Meriter ambulance design might not be safest, some EMS experts say

[MMiz]

Meriter ambulance design might not be safest, some EMS experts say

The Meriter Hospital ambulance that crashed this month, killing a doctor on board, was a “box on a truck” model that isn’t as safe as van-style ambulances used in some places, national EMS safety experts say.

Other EMS officials say vans aren’t big enough to carry specialized equipment and personnel, a key reason the box-style ambulances are much more widely used.

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[Jim37F]

But while van ambulances work for non-emergency transfers of patients between hospitals or to nursing homes, they aren’t big enough to hold immobilization boards, oxygen tank cabinets, special chairs for going up stairs and other emergency equipment, said Tim Hillebrand, EMS coordinator for Dane County EMS

Um, our van ambulances (Ford E-350) have no problem carrying all that...We're a strictly non emergency IFT company that does BLS, ALS, and CCT. Most of our rigs are Type II van ambulances (though with more than a few Type III box's including all CCT being box ambulances)

All our ambulances, regardless of if they're a van or mod, carry a house O2 tank and two spare O2 tanks for the gurney (in addition to the tank strapped to the gurney itself), plus a spinal board, plus a shorter CPR board, plus a stair chair and plus the "flat" (the folding litter we use to carry patients up and down stairs who can't sit in the stair chair), plus 4 each long and short cardboard splints and a traction splint (yes I have actually used a traction splint before on an IFT) in addition to every other medical supply the county requires for an ambulance (all IFT ambulances carry the same gear as a 911 rig)

What I'm trying to say is either Mr. Hillebrand hasn't been in the back of a van type anytime recently or only in piss poor designed ones.

 

[TransportJockey]

Um, our van ambulances (Ford E-350) have no problem carrying all that...We're a strictly non emergency IFT company that does BLS, ALS, and CCT. Most of our rigs are Type II van ambulances (though with more than a few Type III box's including all CCT being box ambulances)

All our ambulances, regardless of if they're a van or mod, carry a house O2 tank and two spare O2 tanks for the gurney (in addition to the tank strapped to the gurney itself), plus a spinal board, plus a shorter CPR board, plus a stair chair and plus the "flat" (the folding litter we use to carry patients up and down stairs who can't sit in the stair chair), plus 4 each long and short cardboard splints and a traction splint (yes I have actually used a traction splint before on an IFT) in addition to every other medical supply the county requires for an ambulance (all IFT ambulances carry the same gear as a 911 rig)

What I'm trying to say is either Mr. Hillebrand hasn't been in the back of a van type anytime recently or only in piss poor designed ones.

I was thinking the same thing... I run rural 911 in an AEV TraumaHawk Type II, and I can hold everything that our box units carry. I carry two spine boards, KED, traction splint, collars and straps... etc (no stair chair yet, but our truck is made with a holder for it under the cabinets, and we are due to get ours by the end of the year). I love my vanbulance for 911, I hate running in a box.

 

[Aprz]

Yep, I can fit a stair chair, backboard, etc. easily in type II. 911 used to be type II only here.

Hard for me to believe all of them were wearing lap belts. I kinda doubt that to be honest.

 

[DesertMedic66]

2 backboards, 1 break-away flat, 1 KED, 1 traction splint, 2 spare O2 tanks, main O2 tank, stair chair, pillows, blankets, and a good number of C-collars and head beds (plus the normal equipment).

All of that easily fits into our vanbulances (designed by Leader on a ford E series). We only run vanbulances. Now if we get anything else we may need to upgrade to a box for more room but not likely.

 

[medicdan]

I think we can all agree that vans are capable of holding everything necessary for a 911 ambulance... my real question is if this is a public discussion/wakeup call for something we've known for some time-- these vehicles are not safe in accidents or crash worthy, despite the attempts of some manufacturers. There are some great videos on YouTube, plenty of articles... why aren't services valuing safety, especially given the rate of fatal vehicle accidents? Do unions or the government need to get involved?

 

[waaaemt]

The rig that crashed in the article was not a 911 unit, it sounds like it was a specialized NICU (neonatal ICU). I've been on NICU transports plenty of times and all I have to say is...try fitting a huge incubator + the NICU team (2-4 nurses and docs) plus all their bags of equipment into a type II on top of all the equipment mentioned that are stocked..

 

[DesertMedic66]

The rig that crashed in the article was not a 911 unit, it sounds like it was a specialized NICU (neonatal ICU). I've been on NICU transports plenty of times and all I have to say is...try fitting a huge incubator + the NICU team (2-4 nurses and docs) plus all their bags of equipment into a type II on top of all the equipment mentioned that are stocked..

We have a company in our response area that routinely uses type II for NICU.

 

[Meursault]

I've had to transfer the gear from a Type III to a Type II before, and while it's certainly possible to fit everything in there, it requires sacrificing a lot of accessibility and not stocking anything extra. I can't find the dimensions for the isolette carriers we use, but Stryker bariatric stretchers barely fit in our Type IIs, and we've had issues with certain isolette carriers being too tall to fit through the doors of a Type II. Can't imagine the second would be an issue with a Sprinter, though, and the first can be mitigated with variable seating.

As far as crashworthiness, I think inadequate restraint was the issue in this case, not box separation. The fatality was in the airway seat and likely had more freedom of movement both towards the roof and towards the passenger side. It's not hard to slide out of a lap belt.

There are some great videos on YouTube, plenty of articles... why aren't services valuing safety, especially given the rate of fatal vehicle accidents??

Inertia and blindness to problems in my EMS?!

 

[bbmtnbb]

As far as crashworthiness, I think inadequate restraint was the issue in this case, not box separation. The fatality was in the airway seat and likely had more freedom of movement both towards the roof and towards the passenger side. It's not hard to slide out of a lap belt.

QUOTE]

THIS ^^^^

A box detached on impact for a hot shot crew in the Butler II fire mop up and that was 235 feet down a mountain side at a 100% grade. NO ONE DIED, one was injured on his shoulder though and he was in the cab. They were all restrained properly with a lot more than a lap belt. See the safety report here:

http://www.nifc.gov/safetyAlerts/Bulletin/SB_20071018_72_Hour_Report_H534_Crew_Carrier_Rollover.pdf

I know the lap belts in my van style are not very snug and I could easily see slipping out of it in a crash (sometimes for patient care and interventions it is not even on, but I try to limit that.) If this was a NICU call, I cannot see how you could be belted and render care to the patient in the NICU Isolette. I am leaning in the direction that this has to do with seatbelts failing or not being used. NOT that it is a box style. I may be wrong but that is something to consider.