Sunday, April 25, 2010

Unacceptable risks...

The other day I stumple upon an interesting post on 9-Echo-1's Blog.

He has a very serious point about emergency care providers not beeing retraint in the back of a moving ambulance. Go and read his article, I highly recommend it.

I have to say that riding in the back of a moving ambulance is not a safe thing to do if you are not restrained. And there is no excuse.

I wholeheartedly agree with him! It's not safe and should not be taken lightly.

Studies here in Germany have shown that an emergency vehicle running lights and siren are 8 times as likely to become involved into an MVA as opposed to running without l&s. Given that risk it is, in my opinion, unacceptable to not be restraint in the back of the rig.

In most every unit I have been in, the primary care position is the bench. So why is everything placed in a way that requires you to do something stupid like get up?
Now this one got me thinking. When I visited the US last year, I went and visited a couple of fire stations. The guys over there were very open and forthcoming. They showed me around their station and their apparatus, and I got to look into the backs of several run-of-the-mill Amercian ambulance. And while the fire engines are huge compared to the ones we have here, the ambulance seemed a little pathetic in my eyes. Very narrow and confined, not even full standig height.

The basic concept of american ambulances seems to be: Cot on the left, cabinets on the left, bench on the right, captain's chair (is that what you call it?) facing the cot on the front wall, next to it a door way to the front cabin. Give or take a few storage cabinets, that's about it.

The first thing that crossed my mind is "why is all the portable gear (i.e., Lifepak, gear bags, O2 bag) not restrained?" I usually found it sitting on the floor, the bench or the cot without proper mounting or restraint. Consider this: Your partner has to hit the brakes real hard, or worse yet collides with another object. What do think will happen to that 8 KG LP12, that was previously resting peacefully on the benchseat?

Speaking of bench. That one's a mystery to me aswell. While I might see a benefit of fitting more people, be it patients or providers, into the ambulance, I see it as a major safety issue. Even if restrained a person will be sitting sideways restrained only by a two-point safetybelt around the hip, leaving the whole upperbody and head vulnerable to front- and backward movement. If you collide your head will probably hit something on it's way to the front.

The next thing I noticed is that the cot rests on the floor of the ambulance. Granted there are mounting brakets to keep it in place, but they didn't seem strong enough to keep it in place in case of collision, much less if the ambulance turns over. But that was just the impression I got, correct me if I'm wrong.

Given these factors I would consider it highly unsafe to even be in the back of an american ambulance, even more so if I weren't restrained. It seems to me I could be hit by UFO's (unrestrained flying objects) at any given time during the ride.

Don't get me wrong. I do not want to bash your rolling workplaces, I'm just pointing at things that I noticed when I got to peek inside your rigs. Things that might have never crossed your minds, but seem blatantly obvious for someone from across the pond.

Fortunately for us in Europe there are certain safety requirement that all ambulances have to meet. Among other things the cot has to be accessible from three sides with specific minimun requirements as to how much space there has to be around the stretcher, placing the stretcher in the middle of the compartment. Also all portable devices have to me specially mounted, and those mounting brackets have to withstand forces of 10 G in every axis. And above all manufacturers have to perform crash tests and ensure that the patient compartment withstands 10 G in every axis aswell - this was particularily huge. Additionally our stretchers are mounted on specific tray (like a table of sorts) which have to meet the same criteria and have to be "roll-over proof".

I will try to attach a few pictures to give you an impression of how our ambulances look like inside.

Stretcher tray in a reeled-out position.

Device wall mounting (with battery loading docks).

Stretcher accessible from all sides.

As you can see we have not only full standing height, but are also able to access the patient from all sides. We also have three seats at our disposal, two of which are fold-away (right/left), each offering a full three-point safetybelt to strap ourselves in while on the move.

I hope this might have raised your eyebrow and made you think about your safety while in the back of the bus. Things you might have not ever thought about. Scene safety is not everything out there. And just maybe the ambulance manufacturers will take hint from good old Europe and pick up a few of our safety standards and incorporate them into their products.

Be safe!


  1. Great post, Sam. It's amazing to see just how spacious your ambulances are over there in Germany, and awesome to see how advanced the safety standards are as well. Unfortunately, the United States is lagging behind in that respect I think, but I've heard of some services that are working to turn that around.

  2. Thank you for taking interest and your comment!

    I think we face enough dangers day-in and day-out, we shouldn't threaten ourselves with preventable hazards. Accidents waiting to happen so to speak. In posting this article I'm trying to raise some awareness, about simple things that might have never crossed one's mind.
    If just one of my collegues in the US decides to strap in his LifePak or put on his safetybelt after reading this, I'm proud to have made a little difference.

    Be safe,