ambulance innovations

28 Pages·2016·3.23 MB·English

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Advances in design, safety & technology
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CONTENTS DemAmb_JEMSLogo_1610 1 9/1/16 11:04 AM FRAZ_JEMSLogo_1610 1 9/6/16 M e4d:S4p3e _PJEMMSlogo_1610 1 9/7/16 Z 1o0lD:2a3t _AJMEMSLogo_1610 1 9/1/16 11:27 AM
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24 THINKING OUTSIDE (& INSIDE) THE BOX: 30 LIGHTS & SIRENS: Improving the safety of the 44 THE PRICE OF SAFETY: Two EMS agencies
FerWas_JEMSLogo_1610 1 9/1/16 4:16 PM
How Cranberry Township, N.J., designed a safer sights & sounds of EMS compare the return on investment in safe driving
ambulance systems
38 TAKE A SEAT: New ambulance seating improves
safety, size & functionality
22 JEMS | OCTOBER 2016 www.jEms.COm
An editorial supplement to JEMS. Copyright 2016 by PennWell Corporation
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DemAmb_JEMS_1610 1 8/31/16 5:03 PM
AMBULANCE INNOVATIONS
ADVANCES IN DESIGN, SAFETY & TECHNOLOGY
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How Cranberry Township, Pa., designed a safer ambulance
By Jeff Kelly, BS, EMT-P
n April 2014 report from the could only be accomplished by changing Historically, the organization had never
ANational Highway Transportation many of the norms of ambulance design in purchased custom ambulances. The tradi-
Safety Agency identified that EMS the United States. tion was to run an ambulance until it could
providers weren’t using safety restraints in As for crash survivability, there had no longer be in service and then search for
80% of investigated ambulance crashes.1,2 already been a few industry leaders who had something similar—and make it as inexpen-
This single astounding fact was the stim- researched and even implemented some of sive as possible.
ulus for the Cranberry Township (Pa.) EMS the same ideas that we were exploring. A team of CTEMS personnel, led by EMS
(CTEMS) to develop what we wanted to be In early 2014, CTEMS developed a cap- Chief Jeff Kelly, was formed in mid-2014 to
the safest ambulance in America—one that ital replacement program to help guide us consider how to develop the new ambulance,
would focus on provider safety by address- through the large purchases we’d need to what the costs of development might be, and,
ing crash avoidance, and crash survivability. make in the next few years, including two finally, how such a dramatic change would
We knew that our focus on crash avoidance new ambulances. affect CTEMS.
24 JEMS | OCTOBER 2016 www.jEms.COm
SPRINTER CHASSIS Figure 1: Step-up distance
We began by researching the chassis and
vehicle construction to meet our needs. We
spoke with and visited several manufacturers
to observe and review their design and con-
struction processes as well as to obtain their
feedback and input.
We immediately recognized the Mercedes
Sprinter as our likely chassis of choice. The
Mercedes Sprinter has been a workhorse in
the EMS industry in other parts of the world
for some time. The height of the cab and spa-
cious interior would also help us achieve our
objective of crew comfort. It’s also been a
mainstay in ground delivery vehicles, such
as those operated by FedEx and UPS, for the
past two decades.
We knew that not every manufacturer was
excited about pushing the envelope. Many
didn’t favor the Sprinter chassis nor would
Our older ambulances required providers to step up at least 20" to get into the patient compartment.
they necessarily embrace our “outside the box”
thinking and specific design needs. This led
us to Demers Ambulance in Beloeil, Canada.
We were impressed with the safety stan-
dards set by Demers, especially their pull test-
ing and the enhanced safety design of their
cabinetry. The Demers engineering team lis-
tened to our unique requests and offered sig-
nificant technical assistance, feedback and
constructive criticism when and where it was
needed. We found it refreshing and encour-
aging that they were open-minded and able
to offer viable solutions to help move our
design forward.
Demers put us in touch with other EMS
systems, including Durham County (N.C.)
EMS (DCEMS). DCEMS director Skip
Kirkwood, MS, JD, EMT-P, EFO, CEMS,
explained their design and acceptance of the
Demers Sprinter box platform. Our team was
happy with the feedback from DCEMS and
others, and we made the decision to move
For provider comfort and safety, our new ambulances have two steps that require stepping up only 12".
forward with the Sprinter chassis.
PATIENT COMPARTMENT DESIGN
frontline staff. that all essential supplies could be accessed
The next step in designing our safety-focused We looked at moving the long spine boards while keeping the crew member comfortable
ambulance was to develop a patient compart- from an outside rear compartment to an easy- and safely buckled.
ment that was practical, functional, but most of to-access slide-in configuration within the We discovered that for over 95% of our
all safe for the provider, patients and the public. patient compartment to keep our crews from calls and subsequent transports, our personnel
We spent countless hours taking measure- harm’s way when working at an incident. (See only needed a few items to be within an arm’s
ments, doing call history research, and speak- Figure 3, p. 26.) reach. We positioned our personnel and mea-
ing with our crews to determine the needs We wanted to develop a forward-facing seat sured their arm length and reach to make sure
of our organization and the community we that was easy for the provider to be restrained, to position the swivel seat in the best location,
serve. (See Figures 1 and 2, p. 26.) We were but would also be practical. We explored not necessarily the location that the manufac-
careful not to make changes that would be so exactly what needed to be within reach of a turer chooses. (See Figure 4, p. 28.)
drastic they would cause pushback from the single pedestal-type seating arrangement so With the help of the Demers engineers,
www.jEms.COm OCTOBER 2016 | JEMS 25
AMBULANCE INNOVATIONS
ADVANCES IN DESIGN, SAFETY & TECHNOLOGY
Figure 2: Equipment storage and access
Jump bags, monitor/defibrillators and other equipment used to be stored within
the ambulances. Exiting the patient compartment with the equipment could be In our new ambulances, equipment is stored in an exterior side compartment that
awkward and even unsafe. providers access after they’ve exited the cab or patient compartment.
we designed a single pedestal seat that would safety color. The American and European emergency mode but switch to amber while
swivel into the patient compartment, but EMS industries have adopted and used “high- in park, thus allowing the entire rear of the
could also be locked in a forward-facing posi- visibility yellow” jackets and vests for the past unit to appear like a highway service or con-
tion while traveling and treating the patient. 15 years. In addition, the Pennsylvania Depart- struction vehicle.
This provided the safest alternative to the ment of Transportation found that yellow was We designed the emergency lighting place-
traditional bench seat, while also putting the easy on the eyes and caught the attention of ment to flash in optimal patterns and, more
EMT or paramedic in a practical position to drivers, alerting them earlier than white, green importantly, to all important areas in the front,
treat patients. or red. During our research, we also learned rear and sides of the ambulance.
that individuals who have any degree of color Cognizant that intersection and cross-traffic
EXTERIOR VISIBILITY
blindness are able to identify yellow. collisions are common in our industry, we care-
To achieve our goal of crash avoidance, we Quality and placement, not quantity, was fully positioned emergency lighting to not just
designed the units to be highly visible. our primary lighting objective. (See Figure 5, protect us when entering an intersection, but
We chose the Euro Yellow Ral 1016 color p. 28.) We placed dual-head LED lights on also alert traffic in advance of our approach.
for the exterior paint. Yellow is a proven the rear of the vehicle that flash red when in This was done with careful placement of a
Figure 3: Spine board access
Long spine boards used to have to be accessed from an outside rear compartment In our new ambulances spine boards are kept in a slide-in compartment within
that could be difficult to access, especially for smaller providers. the patient compartment that’s easy to access.
26 JEMS | OCTOBER 2016 www.jEms.COm
For more information, visit JEMS.com/rs and enter 11.
BraInd_JEMS_1610 1 8/31/16 4:26 PM
AMBULANCE INNOVATIONS
ADVANCES IN DESIGN, SAFETY & TECHNOLOGY
Figure 4: Seating position inside the patient compartment
The traditional bench seat in our older ambulances didn’t allow for easy access to A single pedestal seat that swings into the patient compartment allows for pro-
equipment nor allow providers to face forward during transport. vider safety while traveling and while treating the patient.
Jeff Kelly, BS, EMT-P, began his EMS career in 1993 and has
small, bright light bar low in the front grill build an ambulance that’s not just safe for
been promoted through the ranks into his current position of
to “splash” light on the ground far ahead of patients, but is also a more convenient and
EMS chief at Cranberry Township (Pa.) EMS.
our ambulance so that vehicles approaching safe work environment for EMTs and para-
from side streets would be alerted much earlier medics. We learned that we could break from
REFERENCES
than if we had used traditional flashing lights. the mold of traditional thinking and work
1. National Highway Traffic Safety Administration (NHTSA) Office
We increased the exterior visibility even with a like-minded vehicle manufacturer to
of EMS. (April 2014.) NHTSA and ground ambulance crashes.
further by adding the blue Battenberg mark- help us incorporate our ideas and needs into
National Association of EMTs. Retrieved Aug. 13, 2016, from
ings all around the ambulance and by adding the final product.
www.naemt.org/Files/HealthSafety/2014%20NHTSA%20
Department of Transportation-approved chev- In the end it was a team effort that included
Ground%20Amublance%20Crash%20Data.pdf.
rons to the interior of all of the doors. the research of the CTEMS team before the
2. NHTSA advances ground ambulance safety by tracking and
design, the willingness of Demers to build the
CONCLUSION investigating crashes. (n.d.) NHTSA Office of EMS. Retrieved
ambulance, and the providers and community
Aug. 13, 2016, from www.ems.gov/newsletter/marapr2015/
The research, design and procurement pro- to embrace the degree of change that these
cess reaffirmed to us that you can, and should, ambulances offer. JEMS ground-ambulance-safety.html.
Figure 5: Lighting placement allowing for increased visibility
The dual-head LED lights on the rear of the vehicle flash red when in emergency A light bar low in the front grill splashes light far ahead of the ambulance, alert-
mode but switch to amber while in park. ing traffic well advance of the vehicle’s approach.
28 JEMS | OCTOBER 2016 www.jEms.COm
NC.
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AMBULANCE INNOVATIONS
ADVANCES IN DESIGN, SAFETY & TECHNOLOGY
Emergency lights should be mounted high on the
ambulance box and as close to the corner points
as possible. Photo courtesy Crestline Coach Ltd.
Improving the safety of the sights & sounds of EMS
By Wayne Zygowicz, MS, EFO, EMT-P
s the bay doors open and we pull into by texting, loud stereos, telephone calls or cry- hurry to get somewhere fast. Each year traf-
Atraffic, I know this is going to be a ing children? Maybe their air conditioning is fic increases and our roadways and inter-
challenging emergency run. It’s 5 p.m. running and their windows are sealed tightly. states become clogged with drivers who are
on a hot summer night and there’s bumper- “What’s going on with these people, don’t often impaired by fatigue, alcohol, drugs
to-bumper traffic. The incident we were just they see or hear us?” I think to myself. “No or distractions.
dispatched to sounds very serious, so I know one’s moving and I’m in a hurry to save a life.” Driving an emergency vehicle is a risky
time is of the essence. Someone’s life depends Then slowly, like Moses parting the Red business that can have grave consequences
on our unit getting to them quickly and safely Sea, a path begins to open and we carefully around each turn. Each time we get behind the
in the chaos of Friday night rush hour. maneuver through. Will we be there in time wheel of our ambulance and turn on our lights
When we hit Prince and Main Street I can to make a difference? and sirens, there’s risk involved. Therefore,
see we aren’t going anywhere quickly: Gridlock! it’s imperative to crew safety that motorists
RISKY BUSINESS
I change the siren tone and lay on the air horn, can quickly hear, see and identify our ambu-
but no one’s moving. Why? Are they distracted We live in a mobile society that’s always in a lance, or other emergency vehicle, and react
30 JEMS | OCTOBER 2016 www.jEms.COm
These individual surface-mounted lights above the cab are mounted directly on the body. The clear lenses
fast enough to get out of our way and avoid
on each light allow them to perform multiple functions and flash different colors in different patterns.
a collision.
Photo courtesy Wayne Zygowicz
A number of variables affect emergency
vehicle identification: the vehicle size, color
scheme, conspicuous markings and retrore- gency lighting should capture the attention front of the ambulance. These lights make
flective striping, as well as environmental fac- of motorists, bicyclists and pedestrians, and your ambulance visible to low-profile vehicles
tors. Properly positioned emergency lighting alert them to the presence of your ambulance. as you approach them from the rear.
and the use of audible sirens and horns, how- This is especially important when entering New roof-mounted LED light bars are a
ever, may be the most important elements for intersections—where many accidents occur. good option for over-the-cab lighting since
avoiding a deadly collision. Adding emergency lighting increases the they use little amperage compared to older
conspicuity of your ambulance by defining technology. Look for a light bar that pro-
LIGHTING SPECIFICATIONS
the upper and lower clearance lines of your vides 360-degree lighting and can be eas-
Your ambulance chassis comes with the min- vehicle from all sides, making it easier to ily reprogrammed with a laptop computer.
imum lights required by law: headlamps, tail spot day or night. Changing the lighting configuration and flash
lights, signal lights, marker lights and brake Emergency lights should be mounted pattern is easy and can be accomplished with
lights. However, this original manufacturer’s high on the ambulance box and as close to a few keystrokes. Current light bar technol-
equipment (OEM) provides only a limited the corner points on all sides. Lower-level ogy is brighter, more aerodynamic and more
outline of your vehicle. A wealth of industry lights should be added to the front and rear user-friendly than what was on the market
standards has been developed to guide agencies corners, forward and aft of the vehicle’s two in the past.
on the selection and placement of additional axles. LED strip lights work great for this Another effective and economical front
emergency lighting. (See sidebar “Industry application, plus they use minimal power. lighting system design, popular on Euro-
Standards,” p. 36.) Lighting should be installed above the cab pean ambulances, builds the lights into the
Lighting placement is important. Emer- and in the grill/bumper area to outline the ambulance box, which makes the light bar
www.jEms.COm OCTOBER 2016 | JEMS 31