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THE FEDERAL GOVERNMENT has invested a lot of effort over the last several years into trying to improve the ambulance environment. The results of that work should soon be ready for consumption by the EMS community. Within the last year, NIST (the National Institute of Standards and Technology) and its partners submitted 86 items derived from their patient-compartment design efforts for the upcoming revision of NFPA 1917; NIOSH (the National Insti - tute for Occupational Safety and Health) furthered development of guidelines for equipment mounting and impact crash- worthiness; and work advanced on a guidebook that will help agencies specify and procure their rigs with an emphasis on safety. These various efforts should even come together in a safety demonstra- tion ambulance that will appear at EMS trade shows, giving us all a glimpse at best practices applied. "We've been talking with a federal partner who's going through a procure- ment process right now, and we're hoping we can work with them to essentially help design their next ambulance, which would incorporate the key elements of all of our work," says Jennifer Marshall of NIST's Law Enforcement Standards Offce, who is leading its ambulance project. "We're not certain yet about the timeline, but it's defnitely part of the last phase of the effort to come up with a product that epitomizes the work that's been done." In that truck, the cot and seating and other interior elements will meet the standards shaped by NIOSH, in a design consistent with NIST's work and goal to keep providers seated and restrained while they perform patient care, with all equip- ment and supplies within reach. Look for that in 2015. That ambulance will of course be individualized to the needs of the entity buying it, and that's true of any ambulance. Differences in location, mission, patient type and provider capability can infuence how a compart- ment is designed and outftted. Part of the feds' task was to produce guidance that recognized and accommodated those variations while still promoting core safety elements. That's also the challenge of a forthcoming guidebook under devel- opment by partners led by the Depart- ment of Homeland Security. Possibly a companion document to next year's revised 1917 standard, this document will "take providers through the process, similar to what we went through, of developing an ambulance," says Marshall. "It will take them through the requirements they need to collect and all these things they need to consider, including some human-factors and ergonomic sorts of items we felt would aid in a more streamlined and safe and maybe more effective design. "We're not trying to come up with a standardized design," Marshall adds. "These are basic elements we would encourage any practitioner across the country to incorporate." Ideas for NFPA NIST and company also had some ideas for the NFPA 1917 revision, which is now well underway. Their suggestions encompassed areas like compartment confguration, seating and restraints, equipment mounting, cot retention, communications equipment, controls and switches, interior surfaces and storage, ventilation, illumination, and waste and sharps disposal. In keeping with the mission to allow providers to reach their patient, equip- ment and supplies from a seated and restrained position, specifc language sought by NIST refected the reach ranges of average providers (i.e., 5th-percentile females to 95th-percentile males). For instance, one example specifed that interior cabinets, shelves and drawers for commonly needed items should be within a maximum functional reach of 26.7 inches for seated, restrained providers as short as 59.3 inches (4-foot-11 and change). Other submissions covered functional and safety elements of the job; for instance: countertops and work surfaces should have mechanisms to keep items from falling off; cot-securing mecha- nisms should have a universal locking An Ambulance-Safety How-To Federal partners plan guidebook, demo truck to share best ideas By John Erich, Associate Editor Note the sliding seat at the head of the cot. Images courtesy of NIST EMSWORLD.com | APRIL 2014 39 EMS_39-40_EMS2020.indd 39 3/13/14 2:42 PM