After being asked to recount my knowledge of the history of ambulance vehicle design in our province from a safety perspective, my nostalgic nerve sprung into action. The details may cause some shivers in the aging paramedics reading this account. New paramedics might even doubt the story. A brief chat with experienced caregivers or a trip to the Canadian Transportation Museum and Heritage Village in Kingsville, Ontario, would reinforce how far we have come. I encourage young paramedics to do both.
Paramedics fresh out of school come packed with medical knowledge and skillsets. Recruited to a new career, furthest from their thoughts on the first day is personal safety. Most are busy gazing into a future of helping those in distress. Today, EMS leaders and mentors must dispense nostalgia sparingly, especially when safety is at stake. The days of “It’s okay, we have always done it this way” are long gone. Ambulance design is a glowing example. What was it like in the early days of EMS? As the “new kid” starting my career in the early 70s, what constituted safety in the ambulance business was a far cry from where we are today.
At the start of the shift, my preceptor, Larry, looked on with interest as I pulled previously ignored seatbelts off the floor hidden behind seats, dusted decaying French fries off the straps and began to put them into service. I received strange looks that morning and questions from new friends and coworkers during the coffee break. It was the fall of 1974. Medics in the day had seen their share of trauma but rode in silence, ignoring the earliest protection from the laws of physics. Emergency vehicles were still in service with lap belts only. Airbags? Well, they were a distant concept.
Every workplace is influenced by government legislation when it comes to safety. Responsibility is distributed between workers and employers. Despite the best intentions, Medics didn’t always enjoy the safest and most comfortable environment during emergency vehicle operations. Historically, Emergency Medical Services operated as a secondary business attached to funeral homes, furniture stores and other unrelated commercial enterprises. The ambulance was often an afterthought, with some early vehicles serving a dual purpose on the funeral side.
During the late 60s and into the 70s, healthcare delivery, including ambulance service in Ontario, was revised. With more regulations came the first formal edition of ambulance vehicle design specifications. Exterior colour schemes, lighting and patient care equipment hit the top of the government’s priority list—a noble start. Paramedics took a back seat when designers removed the front passenger’s seat from vans to stow patient care equipment, leaving medics to ride in the patient compartment. Can you imagine riding a bench “side-saddle” behind the driver so you could hear the radio and be a spotter for cross traffic?
Terms such as conspicuity and ergonomics were fresh on the regulator’s lips. Ambulances went from dull blue or red to a bright white accented with Omaha orange reflective striping. Once unidirectional and underpowered, emergency lighting sprung to life, employing the evolving technology of strobes, halogen, and ultimately, LED in brilliant flash patterns aging responders could not conceive of. Still, there were gaps in worker protection.
Ambulance design cruised in the minimalist lane, boasting the bare necessities for worker comfort and patient accessibility. Paramedics assumed awkward positions to provide patient care while compromising their safety. Dual stretcher ambulances designed for the interior dimensions of standard vans for non-urgent transfers would not permit paramedics to sit between the stretchers to care for patients. Could you perform adequate CPR from behind the patient’s head?
Our health and safety committee, Pete, Ian, and I, stepped up and defended the principles of patient care using the occupational health platform, seeking improvements. Government inspectors pointed out that the scope of their authority only covered worker safety, not patient care. Inspectors inadvertently enhanced conditions for patients and medics through their mandate to correct our workplace deficiency when we provided and demonstrated specifications for patient care to prove the need to face our patients.
Great strides were made in the late 80s and 90s with patient care equipment and vehicles, yet the improvements were still very narrow in scope. The terms efficiency, sustainability and evidence-based design were not yet on the table. Ambulance designers and manufacturers must take credit at this point for running with their ideas and less formal proposals. Ergonomists were slowly emerging, opining on issues that workers and EMS organizations had previously overlooked or misunderstood.
Starting with outdated tube-style two-way radios and lighting with ancient filaments, electrical demands placed on ambulances soon outgrew automotive manufacturers’ alternator limits. Ambulances arrived, modified with the original version of dual alternators requiring a maze of “V” belts and pulleys to harness the newfound electrical capacity, confounding automotive technicians. Mechanics caught up in the challenge, enjoying the enhanced income to maintain marginally engineered systems that regularly succumbed to their electrical demands.
Emerging ambulance configurations must have left the Society of Automotive Engineers holding their breath in anticipation of the next wave of vehicles hitting the streets. Experts waited in the wings for the technological advances still on the drafting tables. It was the 90s. There were probably a few computer-aided designs in their early stages hiding on PCs. As a young child, I watched out grandma’s door as a horse-drawn wagon arrived with fresh milk twice a week. Fortunately, I missed that era of emergency response.
Join me again for the second of three segments recounting advances in the safety and design of EMS vehicles. Technology, evolving patient care standards and pride in their services contributed to changes instituted by bureaucrats and produced by the manufacturers of emergency response products.