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An Ambulance-Safety How-To
The federal government has invested a lot of effort over the last several years into trying to improve the ambulance environment. The results of that work should soon be ready for consumption by the EMS community.
Within the last year, NIST (the National Institute of Standards and Technology) and its partners submitted 86 items derived from their patient-compartment design efforts for the upcoming revision of NFPA 1917; NIOSH (the National Institute for Occupational Safety and Health) furthered development of guidelines for equipment mounting and impact crashworthiness; and work advanced on a guidebook that will help agencies specify and procure their rigs with an emphasis on safety.
These various efforts should even come together in a safety demonstration ambulance that will appear at EMS trade shows, giving us all a glimpse at best practices applied.
“We’ve been talking with a federal partner who’s going through a procurement process right now, and we’re hoping we can work with them to essentially help design their next ambulance, which would incorporate the key elements of all of our work,” says Jennifer Marshall of NIST’s Law Enforcement Standards Office, who is leading its ambulance project. “We’re not certain yet about the timeline, but it’s definitely part of the last phase of the effort to come up with a product that epitomizes the work that’s been done.”
In that truck, the cot and seating and other interior elements will meet the standards shaped by NIOSH, in a design consistent with NIST’s work and goal to keep providers seated and restrained while they perform patient care, with all equipment and supplies within reach. Look for that in 2015.
That ambulance will of course be individualized to the needs of the entity buying it, and that’s true of any ambulance. Differences in location, mission, patient type and provider capability can influence how a compartment is designed and outfitted. Part of the feds’ task was to produce guidance that recognized and accommodated those variations while still promoting core safety elements. That’s also the challenge of a forthcoming guidebook under development by partners led by the Department of Homeland Security.
Possibly a companion document to next year’s revised 1917 standard, this document will “take providers through the process, similar to what we went through, of developing an ambulance,” says Marshall. “It will take them through the requirements they need to collect and all these things they need to consider, including some human-factors and ergonomic sorts of items we felt would aid in a more streamlined and safe and maybe more effective design.
“We’re not trying to come up with a standardized design,” Marshall adds. “These are basic elements we would encourage any practitioner across the country to incorporate.”
Ideas for NFPA
NIST and company also had some ideas for the NFPA 1917 revision, which is now well underway. Their suggestions encompassed areas like compartment configuration, seating and restraints, equipment mounting, cot retention, communications equipment, controls and switches, interior surfaces and storage, ventilation, illumination, and waste and sharps disposal.
In keeping with the mission to allow providers to reach their patient, equipment and supplies from a seated and restrained position, specific language sought by NIST reflected the reach ranges of average providers (i.e., 5th-percentile females to 95th-percentile males). For instance, one example specified that interior cabinets, shelves and drawers for commonly needed items should be within a maximum functional reach of 26.7 inches for seated, restrained providers as short as 59.3 inches (4-foot-11 and change).
Other submissions covered functional and safety elements of the job; for instance: countertops and work surfaces should have mechanisms to keep items from falling off; cot-securing mechanisms should have a universal locking and mounting system compatible with all models and vendors; and design shouldn’t allow items greater than 31 lbs. to be stored higher than 5 feet off the floor, or items greater than 44 lbs. to be higher than 3 feet
Not all of NIST’s suggestions will make it through the NFPA’s revision process; “NFPA is a consensus organization, and there’s always a give-and-take on certain things,” notes Marshall. Some may be refined and resubmitted. To stay current with the NFPA’s work, see the “Next Edition” tab at www.nfpa.org/codes-and-standards/document-information-pages?mode=code&code=1917.
Delethalize It
While DHS and NIST are relative newcomers to the realm of ambulance safety, NIOSH has worked for a decade-plus on related issues. Its current focus includes developing 10 standards (technically recommended practices) for testing various aspects of the ambulance, for publication by the Society of Automotive Engineers.
Two of those are complete: SAE J2917 describes procedures for front-impact occupant restraint and equipment mounting integrity tests, and SAE J2956 does the same for side impacts. In February a third, for rear impacts, advanced toward publication with approval by the SAE Crashworthiness Committee. Two more have been presented to SAE, for patient-compartment seating and restraints and occupant excursion, and returned with comments for further tinkering.
NIOSH is still working on three more. One of those covers cabinets and drawers. “We want those to stay shut in a crash, instead of expelling all of their contents,” says Jim Green, who’s leading the work. Another deals with the integrity of the patient compartment itself; the third deals with what’s called “interior delethalization.”
“What we want to do is look at how we can make the wall surfaces less likely to injure an occupant,” says Green. “We can’t prevent every occupant from hitting every wall or cabinet, so how can we make them less likely to be injured? If you think about your own car, the framing around your driver’s door—the pillar next to your left shoulder and the pillar that runs forward of your door—all has padding to help reduce the likelihood of injury to your head.” That testing should be done by the end of the fiscal year.
NIOSH is also conducting anthropometric measurement of EMS workers at various sites around the country. Says Green: “Our goal is to measure EMS workers and try to determine the size of that work population for males and females, as well as, as best we can, characterize any unique properties that may be in different minority groups.” For more on that, see www.emsworld.com/11291509.
Paradigm Shift
It’s possible to find ways to perform virtually all patient care seated and restrained, with secured equipment and interior contents mounted to withstand crashes. Lots of people in the federal government and beyond want to help us do it. Change is incremental, but the 1917 revisions, forthcoming guidebook and demo ambulance should help it along.
“It’s really about a paradigm shift as much as it is about the standards and safety work,” says Jim Grove, program manager for the DHS’ Science and Technology Directorate. “We can do so much providing recommendations and guidebooks, but it’s really going to take a shift within the EMS provider community to embrace that they can still perform their jobs in a seated manner, being able to reach the patient. In the end they’ll see they can do that; it’s just something that, because folks have done it a certain way for so many years, has to be overcome.”
EMS still has a chance to sound off; NFPA is taking online comments through May 16 for its latest draft. DHS will seek feedback from sources like those in its First Responder Resource Group and NASEMSO’s Agency & Vehicle Licensure Committee. It also plans to develop a training program to accompany the guidebook and is working through FICEMS to determine how efforts can continue once its interagency agreement with NIST ends later this year.
“From the DHS Science and Technology perspective, we’re trying to make both incremental and large-leap changes in the homeland security enterprise, and this project in particular is making a huge investment into the future and safety of the EMS community,” says Grove. “The work and collaboration we’ve been able to do with the EMS associations and manufacturing community has advanced our work and theirs as well. In the end, the folks who ride in the backs of these ambulances, and the folks who work in them day to day, are the folks we’re trying to protect.”
Stay abreast of developments at www.firstresponder.gov or by following the DHS S&T on Twitter, @dhsscitech.
