Personal Protection and you!

Today I was working with a Paramedic student, who has just started his field rotation last month. He had been an EMT before he went to P-school and gained a good years experience during that time. We took over the ambulance from the early shift and as per usual I would step outside with them and have a cup of coffee and a cigarette and we would chat a little. My student went straight to the ambulance and started inspecting and checking the gear and medical supplies.

A few minutes later, after having finished my coffee, I joined him at the ambulance. And, like I do every day, I hung my jacket on the little hook next to my seat and started my daily paperwork. I looked over to his seat and didn't see his was nowhere to be seen. He had just finished checking the back of the rig and came to me, so I asked him where his jacket was. He told me it was upstairs in his locker, "why do you ask, it's summer and I won't be needing it" he continued. I was a little taken aback by that and told him that if I were to catch him at an MVA without his jacket, we would need to have a serious talk.

A few days back I was chatting with a paramedic from Texas and she asked my why we were all wearing our jackets at an MCI call in 100° F (39°C) weather. My immediate response was to ask her why I wouldn't be wearing one and if they don't wear jackets during MCI or MVA situations, to which she replied no. I was shocked and here is why.

Our jackets are a vital part of our Personal Protective Equipment for a number of reasons, all of which are standardized by the European Commitee for Standardization (CEN) in so called Euro Norms (EN). Firstly and most obviously it has to protect us from weather influences, mainly the rain and the cold (EN 343). Then they need to fulfill certain high visibility requirements (EN 471) in regards to background color (usuallay a bright red, yellow or green) and reflective striping, giving us the necessary proctection to work in flowing traffic without the need to wear additional (traffic) vests. Something I have yet to see in the US, where EMS uniforms are typically composed of dark colored materials - usually navy. Uniforms that I would not feel comfortable working with on any street, road, or highway.

Sample image of a typical German EMS jacket, like the one my service uses.

Another, to me, important fact is that it protects me from mechanical influences to a certain degree. Especially on an MVA scene there will be glass and metal parts scattered around and all sorts of sharp edges that I don't want to cut myself on. Our jackets are made from sturdy materials in order to prevent that from happening. I remember all to well an incident in my first days on the job. It was summer and we were called to an MVA with a person pinned in their car. I don't remember the exact particular, but what I do remember is that Fire had to take down the roof of the car in order for us to extricate the patient. After they had done so the b-pillars, half cut off, stuck up in the air and while I was leaning into the passanger cabin I cut my forearm pretty badly on the sharp edges of said pillar, leaving me bleeding like a stuck pig. That thought me to always wear my jacket on sites like that.

The same is true for helmets. Rarely do I ever see my colleagues wear helmets. Granted the situations were the use of helmets is actually waranted are few and far between, but even then the changes of seeing EMS personnel wear helmets are next to none, in my experience.

An MCI drill. One of the rare occasions, where everyone turns up in full PPE.

I have always been wondering why things are how they are, in that respect. Maybe it's lazyness. Maybe it's because it doesn't look cool - yes our helmets do look ridiculous. Maybe it's something a lot of people don't give it a lot of thought, because in the vast majority of medical calls, those kinds of precautions don't have to be taken. Maybe, sadly, something has to happen first, in order for them to rethink.

Maybe we should take a look at the Fire services. Whenever they turn up on a scene they will generally wear they full bunker gear and helmets. Be it waranted or not, no questions asked. Even in 100 degree weather. And they will keep in on until their commanding officer allows them to take it off. I realize, that this is not the case everywhere on the globe and yet I have the feeling that firemen, in general, show up dressed for the worst.

Firemen - full PPE even while just standing around.

In fact, many times, when not working a fire I would say that they tend to go overboard. Leaving us with another problem alltogether: heat exhaustion. Naturally their bunker gear is not only a whole lot heavier than our clothing, but keeps a whole lot warmer. Yet, they somehow make it work by taking turns, taking rest breaks to hydrate whenever necessary.

I would very much like to hear about your views, protocolls, guideslines, recommendations.

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!