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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level of safety they'd have in their own vehicle driving to and from work," says Green. "They have a moving workplace, and we're trying to bring it up to that same level of safety." • Ambulance Safety Measures Prove Their Worth | By John Erich, Associate Editor Model vehicles are cheaper to run and seem safer for crews The CEN 1789 Standard for European Ambulances In the early years of the European Union, its leaders wanted to bring greater uniformity to their nations' ambulance fleets. The standard they developed, CEN 1789, has now become regulation for the EU's members. CEN 1789 sets forth requirements for the design, testing, performance and equipping of EU ground ambulances. Its primary goal is safety, but also that ambulances be enough alike to be recognized across countries and personnel can easily work in any of them. The standard covers both vehicle and engine types, as well as characteristics It's been four years since a team of technical experts led by the EMS Safety Foundation set out to distill the safest aspects of ambulances from around the globe and combine them into a single vehicle that could be built and put on the road. It's been three since those vehicles began rolling out, to much acclaim, in the U.S. (where they were fielded by the Dallas-area service CareFlite) and Oslo, Norway. It's time to ask: How have they performed? "From a safety perspective, better than I expected," says Jim Swartz, CareFlite's president and CEO, whose fleet added two dozen Sprinters from Crestline. "We've had a couple of crashes, and they've protected our people inside. We're currently preparing to order 10 more— does that tell you how we feel?" Designing the ambulances brought together experts from diverse but integral disciplines: automotive engineering, clinical EMS and patient transport, operational ergonomics and human factors, epidemiology and ambulance manufacturing. They looked at 179 different vehicle types and configurations, gauging each against technical data and principles of human biomechanics, vehicle dynamics and crashworthiness. The resulting ambulances were built into OEM vans that had undergone stringent safety and crashworthiness testing and met automotive standards for occupant protection and crash safety performance. They featured original chassis, electronic safety systems such as electronic stability control and antilock brakes, and the full range of air bags, seat belt tensioners and other standard protective measures. The patient compartment was designed around range-of-reach calculations and operational task analysis, with forwardand rear-facing seats and no squad bench. Portable equipment go-bags reduced the need for cabinetry and thus head-impact hazards. Equipment was secured, sharp edges avoided. The patient-loading height of 27 inches was optimal to minimize the risk of back strain; to the same end, heavy equipment was stored low in exterior compartments. "It's not rocket science," Ronald Rolfsen, an advisor to the Oslo University Hospital ambulance service, told an American audience about these attributes in 2012. "It's common sense." Rolfsen also touted more modest advances like placing lights and siren controls next to the steering wheel (research suggests it's dangerous to drop Outward-facing compartments safely contain loose items in a crash. A child safety seat can be secured in the rear-facing seat. Always use shoulder straps on patients, however, to prevent contact in a frontal collision. Background like size, acceleration and braking power, traction control, heating and cooling, and fire safety. Inside there are ergonomic requirements and specs for patient compartment design. Patient lifting is restricted, and safety measures are featured throughout. European ambulances are typically smaller, and equipment is arranged for seated and restrained reach by attendants. The CEN standard also specifies independent third-party testing by labs certified for the specific tests they perform. Manufacturers can't do their own testing. Other interesting aspects: • Ambulances are classified as A1 or A2 (for nonemergency transports), B (for emergency use, with more treatment space and equipment storage), or C (mobile intensive care unit), with requirements increasing accordingly. • Yellow—visible to almost all people in almost all conditions—is the primary color for all ambulances, with reflective green Battenburg markings running the length. EMSWORLD.com | MARCH 2013 43

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