Crew Sizes on Ambulances

[EMT-7035 4]

I'm currently butting heads with some people at my agency who believe that crew sizes don't matter, and if the crew chief (EMT in charge) is okay with running a 5 person BLS crew, then so be it. Aside from the public image, patient intimidation and the practical amount of size in the back of the ambulance, patient's house or hospital, are there any state regulations that dictate this? I remember reading somewhere that only 4 providers were allowed in the back of the ambulance, but I can't find it to source.

Personally, I prefer a driver, a crew chief, and maybe an aide/attendant/third, when it comes to BLS crews, but my position is challenged by the idea that we need to train people and introduce new members to EMS. I've seen (BLS) crews show up with 5 people, then a medic and ALS trainee jumps on and no one gets off, because they're all "learning" from the call.

Please note that I'm not trying to single out a specific agency, but wanted to get people's thoughts on this.

[SRS131EMTFF 471]

Let me say this, I totally understand where you are coming from and would love to see no more then 3 on a rig (ALS, BLS and EMR driver) but in the days when most crews are having to fend with having two people on a crew at most, I will take my 7 person clown car anyday.

Does more than 2 providers in the back get in the way? Yes. Is there any other way to get experience? No. Will it happen from time to time? Yes, but you adapt and over come, like you were trained to do.

[EMT111 149]

My agency limits crew size to 4 on a call. I personally prefer a 2 man crew, but am just as happy with a 3 man crew. My only gripe is when you get two EMTs on the same crew and both try to be the EMT in charge, however one of the EMTs has no intention of doing the PCR or putting themselves as in charge. In my opinion, if you're not doing the PCR, you sit back and do what the "in charge" EMT says.

[Bnechis 3,961]

are there any state regulations that dictate this? I remember reading somewhere that only 4 providers were allowed in the back of the ambulance, but I can't find it to source.

To my knowledge their are no regulations however you need to look at the Max GVW on the vehicle. Then add up the weight of all the equipment you carry (easiest to go to a truck scale). Then add up the weight of your crew (5 members who average 175 lbs. = 875 lbs. and I have seen many a crew member who is bigger than that.) Now add the patient and their family. And remember to consider that some of those family members/patients could be 200-300+ lbs.

Have you gone over you vehicle capacity? If you have then you are breaking the law and run a major risk of crashing because you are overloaded.

Many years I looked at these numbers on a type II ambulance and it worked out that after the equipment we could only care about 750 lbs. Now we only ran a 2 man crew (450 lbs) have a medic student (150 lbs.) and the family member (150 lbs.) and we had no capacity for the patient.

[FFEMT150 214]

To my knowledge their are no regulations however you need to look at the Max GVW on the vehicle. Then add up the weight of all the equipment you carry (easiest to go to a truck scale). Then add up the weight of your crew (5 members who average 175 lbs. = 875 lbs. and I have seen many a crew member who is bigger than that.) Now add the patient and their family. And remember to consider that some of those family members/patients could be 200-300+ lbs.

Have you gone over you vehicle capacity? If you have then you are breaking the law and run a major risk of crashing because you are overloaded.

Many years I looked at these numbers on a type II ambulance and it worked out that after the equipment we could only care about 750 lbs. Now we only ran a 2 man crew (450 lbs) have a medic student (150 lbs.) and the family member (150 lbs.) and we had no capacity for the patient.

You beat me to it! Many people forget how easy it is to overload a vehicle. Anyone who drives a commercial vehicle or even tows a trailer knows how dangerous it can be to have an overweight vehicle.

[FireMedic049 597]

I'm currently butting heads with some people at my agency who believe that crew sizes don't matter, and if the crew chief (EMT in charge) is okay with running a 5 person BLS crew, then so be it. Aside from the public image, patient intimidation and the practical amount of size in the back of the ambulance, patient's house or hospital, are there any state regulations that dictate this? I remember reading somewhere that only 4 providers were allowed in the back of the ambulance, but I can't find it to source.

Personally, I prefer a driver, a crew chief, and maybe an aide/attendant/third, when it comes to BLS crews, but my position is challenged by the idea that we need to train people and introduce new members to EMS. I've seen (BLS) crews show up with 5 people, then a medic and ALS trainee jumps on and no one gets off, because they're all "learning" from the call.

Please note that I'm not trying to single out a specific agency, but wanted to get people's thoughts on this.

The only regulation that I'm aware of that might be applicable would be that of seatbelt law compliance. Like musical chairs, if you don't have a seat (and seat belt) when the music stops, then you're out.

Are the agencies that are running these mega crews operating more than one ambulance? If so, they should not be sending a mega crew out on most calls if they don't have a guaranteed crew for other units. You're not meeting the (EMS) needs of the community if you put 4-5 people on the first out unit and then can't crew for a second call.

[ryguy12fd 33]

4 or 5 person crew? Where do you put the patient with all those people in the back. 2 people. Maybe a third if it's a hot job.

[50-65 205]

I've seen our local vollies run with 4 or 5 on a call. Then not be able to get another bus out for a second call.

[STAT213 332]

We found that with the E450 chassis, gear and two crew members, we rapidly approached max GVW. This is one reason we moved to the C4500 and now the Terra Star chassis.

Get in a bad wreck, your vehicle will likely get weighed. Don't end up on the wrong side of the scale.

[Jybehofd 85]

We found that with the E450 chassis, gear and two crew members, we rapidly approached max GVW. This is one reason we moved to the C4500 and now the Terra Star chassis.

Get in a bad wreck, your vehicle will likely get weighed. Don't end up on the wrong side of the scale.

WOW I wonder how many people worked out the specs for the patient a medic plus 60lbs of als gear and a patient plus two or three ambulance crew... now thinking about it that adds up pretty fast. And now the new stretchers and auto lifts that weren't original on the ambulance is some additional weight on the chassis.

has anyone thought about that? i am sure the accident investigation team would??

[Bnechis 3,961]

WOW I wonder how many people worked out the specs for the patient a medic plus 60lbs of als gear and a patient plus two or three ambulance crew... now thinking about it that adds up pretty fast. And now the new stretchers and auto lifts that weren't original on the ambulance is some additional weight on the chassis.

has anyone thought about that? i am sure the accident investigation team would??

Why worry about it, all you have to consider is which light pattern you want; Red, White, Blue. and the paint job........

Maybe that's why NFPA came out with a standard. There was a thread about that and why EMS should pay attention to it. It will be the document that is used against you in court.

[50-65 205]

So, I'm willing to bet that the 2500 Van chassis used by most commercial agencies falls short. Two crew, pt, equipment, sometimes a third and maybe a family member....

But then again, how much of our fire apparatus is over weight? Has your department weighed your trucks after you put them in service?

[velcroMedic1987 330]

I've never understood the need to staff an ambulance like a clown car. A crew of 5 is just absurd. I've seen a driver, crew chief, EMT, attendant and designated clipboard carrier (all wearing gloves of course but that's another rant). Do you really need someone to just carry the clipboard? What kind of "training" or "experience" are you getting by doing that?

No ambulance is designed for that and it is just plain dangerous and inefficient.

If the crew chief is that uncomfortable with his/her skills, don't be crew chief. Don't fill the ambulance with a pep squad.

Ideal crew size for an EMS call is 2-3. 90% of calls only need one EMT and for the other 10% a second set of hands in the back is nice to have but three sets of hands will just get in the way.

PS - It's not the BLS crews job to drive the ALS fly-car to the hospital so don't say you brought a valet for that reason. And don't drive to the hospital lights and siren with the fly-car but that is also another topic.

[STAT213 332]

Its easy enough to find out. Just drive to a truck stop with a scale. Even the vanbulance will have a sticker with the GVW on it.

[Bnechis 3,961]

But then again, how much of our fire apparatus is over weight? Has your department weighed your trucks after you put them in service?

To meet NFPA standards you must have tire inflation monitoring and the manufactures will not provide them until you have weighed the fully equipped vehicle.

Our last 4 vehicles had plenty of capacity left after every compartment was filled and every riding position had a body.

[EMT111 149]

I've never understood the need to staff an ambulance like a clown car. A crew of 5 is just absurd. I've seen a driver, crew chief, EMT, attendant and designated clipboard carrier (all wearing gloves of course but that's another rant). Do you really need someone to just carry the clipboard? What kind of "training" or "experience" are you getting by doing that?

No ambulance is designed for that and it is just plain dangerous and inefficient.

If the crew chief is that uncomfortable with his/her skills, don't be crew chief. Don't fill the ambulance with a pep squad.

Ideal crew size for an EMS call is 2-3. 90% of calls only need one EMT and for the other 10% a second set of hands in the back is nice to have but three sets of hands will just get in the way.

PS - It's not the BLS crews job to drive the ALS fly-car to the hospital so don't say you brought a valet for that reason. And don't drive to the hospital lights and siren with the fly-car but that is also another topic.

Agreed. Also, people need to realize their limitations and stop riding when it becomes too much, I've got a few people I ride with who are over 65 and one who's 80. Each crew member should be able to lift and do any of the physical stuff involved with a call, and if you can't do the physical work, then don't come. Unfortunately, EMS is a young persons game and if you can't handle the job, then don't ride.