What's the deal with ambulances?

I apologize for not adding a bunch of links to relevant articles here, but I'll be happy to supply some info/data to anyone who is interested and doesn't mind waiting for me to have time to do it. I'm doing this from memory so some of the facts might be slightly askew, but the general info is correct, and rather depressing.

So...ambulances are, per mile driven, the most dangerous vehicles on the road. Worse than motorcycles. This is by virtue of how and when they are driven, of course, but it also has a lot to do with design of the vehicles themselves and the relative lack of relevant safety standards. From what I saw in a presentation, the standard that is most often applied is the crush test -- how much weight can be applied to the top of the ambulance before it collapses. This is not relevant to the typical ambulance crash -- think t-bone at intersections, rear-end collisions, and front-end offsent collisions. Some with rollover. Even in the case of a rollover, the stresses on the ambulance "box" aren't so much crushing forces as rotational ones.

It's also worth noting that the strength of a box is only somewhat predictive of the safety of what's inside the box. Think of stacking grandma's good china in a very sturdy metal container and giving it a good shake. An ambulance is designed to carry a lot of equipment and a small number of people. A good set up is one where the paramedic or EMT riding in the box with the patient can get at the patient and reach necessary items without moving around too much.

There's usually a space to sit next to the gurney for at least one extra person (a family member, perhaps). There's also usually a space for yet another person to sit way up by the head -- to "bag" the person if necessary, or help out in other ways.

So...figure as many as 4 people on an ambulance run.

The patient is strapped to the gurney. The other folks are, generally, not strapped in, but really, it wouldn't matter all that much because there are so many ways to be hurt by stuff flying around inside that closed box in the event of a crash.

The problem with t-bone crashes at intersections is that the ambulance gets hit at a vulnerable point -- the side of the box -- rather than along one of its strong edges -- or vertically from top down where the crush force is relevant. The side of the box is flimsy by comparison. And it crushes inward pushing various cabinets and people into the center of the box -- horizontal displacement.

The cabinets are very sturdy too. That's good and bad. They cause a lot of injuries when people bounce into them, or when they get displaced into the open areas of the box.


There's some research on all of this, but not a lot.

And here's the kicker, there's also some research -- but not a lot -- that says something about whether or not ambulances even need to go fast to improve the survival likelihood for a patient. There used to be a very strong acceptance of the "golden hour" rule in EMS. That said that the chances of surviving any life-threatening even dropped dramatically starting about 1 hour after the event. People who got medical help within the hour were more likely to survive than those who got help after the one-hour period had expired.

The truth is, naturally, more complex, and there is by no means a strong consensus anymore on what the right thing is. Life-threatening injuries may require immediate attention (within seconds or minutes) or the person could remain stable for hours or even days. There are those who believe EMS need not treat anyone at the scene. Just like the old days -- the first days of ambulances with the old converted hearses -- just scoop 'em up and get 'em in. There are others who believe that paramedics save lives all the time and without them, there are lots of people who wouldn't be around today. Many people have personal stories of the heroism and medical professionalism of ambulance crews. That's not the point. The point is that if you look for data, there is very little and what's there is contradictory.

But...we do know that being in an ambulance is a dangerous way to travel -- especially during an emergency run. The question then arises, what can be done to make it safer? One possibility is to strip down the ambulance and make it a safer vehicle designed solely for transport. Unlikely, but perhaps we can redesign the interior to be efficient and safe. Right now, the job of designing ambulance interiors falls mostly in the realm of cabinet-making. Think something along the lines of a camper-van -- lots of places to store things and a nice sleek-looking finish when it's all closed up. This is not the interior of your car -- automotive safety engineers have not been enlisted to make this a human-friendly environment. Experts in the field are starting to recognize, and recommend, that ambulances get the full interior safety design treatment.

Maybe we strap people in better too. And maybe everyone in the back should wear some sort of protective head gear. It's really unclear what would be best for safety and still allow them work.

We should almost certainly ban ride-alongs by non-essential personnel, including family members. It's true that it helps to keep the patient calm, especially small children, but the risks to bench-seated passengers are just too great. Better you all arrive safely at the hospital and pick it up from there.

Also, speed. At some point we're going to have to decide whether the extra minutes are worth the risk. Perhaps we just don't let ambulances run red lights, period. And perhaps we need to set maximum speeds -- in urban environments especially.

It's going to be interesting to see what comes of the latest trickles of data on this issue.