Focus on Ambulance Safety

October was a good month for ambulance safety.

It's not that fewer providers than normal were killed on the road, or ambulance-involved accidents mysteriously dipped. But a series of high-level industry events focused a lot of intensive attention on the latest findings and developments in the ongoing quest to make the rig a safer place to travel and work.

The most prominent of these was the Transportation Research Board's 2009 Ambulance Transport Safety Summit, held October 29 at the Keck Center of the National Academies in Washington, DC. The goal of the summit was to help bridge the gap between what the EMS and ambulance industry knows and does in the field of vehicle safety, and to enhance the safety of ambulance transport through sharing technical data. It gave microphones to a series of expert speakers across several broad topic areas, including the burdens and benefits of ambulance safety; transport system management; vehicle safety assessment and design; information sharing and policy; and research priorities moving forward.

Preceding that, the EMS Safety Foundation held a preconference workshop on automotive safety and ergonomic issues that looked at design and operational aspects of the primary patient transport modes, ambulance and stretcher. That brought together a trio of automotive engineers for the vehicle portion and a top ergonomist to address stretcher issues.

Recordings and handout materials from the workshop are available from the EMS Safety Foundation. Summit speakers' presentation materials are available through Objective Safety, and recordings are on the way. In addition, both sites offer a November synopsis webinar from the Foundation that highlights key points from both events.

The big truth about ambulance safety underlying the events is that it's a system, and reducing accidents and maximizing safety requires integrated action by multiple players across multiple fronts. The formula for achieving it has several discrete components:

• Avoiding accidents, through driver training and responsibility, operating rules and improved ambulance conspicuity;
• Choosing vehicles with advanced safety technology;
• Engineering the rear compartment interior to be more impact-friendly;
• Restraining attendants safely;
• Restraining patients safely; and
• Securing all equipment reliably.

"I think that really is a template for addressing the key issues," Foundation research director Nadine Levick, MD, said in her November recap of the events. Among current safety technologies, the one possibly most worth noting is electronic stability control, which former NHTSA boss Nicole Nason deemed second only to seat belts in its potential to save lives and reduce injuries. Mercedes' Walter Bloch touted the load-adaptive electronic stability program offered on his company's Sprinter, which has four aspects:

• A rollover mitigation system that detects rollover tendencies in situations with low speed and high lateral forces;
• A roll-movement intervention system that detects rollover tendencies during high-speed and dynamic maneuvers with high lateral forces;
• A load-adaptive control algorithm that calculates mass and center of gravity using parameters that include acceleration and speed; and
• Enhanced understeering control to provide stability during heavy understeer, such as in tight-radius corners.

Speakers also highlighted the vehicle conspicuity efforts of Canada's Muskoka Ambulance (for pictures, see the presentation at www.objectivesafety.net/TRB2009Summit-Vehicles-Levick.pdf) and the compact compartment design of Sprinter and Volvo ambulances used in Norway, which keep attendants seated and restrained, with equipment within arm's reach. That nation also has a formal interdisciplinary ambulance accident investigation program that represents "a model for us all to learn from," Levick said.