Next Generation Ambulance Puts Safety First

Call it innovative. Call it standard-setting. Call it forward-thinking. Call it long overdue. However you characterize the collaboration between American Medical Response (AMR) and American Emergency Vehicles unveiled in August at the 2005 EMS EXPO in New Orleans, you can call me impressed.

The second-generation safety vehicle they debuted was created as part of a joint research project aimed at providing advanced care to patients while significantly improving safety. The first prototype, called Concept Ambulance, appeared last year and traveled coast to coast, allowing hundreds of paramedics and EMTs to inspect the vehicle and provide detailed feedback to its creators for the development of a second model. The model on display at EMS EXPO was the result of that research, and it will be going into service as a functioning ambulance for AMR.

Concept Ambulance II-or C2, as it has been affectionately nicknamed by AMR execs-features numerous safety innovations that protect medics, patients, other motorists and pedestrians from injury. The list includes:

• Two external cameras that allow the driver to monitor blind spots from the cab;
• Rear crew seats strategically located for optimal patient care and configured with four different types of safety harnesses that don't inhibit that care. All have five- or six-point harness systems that lock during sudden deceleration;
• Cargo nets installed along internal voids, such as the curbside doorwell, to stop providers from striking the bulkhead;
• Locking docking ports to secure patient-compartment equipment like EKG monitor/defibrillators and eliminate "missiles" in a crash. To this end, all extra oxygen tanks are also stored externally;
• Turn-signal indicators and brake lighting installed in the back of the ambulance to warn providers delivering patient care of changes in direction and braking;
• A "black box" on-board computer system that records vehicle speed, monitors driving behavior (such as use of turn signals, braking too suddenly, etc.) and warns the driver about maneuvers that exceed preset safety parameters;
• Reflective paint to make the vehicle more conspicuous; and
• A unique lighting package that includes amber caution lights that flash at motorists' eye level, LED emergency warning lights and underbody illumination.

As if all of these innovations weren't enough, other, less-obvious improvements have also been made. The configuration of items in the patient compartment-such as the placement of various switches, radios and supplemental suction units-has been more ergonomically designed to minimize the amount of movement needed to use them. Padding has been increased on hard surfaces, and the overall amount of interior cabinetry has been reduced to lower impact risk. Sharps boxes have been strategically located within arm's length of care providers sitting next to the patient. The back bumper of the ambulance has been mounted on two shock absorbers to minimize its intrusion into the patient compartment in a rear collision. The chance of an accident while backing up is also minimized by the previously mentioned wide-angle camera (activated when the truck is put in reverse), two sensors that activate an audible backup alarm, and the black box system.

In addition to the black box system capturing second-by-second details of operation, the C2 sports three other on-board computer systems:

1. The Mobile Area Routing and Vehicle Location Information System (MARVLIS) combines a Global Positioning System (GPS) with a mobile data terminal for routing of the vehicle.
2. An electronic patient-care report is available via a modified laptop mounted in the patient compartment.
3. Finally, a central "brain" controls all the vehicle's electronics (e.g., emergency lights-whether they flash, how often they flash, etc.), runs the on-board camera system with a 64-hour digital recorder, governs power consumption and, in case of problems, allows for remote diagnosis and repair.

Furthermore the computer technology isn't just limited to systems with wires: In another forward-thinking move, this ambulance also has its own Wi-Fi site. Patient care reports can be sent ahead to the hospital, sharing important information prior to arrival, or back to headquarters to begin the QI and billing processes. Also, the future holds the possibility that, as with General Motor's OnStar system, dispatch centers can be made aware of accidents even if the crew is incapacitated.

The price tag for this vehicle is approximately $200,000-roughly 100% more than the average ambulance. This represents a significant capital investment and may be prohibitive to many services. However, all EMS agencies should take a long, hard look at the various safety mechanisms that have been incorporated into this model and decide which ones they can afford to implement in their own vehicles. Improving ambulance safety-for both patients and EMS providers-is priceless.

As they did with their first-generation safety concept vehicle, AMR executives plan to tour C2 around the country to get feedback as they seek to further improve this amazing ambulance. For more information, visit www.amr.net.