A study on sAfety
compartment with patients and others in the
back, the driver, dispatch and hospitals.
Work environment: This domain concerns
the extent to which the patient compartment will 1) enable the provider to safely and
effectively perform patient care; 2) enables
easy cleaning and restocking after each trip;
3) enable quick and safe ingress/egress; 4)
include safety mechanisms (e.g., padding and
nets) to reduce hazard risks; and 5) provide
space and accessibility for storage of disposal
containers. The participants focused on
overall space design, accessibility of power
and lighting control, as well as flooring and
the height of the patient compartment.
General equipment and storage: This domain
concerns the extent to which the patient compartment will 1) provide space and accessibility of storage for equipment and controls; 2)
allow safe and effective use of patient care
items; 3) facilitate the ability of providers
to perform inventory management; and 4)
allow safe and secure storage of the patient
care items including equipment, supplies
and medicines. The participants focused on
the needs/requirements for accessibility and
location of equipment/supplies.
Special equipment and storage: This topic
covers the special equipment (e.g., cots and
jump bags) and storage. This domain con-
cerns the extent to which the patient com-
partment will 1) allow cots to safely and
effectively be secured/released or loaded/
unloaded; 2) allow the prehospital profes-
sional to securely restrain the patient in
the cot and safely and effectively treat the
patient; 3) facilitate the ability of the EMS
provider to safely and effectively perform
CPR; 4) provide safe and secure storage and
accessibility of jump bags; and 5) allow safe
and secure storage of patient’s equipment/
belongings. The participants focused on
space around the cot, cot loading systems
and jump bag locations.
At the end of each breakout session, the group
identified the essential design requirements
that are most important across both safety
and functionality. The groups also identified a small number of items that should not
be included in the requirement list for a variety of reasons, such as measurability, policy/
regulatory or out of scope. The participants
recommended that some requirements be
merged. The following list includes essential
The workshop participants identified a number of concerns/issues during
all four sessions. Several examples are listed here.
seAting requirements: Participants expressed concerns
about the possibility that new seat designs could infringe on space for
equipment and storage. Participants did not perceive that forward-facing
or rear-facing seating arrangements were functional enough to address
the patient’s needs. The group suggested investigating best practices
and designs used in other countries. The group also suggested that the
community needs to move away from legacy designs behind and be more
innovative in patient compartment design.
restrAint systems: The ability to reach the patient is just as
important as the ability to reach equipment. Comfort was identified as an
important requirement for restraint systems, because the lack of comfort
could hinder widespread use of new systems by practitioners. The group
identified that existing retractable restraints do not work efficiently, and
that there is a need to clarify the difference between restraint systems
and seat belts. It was noted that restraint systems could differ according
to specific needs; for example, an advanced restraint system would not be
needed for “walking wounded,” but such patients would still need to be
subjected to some form of restraint.
CommuniCAtion requirements: Participants expressed
concern about the use of non-verbal communication systems, which
could cause distractions. Hands-free verbal devices were perceived as
safer options. The group noted that new technologies could be readily
available before the next release of NFPA 1917. Participants also perceived
that means of communicating between the EMS provider, the driver and
third parties (e.g., hospitals) do not need to be provided in and accessible
from all EMS provider workstations.
Air AmbulAnCe design: A useful model for ambulance
design would be air ambulance design (i.e., helicopter and fixed wing).
Participants noted that ambulance design is often viewed from the
perspective of designing the inside of a large automobile. They suggested
that the patient compartment be viewed more as a cockpit.
prioritizAtion: The NIOSH accident trend data and no-strike
zones would help prioritize implementation (i.e., procurements).
trAnsport CApAbilities: The ability to transport more than
one patient should be considered as a possible requirement.
ergonomiC storAge: Equipment storage locations should
take into account ergonomic issues such as weight and lifting height.
proteCting our oWn: Participants indicated that they
care about their employees, and that protecting them from injury is the
lift injuries: The leading cause of EMS injury is lifting/loading
injuries. Lifting heavy equipment is also a major cause of back and
Aggressive/unprediCtAble pAtients: Patients who are
aggressive or move unpredictably represent a safety consideration.
A spACe of our o Wn: There should be a space provided to
accommodate EMS providers’ belongings.
Child sAfety seAting: Participants recommended not using
the adult cot equipped with child restraints, noting that a child safety seat
is a better option.
loAding of pAtients: Hospitals are increasingly prohibiting
EMS providers from lifting patients, due to the rate of back injury claims
and patient injuries. Reducing back injury to EMS providers should
lACk of dAtA: Participants expressed concern that there’s no
available data on EMS provider injuries, or the causes, severity, etc. of
proteCt the heAd: Participants recommended EMS providers
individuAl equipment stAndArds: There’s a need to
address the items carried by EMS providers, and there is a need to address
requirements for individual equipment items.
tr Aining: Participants suggested there is a need to address training in the standard.