Ambulance wreck; safety harness

[uscems]

Hi everyone!

I am new to this forum but not at all to EMS. I am an EMT working county 911 in a medium sized city, full time student and applying to medical school in June.

This past weekend we were pt loaded en route to a local ED. No L&S. Pt CC non sub-sternal chest pain. My partner was in the box with the pt and it was my turn to drive. We were making our way down a very familiar one way street approaching an intersection, traveling a slow 25/30mph when out of no where a car came speeding through the intersection, completely disregarded the red light and hit our ambulance at about 65mph on the drivers side door. My partner sustained multiple injuries. The pt was fine(strapped x3 with shoulder straps). I was ok. Driver that hit us was charged with (among other charges) DUI.

Irregardless of the details I would like to now further the safety of our profession in this time of endless unreliability in the field. I have a question for everyone involved in EMS in any way shape or form. If you have heard of a type of a safety device for the crew members treating patients in the back such as a safety harness that is spoken highly of or anything else, please share.

You can make your answer as short or as lengthy as needed:

Does the EMS service you are employed through, or are familiar with, have in place a safety system for crew members treating the patient(s) in the rear of the ambulance to employ?

-if so, is it a product? protocol? etc...

Thank you all for your time!

 

[Aprz]

Sorry to hear about your partner. I hope he has a quick recovery.

Was he wearing a seat belt?

 

[uscems]

Aprz-

She was not wearing a seatbelt. She told me (to the best of her memory) she was actually obtaining a blanket from under the bench seat bc the pt was cold.

Have you heard of, or made use of a safety system other than the lap belts?

 

[ExpatMedic0]

I will seatbelt my self in while riding in front, and when ever possible while in the back. If everything is completed patient care wise and its just a nice cozy ride to the hospital I stay strapped into the airway chair or even the bench seat, ill even seatbelt the lifepack in place. However, its not always possible when procedures are needed en route, especially on more serious calls.

Ive never worked at an agency with any kind of restraint device for the crew other than standard seat belts. I have also been an unrestrained provider in the back during an ambulance crash, in which I luckily only received minor injuries. However the MVC was at a moderate-high speed so I was pretty lucky. The same year and the same agency one of my colleagues was not so lucky and received a broken leg in a MVC on duty.

 

[Aprz]

I cannot imagine any other safety device that would have helped her.

 

[uscems]

-shultz
-Aprz

Thank you. I am still doing some product research.

 

[wanderingmedic]

Sorry to hear about your partner. I hope he has a quick recovery.

Ditto.

Unfortunately, I think that this is just one of dangers that comes with a job/career in EMS. We can do as much as possible (ie wear a seatbelt whenever we can) to mitigate the risk, its just something we have to live with as a part of the job. Public service has inherent dangers, but for me I would rather risk my life for someone else while running a call than risk my life building a skyscraper.

This is however a good opportunity for public education! By helping the public to understand the risks EMS professionals take for others can help to justify pay/benefits increases, and tougher legislation against those who harm EMS providers.

 

[Tigger]

I try to remain belted in (we have six point harnesses on the bench) but this seems like a sort of one in a million occurrences. I will say that I try to keep anything I might need while transporting within reach so that I can be belted in. I keep all my blankets seatbelted to the foot of the bench.

Here's for a speed recovery!

 

[NomadicMedic]

I am a paramedic that intercepts with 21 different BLS companies. Each ambulance has a different restraint system, not only for the provider, but for the gear as well. The best system I've seen was placed in service in a new "Excallance" ambulance. It's a 4 point harness that's attached to a fully moveable seat that replaced the captains chair. This ambulance also has a bracket that holds the lifepak and cabinets to secure the other gear.

 

[Tigger]

Some interior ideas from EMS Today.
Guilford EMS: tech seat rotates. AEV (giant) ambulance.

Valley Health Demers, seat also rotates and note "work station at head end with monitor mount and IV storage.

Miller Coach's type II Sprinter with two forward facing, possibly rotating seats with work station at head end.

AEV with six point restraints on the bench and CPR seat, which is what we have where I work. I would prefer to be able to rotate to a forward position when not doing direct patient care, it's far safer.

 

[mycrofft]

Think outside and inside the box

We kicked this around at great length and brainstormed a while back but nothing useful. Wearing some sort of helmet was proposed I believe.

This is one reason a SMALLER treatment area is preferable. The shorter the distance between acceleration and impact, the lesser the force and the greater the likelihood the flier/EMT will be in a guarded/controlled attitude, not spinning/flying/ricochetting around.

The box photos I'm seeing above would set NHTSA crazy if they were in the cab. Compound 90 deg corners, hard surfaces, plenty of accelleratory room, the seat by the suction station has a hard surface with a 90 deg horizontal angle right at head level and towards the front (most likely direction to experience abrupt movement). Are those little bolts securing the seats to the floor NHTSA approved? Does the sliding track under the side seat have proper safety devices to prevent it breaking and sliding foreward in a front-end accident? Does the box have crumple zones?

Hey. Airbags?? (Oh, airbags and oxygen?).

How is the driver??

PS: the first modulars had a bad habit of the box disconnecting from the frame in an accident and sometimes tumbling away.

 

[WolfmanHarris]

The Demers you posted is what we have started transitioning all our vehicles to at my service. Probably about half have switched over by this year and I'd estimate another two to rotate out those trucks that haven't (our trucks generally last 3 years front line and 1-2 as a spare before replaced; around 200 000 km).

Opinions are mixed, but I find the seat is great. The track and seat adjustments are pretty tough to do while moving so people generally find a position that works and stick with it. They can be changed while moving I just find the levers very stiff to move. Only thing I miss is the little workspace the bench gave me. The drawer has equipment in it and the top of that pedestal has our laptop mount so you end up spreading your stuff our on the patient's lap or in the drawer around the equipment. A little more workspace would be nice.

Biggest thing I'd consider when ditching the bench is getting a seat on the driver's side of the patient as well. Without that extra seating it can be very hard to have multiple providers working in the back. It's a rare occurrence, but given that the acuity of those calls are higher and the chance of emerg transport higher as well it becomes more important to provide for securing those providers.

 

[Tigger]

The Demers you posted is what we have started transitioning all our vehicles to at my service. Probably about half have switched over by this year and I'd estimate another two to rotate out those trucks that haven't (our trucks generally last 3 years front line and 1-2 as a spare before replaced; around 200 000 km).

Opinions are mixed, but I find the seat is great. The track and seat adjustments are pretty tough to do while moving so people generally find a position that works and stick with it. They can be changed while moving I just find the levers very stiff to move. Only thing I miss is the little workspace the bench gave me. The drawer has equipment in it and the top of that pedestal has our laptop mount so you end up spreading your stuff our on the patient's lap or in the drawer around the equipment. A little more workspace would be nice.

Biggest thing I'd consider when ditching the bench is getting a seat on the driver's side of the patient as well. Without that extra seating it can be very hard to have multiple providers working in the back. It's a rare occurrence, but given that the acuity of those calls are higher and the chance of emerg transport higher as well it becomes more important to provide for securing those providers.

Two our medic trucks where I work are Demers and are set up like the above. The last I saw one drawer had been left empty to be used as a workspace but I'm not sure how well that works. I've also seen the monitor being kept on the airway seat to provide more space which kind of defeats the purpose of the crash-proof mount.

 

[Bullets]

unfortunately, side facing seats with multipoint harnesses are actually more dangerous for providers then the lap belt. Dr. Nadine Levick travles the country doing presentations on ambulance safety and this is one of the things she points out. The CPR seat is equally dangerous because you usually have cabinets on either side of your head. The safest is a front or rear facing seat, or one that ca rotate.

 

[DesertMedic66]

Most of our ambulances have lap belts for the rear bench. The only time those seat belts are used is to secure a backboarded patient to the bench or for family members. The lap belts don't allow any movement and I can't even reach the patient with my hands if I'm wearing it.

A couple of our newer ambulances have some kind of an odd harness thing. Once again not used due to its extremely bulky and allows no movement. If family rides in the back they are placed in the harness however.

The only time I've ever seen a provider wear a seatbelt is with a BS call and they are sitting in the rear facing airway chair (which has a 3 point seatbelt or lap belt). And even then it is very rare to see it actually used.

 

[Tigger]

unfortunately, side facing seats with multipoint harnesses are actually more dangerous for providers then the lap belt. Dr. Nadine Levick travles the country doing presentations on ambulance safety and this is one of the things she points out. The CPR seat is equally dangerous because you usually have cabinets on either side of your head. The safest is a front or rear facing seat, or one that ca rotate.

I would like to see the elimination of squad benches. Miller Coach is actively now trying to discourage speccing benches and having one or two forward facing seats instead. These seats rotate to allow for better access, and then you can rotate back when you're not actually starting a line or whatnot. I like this idea.

I'm not sure I buy into the idea that lap belts are less dangerous than shoulder harnesses. I could not find much data on the subjet from her, just a recommendation not to do that. I understand the idea in principle in that they isolate the neck in lateral motion which is bad. However it seems to me that forces needed to cause this injury would also cause your head to strike the bench which would be bad too. In non-crash events (far more common) I feel much more secure in a harness. My torso and head do not sway around which is much preferred.

Most of our ambulances have lap belts for the rear bench. The only time those seat belts are used is to secure a backboarded patient to the bench or for family members. The lap belts don't allow any movement and I can't even reach the patient with my hands if I'm wearing it.

A couple of our newer ambulances have some kind of an odd harness thing. Once again not used due to its extremely bulky and allows no movement. If family rides in the back they are placed in the harness however.

The only time I've ever seen a provider wear a seatbelt is with a BS call and they are sitting in the rear facing airway chair (which has a 3 point seatbelt or lap belt). And even then it is very rare to see it actually used.

That is unfortunate. If you're in the airway chair there is really no experience to no wear a belt (hopefully a three point).

 

[EpiEMS]

Horton seems to have airbags as an option (http://www.hortonambulance.com/safety.cfm?a=88). Only on the airway chair though (I think)?

 

[DesertMedic66]

That is unfortunate. If you're in the airway chair there is really no experience to no wear a belt (hopefully a three point).

The only time we can wear the seatbelt and be in the airway chair is when there is no patient care going on. You can't bag the patient from the seat with the seatbelt on or intubate, or anything aside from paperwork.

 

[Tigger]

The only time we can wear the seatbelt and be in the airway chair is when there is no patient care going on. You can't bag the patient from the seat with the seatbelt on or intubate, or anything aside from paperwork.

How often do we do paperwork compared to bag or intubate the patient?

 

[EpiEMS]

The nice thing about BLS is that if you're doing the stare of life, you can be seat belted...
Heck, even if you're ALS'ing a stable patient, once you've gotten your lock or placed your electrodes, you can take a seat with a seatbelt.