Experts Question Safety of "Box on a Truck" Ambulance Design

July 21--The Meriter Hospital ambulance that crashed this month, killing a doctor on board, was a "box on a truck" model that isn't as safe as van-style ambulances used in some places, national EMS safety experts say.

Other EMS officials say vans aren't big enough to carry specialized equipment and personnel, a key reason the box-style ambulances are much more widely used.

But a Pittsburgh hospital and a Dallas-area ambulance service are among those that use a van to transport newborn patients, as Meriter's box-style vehicle did. Meriter will consider switching to a van, an administrator said.

Van ambulances are safer for patients, medical workers and other passengers because they're designed to absorb energy, equipped with stability controls and undergo extensive safety testing, Dr. Nadine Levick said.

Levick, of New York, is founder of the EMS Safety Foundation and chairwoman of the Transportation Research Board's EMS safety subcommittee, part of the National Academies that advise Congress.

Box models like the Meriter ambulance don't have such safety features, Levick said.

"You have a physician dying in a vehicle that was largely designed by health care providers, not automotive safety engineers," Levick said. "It's a big box stacked on a truck chassis."

Kathy Kostrivas, Meriter's assistant vice president for women's health services, said the ambulance carried an incubator, a stretcher and other equipment -- and up to four medical workers, in addition to the driver -- transferring 60 to 80 babies a year from other parts of the state to Madison.

It's unclear if a van would provide enough space, but Meriter will consider getting a van as part of its review of the crash, Kostrivas said.

"It sounds like this could be something that is currently the state of the art," she said. "We're certainly going to explore that option."

Meriter stopped its newborn transport service while administrators arrange for a temporary service to continue until they determine if the damaged ambulance can be repaired or must be replaced, Kostrivas said. Meriter spent about $200,000 to buy and equip the vehicle three years ago.

For now, Kostrivas said Meriter is using ambulances equipped for newborns from St. Mary's and UW hospitals, if needed. They are the box models.

Crash investigation continues

The investigation into what caused the ambulance crash continues, said Capt. Rick Olig of the Fond du Lac County Sheriff's Office. The incident occurred about 12:35 p.m. July 10 on Highway 26, about 10 miles south of Rosendale.

The ambulance was on its way to Appleton to bring a baby to Meriter for surgery when the driver missed a curve, causing the vehicle to hit a culvert and flip on its side, officials said.

Dr. Stanley Phillips III, 32, died the next day from head injuries. He was sitting behind the driver and facing the rear, with the incubator in front of him, Olig said.

Nurse practitioner Katherine Hirsch and respiratory therapist Amy Duerk were treated for minor injuries. Nurse Marianne Davidson remains at UW Hospital, where she underwent surgery.

All of the passengers were wearing lap seat belts, according to an accident report.

The driver, Ross Fleming, 62, was not injured. No alcohol or drug use was suspected, but results of a blood test aren't available, Olig said. It could be a month before the investigation is finished, he said.

Box models popular in U.S.

The "vast majority" of the 80,000 or so ambulances nationwide are box models, Levick said. Many places in Europe and Australia use van-style ambulances, she said, mostly a model by Mercedes-Benz called a Sprinter.

At least a dozen ambulance passengers are killed in the U.S. on average each year, Levick said. She said she couldn't recall another death of a doctor on board.

National meetings on ambulance safety in 2008, 2009 and 2012 brought attention to the need for improvements in vehicle design, Levick said. The EMS Safety Foundation is preparing recommendations for neonatal transportation.

Transporting a baby doesn't require having up to five adults in the vehicle, Levick said. "Having so many personnel is what drives them to get these huge trucks," she said.

But while van ambulances work for non-emergency transfers of patients between hospitals or to nursing homes, they aren't big enough to hold immobilization boards, oxygen tank cabinets, special chairs for going up stairs and other emergency equipment, said Tim Hillebrand, EMS coordinator for Dane County EMS.

"All of that stuff needs a place to be stored," Hillebrand said.

Vans with raised roofs were widely used until the late 1970s but were top heavy, Hillebrand said. They are different from the Sprinter-style vans.

Children's Hospital of Pittsburgh has used a Sprinter-style van for two years to transport neonatal and other patients, said Jerome Spinnato, a respiratory therapist with the hospital's critical care transport team. Two of the benefits are better safety and gas mileage, he said.

Switching from a box-style ambulance took some adjustment, Spinnato said. But the van is large enough to carry two EMTs in front and a nurse, a respiratory therapist and occasionally a doctor in back, in addition to all necessary equipment, he said.

Jim Swartz, owner of CareFlite near Dallas, said he converted half of his ambulance fleet of about 50 vehicles to Sprinter-style vans about four years ago.

That includes ambulances that transport neonatal patients, Swartz said. He still has some box-style ambulances because fire departments and other government agencies want them, he said.

The national preference for box-style ambulances is "95 percent cultural," Swartz said. "It's because we've always done it this way."

Kostrivas said Meriter will review vehicle options after the state Department of Transportation releases its report on the crash.

"We'll look at all aspects, including the safety features we have, what's state of the art and what types of equipment are in there," she said.

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