Ambulances & Vehicle Ops, Columns

Ambulance Seating and Warning Systems Affect Safety of Crews and Patients

Issue 10 and Volume 41.

This month, JEMS focuses on aspects of ambulance safety, design, seating and warning systems. We present innovations crafted by the ambulance manufacturers and companies that produce audible, vibrational and visual warning systems, as well as newer, safer, more comfortable and, most importantly, adjustable, seats.

These companies work hard to build the safest vehicles and accessories, but safe vehicles and well-designed equipment only offer protection if used and stored properly. Ever see rescuers working at a scene with expensive, well-designed turnout gear unzipped? Many, myself included, have been guilty of it. Sadly, many have been injured because of it, and others have died because of it.

We can’t allow providers to keep moving around in ambulances like marbles in a glass bowl. It’s OK if loose marbles crack a glass bowl; it’s not acceptable if a provider’s head, neck, chest or spine is fractured because they fly into an object in the patient compartment or an unsecured object flies into them.

As an EMS director, I investigated ambulance collisions and rollovers and it’s not a pretty sight to see cracked sharps containers with exposed needles; oxygen tanks launched up into the cab; and monitors and jump kits with their broken contents distributed throughout the patient compartment.

It’s called complacency, a word defined by Merriam-Webster as “self-satisfaction, especially when accompanied by unawareness of actual dangers or deficiencies.” Put another way, we like doing things the way we think they should (or could) be done while not necessarily taking risks or hazards into account.

The reality is providers often place themselves in harm’s way. It’s partly their fault for being so dedicated and focused on the needs of their patient and partly the fault of educators, administrators and supervisors for not stressing that crew and patient safety comes first.

It’s also the fault of managers and those who spec or install equipment in the ambulances. It’s almost impossible to intubate a patient while seat-belted in a captain’s/airway seat. We need smaller, adjustable airway management seats that can be moved like an anesthesiologist’s chair in the operating room.

In the ’70s, firefighters seldom wore seat belts and often donned their SCBA while on the way to a fire. I vividly remember a response to a second-alarm fire one evening while riding with my dad, where both mistakes were made. By protocol, the ambulance went last, behind the chief’s car, engine and ladder.

En route to the scene, a firefighter, putting his SCBA on while unrestrained in the “doghouse” of the ladder truck, accidentally leaned against the door. It opened and he rolled out onto the street in front of the ambulance.

As a firefighter in Bethlehem Township, Pa., I often raced to a small light rescue pumper when accident calls came in. It was a great little quick attack pumper on a smaller Dodge chassis. We loved being first out on that truck because that meant we would be first in and able to start rescue operations before our big heavy rescue truck arrived.

The problem was that only two firefighters could ride in the cab, so two others had to ride on the rear platform—affectionately named the “tailboard” or “beavertail.” All we had was an overhead grab rail to hold onto, and a safety belt that was secured around our waist. It was a hell of a view and open-air ride, but you went airborne whenever the driver hit a bump in the road or took a corner fast.

It was exciting but stupid, and it took years for the fire service to abandon tailboard riding and mandate SCBA seats and seat harnesses. But they did, and we in EMS must develop the same mindset because ambulances have the same safety issues as firetrucks once did.

Crews and EMS managers have to accept that ambulances are forced to stop abruptly, have to swerve in traffic and can occasionally get broadsided at intersections. There’s no way you can brace yourself at the moment of impact and then stop a 45-lb. cardiac monitor or fully loaded jump kit from becoming airborne missiles that can debilitate or kill you or your patient.

Isn’t it odd that we often have other EMS crews or firefighters seat-belted when they respond to a call, but are forced to stand up and move around in the patient compartment on the way to the hospital because we don’t have seats that can be properly positioned (extended/rotated/elevated) to allow care to be rendered while the crew member is safely secured in place? Nor do we have equipment conveniently located for easy access while seated.

Personnel and all of their equipment should be secured and under control at all times. Take a close look at these issues internally. Install monitor brackets on the street and curb side of your units, set up a secure drawer or cabinet with must-have supplies so you don’t have to have a massive kit open on the floor or seat while en route to the hospital when all you need is IV fluids and catheters, blood draw items, tape and a blood pressure cuff. Most importantly, have crews, when inventorying their rigs, do a safety scan for anything left out that can become an airborne missile.