Inside the Box: Protecting Patients and Medics in the Backs of Ambulances

Al Petrillo goes into detail about ambulance designs and safety systems.
Getting an ambulance and crew to the scene where a patient is waiting and then transporting that patient to a medical facility, all in the safest possible manner, is a major concern among ambulance makers.

Manufacturers have developed a variety of ambulance designs and safety systems that protect both patients and medics inside the patient module.

Chad Newsome, national sales manager for P.L. Custom Body and Equipment Company Inc., points out there are many safety standards mandated by the Ambulance Manufacturers Division of the National Truck and Equipment Association. Newsome notes many of that organization’s standardized tests for ambulance safety also make up the foundation of other standards, such as National Fire Protection Association (NFPA) 1917, Standard for Automotive Ambulances, the General Services Administration’s KKK-A-1822 standard, and the Commission on Accreditation of Ambulance Services (CAAS) Ground Vehicle Standard.

“These relate to the construction of the vehicle, seat belt retention, mounting of oxygen bottles, cot mounting, and securing of cabinetry, among other items,” Newsome notes.

Newsome says, “P.L. Custom follows the industry standards and then goes well beyond them to provide for safety inside our ambulances. One of the ways we do so is through our Medic in Mind interior design that encompasses a number of safety features. For example, we use radiused edges on all cabinets and countertops to mitigate potential injury during a crash. And the addition of Austin Life Defender cabinet doors has enhanced the safety and functionality of our cabinets.”

P.L. Custom Body and Equipment Company uses the Medic in Mind interior design that encompass several safety features for its ambulances. Note the radiused edges on all cabinets and countertops. (Photos 1-2 courtesy of P.L. Custom Body and Equipment Company.)

On the curb side of the patient module interior, P.L. Custom installs cabinetry to the front and rear of a single seat so storage is at a belted medic’s fingertips.

Horton Emergency Vehicles outfits its ambulances with the Horton Occupant Protection System (HOPS), which includes use of four-point Per4Max seat belt harnesses that allow a medic to attend to a patient while remaining fully buckled. (Photo 3 courtesy of Horton Emergency Vehicles.)

On all seating positions, P.L. Custom offers six-point seat belt harnesses with mounting panels welded into the structure of the vehicle so they are extremely secure, Newsome says. “The use of six-point seat belt harnesses allows a medic to work on a patient without getting out of the seat. “On the squad bench side of the patient box, we install cabinetry to the front and rear of a single seat so storage is at the medic’s fingertips, meaning the medic can stay seated.”

P.L. Custom’s patient module is designed to withstand the forces of an impact and protect occupants from serious injury, Newsome points out. “The ambulance body will remain securely attached to the chassis; the interior cabinets will remain intact; and the entry doors will open, allowing for safe evacuation.”

Lance Randolph, vice president and general manager of Horton Emergency Vehicles, a division of REV Ambulance Group, says that ambulance manufacturers have done a good job of building ambulances that hold up in a crash situation, but the biggest issue is getting medics to buckle up in the back of the rig. “The latest information we have is that 84 percent of the time medics are not buckled up in the back, even when they are not transporting a trauma or critically ill patient,” Randolph notes. “The challenge for the industry is to change the culture on seat belt use and educate the users on the value of belting up. We also should educate them about standard operating procedures that allow loose, heavy equipment to be unsecured.”

Life Line Emergency Vehicles offers ultraviolet (UV) disinfectant lighting in its rigs along with UV lighting in the ceiling center lighting strip to allow disinfecting to continue when the ambulance is parked with its doors closed. (Photos 4-5 courtesy of Life Line Emergency Vehicles.)

A UV lighting fixture on the interior box wall above a seat cushion in a Life Line ambulance.

Randolph points out, “We go above and beyond in terms of safety by outfitting our ambulances for passenger protection with the exclusive Horton Occupant Protection System (HOPS). In addition to implementing air bags in the module, we also utilize a progressive foam at head strike points that gradually absorb energy upon impact. And our four-point Per4Max seat belts are both comfortable and easy to use, with a one click, single-buckle design that allows a medic to attend to a patient while remaining fully buckled.”

He adds that Horton’s occupant protection system used in its body construction can withstand a 90,000-pound load test. “Thanks to 50 years of dynamic crash testing, we are able to deliver crews with a high level of safety while they are on the road,” Randolph says.

Horton looks at creative ways to design the interior of patient modules to allow medics to do patient care and reach needed equipment without removing the seat belt, Randolph says. “We offer a series of options on seating, like a flexible seat on the curb side that slides fore and aft and swivels 180 degrees and carrying the Per4Max harness system with retractors at the hips and shoulders,” he notes. “Around the seat we place overhead cabinets and hanging pouches on a Ferno InTrac system to make equipment easy to reach.”

Dan Ingersoll, engineering manager for Life Line Emergency Vehicles, says overall safety is first and foremost for everyone involved in ambulance design. “We want to be sure the medics and patients riding in the ambulance are protected and cared for,” he observes. “Life Line uses a four-point harness restraint system with retractors on our seating, and we are seeing more air bag systems being placed in patient modules.”

In terms of air filtration, Life Line has installed various air purification systems requested by customers, Ingersoll says, and has a standard HEPA air filtration unit available in its ambulances. “We also have ultraviolet (UV) disinfectant in the air system stream,” he adds, “as well as a UV light in the ceiling’s center lighting strip so when the ambulance is parked with the doors closed, the lights can stay on and continuing disinfecting the module.”

Ingersoll says that all aluminum extrusions on cabinet corners are rounded, as are countertops in the module. “Wherever there are potentially sharp corners, we have side cushions and head cushions installed,” he says. “In the body, we surround the ambulance with the Life Line Crash Rail System, a rigid, two-piece extruded aluminum rail mounted to a solid aluminum 2- × 3- × 12½-inch rectangular extrusion. The box’s extruded aluminum outer shell can stand on its own and provide full strength without relying on the cabinetry.”

He adds that in the fourth quarter of this year, Life Line will introduce Critical Event Recording, a 360-degree telematics camera system where the telematics will record the high G forces in a rollover, and the camera system will save 30 seconds of video before and after the crash event of the external view.

Jason Hamm, AmbuResponse product manager for First Line Technology, says First Line makes the AmbuBus system that can be installed in the back of a bus, cargo van, or Sprinter type vehicle to allow multiple patients to be safely transported by stretcher. “Depending on the size of the vehicle, we can transport up to 18 patients, with each stretcher having a belt harness to strap the patient to the stretcher,” Hamm points out. “We also have wheelchair racks that can hold 18 patients in a regular-size school bus. The racks resemble a roll cage that fits into our frame and locks in the wheelchair for safe transport.”


ALAN M. PETRILLO is a Tucson, Arizona-based journalist, the author of three novels and five nonfiction books, and a member of the Fire Apparatus & Emergency Equipment Editorial Advisory Board. He served 22 years with the Verdoy (NY) Fire Department, including in the position of chief.

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