Ambulance Safety Specs Webcast Q&A

 

 
 
 

| Monday, June 21, 2010


On June 10, 2010, Wayne Zygowicz, EMS Chief of Littleton (Colo.) Fire Rescue and a JEMS editorial board member, presented a webcast, titled "Ambulance Construction 101: A Global View," on how ambulance safety innovations from Europe.

Watch the archived webcast here.

During the webcast, we were able to answer only a handful of questions. Here are Wayne's responses to all other questions submitted by attendees. 

Q: How should the patient ride in a medium-duty chassis? Is there anything I can do to improve the ride in a medium-duty chassis?

Wayne's response: The patient should ride smoothly on the cot in the medium chassis. Ride has been the problem with the medium-duty chassis, but new improvements in intuitive transmissions and air ride systems have greatly improved the ride. The air ride system is the key, and there are a few to choose from on the market. Do your homework and call other users.

Q: Having been in an ambulance rollover myself, I wonder why we are so far behind the curve. The technology is there, why don't we use it?

Wayne's response: The industry is very slow with new innovations, and consumers are not well educated on how our ambulances are actually constructed. Also, the topic of ambulance safety is a fairly new science in the U.S. It's coming, and manufactures who see the future and adapt will be the leaders in the industry.

Q: How have, or have you been able to, overcome the traditional U.S. fire service opinion of "The Color is Red" when developing vehicle specifications (in spite of contrary scientific data)?

Wayne's response: History and tradition are often stronger then data and science. My agency had lime green fire trucks and went back to red because that is what the chief wanted. This was not based on any science or data but the fire service tradition of a red fire truck.

Q: Why the interest in gasoline engines?

Wayne's response: I'm not really sure but my personal thoughts are so Ford gives consumers more options for ambulance chassis packages.

Q: What is more economical: gas or diesel?

Wayne's response: My fleet manager believes diesel, especially in maintenance costs.

Q: You mentioned manufacturers do not use automotive crash test dummies. One manufacturer (Horton) shows crash test dummies on their Web site and in their promo videos. Are these dummies not the proper ones to use? Is their air bag system safe by automotive standards?

Wayne's response: I have seen the promotional add in JEMS where Horton is using dummies to test their head strike air bag system but I have never personally seen any data to validate the effectiveness of this system. Side facing seats showed poor results in independent crash testing video that I have seen.

Q: Is wood or aluminum safer for cabinetry?

Wayne's response: We had used wood in our ambulances for years and switched to aluminum, which is stronger, lighter and adds structural integrity to the unit.

Q: What do you think of the crash testing like AEV crash video?

Wayne's response: I applaud any manufacturer who performs realistic testing on their product to determine its performance, but my personal feeling is that ambulance crash testing should be performed by independent experts in design and automotive safety.

Q: What are some of the new ideas that will result from a new NFPA standard on ambulance design?

Wayne's response: The NFPA committee on ambulance standards has just begun meeting so it's too early to tell what their scope of work will include.

Q: Is the "block the right of way" lighting compliant with KKK standards, as you installed it in Littleton's ambulances?

Wayne's response: This lighting configuration is not a recommendation in the KKK standards but is recommended in FEMA FA-272, Emergency Vehicle Safety Initiative.

Q: Is there anyone in the fire/EMS industry lobbying for regulation in the ambulance regulation?

Wayne's response: National Fire Protection Association (NFPA), which has created standards for fire apparatus and public safety since 1896, has decided to develop design standards for ambulances. NFPA expects it will take three to four years for a 30-member committee to create the new standards, which may take the place of the current KKK standard for purchasing ambulances.

Q: Are the box designs better or worse than vans in a crash?

Wayne's response: Since there is no repository for crash and injury information accessible anywhere within the government, I could not accurately comment on this question.

Q: Do you anticipate NFPA taking over regulation of ambulance standards? If so, when?

Wayne's response: Yes, NFPA expects it will take three to four years for a 30-member committee to create the new standards, which may take the place of the current KKK standard for purchasing ambulances.

Q: Are manufacturers experimenting with composite materials?

Wayne's response: I do not know of any manufacturers testing composite materials for ambulance construction.

Q: Is there any pushback from manufacturers on building stronger/safer apparatus? How much are budget constraints hurting the agencies' ability to upgrade safety standards?

Wayne's response: I believe manufacturers want to build the best ambulance they can build, but there has been little direction from our industry (we the consumers) and no oversight from the government or any other regulatory agency. The top manufacturers have insight into where we are going as an industry and are changing their designs as the industry evolves. Next time you're ready to purchase a new rig, ask your manufacturer what innovations they have to offer or what the future looks like in their eyes. There will be an increased cost to some safety improvements.

Q: Why are there so many ambulance crashes in the USA? In Mexico, there are fewer ambulance crashes.

Wayne's response: Poor driver training, lack of a tiered response system. I cannot comment on issues in Mexico since I do not have information on their country's ambulance safety record.

Q: I may have missed it in the beginning, but I have heard rumors of NFPA moving in with ambulance standards? Is this true?

Wayne's response: National Fire Protection Association (NFPA), which has created standards for fire apparatus and public safety since 1896, has decided to develop design standards for ambulances. NFPA expects it will take three to four years for a 30-member committee to create the new standards, which may take the place of the current KKK standard for purchasing ambulances.

Q: Have you seen or heard any comments regarding swivel seats in the "box"? We added them on our new ambulances, and they will be in service in two weeks.

Wayne's response: Yes, I have seen these seats and they look well designed and thought-out. I have not seen any crash test video on them or real life field data on them.

Q: What was the one safety difference in Europe versus the U.S. or North America that stood out to you?

Wayne's response: I personally saw many innovations that I thought were outstanding contrasting Europe and the U.S. (see my blogs at JEMSconnect.com), but one of the most impressive regulations was the restriction of EMS providers lifting patients and equipment. Every ambulance in Europe had a cot-lifting system and all medical equipment was light and ergonomically designed. The Stryker Corporation will be releasing the first cot-lifting system in the U.S. next year. It was previewed at EMS Today 2010 in Baltimore this year.

Q: What innovations are being introduced to increase the effectiveness of the air conditioning/heating systems?

Wayne's response: The most recent change to increase heating/cooling effectiveness is venting the system air handling thru multiple roof vents instead of one hole, as we have seen in ambulances for the last 30 years. This is much more efficient and heats and cools the ambulance much more quickly and effectively then in the past.

Q: Do we know why patient compartments are exempt from the occupant protection standards of the Federal Motor Vehicle Safety Standards?

Wayne's response: Despite the large strides that the general automotive industry has made in the last 30 years in the safety of passenger vehicles, this expertise has not yet been translated substantively to the safety of ambulance vehicles. There are few safety standards and no crash safety test procedures or guidelines that provide occupant protection in ambulance vehicles in the USA. Please refer to this article
http://www-nrd.nhtsa.dot.gov/pdf/esv/esv20/07-0074-O.pdf.

Q: When can we expect NFPA to release standards for ambulances?

Wayne's response: NFPA expects it will take three to four years for a 30-member committee to create the new standards, which may take the place of the current KKK standard for purchasing ambulances.

Q: What about dividing the patient compartment from the front cab from a ventilation point of view?

Wayne's response: Some ambulance designs do just that. Two separate independent units and the driver and attending EMT talk via a headset. This would be a purchaser's design and preference.

Q: You don't need multiplex to have side and backup cameras, correct?
Wayne's response: Correct, they would be independent systems not integrated with a multiplex electrical control system.

Wayne's response: Correct, they would be independent systems not integrated with a multiplex electrical control system.

Q: Are low-tone siren systems, howlers and rumblers as effective as their manufacturers are claiming?

Wayne's response: I don't have the data on these, but I did look at the "rumbler" for an article I was writing and it made a lot of sense to me. I like the idea especially with people tuning out while driving with iPods and loud stereo systems while they drive.

Q: With several manufacturers offering antimicrobial technology as standard equipment in some features, such as grab rails, do you see more antimicrobial technology being used in ambulance interiors for better infection control?

Wayne's response: While researching an article on ambulance design I did come across this technology. I have never looked at the data to support the purchase of these. I believe in the proper use of PPE and continual cleaning of all surfaces inside the ambulance daily, including steering wheels and mobile computers. Completely disinfecting an ambulance is still an issue that we struggle with in EMS.

Q: As viruses and bacteria contaminate the breathing space between paramedic and patient, can you insure that paramedics don't become susceptible to the contaminants floating between them?

Wayne's response: There are no guarantees with these air handling systems and proper use of respiratory PPE should always be encouraged.

Q: Are there any specifications for the Kendricks restraint? My company didn't get the device on the new units because they said a head would fit through mesh.

Wayne's response: I am not familiar with this product and tried to research it on the Internet and on JEMS.com and could not find this product.

Q: When will attendant restraint systems become more practical and user-friendly?

Wayne's response: Check out seat manufactures at your next conference; there is a new seat on the market that is very well designed and has crash test video to support their safety features.

Q: These new ambulances look top-heavy. Any data on rollover stats?

Wayne's response: They do look a little top heavy but I drove one on a test track in Germany (up to 90 mph to a full stop, off-set alleys, etc.) and they have all of the stability control that you would expect in a Mercedes-Benz product. I do not have conclusive data to support those personal feelings.

Q: Has what you learned in Europe changed the way you will be designing ambulances for your department? How?

Wayne's response: YES, it has. First, I'm convinced we don't need to carry all the equipment and supplies that we do. Makes little sense to carry enough supplies for 25 patients when you usually only treat them one at a time. I'm working with the manufacture of our ambulance on interior design and seat position.

Q: Why would it be so difficult for the U.S. to adopt and utilize the good work that the Europeans have done to date?

Wayne's response: Change is difficult in our industry, especially in the fire service. While these innovations have been occurring in Europe for years, believe it or not, it simply has not filtered over to the U.S. It is happening now, slowly.

Q: Is there any specific study that supports the forward- and/or rear-facing seats. Any evidence/test based reports?

Wayne's response: http://objectivesafety.net/index.html

Q: What is the estimated financial impact of the improved safety standards?

Wayne's response: It might be as much as a $500 million/year savings in prevented ambulance crashes. Costs in vehicle upgrades range from low cost passive changes in design to high costs drive alerting systems.

Q: What is Australia doing different than the U.S.? Their crash fatality is 35 times lower?

Wayne's response: Much of Europe, Scandinavia, Asia and Australasia currently use fleets of automotive-industry-designed and manufactured vans with specialized aftermarket additional retrofits to adapt them to the ambulance market. There is decreasing presence of the chassis with aftermarket box outside of the USA. Australia has had the ambulance restraint standard ASA 4535 in place since 1999 (AS/NZS 4535:1999), and it is the most stringent to date globally.

Q: What about Australia? How do their standards compare, and is there anything we can learn from their standards? Comparing the integrity of chassis cabs (box) ambulances and panel vans (e.g., Sprinters), do you think there is a difference?

Wayne's response: Much of Europe, Scandinavia, Asia and Australasia currently use fleets of automotive-industry-designed and manufactured vans with specialized aftermarket additional retrofits to adapt them to the ambulance market. There is decreasing presence of the chassis with aftermarket box outside of the USA. Australia has had the ambulance restraint standard ASA 4535 in place since 1999 (AS/NZS 4535:1999), and it is the most stringent to date globally. There are few safety standards and no crashworthiness safety test procedures and guidelines that pertain to ambulance vehicles in the USA.

 



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