How We Built a Better Ambulance

The Children’s Hospital of Philadelphia designed for safety from the ground up


We knew it would be a challenge to design new specialty-care transport ambulances that were both efficient for medical teams and safe for patients and crews. Engaging in a free flow of ideas with vendors and stakeholders while working to remain fiscally responsible complicated the effort further. But we were able to do all this and more to achieve our operational goals for The Children’s Hospital of Philadelphia’s Emergency Transport Team.

In developing the vehicles, we blended the latest technology with a safety package that provides all occupants with a safe operating environment both internally and externally. The design team and ambulance manufacturer, American Emergency Vehicles (AEV), worked together to create three new specialty-care transport units for the hospital (known as CHOP) and American Medical Response. Over the past five years, CHOP and AMR have shared a unique partnership providing advanced critical care to a diverse neonatal and pediatric population. Three ambulances are equipped to provide care to patients from neonates through adults, and they meet EMS licensure requirements for Pennsylvania and New Jersey.

Getting Started

We reviewed crash data testing from Objective Safety and concluded many ambulance crashes cause catastrophic injuries and deaths due to design flaws within the patient compartment. Research shows that approximately 22 people die annually in ambulance crashes. Objective Safety provided video crash-testing using dummies in scenarios common to the transport and 9-1-1 environments. AEV also has done crash-testing of its design and demonstrated maintenance of box integrity through multiple 40-mph T-bone-type impacts. AEV defined safety zones that required attention and made design recommendations to minimize occupant injury potential. We took that information and worked closely with AMR and AEV to design the vehicles.

The CHOP Emergency Transport Team (ETT) transports approximately 3,000 patients every year by ambulance, helicopter and fixed wing. The team averages 2,500 ground transports annually. Its ambulances average approximately 7,500 miles a month. Important among our needs was a dependable chassis that could withstand the rigors of constant urban/suburban use. AMR’s fleet management team suggested CHOP consider the Ford E-450 Super Duty chassis with the V-10 Triton gas engine. Several of AMR’s operational hubs in the Midwest use them with great success. We decided to mount them on the Ford gas chassis based on out-of-service data and AMR’s recommendations.

The Patient Care Area

The next challenge was to design a patient care area that was both safe and efficient, blending ergonomics with functionality. One big concern was rider comfort. A normal CHOP ground transport can range between 2–5 hours depending on the destination and traffic. We knew having a comfortable ride would reduce stress and fatigue on providers, allowing them to maintain focus during patient care. CHOP, AEV and EVS (Emergency Vehicle Seating) Ltd. held a conference call to discuss our concerns. This helped EVS engineers understand our unique needs, which allowed them to design and build one-of-a-kind custom seating for the transport team. The seats (see Figure 1) provide the rider with comfort for long trips as well as a crashworthy design.

The finished product is constructed with an integrated five-point restraint harness in high-visibility yellow. The harnesses have pretensioners built in that allow the occupant to move freely in the seat but lock when stressed by G-forces. The seats adjust forward and aft and are on a swivel base that locks in various attitudes to allow the crew to get close to the patient and remain seated while the vehicle is in motion.

The Interior

We planned the interior crew area to maintain function and diminish the potential for injury.

Head strikes and projectiles are two of the major causes of injuries to crew members in the patient care area. By padding and protecting corners, we reduced the risks associated with head strikes during a crash.

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