Question about the position of the ambulance cot

[santanna620]

Hi.
My name is Ricardo and I’m an EMT from the city of Braga, in Portugal. As many of you may know, in Europe, almost all of our ambulances have their ambulance cots in a higher position, in relation to American ambulances. Between the cot and the floor, we use an equipment called “chariot”. It allows us to work standing up, and allows the cot to assume various positions, like “tredelenburg” and “fowler”.

In recent years, at least here in Portugal, several ambulance builders are beginning to put the cot directly on the ambulance floor, but attention, for economic reasons… no studies or ergonomic reasoning.

Back in 1998 I had the privileged of going to the U.S. to take the NAEMT PHTLS course, and had the opportunity to do some ride along in several New York State Ambulance Services. What I observed was that back then, few American EMS personnel knew this reality, so when I asked what was the best system, no one could give me a good reason for choosing one or other system better. My experience told me that both systems had their obvious advantages.

My question now, after all this time, is basically the same: Which system do you prefer? And what’s the reason for that?
Here in Europe, the security and safety of patients and EMS personnel is finally beginning to be an important issue, but the advantages and disadvantages of the position of the cot in the ambulance is being neglected. I’m searching the web for studies, but I can’t really find a lot of information about this matter. I’m interested not only in the ergonomic side, but also on the impact of the laws of physics on the body of the patient: vibrations, lateral movements, etc. Does the height of the cot influences?

Especially in my case, my primary function in the private ambulance service I work for is inter-hospital transportation; the secondary transport of serious patients between facilities. So, not only we have to provide with plenty of room for equipment, but also guarantee a safe and hazardous free environment for the patient and medical staff. Of course, as you can imagine that the impact of the ride on the patient must be controlled.

Sorry for the long question. Please, I would really like to know your opinion on this matter, and of course, if you have pertinent info on the subject I could study. We are going to buy a new ambulance next year, and I would really want it to be perfectly suited for the job. Also, any information received and discussed could be passed to other colleagues in Portugal.

I’m sending a few links so you can see our ambulances in Portugal and our main manufacturers. Also I’m posting a few photos of “my” rig, so you can see the “chariot”.

Thanks.







http://www.autoribeiro.pt/index.php

http://www.emergencia2000.pt/homepage.aspx

http://www.futurvida.com/index.php?lingua=pt

 

[Stephanie.]

Welcome and thanks for posting. I must say that I am not familiar with the chariot option. I just don't think it is available in the US. I can see where it has some advantages but one thing that concerns me is safety, if it is elevated up higher, wouldn't it make unsafer? Causing the EMT to stand up or over the patient? The ground level cots we have are easy because we can always sit down and strapped in and perform just about any skill that needs to be done, aside from compressions.

 

[Shishkabob]

So the draw to the raised cot is so that you can work standing up, but also to be safer for the attendant? Is the attendant somehow strapped in safely whilst, um, standing?


With the cot all the way to the floor, in some ambulances (and increasingly so) that provider in the back can be seated, and strapped in, and still do 90% of what they need to do to the patient (The new CareFlite Sprinters here in DFW are an example of that)



Now, maybe if they had a way to raise / lower the cot, that'd be ideal. Say lower it for transport, but raise it for things such as doing CPR (while not in motion, obviously) or to intubate.





I can't say that I have a preference because I've never worked on a raised cot in the back of the ambulance before.

 

[emt_irl]

we have in one of our fleet the same stretcher as you, and i hate it!!! its so awkward compaired to the likes of the ferno's.

in any ambulance ive worked in its always been on the floor, id say max height is somewhere mid tib/fib or the higher ones up to my knee. i mostly work from the seat beside or the "airway" seat which is close enough to work on the patient unless is an arerest or something else where id need to be staning above them

 

[FrostbiteMedic]

It looks to be easier to load, however, I think that it would be much more dangerous to be standing during transport. No matter how good your restraint system, in a rollover you would be thrown around pretty bad unless it completely immobolized you from the chest down....

 

[emt_irl]

it doesnt collapse or raise up straight like most you have to walk forward with it as it falls. i dont like the restraints belts clip either. its not like the seatbelt clip type on most.

one good thing about it is, its very solid and looks like it will take more stress then the rest

 

[santanna620]

Thanks a lot for replying.

As you say, it has advantages and disadvantages. My opinion, after all the years in service, is that I like the high position when I have to work on the victim or the patient. For CPR or establishing an IV line is the best position. BUT only if the ambulance is not in motion. And as you can imagine, an ambulance has four wheels and an engine for a reason.

For normal transport or for routine procedures I advocate for the low position cot. Not only provides much security for the technicians, but I think it provides most security and comfort for the patient.

I think (and please, correct me if I’m wrong), because of the cot being so high, the patient will suffer more vibrations and movements during transport because the chariot will receive the vibrations and will transmit and intensify them to the patient. And being so high, the lateral movements and the acceleration and deceleration movements will also be “amplified” by the all ensemble, due to the high placement of the patient center of gravity. Does my thinking have any logic in terms of physics?

About the ergonomics, I think there’s not much to say. I’ve already had my share of back problems due to lifting these cots, and loading them to the rig. And you all can imagine the hard work involving loading and downloading bariatric patients.

Tomorrow I’ll make a short video of the loading and downloading this kind of cot to the ambulance.

Again, if you have any documentation, papers, studies, etc. regarding the benefits of the low position of the cot, please tell me. I’m really interested. As you all know, in these days, we need hard evidences to fight a log enduring tradition, which has never been disputed before, even if there is a majority of people that says is wrong.

Thanks again.^_^