Transport Safety: Challenges, Innovation, and Future Direction

Safety is an extremely important yet complex issue in the patient transport environment, given the added dimension of providing emergency acute care, usually to a recumbent patient, while transport is underway in a nonuniform automotive vehicle.

The ground transport environment, although hazardous because of its very nature, includes predictable and preventable occupant risks, particularly to the occupants of the rear compartment, which has been clearly demon­strated in safety crash test and epidemiology studies. Much of the sparse epidemiology and engineering literature has been published recently—how- ever, it is now clear that application of even basic automotive safety prin­ciples is well overdue in ground patient transport vehicles. Crashworthiness in ground vehicle design, both interior structure and exterior structure; use of appropriate restraints (with monitoring) and safe placement for all occu­pants and equipment; and ergonomically and biomechanically appropriate interior designs with protective padding and the use of safety “intelligent transportation system” technologies are key to the safety of the occupants in patient transport vehicles. Intelligent transportation system technologies include hazard warning devices, vehicle stabilizing technologies, and crash prevention devices, to mention a few. An excellent overview of ergonomics and safety is described by Ferreira and Hignett,⁵ highlighting the impor­tance of this science to the field of patient transport and the limited avail­able research data.

Oversight of safety, particularly in ground transport, has some substan­tive challenges. Although the FAA is required to investigate aviation EMS crashes, there is not a similar mandate for ground transport, with ground transport vehicles essentially exempt from Federal Motor Vehicle Safety Standards. Even capturing data on ground transport safety and adverse events can be difficult. The 2006 American Society of Safety Engineers and American National Standards Institute Fleet Vehicle Safety Standard ASSE/ ANSI Z15.1 provides a valuable model for the development and design of ground vehicle safety oversight.⁶ The purpose of this standard is to provide organizations with a document for the development of policies, procedures, and management processes to control risks associated with the operation of vehicles. This standard sets forth practices for the safe operation of vehicles owned or operated by organizations, and the scope of the standard specifi­cally includes emergency vehicles. Each of the sections covered in the Z15 standard—management, leadership and administration, operational environ­ment, driver and vehicle considerations, and incident reporting and analy­sis—provide clear structure relevant to the development of a comprehensive vehicle safety program. It should prove to be a useful tool to optimize the safety of the system.

Dissemination, acceptance, and implementation of best practices can be challenging in the rapidly changing, developing, and competitive area of transport medicine. The importance of including a focus on safety, when initial training is conducted and with continuing education, cannot be over­stated.

It is important to continue to advance the field of patient transport safety and to reevaluate the design of transport vehicles and practice poli­cies with multidisciplinary teams, including EMS providers, automotive engineers, ergonomists, and public health researchers. Restraint techniques that have been demonstrated in engineering safety testing to enhance patient transport safety should be used. Injury-mitigating interventions that have been demonstrated to be safe need to be included in the specifications for ambulance vehicles. Personal protective equipment options during transport should be presented to EMS providers in training courses. Standards specific for ambulance vehicle occupant safety need to be developed and supported by ambulance safety testing designed to simulate the real-life setting and practice. Technologies that have been demonstrated to be effective, such as high-visibility clothing, head protection, and black box monitoring and feed­back devices, should be encouraged for all patient transport services.