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New Ambulance Crash Requirements Will Enhance Provider, Patient Safety

Manufacturers Scramble to Meet New SAE Standards

Jason Busch | | Tuesday, December 29, 2014

Ask anyone who works in EMS and they’ll agree—the back of an ambulance is far from a safe work environment. The good news is ambulance manufacturers are always striving to make their vehicles safer. And now the federal government has gotten in on the act with new crash safety standards, which will provide manufacturers with even more stringent safety requirements to adhere to.

When industry experts gathered in Nashville for EMS World Expo 2014, among the topics of discussion was building ambulances to meet new crash safety requirements from the Society of Automotive Engineers (SAE). Those requirements, released in July 2014, are aimed at creating safer patient compartments and work environments for EMS personnel.

During the “Building Your Ambulance to Meet the New Crash Safety Requirements” session, experts explained who developed these standards, how and why they were created, how states will adopt them, and how you should prepare your agency for compliance.

To begin with, ambulance crashes aren’t an insignificant problem. Between 1992–2011 there were an annual estimated mean of 4,500 motor vehicle traffic crashes involving an ambulance.

Of these crashes:
•65% resulted in property damage (only)
•34% resulted in an injury/injuries*
•<1% resulted in a fatality/fatalities*

*Injuries and fatalities include occupants in all cars involved in a traffic crash involving an ambulance

Additionally, during this 20 year period there was a mean of 29 fatal ambulance crashes and 33 fatalities (includes occupants and non-occupants of all vehicles involved) each year. And there were an estimated annual mean of 1,500 injury crashes involving an ambulance and 2,600 injured persons (includes ambulance occupants and occupants of all other vehicles involved).

Of the annual mean 29 fatal crashes involving an ambulance, 58% occurred while the ambulance was in emergency use, while 42% occurred while in non-emergency use. Of the estimated annual mean 1,500 injury crashes, 59% occurred while the ambulance was in emergency use, and 34% occurred while in non-emergency use.

According to Jim Green, project officer, Division of Safety Research, National Institute for Occupational Safety and Health (NIOSH), the overarching goals of the effort to revise the ambulance crash safety standards were to:
•Provide patient compartment occupants with the same level of crash protection as passenger vehicles;
•Work with end users to ensure designs meet needs;
•Develop system specific standards for publication to be referenced nationally or internationally in the near term;
•Incorporate changes into one or more bumper-to-bumper ambulance national standards in the long term; and
•Most importantly, ensure all proposed standards are based on actual test data.

Among the new requirements is the J3027 recommended practice that describes testing procedures for evaluating the integrity of ground ambulance patient litters, litter-retention systems and patient restraints in frontal and side-impact collisions. Its purpose, the SAE says, is to provide litter manufacturers, ambulance builders and users with testing procedures and acceptance criteria to ensure the patient litter, its retention system and the patient restraint utilize dynamic performance test methodologies similar to those applied to other vehicle seating and occupant restraint systems. It includes descriptions of the test setup, instrumentation, photographic/video coverage, test fixtures and performance metrics.

Released at the same time as J3027, J3043 explains dynamic and static testing procedures for evaluating the integrity of equipment-mount devices or systems in a frontal or side crash. It is intended to provide equipment manufacturers, ambulance builders and users with testing procedures and acceptance criteria to ensure mounting mechanisms meet the same performance criteria across the industry. It allows manufacturers to conduct either dynamic testing or static testing.

A third recommendation, J3026, specifies testing procedures to evaluate the integrity of ground ambulance occupant seating and restraint systems for workers and civilians transported in the patient compartment during frontal and side collisions. This practice is based on specific dynamics of the ambulance patient compartment and doesn’t apply to other vehicle applications or seating positions. J3026 accommodates seating systems installed in multiple attitudes, including side-facing, rear-facing and forward-facing. Its purpose is to ensure ambulance occupant seating and restraint systems meet similar performance criteria as FMVSS 208 requires for seat-belted passengers in light vehicles.

According to the National Association of State EMS Officials (NASEMSO), both major U.S. ambulance cot manufacturers, Ferno and Stryker, offer some cots that will meet the new test standards. Many other current cots and cot mounts with antler-style retention hardware will not.

An example of how manufacturers are already accommodating the new standards, the Ferno® Stat Trac® Cot Fastening System has been fully tested to and meets the new requirements from SAE.

“The Stat Trac was released almost 20 years ago and was already a rock solid device,” says Tim Wells, Ferno’s global emergency product manager. “The main change we made was changing the Stat Trac from a plastic or composite housing to an aluminum extrusion,” he explains. “That gave us added strength, and made the part easier to assemble. We also added a bracket on the head-end of the Stat Trac, which helps us meet the new SAE standards, especially the forward excursion rating,” which is less than 14 inches. Ferno also changed the design of the shoulder harnesses on its cots in response to the new forward excursion rating requirements, and those new restraints are included with all of its Stat Trac-compatible cots.

Additional work on these standards remains underway, Green said. This includes:
•SAE J3057: Patient compartment structural integrity standard, which will dynamically and statically test the modular body to improve a builder’s ability to design and test for roll impact loading. Likely to be published in summer 2015;
•SAJ3058:E Cabinet and cabinet latch integrity standard, which will ensure cabinets retain equipment using established crash pulses. Likely to be published in summer 2015;
Interior surface delethalization involves making impact surfaces less likely to injure the worker or patient; and
•EMS Worker Anthropometry Study, which will assess body sizes and shapes (620 human subjects planned—480 completed so far).

So, what does all of this mean for ambulances of the future? According to Steve Spata, technical services manager for NTEA, ambulance build standards are clearly changing/multiplying/becoming more stringent. These improvements in safety may limit variety and yesterday’s products may change or no longer be available. Additionally, improvements in litters/attaching hardware will eliminate the “antler system” and the potential for reverse compatibility of existing gurneys. And higher performance requirements tend to increase costs.

However, the good news is manufacturers have already been developing products to meet the new SAE standards, such as the Ferno Stat Trac. Seating, litter and other equipment costs to meet new performance requirements already being amortized and product compliance is being pulled ahead of requirements. That means manufacturers are not only taking the requirements seriously, they’re taking safety seriously. That bodes well for the future of EMS, and prolonging EMS providers’ careers and lives.