If, in moving through your life, you find yourself lost...go back to the last place where you knew who you were, and what you were doing, and start from there. Bernice Johnson Reagon.

11 October 2012

Seat belt use and poorly designed ambulances...

Over on Facebook, a ‘question’ was posted by ‘Paramedics on Facebook’-

Here is a good question to throw around...... How many actually use their seatbelts in the back of the Ambulance???

From the responses, it seems that most people don’t. A scarier thing is that it seems that most of those either think it is not necessary or just not possible.

For years I didn’t wear one. Many of the ambulances that I have worked on over the years just did not have seat belts for the crew member(s) in the back to us, or the ones that were present were not a very good design.

However, seeing all of the crashes that involve EMS units, and realizing that many of the fatalities are the unrestrained medics in the back, I have adopted certain rules for myself. They may go against some generally accepted practices, but these are my way of helping to ensure I go home at the end of my shift-

1. Seat belt is on.  The only time it is off is if I have to change positions to use the radio (note, only in a poorly designed ambulance is the radio controls and switch panel on the opposite side of the ambulance from the primary care position, which happens to be the patient’s left side).

2. If I cannot do it while sitting down and belted, it is done before we leave. My taking 1-2 extra minutes to secure an IV if needed is not going to be clinically significant. I gather everything that I will need beforehand for patient care that I will be providing during the transport. If those guidelines that 10 minute scene times are so clinically significant, then we need to be doing everything we can to ensure we are set up to cut out inefficient practices that hamper us, like bags with too much stuff, pre-attached backboard straps (especially those that are tangled up), etc.

3. Strap down everything. Actually, this is easier said than done. I at least strap down my monitor. That only leaves the ‘jump’ bag and the airway bag, and maybe the drug box and suction unit, left lying around.

I have found that I can do a lot of things, things that most people say you cannot do, from a seated and belted position.

As to those that say “but what out CPR?” , it has been proven and documented in peer reviewed studies and research that effective chest compressions are not consistently possible in the back of a moving ambulance. Like one respondent stated in his reply in the referenced thread- "Doing CPR while moving the patient is a guarantee of a final outcome - death. Work 'em where you find them and call them if it's not successful. There is nothing to be gained by moving to the hospital.

In my own experience over many, many years, in several counties here in NC, I have never once seen a full arrest, adult or pediatric, medical or trauma, that was resuscitated and discharged home, that did not experience ROSC on scene and maintain it. I’ve never even heard of one. So why are we still transporting arrests? We are doing nothing more than endangering our crews and the general and motoring public.

But the basic question, "do you wear seat belts?" is also influenced by the poor design of the 'modern' US ambulance. We are still stuck with the bench on one side, the 'captain's chair', and a pretty useless CPR seat.

Take a look at your ambulance. Most ambulances establish the primary care position at the patient's left side by virtue of the bench. Whether that is the ideal location and whether or not we really need to have 'walk-around' access is something to tackle later. But going on the idea that the left side is the ideal position, ask these questions-

1. Do you have to get up from the primary care position to get to the radio(s),light switches, oxygen connections, suction unit, and climate controls?

2. Do you have to get up to access 'routine' items to provide care for the patient, like gauze pads, syringes and needles, tissues, wash cloths, or some medications?

3. Is there a way to secure all of the equipment in a compartment or cabinet, or do you have to rely on materials carried in 'the bag' to provide care during transport? Or do you just 'set' all that stuff (potential flying objects) down on the floor because you keep in on the stretcher between patients?

Maybe if our ambulances were a little bit better designed (OK, a lot better designed), we would not have to asking questions on Facebook like "Do you wear seatbelts in the back?". And maybe we would not be reading about medics getting killed from being thrown around or out of the patient compartment.

Just a thought (or two).

Ambulance crash picture from internet source. Seat belt picture from personal files.

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