Ambulance wreck; safety harness

[mycrofft]

Further outside the box, make ambulances like MRAP s ?

As I see it the dilemma is thus:

1. You want lots of room to stand up and move around a patient in the ambulance.
2. But you can't do that with a harness etc on.
3. No one wants to wear a Sumo suit and helmet while treating the patient.
4. There is a danger from abrupt maneuvers or collisions to the attendants in back when not secured, and sometimes when they ARE secured due to design flaws.
5. If you have lots of room you have lots of milliseconds/feet to accelerate through before you slam against the other side of the box and you cannot brace for increased-G turns/decelerations below those of an accident.

OK, some ideas, with one prerequisite idea: There is no such thing as 100% safe. The drunk in the intersection deal is not real frequent and somewhat out of your control, so some things like that you can only mitigate.

1. If you treat ONLY before loading you don't need as much room. Win, stabilize or lose on scene. You also shed the trouble with wearing restraints that inhibit movement around the pt. If stabilization slips enroute, you pull over. This is OK but there are cases where getting to the hospital makes the best sense for the pt's condition. Not kamikaze runs, just "Get there" cases.

The obverse to this is to keep cabin space to a minimum necessary.

2. If the vehicle is driven safely, defensively and at lower speeds, the incidence of flying attendants will be lower. Dangers can be seen and reacted to in a safer manner by the driver.

3. Utilize the same NHTSA principles in the box as the cockpit. Pad over, round-off, eliminate, recess into the walls, make the interior safer. Non-skid floors, air bags, patient care "boxes" with crumple zones.

Adopting some of each of these will help, but I think the biggest common best practice is to cut the speed down.

 

[DesertMedic66]

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

Much more often. But a lot of the medic I work with like to do everything enroute to the hospital (could be 1-210 minute transport.) so for the longer transports we have time for paperwork (usually). On the shorter transports may not have time. All depends on the medic

 

[Bullets]

1. If you treat ONLY before loading you don't need as much room. Win, stabilize or lose on scene. You also shed the trouble with wearing restraints that inhibit movement around the pt. If stabilization slips enroute, you pull over. This is OK but there are cases where getting to the hospital makes the best sense for the pt's condition. Not kamikaze runs, just "Get there" cases.

I am a proponent of this method of EMS. I want to keep the provider to patient ratio in the patients favor for as long as beneficial. So with the exception of strokes, all my treatments try to occur on scene unless the scene isnt safe or its a stroke.

Problem with eliminating bench seats is that NJ regs require the ability to transport 2 supine patients. so there has to be some way to put a second patient in the truck. We have accomplished this with the fold down bench seat and a hidden cot, really more of a litter. we are buying new trucks this year and i am going to actively lobby for a Demers or another with rotating seats

 

[waaaemt]

the most effective safety feature would definitely be to have stuffed animals and bean bags all over the inside walls of the mod

 

[Tigger]

Problem with eliminating bench seats is that NJ regs require the ability to transport 2 supine patients. so there has to be some way to put a second patient in the truck. We have accomplished this with the fold down bench seat and a hidden cot, really more of a litter. we are buying new trucks this year and i am going to actively lobby for a Demers or another with rotating seats

Loading two patients into that Demers type box is no big deal, the tech seat folds down and there are seatbelts in place to strap a backboard or folding litter or what have you.

 

[RocketMedic]

Fighting our battles on-scene is silly, many of our really sick people need hospital intervention quickly.

I personally think a large SUV (Expedition/Suburban) with a rotating tech seat and an airway seat would be ideal for most urban EMS.

 

[Bullets]

Fighting our battles on-scene is silly, many of our really sick people need hospital intervention quickly.

I personally think a large SUV (Expedition/Suburban) with a rotating tech seat and an airway seat would be ideal for most urban EMS.

Yeah, but we don't get that many "really sick people" just sick people

I did not know that about Demers, they just went up in my book. There does seem to be movement towards a safer box. This is a good thing I think. I like the concept Of Hortons HOPS system in theory but I wonder how it would work in practice

 

[Tigger]

Yeah, but we don't get that many "really sick people" just sick people

I did not know that about Demers, they just went up in my book. There does seem to be movement towards a safer box. This is a good thing I think. I like the concept Of Hortons HOPS system in theory but I wonder how it would work in practice

For what it's worth, most ambulance manufactures will build you a module with seating arrangements similar to the Demers. I've seen that sort of interior on AEVs, LifeLines, and PL Customs.

 

[mycrofft]

the most effective safety feature would definitely be to have stuffed animals and bean bags all over the inside walls of the mod

I like that!

 

[mycrofft]

I'm tossing these ideas out without weighing the ratio of cases needing certain time frames to hospital etc. I'm an advocate of getting to a real hospital promptly after doing what stabilization is beneficial in a risk/time/benefit estimation.

Used to be ambulances larger than the cadillacs and Suburbans (semi-mods, mods) were all built to hold four max (two on ceiling hooks, one on the bench, one in the floor clips). Caddys often had hooks over the bench. Thank God I never had to load such numbers, enroute care and monitoring would have been nearly impossible other than shouting "Are you OK!?".

Suburbans were cool, except that they were being built with the modification kit held in mostly by gravity and then some bolts here and there. Like the first modulars, they tended to fly apart when there was an accident, starting with the roof cap, then then contents of the care compartment ejecting out.

I think the locus of the safety improvement sectors (smaller interior, wear restraints, safer interior and exterior of the module, more-conservative driving) can be distilled down to slowing down and safer modules. What you can do today/right now, is drive better, insist your driver drives better, and keep clutter and hard impact objects in the module to a minimum.

Except the beanie babies, as noted above.

Now, how to prevent back injuries, the REAL epidemic?

 

[Bieber]

I'll echo Mycrofft's statement in saying that the safest and probably best thing for the patient is for us to perform our interventions on scene and THEN transport. Slow is smooth, smooth is fast. Treat, stabilize if necessary, package, move to ambulance, repackage PRN (grab that extra blanket before you get going, switch over the O2 if you're giving it, hang the IV bag from the ceiling, etc) and then transport.

If you're racing the patient to care, you're risking 3 lives.
If you're racing care to the patient, you only risk 2.

Excuse the gross oversimplification, but all the same it's true that you will always risk at least one more life by emergent transport than you will with emergent response; but at least the latter is scientifically justified at least for a small subset of patients (e.g. cardiac arrest). In any case, it just makes sense in my opinion to take our time performing our interventions on scene and performing them correctly, instead of rushing and risking overlooking those interventions or making a mistake because we're in a hurry. Do what you can, do it well, then transport. Sometimes, there is nothing we can do, or very little; in which case, there's no sense hanging out on scene after we've done what we can do. But this doesn't mean we should intentionally make things more hazardous to ourselves, either.

Most of the ambulances I've seen, with the exception of some of these Sprinters and newer models, have about the worst design I could imagine. Why in the world did we ever think that making the box so big and putting all our equipment out of arm's reach was a good idea? Keep it small, compact, and put those critical and most frequently used items close enough that you don't have to get up to reach them and try to reserve the moving ambulance for transport, not as a critical treatment period.

Just my $0.02.

 

[mycrofft]

Bieber,

I'll echo Mycrofft's statement in saying that the safest and probably best thing for the patient is for us to perform our interventions on scene and THEN transport. (Yes, sometimes. I was not proposing it , just tossing it out) Slow is smooth, smooth is fast. Treat, stabilize if necessary, package, move to ambulance, repackage PRN (grab that extra blanket before you get going, switch over the O2 if you're giving it, hang the IV bag from the ceiling, etc) and then transport.

If you're racing the patient to care, you're risking 3 lives.
If you're racing care to the patient, you only risk 2.
(If you're racing to or from the pt, you risk the lives of all the motorists and pedestrians around you).

Excuse the gross oversimplification, but all the same it's true that you will always risk at least one more life by emergent transport than you will with emergent response; but at least the latter is scientifically justified at least for a small subset of patients (e.g. cardiac arrest). In any case, it just makes sense in my opinion to take our time performing our interventions on scene and performing them correctly, instead of rushing and risking overlooking those interventions or making a mistake because we're in a hurry. Do what you can, do it well, then transport. Sometimes, there is nothing we can do, or very little; in which case, there's no sense hanging out on scene after we've done what we can do. But this doesn't mean we should intentionally make things more hazardous to ourselves, either.
(Sure)

Most of the ambulances I've seen, with the exception of some of these Sprinters and newer models, have about the worst design I could imagine. Why in the world did we ever think that making the box so big and putting all our equipment out of arm's reach was a good idea? Keep it small, compact, and put those critical and most frequently used items close enough that you don't have to get up to reach them and try to reserve the moving ambulance for transport, not as a critical treatment period. (Good point. Most-used needs to be closest at hand. If it isn't used for 6 months and it isn't mandatory, consider putting it under the bench or on the curb)

 

[Christopher]

Fighting our battles on-scene is silly, many of our really sick people need hospital intervention quickly.

I personally think a large SUV (Expedition/Suburban) with a rotating tech seat and an airway seat would be ideal for most urban EMS.

We've moved to treating everything but Trauma and STEMI largely on scene or before leaving the scene. Those two have little justification for hanging out to do work...but now we're learning that even Trauma could probably hang out on scene.

 

[EpiEMS]

(Good point. Most-used needs to be closest at hand. If it isn't used for 6 months and it isn't mandatory, consider putting it under the bench or on the curb)[/COLOR]

Even worse is mandatory equipment that doesn't get used (or is low benefit or harmful). Bite sticks, short-board, urinal, emesis basin (I've got emesis bags...much preferred), etc.

 

[Tigger]

Even worse is mandatory equipment that doesn't get used (or is low benefit or harmful). Bite sticks, short-board, urinal, emesis basin (I've got emesis bags...much preferred), etc.

When I get to keep an ambulance for more than a shift, the first thing I do is take also the "less-used" equipment and put it in the most inaccessible cabinet or under the seat. No bitesticks, shortboard is used to wedge stair-chair to keep it from rattling, emesis bags tucked into suction canister mount for quick access, that sort of thing. My partners think I'm silly but it takes an hour to make the truck so much more useable.

You don't want to get rid of urinals...

 

[EpiEMS]

When I get to keep an ambulance for more than a shift, the first thing I do is take also the "less-used" equipment and put it in the most inaccessible cabinet or under the seat. No bitesticks, shortboard is used to wedge stair-chair to keep it from rattling, emesis bags tucked into suction canister mount for quick access, that sort of thing. My partners think I'm silly but it takes an hour to make the truck so much more useable.

You don't want to get rid of urinals...

Aye, I do the same. Less used stuff gets tossed in inaccessible places, I'll usually add extras of what I do often use (hand sanitizer, 4x4s, spare BP cuff, etc.), and remove useless stuff to the minimum required by the service and state.

Our transports are maybe 15 minutes, max, and I've yet to see the fluid-absorbent pads fully soaked thru, even with a patient that's had a full bladder.