New Side-Load Ambulance Sparks Interest and Questions

That the ambulance industry is at last waking up to the dangers of side-facing seating in the patient compartment is great news. But the quest to phase it out--and figure out a viable way to replace it--seems likely to spur more debate.

The latest design to eliminate the dreaded squad bench along the side comes from SJC Industries, which makes McCoy Miller, Marque and Premiere brand ambulances. The company's new side-load ambulance keeps providers forward and rear facing in sliding attendant seats--and takes the novel step of turning the patient crossways, parallel to the axles.

That's raised some eyebrows, and prompted both interest and worries from some ambulance safety advocates. But the company believes it's the right thing to do for providers.

"This design was created for attendant safety, because it was the attendants getting hurt in crashes," says Product Manager Bob Parks. "Those are the people we're trying to protect. We wanted to create a safer vehicle for attendants to take care of people."

To that end, the side-load unit keeps providers in high-back seats mounted on tracks to slide up and down the length of the patient. They also telescope forward and backward. Providers are secured with five-point harnesses. The design also features electrical controls and oxygen on both sides of the patient, toward the goal of letting crew members stay seated and restrained while using them, and fewer cabinets and other head-strike hazards.

Its defining feature is wide sliding side doors that allow the patient to be loaded and unloaded from either side. The storage space this displaces has been shifted to the rear.

"We've taken roughly the same cubic feet that were in the smaller storage compartments on the sides and made one big storage space behind the rear wheels," says Parks. "That will let you carry a Stokes stretcher, Jaws of Life, those types of things."

Implications for Providers

Absent crash testing, precisely what this design portends for ambulance occupants is hard to tell. For providers, seated and restrained is certainly better than standing and unrestrained, and forward- and rear-facing is better than side-. But the radical reorientation of the patient compartment changes several aspects of the safety equation.

First is loading. Inserting the patient laterally means crew members start the process 8-12 feet beyond the side of the ambulance. "To get the patient in," notes leading ambulance safety expert Nadine Levick, MD, "you and your patient could become a 12-foot projectile into oncoming traffic."

That may not make the ambulance an ideal choice for some roadside scenes. Where you do have sufficient space, it puts a premium on careful advance mapping of patient moves (which is, of course, something EMS should be doing anyway).

"That's something you'll have to preplan," says Dan Alvey, director of Indiana's Gibson County EMS, which is deploying the first of the side-load units into the field. "You'll have to figure out when you're arriving either on scene or at a hospital which way you're going to load the patient and bring them out."

The patient must also be removed from the same side they were loaded into, or else attendants will have to assume their entire weight, as the cot legs won't drop down.

The rig also means a new approach to some patient interventions. How will being seated and restrained perpendicularly to the patient's head work when, for instance, managing an airway?

"To intubate, at least, you need to be at the head end of the patient and have probably 18-20 inches of seating space, and the lower you can get, the better," notes EMS safety advocate Thom Dick, quality care coordinator for Colorado's Pridemark Paramedic Services (the side-load, with a cot fully extended, will have about 9 inches at the patient's head). "I could see people sitting on the floor to do that, which means being unrestrained."

Implications for Patients