Are You Safer In A Type II Ambulance?

[x635 4,066]

Are you safer in a Type II (Van) ambulance then you are in a Type I/III (pickup front/van front)?

There really are no current safety standards, since the KKK standards (antiquated and set by the Federal Government), and NFPA 1917 (standards for ambulances) not where it needs to be. Fire Apparatus in this country is held to higher standards, yet EMS vehicles, a tool in patient care, aren't held to the same high standards.

Here's my perspective. Let's say I'm driving a Chevrolet Type II ambulance. The engineers at Chevrolet have spend years and millions of dollars investing in safety engineering, for instance, crumple zones and other things that are designed to keep you safe in the vehicle. The van is largely unmodified, except for the roof.

However, there are no comparable testing done on boxes. Sure, there are manufacturers out there that build sturdy boxes, but what happens in the event of a collision? The Type II has the government standard crashworthiness testing and stands that Chevrolet follows, but can a box keep you safe in the same types of collisions the van is designed for?

I know there's lots of opinions out there, so let's hear them.

[99subi 121]

Id rather be in a box during a roll over.

[Bnechis 3,961]

Are you sure that vans and trucks are tested? At one point crash test were only required on cars and not on cans and trucks.

[Morningjoe 162]

Are you sure that vans and trucks are tested? At one point crash test were only required on cars and not on cans and trucks.

But there are a few hundred can crush experiments out there. Here's one:

http://m.youtube.com/watch?v=vcsxB5dKJMg&desktop_uri=%2Fwatch%3Fv%3DvcsxB5dKJMg

[Bnechis 3,961]

But there are a few hundred can crush experiments out there. Here's one:

http://m.youtube.com/watch?v=vcsxB5dKJMg&desktop_uri=%2Fwatch%3Fv%3DvcsxB5dKJMg

So based on that you should not boil water in the back of your Type I, II or III ambulance before flipping it over and dunking it in water.

[x635 4,066]

Are you sure that vans and trucks are tested? At one point crash test were only required on cars and not on cans and trucks.

I stand corrected. That's weird, though, I wonder why not. But I'm figuring that there's more safety engineering in them then a lot of the boxes out there.

[FireMedic049 597]

Are you safer in a Type II (Van) ambulance then you are in a Type I/III (pickup front/van front)?

There really are no current safety standards, since the KKK standards (antiquated and set by the Federal Government), and NFPA 1917 (standards for ambulances) not where it needs to be. Fire Apparatus in this country is held to higher standards, yet EMS vehicles, a tool in patient care, aren't held to the same high standards.

Here's my perspective. Let's say I'm driving a Chevrolet Type II ambulance. The engineers at Chevrolet have spend years and millions of dollars investing in safety engineering, for instance, crumple zones and other things that are designed to keep you safe in the vehicle. The van is largely unmodified, except for the roof.

However, there are no comparable testing done on boxes. Sure, there are manufacturers out there that build sturdy boxes, but what happens in the event of a collision? The Type II has the government standard crashworthiness testing and stands that Chevrolet follows, but can a box keep you safe in the same types of collisions the van is designed for?

I know there's lots of opinions out there, so let's hear them.

I think your line of thinking is a little off on this and to an extent, incomplete.

When you talk about occupant safety (for providers) in ambulances, it has to be a two part conversation. You have to look at both the cab area AND the patient care areas of the vehicle. Furthermore, you also have to look at the type of collision.

I'm not sure about crash-testing of the medium-duty chassis, but the light-duty chassis being used currently has been crash-tested. So, for a crash involving the cab part of a Type 3 should be pretty much the same as a Type 2. It's probably debatable as to whether a Type 1 is "safer" than a Type 2 or 3.

In a typical front end collision, the "safety" aspect of the pt care area should be limited to how equipment and occupants are or are not secured in conjunction with some aspects of the interior layout since the box isn't taking a direct hit. The "strength" of the patient care area will be tested in situations where it takes the direct hit or in a rollover. I would suspect that a box is going to hold up better than a Type 2 in a rollover situation since the top of a Type 2 is fiberglass and would probably be more likely to be compromised.

I know for sure that Horton has been doing crash testing on their patient modules for quite some time now. A brief search of the web revealed that most of the major manufacturers also perform crash testing to some extent. I would certainly agree that there should be some universal crash worthiness standards for ambulances and I think we're headed there. We'll see how long it takes.

[FireMedic049 597]

Are you sure that vans and trucks are tested? At one point crash test were only required on cars and not on cans and trucks.

Correct, however vans and pick ups are subject to crash testing currently.

[SRS131EMTFF 471]

NIH has done some research regarding cab area and pt area provider injuries.

"In the ambulance, most serious and fatal injuries occurred in the rear (OR 2.7 vs front) and to improperly restrained occupants (OR 2.5 vs restrained)."

http://www.ncbi.nlm.nih.gov/pubmed/11446540

Thus crew members providing crew in the pt care area, unrestrained, are 6.75 times more likely to be injured then your partner.

GIves you something to think about next time you take your seatbelt off in the ambulance.

[x635 4,066]

Where you sit in the ambulance makes a big difference as well.....everyone loves to spec "CPR seats".....watch this video on why this seat is dangerous without a 3 point restraint.

http://www.youtube.com/watch?v=5-TWXjDYqCk

I think your line of thinking is a little off on this and to an extent, incomplete.

I'm just trying to make conversation.

[FireMedic049 597]

I'm just trying to make conversation.

No problem. I'm just helping you out with that.

[STAT213 332]

You're not safe in any ambulance. No manufacturer does adequate testing. Horton won't release their crash test data. The way to ensure safety is to insist on specs that increase occupant safety i.e. restraints, equipment securing and design features.

Most importantly, you need to train your drivers. Do background driving checks on them. Don't let them speed. Speed and these vehicles are a match made for disaster. Train them to drive safe and slow.

[recoiloperated 16]

I don't know about the Chevy's but the recently discontinued Ford E-Series vans were riding on a 30 year old chassis. They may have been crash tested but the results were not pretty; I saw more than one of them crushed beyond recognition from what seemed like a low energy collision (in relative terms).

[DWC295 70]

I think STAT213 hit the nail on the head! The concepts coming out of Europe for safer designs seem like an improvement but we as an industry are slow to adopt them. I rarely see forward facing/swivel sweets on new trucks coming out etc that you posted from manufacturers on the web. The design of the ambulance seems stuck on tradition, a dangerous one.

[Hudson61 11]

I never did any research on which type of vehicle is safer. However from my personal experience, safety in an ambulance begins with US. One of my per-diem jobs is with a commercial EMS company. A few times I had to tell my driver to "slow the #%%% down" Really guys driving 70 miles an hour through heavy traffic is NOT safe. A few of those times I was in the back with a patient on a routine ALS run stable patient and my driver is driving like he was at a NASCAR race. Another time working an area I was not familr with, I was in a fly car and the BLS ambulance crew said follow us. I said OK, As we hit the main road, I was 10 over the speed limit and they sped out of site in a heart beat. Later the driver admitted he was doing 70+ to get to the call in the required time limit. We need to drive safe, these rigs tip easily, and they do not stop on a dime. Also, we need to keep our gear in compartments, not laying loose on the floor or bench seat. I know the whole seatbelt issue is going to come up. Yes we are all suppose to wear our seatbelts even in the back with a patient. But lets be real, how many really do?? All the more reason we should drive safer.

Folks we do a very important job. But first we need to get there to do our job.

We have lost too many co-workers to unsafe actions. If it is not safe, don't do it.

I know many folks in commercial EMS work for different companies to make ends meet, going from one tour to the next with little to no rest. Hey, when you show up to work, you need to be well rested, ready to work, with your thoughts on the job at hand.

Keep it safe out there.

[antiquefirelt 994]

Not sure how you'd gauge how another type of bus would have done, but here's a Type III that rolled over and looks pretty good.

http://bangordailynews.com/2013/12/02/news/penobscot/ambulance-drives-off-i-95-near-howland/?ref=relatedBox

[MoFire390 118]

Seth a few of the manufactures are now doing crash testing on on the rigs they put out. Demers, Braun, and Lifeline do extensive testing. Trying to make not only the boxes safer but making the pt and crew safe as well.

[velcroMedic1987 330]

We have a tremendous influence over the issue of crash safety. That's by training drivers and making crews use personal protective equipment that's there. How many of the injuries are sustained by unrestrained occupants? We can change that without any help from the manufactureres

[BM234 2]

To my knowledge, Mercedes (more expensive Sprinter) is the only one that has done extensive testing on their van to ambulance modified vehicles.

[Idlewild 0]

There is a difference between Crash Testing and some of the other tests that ambulance manufacturers do. Per the outdated KKK spec, and now the new NFPA 1917 spec, all ambulance builders are required to perform load tests on the roof of their ambulances. Roughly 2.5 times the weight of the vehicle completed. After researching this topic quite a bit for my department, I found only three ambulance manufacturers have ever conducted any dynamic testing on their bodies. Wheeled Coach did a bullet vehicle and drop test back in 08. AEV did a bullet vehicle test in 08, and Horton did/does a whole bunch of SAE Sled, Destructive, Hygee, and Rollover testing. From what I can see on their website, their last set of testing was 08 as well.

In talking to the Demers Rep, Lifeline Rep and Braun rep in my area I learned all they do is the static load testing, with the exception of Demers doing some in house pull testing on their cabinet wall. I think anything is better than nothing... but for my money, the Horton impressed me the most. They were also the only ones who have an airbag system in the back of their ambulances, but it's only for rollovers right now though.

I'm not sure who said Horton doesn't release their crash testing data, but all I had to do was ask during the last demo we had with them and they provided us with everything, AEV was also very forthcoming with info during their visit. Both have everything right on their website. Everyone else we talked to from the other builders was just kind of gun shy on the topic.

[Idlewild 0]

Forgot to add something. We were looking at a Type II also. The Type II's all start out as cargo vans and only have to meet the cargo van standards, which are very minimal. Yes, those standards are better than the KKK standards and do require all aspects of the vehicle to be tested. So in an argument of who's standards are better, the Type II standards win. But when you look at the actual tests of the vehicles, the Ford E-350 P15 cargo vans do not undergo front and side impact testing, and only gets 2 stars in the rollover test.

We used the safercar.gov website to look at the test results. The NHTSA did not provide testing results for the E-350 cargo vans for front and side impact since 2006.

So we decided a box was the better way to go. I guess the moral of my story is, do not accept everything at face value.

[McBuffin51 5]

Seth a few of the manufactures are now doing crash testing on on the rigs they put out. Demers, Braun, and Lifeline do extensive testing. Trying to make not only the boxes safer but making the pt and crew safe as well.

In Canada each province has their own set of safety requirements. Altogether they're pretty much the highest standards in the world. The reason why Demers has a huge portion of that market is because they build their rigs to meet or exceed the highest standards that are set up there, which eventually satisfies the safety standard of all provinces. Granted they're based in Canada so they do have home field advantage, but most US based manufactures don't sell up there since they can't build to standards. Demers is very safety-centric. Youtube their pull tests on interior cabinetry. Pretty interesting. They also use dynamic load testing on their boxes, which is a step above what others do in their static load testing.

[Jybehofd 85]

Where you sit in the ambulance makes a big difference as well.....everyone loves to spec "CPR seats".....watch this video on why this seat is dangerous without a 3 point restraint.

http://www.youtube.com/watch?v=5-TWXjDYqCk

I like the video and it only confirms what i have thought in the past the captains seat/airway seat is the safest and facing to the back on the ambulance. but now my company has a memo all emts and medics taking care of a patient need to be seated on the bench... i still have strong feelings against this. especially when working als in a van style ambulance and limited room for equipment.

[Idlewild 0]

In Canada each province has their own set of safety requirements. Altogether they're pretty much the highest standards in the world. The reason why Demers has a huge portion of that market is because they build their rigs to meet or exceed the highest standards that are set up there, which eventually satisfies the safety standard of all provinces. Granted they're based in Canada so they do have home field advantage, but most US based manufactures don't sell up there since they can't build to standards. Demers is very safety-centric. Youtube their pull tests on interior cabinetry. Pretty interesting. They also use dynamic load testing on their boxes, which is a step above what others do in their static load testing.

All good info. I didn't realize until you just posted this, that Canada has a bunch of different standards. So I did some research ( it was a slow day) and read through the CMH 20.21 standards, which were the most comprehensive. No question, they are better than KKK 1812-F and NFPA 1917 here in the states, but not much better. I found the website of a Demers dealer from the Midwest who had a PDF of the testing forces they use to meet the Canadian spec. Comparing those numbers to some of the other manufacturers numbers we were provided, I don't think other manufacturers "can't" meet the CMH because they do. It's more likely the stringent documentation requirements to adhere to those specific Canadian tests, which mirror the tests here in the US, but require different paperwork.

I see it this way, if Demers has X numbers for their cabinet pull test, Load Tests, and Seat Belt tests, but Horton, AEV, and Braun have Y numbers for their tests, and Y is better, than its not that they can't meet those standards like you said.

I thinks it's more likely the home field advantage, like you said, plays the biggest factor. With so many more providers with statistically bigger budgets here in the states, is it worth setting up shop in another country? Plus dealing with all the export fees? It's cheaper to import from Canada then export too Canada.

I'm not throwing stones at Demers understand, they might be a great truck. Just though the standards vs standards conversation is a great one to have. The US is really behind.

Edited October 31, 2014 by Idlewild

[eagle5473 7]

When we built our last ambulance i did some research, and found currently Australia has some of the most stringent ambulance specs going and has reduced provider deaths with the new designs they have came out with. Australia used to have many (type 1 and 3) ambulances, and is now almost exclusively type 2 with many differences forward facing seats and other occupant protection measures.

aaron

[Remember585 815]

Safest solution: Don't ride in an ambulance!

[newsbuff 286]

Safest solution: Don't ride in an ambulance!

And for those of us that work in them???

[Remember585 815]

And for those of us that work in them???

Search the "Want Ads?" J/K

[velcroMedic1987 330]

I don't know about the Chevy's but the recently discontinued Ford E-Series vans were riding on a 30 year old chassis. They may have been crash tested but the results were not pretty; I saw more than one of them crushed beyond recognition from what seemed like a low energy collision (in relative terms).

Crash tests aren't supposed to be pretty. Vehicles are supposed to deform to dissipate the energy of the crash. Crushed beyond recognition but how was the passenger compartment? What was the force remaining that could be transferred to the occupants?

Physical appearance doesn't have anything to do with survivability.

[recoiloperated 16]

Crash tests aren't supposed to be pretty. Vehicles are supposed to deform to dissipate the energy of the crash. Crushed beyond recognition but how was the passenger compartment? What was the force remaining that could be transferred to the occupants?

Physical appearance doesn't have anything to do with survivability.

Between FF1, FF2, and AVET along with my experience on the job I do have an understanding of crumple zones and their function. To illustrate my point, here is a picture I took at my last job:

This was a sub-30mph offset collision in which the front driver's side wheel intruded into the passenger compartment and caused injuries to the driver's legs.