A stuDy on sAfety
and planners, to aid in the development
of standards for the design of ambulance patient compartments.
The project, titled “Ambulance
Patient Compartment Design,” will
develop new crash-safety design standards and improved user-interface
guidance that will result in patient compartments that are safer for EMS personnel and patients, and that enable the
effective delivery of patient care.
The project includes the following
five major tasks:
Needs and requirements analysis: To identify needs and requirements of future
patient compartment design through
structured and systematic approaches.
Design concepts evaluation: To validate
requirements using a set of alternative
design concepts and criteria.
Final requirements identification: To identify critical and important requirements
that would improve patient care and
safety based on the results of the design
Industry review: To ensure that the selected
requirements satisfy community needs.
Standard recommendation: To present the
requirements document to the NFPA for
incorporation into the next draft (2013) of
the NFPA 1917 standard.
To understand ambulance design and current practices issues, the project team studied documents that included the NFPA 1917
standard, the General Services Administration (GSA) KKK-A-1822F standard, ASTM
International Standard Guide for Training
Emergency Medical Services Ambulance
Operations, Alberta Ambulance Vehicle
Standards Code, Australian/New Zealand
Standard 4535 and British Standards Institution BS EN 1789. 2–8
The project team then performed needs
and requirements analysis of patient compartment design. Their approaches included
practitioner interviews, ridealongs, patient
care walkthroughs, focus group meetings, a
Web-based survey, and a workshop. These
approaches allowed the project team to gain
firsthand experience with practicing EMTs
and paramedics to better understand their
work environment, constraints, and concerns and hence, understand the needs of
those in the EMS community.
The interviews, ridealongs and patient
care walkthroughs were carried out
Figure 1: Likert Scale
Would significantly improve patient and EMS crew safety if
Would significantly improve patient care if implemented.
Would improve patient and EMS crew safety if implemented,
but not to a significant degree.
Would improve patient care if implemented, but not to a
Could improve patient and EMS crew safety to some degree if
implemented, but not an important requirement at this time.
Could make patient care somewhat easier if implemented,
but not an important requirement at this time.
prioritize design requirements. The
workshop participants included practitioners, practitioner organization representatives and federal government
throughout the country at a variety of volunteer, state, local, private and hospital-affili-ated EMS organizations.
The goal of conducting focus group meetings was to gain a broader understanding of
the issues involved in ambulance safety, from
a variety of stakeholder viewpoints. Three
focus groups, including one manufacturers
group and two groups of EMTs, were conducted in August 2011 in Las Vegas in conjunction with the 2011 EMS World EXPO.
These groups identified several design challenges and suggestions for the improvement of working the environment within the
The findings from these focus group meetings were used as the basis for developing a
nationwide ambulance survey that was conducted in December 2011. The purpose of the
survey was to aid in soliciting requirements
for design standards for ambulance patient
compartments and to measure customer satisfaction with current design standards. This
Web-based survey received more than 2,500
responses from EMS personnel across the
country. As the result of these efforts, a draft
version of needs and requirements for patient
compartment design was generated. The
aforementioned efforts culminated in the
EMS Today workshop to review, add to and
prioritize the needs/requirements gathered.
The workshop was structured to promote dialogue and knowledge sharing
among a diverse group of practitioners and assess the collective priorities
for the design requirements of patient
compartments in ambulances. It used
breakout sessions to initiate focused
discussions. A set of needs and requirements, which was developed by the
project team based on the results of previous project tasks, was provided to the
participants of each breakout session.
They were instructed to assess the requirements from the safety, functionality, and the
combined safety and functionality points of
view. The assessment used a three-point Likert scale. (See Figure 1, above left.)
Why the Workshop
The purpose of the workshop was to work
with practitioners and federal stakeholders
to identify gaps in current practice, establish consensus on technical issues related
to ambulance design, and review and
topics & Design neeDs
Participants were grouped into four breakout sessions in order to facilitate the discussion of technical design issues, current
practices, and needs and requirements in
different topical domains. The topics of
these sessions included:
Seating, restraints and communication systems:
This covered two domains. The seating and
restraints domain concerns the extent to
which the patient compartment will enable
EMTs and paramedics to provide safe and
effective patient care from a seated and/or
restrained position in the ambulance patient
compartment. The participants focused on
the needs/requirements that will help achieve
a critical balance between safety and effectiveness—restraints vs. seating, adjustabil-ity of seating for better access to patient and
equipment, being able to interact with the
patient while seated, and ergonomic seating.
The communication systems domain
concerns the extent to which the patient
compartment shall 1) enable efficient and
effective communications between the
patient compartment, the driver, and others; 2) facilitate driver awareness of activity in
the patient compartment; and 3) facilitate the
EMS provider’s awareness of driver actions.
The participants focused on ways to communicate effectively within the patient