Smaller, Lighter, Brighter and Safer: The Best of RETTmobil 2016

Our counterparts in the ambulance services of Europe have some innovative ideas. To stay abreast of the latest, the EMS Safety Foundation makes an annual excursion to Fulda, Germany. Located 50 miles northeast of Frankfurt, Fulda is home to RETTmobil, Europe’s leading trade fair for rescue and mobility products.

The three-day event is held each year at the Messe-Galerie, a large exposition space surrounded by rolling green hills and fields of bright yellow rapeseed flowers. Continuously expanding since its debut in 2001, RETTmobil now boasts 20 open-air exhibit halls, 500 exhibitors and 25,000 visitors from across Europe and around the world.

The annual journey is spearheaded by the founder and research director of the EMS Safety Foundation, Nadine Levick, MD. A delegation of foundation members descends on the show each year to observe and document the forward-thinking ideas and products. The innovative designs, with a clear focus on safety, are field-proven examples for improving the safety of EMS practice in the United States.

This year was an exceptional experience for the RETTmobil delegation. Members both new and seasoned witnessed not only what’s common European EMS safety technology, but an exceptional number of new and extremely innovative designs as well.

Common Sights

High-visibility colors and reflective striping—Feuerwehr (fire department) and rettungsdienst (rescue service/EMS) vehicles are painted primarily in highly visible fluorescent colors such as yellow, orange and green. Additionally these vehicles display retroreflective striping in patterns and other designs that highlight their size and shape. Equipment, including stretchers, stair chairs, medical bags and even firehoses, also features high-visibility colors. Personnel are not left out; uniforms round out the scene in similar eye-catching hues with retroreflective accent stripes.

Small, compact vehicles—Safe and fuel efficient, the vehicles are small with no exterior modifications. Transport vehicles typically utilize the Mercedes-Benz Sprinter chassis, but many are even smaller, such as Volkswagen and Renault minivans. First-response vehicles are commonly sports cars by Mercedes and BMW, with some using a crossover SUV chassis. At the far end of the spectrum, a few manufacturers use vehicles as tiny as a MINI Cooper or Fiat 500.

Efficient use of space—Small vehicles are wisely designed to make efficient use of limited space. Uniquely designed storage compartments take advantage of unused areas, sliding or folding out from under or behind seats, behind walls and even inside cabinet doors. These areas are often easily accessed by a seated attendant or from standing at the side or rear doors.

Safer interior surfaces—Ambulance interiors are commonly molded plastic with smooth walls and flush cabinets. Where outside corners exist they are rounded and often padded. Commonly used equipment, such as ECG monitors and suction units, is securely mounted to walls and additionally covered in its own padded cases. The patient compartments may appear bare to U.S. observers, as infrequently used equipment is tucked away inside cabinets and in exterior compartments.

Removable transport seats—Many ambulances feature wheeled seats mounted securely to the floor. To provide the attendant optimal safety and patient access, these seats are secured forward-facing beside the stretcher or rear-facing at the head of the stretcher. With an ingenious dual purpose, these seats can be removed from the vehicle and used as stair chairs. The chair, with the patient belted in, can then be rolled into the ambulance and resecured for safe transport in a seated position.

No-lift equipment—To minimize injuries, equipment is designed to need little if any lifting. Stretchers have an independent-leg H-frame design. While loading, the legs under the patient’s head fold up, allowing the weight to be supported between the floor of the ambulance and the foot-end legs. When the foot of the stretcher reaches the bumper, the load is entirely supported by the floor, and the second set of legs folds up. This design allows for loading and unloading with no vertical lifting. Equipment bags are designed with wheels and handles (like luggage), and most are also equipped with backpack straps for hands-free carrying when terrain doesn’t allow rolling. Incredibly, the removable transport seat makes things easier here too: A small device clipped onto the back allows it to power up and down stairs. And of course the seats roll up narrow tracks into the ambulance, requiring no lifting.

New for 2016

Increased use of the Mercedes Sprinter chassis—RETTmobil is teeming with many types of vehicles by numerous manufacturers, including non-Europeans such as Toyota and even Ford. But it appears many are now exclusively using the Mercedes Sprinter chassis. This chassis is known to be high-quality, light and fuel-efficient, and packed with safety features. Demonstrating its versatility, the Sprinter has spawned new breeds of vehicles, including personnel transport, fire command and hazmat response units. By far the most intriguing was a fire-suppression vehicle. The Rapid Intervention Vehicle (RIV) is built in the Netherlands by BMT Fire and Rescue. The interior of this Sprinter features a 350-liter (92.5-gallon) water tank, a 20-liter (5.3-gallon) compressed air foam system, an FP 8-300 pump and a 70-meter (230-foot) fast-attack hose reel.

Added reflective striping—Every vehicle at RETTmobil utilizes retroreflective markings, typically in the form of graphic patterns and profile-highlighting stripes. This year saw an increase in reflective accents. Many vehicles displayed small reflective decals (around 1.5 by 4 inches) outlining their profiles and additionally along wheel wells, steps, cabinet doors and other features. In low light, this addition likely helps further identify the vehicle and indicate its direction of travel.

Additional options for securing equipment—To aid in the efficient use of space, manufacturers have developed several interesting products for securing equipment to walls, doors and compartment interiors. Often in the form of a clip, they are custom-designed for the products they secure. They appear to be nearly integral with the product, and their strength is assured. Like all other components of European ambulances, they must withstand a dynamic crash test of 20G front and 10G side and rear impacts.

LED highlights—Highlighting of vehicle features, previously seen only in colored or retroreflective material, was updated this year with LED lighting. Several vehicles used strips of LED lights to illuminate the rear deck, curbside step, wheel wells and even interior grab bars. These lights were no-glare and usually recessed to provide a backlight effect that is conspicuous but not distracting.

Extremely lightweight stretchers and stair chairs—Unlike the few standard U.S. designs, uniquely designed stretchers and stair chairs are common in Europe. Two products stood out this year.

• Spencer, based in Italy, offers a small aluminum stair chair. This product has no exposed screws, bolts or rivets and is the industry’s lightest stair chair at 9.4 kg (21 lbs). Salespeople were happy to demonstrate this featherweight design by lifting it with one finger.
• One of the most innovative products this year was a stretcher made by Pensi, a company based in Finland. This stretcher has amazing features and performs an astonishing feat. Made of aluminum, fiberglass and carbon fiber, it weighs only 36 kg (79 lbs). A typical stretcher in most ways, it has an independent-leg H-frame design and is standard size, with adjustable height and head/foot configurations. It is also compatible with power-load systems and has an amazingly low profile when lowered to the floor. Also, due to its light weight, the head can be raised from the ground to vertical, allowing a standing takedown.

Its most amazing feature, though, is its ability to fold into a stair chair. Even with the weight of a patient, the transformation occurs simply by raising the head and collapsing the foot-end legs. The more significant foot-end adjustment is accomplished not by a grip-altering hand release but by a safe and stable foot-kick release mechanism. As if that were not enough, a small, 7-kg (15-lb) device consisting of two tiny wheels and a pneumatic strut clips on to the rear and allows the product to glide effortlessly down stairs.

Powered door assist—This feature is currently offered exclusively by WAS, a German manufacturer. With a simple lift of the door handle, the door assist provides smooth, quiet and automatic opening or closing of the curbside door.

Mini ECG monitor—Not exactly a safety product, this device captured the attention of all who viewed it. The handheld ECG monitor is manufactured in China by Contec Medical Systems and distributed by Pulox, a German medical equipment company. The size of a cellphone and charged by USB, it’s held in the patient’s hands. Contacts on the ends provide the +/- of RA/LA, and the small LCD screen displays a view of lead II. The ECG rhythm is recorded and analyzed, and the screen shows normal or abnormal for the lay user. Foundation members experimented with the device and discovered that just holding one end in a hand and touching the other end to the proper locations on the chest worked to individually display most of the 12 ECG leads. A trade show special price of around $112 ensured a few of these devices returned with Foundation delegates.

Telepresence robot—The EMS Safety Foundation brought along “Andi,” its telepresence robot. Andi’s small, two-wheeled, Segway-like body let it navigate most areas of RETTmobil. With an iPad for a head, the video camera streams the robot’s view as the screen displays video of the user’s face. Internet-based controls allow operation from most computers, tablets or cell phones. Several users from the U.S. piloted Andi around the exhibit halls, experiencing RETTmobil from the comfort of their homes and offices across the globe. Find additional details about Andi at www.emssafetyfoundation.org/.

Conclusion

Europe’s unique needs-based solutions and superior attention to safety were clearly on display at RETTmobil this year. Sharing these innovative ideas should serve to inspire U.S. EMS services and manufacturers to apply the same level of ingenuity toward advancing the safety of EMS on this side of the pond.

David J. Turner, BS, NRP, has 24 years of experience in EMS as a provider, fire/EMS lieutenant, field supervisor, educator and author. He has been a member of the EMS Safety Foundation for eight years. Dave offers EMS safety consulting and education through a new company, Safety Solutions, LLC. Contact him via safetysolutionsllc.org or facebook.com/EMSsafetysolutions.