Advances in Patient Transportation: Moving Beyond "Get In and Hold On"

By Steve Rowland,
OEM Sales Manager,
Ferno-Washington, Inc.

It is safe to say the latest generation of first responders grew up with family cars equipped with "state-of-the-art" safety features like seat belts with reminder "chimes," air bags, automatic headlights, vehicle event recorders, and intelligent "multiplexed" electrical systems. It is also safe to assume that these systems were developed and are continually refined by a well-established passenger automotive safety ecosystem driven by regulating authorities. From this, one would think a fair conclusion is that the same has existed in ambulance design for all those years as well. That is often not the case. Fortunately, a transformation is solidly underway.

Much has been written, spoken, blogged, tweeted, and otherwise communicated about the recent involvement of the National Fire Protection Association (NFPA) in the realm of developing NFPA 1917, Standard for Automotive Ambulances. The intent of this article is not to take one side or the other regarding questions concerning authority, expertise, or any other division point. No matter which camp you are in, it is undeniable that the exciting, beneficial results this national discussion has provided to the industry-in whatever final form they take-will make ambulances safer for both the patient and the emergency care provider.

Medic Ergonomics

"Seat belts save lives." We know this mantra. We have watched the news reporter interview the emergency medical service (EMS) spokesperson, with a mangled vehicle in the background, remark, " ... and we would like to take this time to remind everyone to wear their seat belts, because the driver of this car was able to walk away." But the data about care providers in the backs of ambulances show we don't often practice what we preach.

"I can't do my job buckled in," states a medic. "It's only a short ride to the hospital." "But, we are going in nonemergency." Excuses abound. What about a solution?

Several years ago, Las Vegas (NV) Fire and Rescue (LVF&R) undertook a focused project to make its ambulances safer for the paramedics, as well as improve patient medical outcome. Perhaps one of its greatest advancements was a concerted effort to cut the weathered ties to tradition and reexamine how ambulance interior design needed changing to solve the problem.

"If the paramedics said they could not stay buckled in their seat during the patient transport, we analyzed why," says Tim Orenic, EMS coordinator for LVF&R. "If the seat was in the wrong place, we moved it. If the medicines or medical devices were out of reach, we brought them in closer. If different emergencies called for different treatment positions, we added additional belted seating spaces. But if a medic should not sit in a particular location, we removed the possibility of sitting there." Since the commissioning of these "new-generation" ambulances, it has been the standard operating procedure of the LVF&R to be buckled at all times in the rear of an ambulance. Compliance is not an option, but it is not a problem either. "The medics know they need to buckle up, and they do," says Orenic. "It's a habit now, and it works."

Patient Restraint Systems

In the modern era of American EMS patient transportation, stretchers have largely remained unchanged, along with the way patients are secured onto stretcher and how the stretchers are secured in ambulances. Some may think the industry has not kept up with the available science. But until recently, the science wasn't where it needed to be.

"For the last several years, an extensive, collaborative effort has been underway between federal agencies, industry groups, manufacturers, and other interested parties to utilize a scientific approach to develop a family of standards that will provide end users with crashworthy yet manufacturable patient cots, seating, occupant restraints, and equipment retention devices," comments James D. Green, safety engineer at the National Institute for Occupational Safety and Health (NIOSH). "Utilizing the latest research on crash and impact data-both frontal and side impact-conclusions are being compiled. In the very near future, patients and responders will have access to the most secure seating, cot, and equipment mounting systems in the history of the emergency medical services in the United States."

Modern Electronics

Make no bones about it-a simple, relay-based ambulance electrical design is the least expensive method of building an ambulance electrical system and is very reliable. The mechanical relay was invented in the mid 1800s and was used in the primary systems of passenger automobiles until the 1990s. In 1986, Chrysler was the first automotive manufacturer to incorporate a multiplexed design. But since then, times have changed. Visualize that suitcase telephone carried only by chiefs of big departments in the 1980s compared with the smart phone in the pocket of most rookies today.

"Being able to electrically predesign everything to a well-equipped standard, then make custom changes to the customers' wishes through a drop-down menu on a computer is the only way to go," comments Chad Brown, vice president of sales for Braun Industries. "With the growing electrical complexity of current ambulance chassis along with the requirement that onboard electrical systems both 'communicate' within the ambulance and transmit vehicle data to monitoring systems in real time, we cannot afford to be on the trailing edge of technology."

With the proliferation of a robust domestic cellular network, systems now exist to provide not only real-time vehicle location data but real-time alerts to critical chassis system information such as fuel levels, diagnostic trouble codes, engine rpm, coolant temperature warnings, and more. Think of the increased efficiencies and lower catastrophic repair costs if a mechanic receives a text concerning a vehicle malfunction before the crew notices the problem.

To wrap it up, reflect on the fire truck of the 1980s: open cab, some seat belts (rarely worn), and tailboard riders. There is truly a paradigm shift underway in the modern ambulance akin to that seen in fire apparatus 20 years ago, and Fire Apparatus Manufacturers' Association (FAMA) member companies continue to offer guidance during the undertaking.

STEVE ROWLAND is the OEM sales manager for Ferno-Washington, Inc., and is responsible for integrating Ferno products into ambulance designs and builds at the manufacturer level. A former firefighter and EMT, he has served in the sales groups of leading public safety companies Federal Signal, Akron Brass, and Pierce/Medtec. Rowland is co-chair of the Fire Apparatus Manufacturers' Association's (FAMA) ambulance technical subcommittee and is FAMA's alternate to the NFPA 1917, Standard for Automotive Ambulances, committee.