Provider seating in the patient compartment of the ambulance has come a long way from the days of the bench seat and fold-down “jump seat” in the now antique limousine-style ambulances. As these vehicles grew in size to meet federal specifications, seating configurations changed and settled in to a number of standard configurations.
There’s historically been a bench seat along the curb side of patient compartments, which often had brackets and belts for securing a folding stretcher or backboard. enabling providers to transport two supine patients in the same ambulance. The seatbelts designed to secure providers, however, made providing patient care difficult, if not impossible, forcing most crews to ride dangerously unbelted.
The EVS Ltd. Model 1769 Seat with Mobility 1 Tracking System. Photo courtesy EVS Ltd.
The “captain’s chair,” also known as the airway seat, has customarily been a bulky, thickly-padded, rear-facing chair on a large base that could swivel in a limited manner and recline if there was room.
The other seating position was optional. During the 1980s and 1990s, almost every cardiac arrest patient was transported and, with rare exception, compressions were performed by crew members, not mechanical devices. The “CPR seat” has been positioned on the driver’s side and was created by eliminating some cabinetry. This seat was supposed to allow a fairly good position while performing compressions on a patient in cardiac arrest, but we all know CPR can’t be performed adequately from a seat-belted position.
Seats in the patient compartment of ambulances were often cloth-covered and the ability to decontaminate them was almost nonexistent. In fact, since safety needles hadn’t been invented, it was common practice to jab the contaminated sharp into the seat cushion and place it in a sharps container after the call was over.
Overall, seatbelts in the rear of the ambulance were adequate for patients and their families, but not for EMS providers. We were mostly stuck in the mindset that ambulances don’t crash or that safety and injuries were problems encountered by other departments with poorly trained drivers. Boy were we wrong!
This sturdy, compact chair has a thinner seat that folds up when necessary. Photos A.J. Heightman
Ambulance manufacturers were limited in the seating and configurations they could offer because the outdated KKK-A-1822 federal standard on ambulance specification limited them to only a few interior configurations. But that’s all changing as new ambulance standards have been developed. Most importantly, we’re increasingly and painfully aware that ambulances crash and manufacturers are working hard every day to improve the safety of their vehicles.
Emphasis on Safety
The latest round of seating advancement is due to the combined efforts of the General Services Administration (GSA); National Institute for Occupational Safety and Health (NIOSH); National Highway Traffic Administration (NHTSA); National Truck Equipment Association’s Ambulance Manufacturer’s Division; and ambulance seating manufacturers EVS Limited, Wise Seating and Serenity Safety Products.
The impetus behind this group is to improve ambulance vehicle safety—specifically crash survivability. If you’ve purchased an ambulance in the past few years you’ve heard about the new Society for Automotive Engineers (SAE) standards and how they’ll improve safety by providing scientifically proven standards to keep patient litters attached to the mount, keep EMS workers restrained in properly designed seats and keep equipment secured in cabinets and in equipment brackets or mounts.1
The SAE J3026 Occupant Seating standard is just one part of the overall bumper-to-bumper standards outlined in the National Fire Protection Agency (NFPA) 1917 and CAAS GVS-2015 standards. The key requirement are for dynamic crash testing, seat and restraint systems that must protect occupants to the same crash standard as automotive seating and for crash test dummy loading to fall below automotive test limits.
Dynamic crash testing standards were developed and a number of ambulances were tested in May 2010 and June 2011. It was determined that a 60 mph crash test was likely not survivable and a 30 mph crash was likely survivable, so the 30 mph standard was established as the test load. Three frontal impact tests were conducted at 30 mph into a stationary barrier and four side impact tests were conducted using a 3,300-lb. sled striking the stationary ambulance at an angle.1
For occupant seating in the patient compartment, measurements were taken to determine how far the crash test dummy’s head would travel with current restraint systems. Those parameters were charted and analyzed for improved design and seat placement patterns to minimize injury.
Measurements taken during the tests established a “stay-away zone” 20.5 inches to the front, 13–14 inches to the sides and 32.6 inches to the rear of the seat. Care should be taken to ensure there aren’t hard surfaces within these zones to minimize injury potential.
Serenity Safety Products has a unique three-in-one design that accommodates adults, children/toddlers and infant car seats. Photo courtesy Serenity Safety Products
Ambulance and seat manufacturers have heard the call for safer, more functional seating and responded with impressive innovations that comply with the new SAE standards.
One of the most notable is the trend to eliminate the squad/bench seat in favor of one, two or three high-back seats that can swivel and travel forward and backward. Some now travel sideways on tracks and lock in place. Today’s CPR seats are a bit better because most are mounted on assemblies that allow providers to slide close to the patient, and fabric upholstery has been replaced with fluid-resistant, antimicrobial material.
Ambulance seat belts are also in the midst of change. The traditional two-point lap belt, which offers little protection beyond fixating you in the seat, is now being replaced by a three-point restraint similar to what you have in the cab and in your personal vehicle. Several manufacturers even offer four-, five- and six-point restraint harnesses to prevent you being tossed around the patient compartment during a crash.
The EVS Ltd. (www.evsltd.com) Model 1769 Seat with Mobility 1 Tracking System (a 2016 Hot Product at the EMS Today Conference) has a three-point belting system and a swivel base that can be in three locations on a sliding track, to provide several possible floor plan configurations.
Ambulance and seat manufacturers have heard the call for safer, more functional seating and responded with impressive innovations that comply with the new SAE standards. Photo A.J. Heightman
This seat uses a more compact base and functional design that’s been popular in European ambulances for years. The seat folds up out of the way, offering more room to move and work while loading or caring for a patient on scene. It also can be tilted forward, allowing you to carry a second patient. It then flips down, locks in place, swivels and adjusts every 45 degrees. This enables the provider to face forward when no patient is on board or position themselves at various angles, making it much easier to work on patients from head to toe while secured in a safer, near forward-facing position.
EVS also offers a smaller European-style, adjustable fold-up seat that’s becoming popular in Sprinter-type vehicles because it takes up less room than regular seats and its base doesn’t take up a lot of space. The Ferno iN∫TRAXX concept ambulances have illustrated the space saved by seats of this type.
The USSC Group (www.usscgroup.com), a company that’s designed seats for military vehicles for many years, recently entered the EMS/fire market and offers an air suspension, ergonomically designed seat (the Valor M series) that reclines and features “ready-reach” dual retractor belts, upper/middle/lower lumbar back support and quick-change zipper cover.
The USSC Group also offers an innovative four-point harness secured with one buckle. It features four retractors—the part from which the seatbelt extends—that provide a great deal of seatbelt travel, allowing the provider to sit on the edge of the seat to more easily reach the patient when starting an IV or assessing blood pressure. The four retractors lock in place at 0.7 G, preventing you from being thrown during hard breaking or in a crash.
Wise Emergency Medical Seating (www.wiseems.com) offers several models that feature swivel bases, cabinet bases and 2–6 point belts. Their WM1805 attendant seat features a three-point restraint system and a folding back. When the seats are turned to face each other, the backs can be folded down and a second patient can be secured supine on a backboard or stretcher via straps that can be mounted on the wall. This option can be important for many rural services where the ability to transport two patients is an operational reality.
The Wise EMS seats can be mounted to WM1935 swivel bases, affixed to the wall or mounted side-by-side to a three-seat squad-type bench (Model WM1966). These seats are extra tall and feature a headrest and ergonomically designed seat back.
The USSC Valor M seat includes a fold-out child seat to save space, as well as a one-click seatbelt assembly. Photo courtesy USSC
Child & Infant Seating
Built-in child safety seats are now offered by most ambulance seat manufacturers. These seats usually feature 4–5-point harnesses designed to secure a child weighing 20-85 lbs. This is a vast improvement over the days of placing the 35-lb. toddler in the captain’s chair when transporting the injured parent and hoping the 2-point lap belt would be enough in the event of a crash. The way the new built-in child safety seats flip down from inside the primary seat and can be deployed in about five seconds makes these seats a must-have option.
EVS offers the 1880 Hi-Bac Child Safety Seat for uninjured children between 20–50 lbs. that features a molded foam back with lumbar support, available with three- or five-point belting systems.
Serenity Safety Products (www.serenitysafetyproducts.com) offers several seats that can accommodate children. Their Guardian Safety Seat has a unique three-in-one design that accommodates adults, children/toddlers and infant car seats. Their pediatric restraint system also offers the ability to secure an infant up to 20 lbs. in a car seat in the base of the standard attendant seat. When transporting an infant, remove the bottom seat cushion with the attached child restraint pad and secure channel, and rotate the child seat up from the base of the seat and securely locked in place. This eliminates the need to designate compartment space for a separate infant car seat.
Your personal preference, operational needs, call volume, clientele and budget will help determine your fabric choice. Fabric choices for seating in the patient compartment include more options than just color. Seats are generally molded or sewn. The molded seat has a smooth surface, which is very easy to wipe clean and has a more utilitarian look. A sewn seat has lines of stitching that keep the various fabric panels together, provides a more finished look, but can allow blood and other substances to infiltrate.
It’s very encouraging that some seat manufacturers are now experimenting with antimicrobial fabrics that will not only make cleaning the ambulance easier, but will reduce the likelihood of organisms surviving and colonizing.
We’ve hopefully exited the era when crews used Armor All on the vinyl bench seat to get it ready for a parade, and then slid off of it and into a cabinet or, worse yet, down into the side door step well, when their driver braked suddenly during a patient transfer to the hospital.
The ambulance and seat manufacturers have made the move to offer safer patient compartment designs and seat options. Your agency now needs to do the same and transition to safer and more functional seating for your personnel and the benefit of the patient.
1. Green J. (2015) Ambulance technology and standards update part I. General Services Administration. Retrieved August 13, 2016, from www.gsa.gov/portal/mediaId/209043/fileName/2015FFMT_Ambul_Tech_&_Stds_Part_1.action.