EMS World

MAR 2013

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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SPONSORED BY The Quest for a Safer Ride From the government to the grass roots, there are efforts to improve our vehicles | By John Erich, Associate Editor Welcome to the third installment of EMS 2020. Last month we examined risk in EMS. This month's content looks at efforts to develop standards that can improve the safety of the ambulance environment. Read more at emsworld.com/2020. The ambulance environment may not be optimally safe or ergonomic, but there are a lot of people working to make it better.1 Those who operate individual ambulances or entire fleets should understand what's at stake, who's playing and the parameters of current efforts. Here's an update. The U.S. Government Spurred by the high rate of EMS worker injuries, the National Institute for Occupational Safety and Health (NIOSH) has been working for nearly a decade with a variety of industry partners, including the National Truck Equipment Association's Ambulance Manufacturer's Division (AMD), on issues such as patient compartment restraints, and cot and equipment mounts. When the Department of Homeland Security, at the behest of its First Responders Working Group, ventured more recently into the realm of ambulances, it partnered with NIOSH, NIST (the National Institute of Standards NIST's design had twin work stations with seats that rotated toward the patient and storage in back. and Technology) and other players in a comprehensive effort to redesign the compartment and strengthen key crash safety elements. NIOSH's work initially examined mobile restraints, but "a better design, certainly, would be to marry crashworthy seating, cots, interior equipment mounts and surfaces with a redesigned layout," says Jim Green, who's led the project for NIOSH's Division of Safety Research. Conceiving a new layout is the charge of NIST and its partners. "If we are fully successful and are able to provide a layout that allows the worker to complete all patient care tasks seated and restrained," Green says, "we would, in effect, eliminate the need for restraints that allow full mobility." NIST's arm of the project began in 2011; it spent nearly a year gathering input from EMS stakeholders on what worked, didn't and needed to change. Three major points emerged: Providers had to be able to reach patients from head to knee; reach critical equipment and supplies; and maintain face-to-face interaction with the patient, all while seated and restrained. Ambulance Specs & Standards Compared As part of its Model Rules for Ambulance Vehicle Design (MRAVD) project, the National Association of State EMS Ofcials has compiled a handy comparison of U.S. ambulance guidance that contrasts NFPA 1917, the Triple-K standard and the ASTM's F202002a, which defines standard practices for designing, building and procuring EMS ambulances. (ASTM was formerly the American Society for Testing and Materials.) Find the chart at www.nasemso.org/Projects/ AgencyAndVehicleLicensure/AmbulanceVehicleDesignProject.asp. NASEMSO's MRAVD project aims to produce model language states can use to govern ambulance design and identify options state vehicle specifications might include. Leaders hope the result will increase safety and cost-efectiveness, while reducing variation between states. The project was spawned by the coming demise of the K specs (now postponed to 2015), which were created for federal purchasing but are utilized by many states to define what can be used as ambulances. Their replacement, NFPA 1917, "includes several departures from and additions to the KKK specs that have raised concerns among NASEMSO members," the organization says. EMSWORLD.com | MARCH 2013 41

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