VIDEO: Ambulance Crash Tests Highlight Risks

A research and development project, involving three federal government agencies, has produced an updated ambulance design standard that promises to better protect emergency medical service workers and patients.

The project has involved the National Institute of Standards and Technology (NIST), the National Institute for Occupational Safety and Health (NIOSH, which is under the Centers for Disease Control and Prevention), and the Department of Homeland Security (DHS) Science and Technology Directorate.

Emergency medical service (EMS) providers riding in the back of ambulances are currently at a high risk of injury during a crash or an evasive traffic maneuver if they’re not using restraints, NIST said. (To view a video featuring NIOSH crash tests on ambulances with traditional safety features, click on the photo or link below the headline.) However, EMS workers often complain that restraints make it difficult to access and treat patients in transit.

Trading off protection for function often comes at a price. Between 1992 and 2011, the National Highway Traffic Safety Administration (NHTSA) estimates there was an average of 4,500 vehicle crashes involving ambulances annually, a third of which resulted in injuries. The crash statistics also show that 84 percent of EMS providers riding in the patient compartment were not restrained and only 33 percent of patients were secured with both shoulder and lap restraints. 

To better balance safety and efficiency, researchers developed new design guidelines for ambulance patient compartments. The National Fire Protection Association this summer adopted the guidelines, integrating them into a voluntary consensus standard used by ambulance component and vehicle manufacturers.

“With the new design standards, emergency personnel should be able to do nearly 95 percent of their tasks while properly restrained,” said Jennifer Marshall, homeland security program manager in NIST’s Special Programs Office. 

Marshall added that the updated NFPA standard details safety, efficiency and ergonomic improvements for compartment configuration. It also includes recommended specifications for seating and restraints, equipment mounting, patient cot retention, communications equipment, controls and switches, interior surfaces and storage, ventilation, illumination, and medical waste disposal. 

“For the first time, we now have a voluntary consensus standard that includes testing and performance requirements from a crash perspective,” Marshall said. “Those requirements range from ‘soft’ recommendations, such as countertops and work surfaces designed to keep items from falling off, to ‘hard’ directives such as how the patient cot and caregiver seat are positioned.” 

Submitted to NFPA by NIST and NIOSH, the new ambulance design guidelines were developed following a four-year R&D effort. Data were gathered through many methods, including surveys, focus groups, EMS worker interviews, visits to equipment manufacturers and EMS stations, computer simulations and crash tests.

The new standard (NFPA 1917, 2016 Edition) will go into effect on Jan. 1 of 2016. NIST and its partners are now working with ambulance component and vehicle manufacturers, the National Association of State EMS Officials, trade organizations, and state and federal government entities to increase awareness and foster understanding of how to improve ambulance safety using voluntary consensus standards.

Additionally, the agencies are also collaborating with NHTSA’s Office of Emergency Medical Services and the General Services Administration on a project aimed at creating 10 new ambulance crash safety test methods. The project, which began in 2009 and extends into 2016, has already produced six recommended practices published by the Society of Automotive Engineers (SAE) and referenced by other national standards. Also involved in this project is the ambulance manufacturer’s division of the National Truck Equipment Association.

These recommended practices cover ambulance crash response in frontal impact, side impact, rear impacts, seating and restraints, gurney and patient restraint, equipment mounting, patient compartment integrity, cabinet mounting and content retention, occupant excursion when restrained, and interior surface safety (“delethalization” in crashworthiness design jargon).