norway has a tradition of using smaller ambulances than the U.S. The most common models in use today are the Mercedes Sprinter and Volkswagen T5. So space, and safety, are at a premium.

“In our service we have tried to set a principle for when we construct an ambulance, and that’s a triangle between you, the patient, and the equipment and controls of the vehicle,” Rolfsen says. “So when you sit in your seat, which is either forward- or rear-facing, you should have your seat belt on and be able to treat the patient without loosening or taking it off.”

Rolfsen is very serious about safety, but he’s willing to make one small sacrifice for the sake of reality—you can’t make an ambulance that works 100% of the time for 100% of the calls, he says. But he’s firm in his belief that it’s feasible for an ambulance to work 100% of the time for 95% of calls, and at least 95% of the time for the remaining 5%.

That may sound like an exceedingly high standard, but ambulance design “isn’t rocket science,” Rolfsen jokes. “It’s common sense.

“In our vehicles we have two places we start for treatment,” he continues. “One is the head end for doing airways and neck stabilization. That seat is the one we use less often because it’s only for airways and neck stabilization. So, basically, we use the seats on the side of the patient. We have moved, particularly in the Sprinters but also in the T5s, as much of the equipment as you need during transport over to the right-hand side, so you don’t have to reach over the patient to get to equipment.

“It actually just comes down to the adjustment of the seat, the stretcher and the equipment. What we have also done with all the equipment you need outside the vehicle—your bags, everything that’s heavy—is placed everything low and very close to the doors. You’re not supposed to go into the vehicle to get the equipment you need outside. And all the equipment you need inside is supposed to be clear. That means all those little things like needles, drugs and bandages are in compartments reachable from the seats so you don’t have to open any bags to get them out—with one exception. Some of the equipment for pediatrics is actually in bags because we so seldom use it.”

One thing that helped as teams set about designing safer ambulances, Rolfsen says, was the involvement of the medics who would use them.

“In our service we have a working group consisting of people from the unions, including a health and safety representative, and some people from management, including myself,” Rolfsen says. “Basically the crews decide where to put all the equipment. I don’t mind if they want to have the cannulas on the right or left—the point is, I’m looking at the safety. So they are more or less able to keep the equipment where they like it. My job is to apply some points that, again, all the heavy equipment is placed low, in a safe place and easy to reach.

“The medics are the ones who are going to use the vehicles,” Rolfsen says. “I haven’t driven an ambulance for 10 years, so why should I make the decisions on where they put the equipment? But I have very strong positions on safety. That’s my job.”

Since his service started taking a more commonsense approach to ambulance safety, Rolfsen notes, it also began a more concerted effort to train employees in the proper ways to move patients, whether it’s using sliding boards to prevent outright lifting or stair chairs to reduce the strain.

“One of our stations has seen a significant reduction in sick leave for back injuries since we started training our people this way. And in the past 10 years, we have not had any fatalities due to car accidents, nor have we had any serious injuries from car accidents in my service,” he says.

“The basic principle is that you, the patient and equipment all should be safe, and you should be able to do your job without getting out of your seat or taking off your seat belt,” Rolfsen says. “I believe we have achieved that for approximately 95% of the calls. The biggest problem is the mind-set. If you’re going to change it, it’s going to take time. Particularly if people are used to not wearing seat belts, it will take time to get them used to wearing them.”