How to make ambulances safer

An ambulance is parked in front of St. Vincent's Hospital on April 7, 2010 in New York City.

The professional lives of emergency medical services workers are often intense and dramatic. But dangerous?

It is dangerous — EMS workers have on-the-job fatality rates that are nearly three times the national average of other professions. That’s prompted many in the industry to call for better, safer ambulances.

The U.S. Department of Homeland Security’s science and technology division has taken up that challenge, drafting new rules and recommendations for ambulance safety, including new standards for crash testing. 

Ambulances are long overdue for a redesign, says Skip Kirkwood, a director and chief paramedic at Durham County Emergency Medical Services in North Carolina.

“Today’s ambulance design is essentially unchanged since about 1974,” he explains.

Prior to the mid '70s, Kirkwood says ambulances were often adapted from a Cadillac hearse design. They then moved to the truck or van chassis we often still see today.

“Essentially, those ambulances have been boxes built by ambulance manufacturers, many of whom had their original heritage as motor home or Winnebago or travel trailer builders,” he says.

The body style means that accidents can be dangerous for EMS workers and the patients they are transporting.

“Let’s say the ambulance rolls on its side, the stretcher is now hanging up in the air and will fall out of [its] mount,” says Kirkwood. “If the ambulance decelerates quickly, that mount comes loose from the floor and the patient may fly forward like a torpedo.”

The emergency medical technician or paramedic might not be properly restrained either, says Jim Grove, a senior advisor in DHS’s interagency office of science and technology and a former EMS worker.

“When I would ride in the back of an ambulance, it was not uncommon to stand up and be doing chest compressions on somebody and having someone be holding on to my bunker pants and going down the road at 35, 40, 50 miles per hour even,” he recalls.

Based on DHS research, Grove says future ambulances might feature pivoting chairs that slide along a track, so EMS workers can treat a patient and reach their gear while properly restrained. DHS is also working on crash-test standards for ambulances going 30 miles per hour.

“I can’t answer for why it’s taken this long to get to this point,” Grove says. “There has been crash testing done, but not to level [Homeland Security’s science and technology division] has been doing, and especially with crash testing dummies.”

One potential hurdle could be cost. Grove says early estimates say these new features could add $10,000 to $15,000 to the price of an ambulance. 

It will eventually be up to individual states to adopt any new safety requirements and take on those costs.

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