Electronic stability control (ESC) systems also have solid backing data. ESC is a computerized technology to detect and mitigate skids. When an ESC system identifies a loss of steering control, it automatically applies the brakes, and may cut engine power, to help control and direct the vehicle. According to NHTSA and the Insurance Institute for Highway Safety, up to a third of fatal accidents might be prevented this way. ESC is increasingly featured in EMS apparatus, particularly modern van-type units, and could be especially beneficial in rural areas, where single-vehicle crashes produce so many ambulance-related injuries.
Data describing the risks of crashes to unrestrained providers is also helping create a trend toward smaller ambulances, such as the Mercedes Sprinter. This notion, flouting the idea that bigger is better, has been a hard sell at times. But a smaller environment, artfully arranged, means providers can reach what they need without getting unbuckled and moving around. They're also more fuel efficient and cheaper to buy and use.
"Ten years ago, people didn't want to look at a vehicle like a Sprinter," says Levick. "Now people have been exposed to those vehicles and realize they can actually reach the patient and their equipment without having to walk around. Everything is a lot more ergonomically comfortable and, from a vehicle safety and handling point of view, more effective."
That's fine for new ambulances, but the larger, older models populating so many fleets aren't leaving the road any time soon. For them it becomes about technologies and procedures that can mitigate known risks. And we know that riding unrestrained is among the greatest of those.
Technologies discussed throughout this supplement can help limit activities that can require unbuckling and standing and moving about. Smart protocols can too. Some agencies, for instance, are looking at terminating futile resuscitations in the field, rather than transporting patients who aren't viable. Others are reevaluating how emergently they transport. Ft. Worth's MedStar, for one, recently stopped using lights and sirens when CPR is ongoing for cardiac arrest patients it transports. "Traveling in the emergency mode makes it more difficult for crews to perform procedures such as CPR, IVs and EKGs," a service official explained. "And our studies have shown that traveling with lights and siren only saves an average of two minutes in travel time to the hospital."
Putting It Into Practice
As we zero in on what ambulance safety looks like, what we learn is making its way to the field. Manufacturers are striving to incorporate advances and build safer products, and prudent buyers are increasingly demanding features toward that end. Texas service CareFlite drew a lot of attention earlier this year with a high-profile commitment to the concept. President Jim Swartz worked with the EMS Safety Foundation to identify international best practices in ambulance safety. CareFlite then became the first ground service in the U.S. to completely eliminate side-facing seats in its emergency vehicles. It is rolling out 24 new ambulances-Sprinters from Crestline-with forward-facing seats, tested to 20 Gs, that swivel to the side and fold up when not in use. "The seated medic can reach all of his soft goods without ever having to unbuckle, so there's very little that would require him to get out of that seat," Swartz told EMS Magazine in March 2010.
The vehicles will also feature easily accessible monitoring and suctioning equipment on the forward wall facing the medics, and special exterior compartments for loose equipment that might otherwise become projectiles in a crash.
Word is spreading. The NFPA is now working on ambulance standards. Interest has soared in the international ideas showcased at conferences like Europe's RETTmobil, and entire state EMS offices are striving to do better.
"There was enormous interest in the National Academies' 2008 and 2009 (Transportation Research Board Ambulance Transport Safety) summits because people realize there are technical experts in fields like automotive safety and ergonomics who can work with the EMS community to bridge gaps and provide access to information," says Levick. "For EMS, it feels like there's a brand new world opening up where there are all these resources and people motivated to move the playing field forward. I think the cat's out of the bag, and we're all going to benefit."