Ambulance safety is not something that is taught to most new EMT's. Sure they get ambulance operations in
but their practical lessons in ambulance safety doesn't start until they hit the streets. EMS is one of the more dangerous jobs in the United States. During the course of their job, many EMT's are injured, some fatally. In fact to be an EMT means that you are twice as likely as the regular population to be killed on the job. The department of labor estimates that 12.7 EMT's are killed (per 100,000 EMT's) per year while performing their duties.
Ambulance Safety is something most EMT's take for granted. Working in EMS means working in unusual circumstances as compared to the regular populace. For example, EMS workers often work in and around wrecked vehicles. In addition, EMS workers also work "In the road" and are often struck by passing cars.
There are some sad truths about EMS fatalities. The single largest cause of EMT fatalities is related to transportation (74%) with about one fifth of those who were struck by other vehicles. In addition 11 % died as a result of heart attack, 9% homicide (hey it's dangerous out there) and 4% attributed to other causes. Clearly since transportation is the largest contributor to EMT fatalities the science of ambulance safety needs some reconsideration.
Most people think that once they have reached the patient compartment of an ambulance that they have reached a safe haven. This couldn't be farther from the truth. In fact, riding in the back of an ambulance is probably the most dangerous place to be in the ambulance especially for the EMT's.
Let's be honest with ourselves. How many of us actually use the lab-belts provided in the back of the ambulance? Just how practical are those belts? I have worn them, especially in bad weather, and not be able to reach all the equipment I have stored in the back of the rig. Most of us never even buckle up. This is a practical decision. How easy is it to perform CPR or to intubate a patient while strapped in? What if you need something that is stored under the bench seat? You just have to get up to do it - or kneel down - or bend over - or reach…
The EMS community and vehicle manufacturers have not been silent on the issue of ambulance safety. In fact two organizations have published standards for ambulances. The first is the United States federal government under the auspices of the General Services Administration. They published the
for ambulances to be purchased by the government. The second organization is the
Ambulance Manufacturer's Division
of the National Truck Equipment Association. This is a private organization who has issued guidelines for manufacturing ambulances.
There are some problems with both organizations methods and recommendations. Neither standard mandates that dynamic testing be done for the ambulance. This implies impact or crash testing. Every car or truck sold in the United States had a one to five star rating for crash-worthiness. Not so for Ambulances in which only the cab is "Star" rated.
Rather both standards require that the ambulances undergo a static load test to see if the structure of the ambulance is compromised. What is done is a great weight (usually a tank with 5,000 gallons of water) is place on a side of the ambulance - top or side - see if any crushing occurs.
Just how likely are you to drive to a call with a swimming pool on top of your ambulance or just as likely, how about the side?
Clearly to prove ambulance safety, crash testing is necessary but once again, neither the KKK or the AMD standards require that impact testing be performed or mandates the use of "Crash Test Dummies".
The back of an ambulance is essentially a small room with cabinetry and furniture. None of the national standards require any sort of compliance when these items break loose from their mountings. In the case of automotive standards or even recreational vehicles where a successful test is one when after the test there is no structural damage to any load bearing or supporting member (i.e., torn or broken material, welds, popped or sheared rivets or fasteners) during the application of force and after the release of force.
There are just no national standards regarding ambulance safety for what goes on in the back of the ambulance (we mean from a design and construction point of view). Ambulances are not built by automotive or truck manufacturers (only the cab and drive train are built by them) Many new inventions make into the back of the ambulance with out sufficient product testing (this seems to be the rule in EMS not the exception.) Consider the restraint system for EMT's that is suspended from a track from the ceiling of the ambulance. This is not a fully tested device. This short video shows how it is supposed to work:
Of course, I think that the ambulance is not moving in this video. The plain fact is that there is no oversight at the national level to oversee what is manufactured in the United States today.
Ambulances do not have to undergo crash testing as to trucks and automobiles. In fact a UPS delivery truck undergoes more extensive testing than do most ambulances.
The following series of videos are taken from outside and inside an ambulance involved in a 30 MPH (50 KPH) front end collision. There is one patent on a standard stretcher with EMT's in the following positions: Rear facing seat at the patients head, "Medic" seat at the patients right side, a seated EMT on the patient's left side and a standing EMT.
This is the outside video for the crash test:
This next video shows that an EMT is seated in the "Medic" seas on the patient's right side. The EMT is restrained with a 4 point harness. The EMT sides forward and strikes his head with considerable sideways neck flexion. This is probably fatal but definitely disabling.:
Think you are safe in the rear facing seat? The science of Ambulance Safety thinks that since you are facing backwards you can't go anywhere in a front end collision. This is mostly true but what about the stuff in the back of the ambulance? Think the stretcher can not move? What about the patient. In this video the patient slides forward to strike the EMT in the knees possibly displacing the hips backwards and fracturing the femurs.
The science of ambulance safety implies that if you put enough straps on an EMT they will stay put in an accident. This next video shows an EMT seated on the bench at the patient's left side. This EMT is restrained by a 4 point harness which is secured to the ceiling. The EMT is forces forward with a significant amount of rotation. Pay attention to the EMT's head and how it rolls and the neck flexes. Finally in this video the stretcher breaks free of it's mounts:
This final video shows an EMT in a standing position. You might find yourself in this position while performing a variety of functions including CPR. The theory here is that if you are tethered to the ceiling you won't go anywhere in a crash. This video shows just the opposite. This EMT rotates significantly and his hips are thrust though the passageway between the cab and the patient compartment. The EMT would have experienced neck injury, spine injury and hip injury. If not restrained the EMT would have ended up in the cab so I guess the device worked in some manner.