Design the Ambulance of the Future

Issue 8 and Volume 38.

Futuristic movies and television shows always depict whimsical possibilities with travel, whether it’s the DeLorean from Back to the Future or the flying cars in The Jetsons. When imagining the ambulance of the future, however, EMS administrators can’t envision features that are too far out of the grasp of the present. In this month’s video series on EMS in the year 2020, we traveled to Richmond (Va.) Ambulance Authority, Wake County (N.C.) EMS System and Durham County (N.C.) EMS to talk to administrators about issues surrounding their current vehicles—and imagine the ambulances of their future. Here’s what they said. 
Question: What is the single, most pressing safety issue for EMS, and what is the most pressing safety issue with the ambulance? 
Answer: “Single” is hard. My top three are improving fitness (to prevent musculoskeletal injuries), communication skills and in-vehicle safety. Inside the ambulance is construction that is safe but still allows treatment while moving. Probably the most serious narrow issue is “sitting sideways.” The squad bench is a very unsafe place to be.
—Skip Kirkwood
Question: What safety issues are you most concerned with in a moving ambulance, and how have you addressed them?
Answer: My biggest concern is providers who are unsecured performing patient-care activities during transport. We have attempted to minimize compression and other interventions during transport.
—Brent Myers
Answer: Safe and skilled vehicle operation is key, as we believe prevention—of any type of incident—is better than a cure. RAA has fully embraced the EMS “culture of safety” philosophy that begins with new employee orientation and pervades through the organization.
—Rob Lawrence
Question: What are your key considerations when laying out an ambulance?
Answer: We need to look at paramedic workflow and design the workspace to match work practices—or change work practices to fit a good ergonomic design.
—Skip Kirkwood
Equipment layout and ergonomics play a major part. The reach of the medic from the CPR seat or captain’s chair sets the limit of ready–use equipment. The kit and equipment for managing the patient transport (which, for a city system like RAA, is usually of limited duration) is therefore safely accessible for short transit.
—Rob Lawrence
Question: What attendant seat changes or enhancements would you like to see made to ensure better safety, comfort and convenience for the attendant and more accessibility to the patient?
Answer: I would like to see the ability to stay seated/secured while performing patient-care activities and communicating via the radio.
—Brent Myers
Question: How do you optimize space and workflow in the ambulance?
Answer: RAA employs a “make ready” equipment bin system. The bins are pre-stocked in sealed bags but treatment type (for example, an IV–giving set may comprise one stocked bin) sealed bins are placed in the same storage place on each vehicle, so the crew knows their location, no matter which truck they are on. The design and placement of the bins complements the cabinetry on the vehicle.
—Rob Lawrence
Question: How would you enhance your ambulance design in the future?
Answer: I would eliminate much of the cabinetry in favor of soft packs. I’d like to see front-facing chairs with good seat belts, better construction (built to withstand front, rear and side collisions), and brackets for biomedical equipment (e.g., cardiac monitor and suction unit) that hold the equipment in a manner that is secure, while still allowing easy access and removal. 
—Skip Kirkwood
Question: What other issues need to be addressed to create a safer ambulance in the future? 
Answer: I would like cot mounts and lifting mechanisms with sufficient strength to address heavier patients. 
—Brent Myers
The discussion about the future of EMS starts today. Go to 
jems.com/2020vision to watch videos that were filmed where the action happens—the back of the ambulance. Take a tour to see how each service has designed vehicles with workflow and safety in mind. Then share what your agency has done to advance safe and ergonomic ambulance design in the LinkedIn EMS 2020 Vision group. JEMS