NIOSH Turns the Camera on Ambulance Integrity

While the primary focus of the Fire Apparatus Manufacturers’ Association (FAMA) involves fire suppression and rescue products, several of our FAMA member companies also support the industry with emergency medical service (EMS) vehicles. FAMA members continue to be involved in ambulance standards committee work, and we all are interested in those safety technologies that can be shared for the mutual benefit of firefighters and emergency medical technicians.

The Problem

In 2001, the National Institute for Occupational Safety and Health (NIOSH), the nation’s leading research arm aimed at improving worker safety, began investigating EMS worker safety issues when in the patient compartment of a moving ambulance. Very early in its work they found something many of us already knew: our vehicles were large and most of our lifesaving equipment was located out of reach of our primary seating position. This caused most EMS professionals to work unrestrained in the back of an ambulance—especially when a patient was onboard. NIOSH also found that because of their size, ambulances fell outside most automotive crash testing requirements.

Industry Partners

Armed with this knowledge, the NIOSH research team began its search for solutions by conducting internally funded crash testing of ambulances, worker seating, and the patient cot. As its knowledge and understanding grew, NIOSH expanded its research focus by forming partnerships with industry leaders and other federal agencies. The goal was to solve some of the design and testing issues it found. Key industry partnerships were formed with the Ambulance Manufacturers Division of the National Truck Equipment Association (AMD-NTEA), cot manufacturers Ferno and Stryker, and seating manufacturers EVS, Serenity, and Wise. The Department of Homeland Security, Science and Technology Directorate, First Responders Group also provided funding support and expertise to expand the research being conducted by NIOSH. Similarly, the National Institute of Standards and Technology provided Human Factors engineering expertise.

The Research

For EMS workers, wearing a seat belt can be at odds with doing their jobs properly. They need the mobility to reach the patient at all times, collect needed supplies, adjust lighting and temperature, and communicate with their driver and the hospital. This is a significant safety concern. A 10-year review of serious ambulance crashes conducted by the National Highway Traffic Safety Administration found that 84 percent of EMS workers in the patient compartment were not wearing their seat belts at the time of the crash. From 1992 to 2011, there was an estimated annual average of 1,500 injury crashes involving an ambulance and 2600 injured persons—including both occupants and pedestrians of all vehicles involved in the crash.

“Given the evolution of ambulance design, our research sought to make improvements in seating, patient cots, equipment mounts, storage cabinets, and the overall patient compartment body, leading to the development of newly published SAE test methods” says James Green, NIOSH lead project officer and safety engineer. “Working alongside other agencies and in collaboration with industry partners, our team has improved the structural integrity and crash survivability of the vehicle and increased worker safety and security while still allowing workers to do their jobs.”

Test Specifications

With its work now largely complete, NIOSH and its many partners have much to show for their efforts. Over the last four years, NIOSH has worked very closely with the Society of Automotive Engineers International (SAE) to publish a family of 10 new test methods. These new SAE test methods were all designed around the same testing criteria used to test automobiles in the United States. The test methods provide seating and cot manufacturers with the testing procedures they need to improve their products. Test methods were also developed to improve equipment mounting systems, storage cabinet security, and the ambulance body structure. All become new tools manufacturers can use to improve product security and worker safety. With these new test methods, patient compartments in an ambulance can become increasingly crashworthy for both the patient and the worker. In the event of a crash, there is less of a risk of flying objects injuring occupants, cots and seats remain more stable and crash resistant, and EMS workers can engage in seamless patient care while remaining properly belted in a moving ambulance.

Impact on Ambulance Standards

Each of these new test methods is now referenced in the General Services Administration’s Star-of-Life Ambulance Purchase Specification (KKK-A-1822F), effective July 1, 2017. National Fire Protection Administrations 1917, Standard for Automotive Ambulances (2016.ed.), references the first six published SAE tests, with the 2019 edition likely to reference the final four. Finally, the Ground Vehicle Standard for Ambulances (GVS v1.0), published by the Commission for the Accreditation of Ambulance Services in 2016, also references the first six published SAE tests. The GVS v2.0 committee is expected to consider including the final four SAE tests when they reconvene in the summer of 2018 to revise their standard. So regardless of the standard you might use to purchase your next ambulance, you are likely to see and feel the effects of the positive safety enhancements that have resulted from the NIOSH research.

Ambulance Testing Video Series

To help the EMS community better understand this work and the changes happening in the industry, NIOSH released a seven-part video series that highlights these recently published SAE test methods, provides demos of crash-tested products, and highlights opportunities for improvements to the design of ambulance patient compartments.

The seven videos can be found at NIOSH is the federal institute that conducts research and makes recommendations for preventing work-related injuries, illnesses, and deaths. For more information about NIOSH visit FAMA is proud to have had members involved in this very important example of government and industry working together for the benefit of everyone and encourages those interested in ambulance safety to become more familiar with these key research results.

FAMA is committed to the manufacture and sale of safe, efficient emergency response vehicles and equipment. FAMA urges fire departments to evaluate the full range of safety features offered by its member companies.