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AMBULANCE DESIGN to develop a vehicle design that would be appropriate for current operating procedures yet give us the safest product we could have. The subsequent development process extended over months. We started with tape on the floor and cardboard boxes (yes, really). We took the floor plan of our current ambulance compartment in feet and inches and put it on the floor with tape. For MIT, this was decidedly low-tech. We started the actual design process in cooperation with two ambu- lance builders, PL Custom and Braun. We took a number of their designs that seemed to be similar to our initial thoughts and started working with them to suit our remaining needs. Compartment Changes Since our major goal was safety, we looked seriously at our present construction and design and decided to first get rid of the squad bench. Using this standard ambulance fixture leads techs to be unrestrained during transport, or unable to reach and work with the patient if they are restrained. As well, in a collision, lap belts provide poor restraint. Additionally we realized that in a number of ambulance designs, over- head cabinets cause significant head- strike zones. But we still needed space. We'd seen a number of vehicles with drawers; these seemed to be an answer. As it turned out, the eight drawers we put in more than made up for the cabi- nets. The reason was simple: About half the space in a cabinet is waste—the top half stays empty, and you can't access the back through the sliders. Full-exposure drawers allow better utilization of available space. Although it's not required by federal KKK specifications, we thought it would be good to be able to transport a second patient. We accomplished this by adding a forward bracket with the cabinets and a fold-down seat. A backboard can now drop into the space across the top of the cabinets. This seems more secure than previous designs, as the board has very little forward-and-back motion allowed in its space. Horizontal motion is limited by the three "over-the-top" straps that extend from the wall to the floor. Of course, with the new specifica- tions, the engineering was complex. The truck had to be pulled from sequence a few times to re-engineer portions to make the design work. In the end it came together. The step wells were added by Braun and turned out to be a good addition in terms of comfort and usefulness. They provide an excellent leverage point for working. None of this does any good if the folks don't use the features. Our proto- cols now require that everyone be restrained and remain that way while the vehicle is moving. This is a major part of this journey; we have to change the culture. We also restricted the seat swivel (by SOPs) to 45 degrees; we don't want lateral impacts if we can avoid them. If there is no patient aboard, staff in the rear seats must be facing forward. We believe this is a safer design; yet we know it is not perfect and can be improved upon. We all need to look to how we do our jobs and how we can perform our tasks in a manner that is safer for both us and our patients. Keep the tape and cardboard boxes handy. Mark Forgues, MEd, EMT-P, has more than 30 years of EMS experience in municipal, hospital-based, volunteer, private, fxed-wing, collegiate and fre- based EMS agencies. He is director of Medical Re- sources Group, LLC, an education and consulting frm; technical director of the Massachusetts Insti- tute of Technology Emergency Medical Services and Harvard Crimson EMS; and a per diem paramedic with Wayland (MA) Fire Department. Contact him at mforgues@mit.edu for drawings and additional information. "Our protocols now require that everyone be restrained while the vehicle is moving." Although not required, a backboard can be slid into place. However, access to the patient now requires staff to be unsecured, so it is not recommended. Note the clear overhead area. The most needed supplies are kept in the drawer; nothing remains out during transport. The O 2 flow meter is stored in the drawer. Eight drawers more than make up for the lost cabinet space. Access is possible while restrained. Staff members face forward during transport. Patient contact is still maintained. Seats rotate inboard 45 degrees to increase access. 38 APRIL 2014 | EMSWORLD.com EMS_37-38_BuiltAmbulance.indd 38 3/13/14 2:41 PM