This is the second installment in a three-part series recounting advances in safety in ambulances to protect patients and Ontario paramedics. If you missed the first post, I encourage you to backtrack and read about my earliest years, starting in 1974. Imagine yourself in the front seat of an Ontario ambulance. That is, of course, if there was a front passenger seat! Many surprises lay ahead in pre-hospital care.
As I was promoted to supervisor, including fleet operations in 1989, things had changed significantly from my earliest days in EMS, where co-workers expressed dubious frowns as I employed the protection of lap-style seatbelts in the ambulance. Advances were being made to improve the working conditions for paramedics and strengthen the patients’ experience. Amid a quickened pace of introducing technology in ambulance design, a low-tech improvement arrived with extended roof profiles in vans, allowing paramedics to work in a less restrictive environment than early SUV body styles. The '60s Chevrolet Suburban's rear interior height forced medics to brace their backs against the roof liners while only being able to perform bent arm CPR, something akin to resuscitating a victim in mom’s freezer.
Following years of a slow but measurable theft rate, EMS units were modified to include an anti-theft button. I will never forget hearing my co-worker Ian’s account of watching his ambulance drive away one night as he stood helplessly in a convenience store. With this new feature, you could remove the keys, allowing paramedics to leave their units secure, engines running, and, if necessary, emergency lights activated. GPS tracking on today’s ambulances has added to EMS supervisors’ resources in the unlikely event of a theft.
Our London health and safety committee shared the victory, changing the dual stretcher ambulance design. The latest Ontario ambulance interiors received a second win during a makeover, adding bright yellow padded corners, head bolsters above doors, and grab rails on the ceiling to protect paramedics during abrupt driving manoeuvres. Additional “safety bars” were installed on the inside of the side and rear doors to the patient compartment, reducing falls while climbing in and out. These features have redeemed all responders at some point. My favourite lifesaver is the “nurse catcher” net. A simple but strong mesh barrier was installed at the squad bench’s front end, preventing passengers from slipping off the seat onto the floor in a collision or hard stop. I loved telling the nurses that it was invented just for them. The upgrade to commercial non-slip flooring replacing household linoleum was also a welcome development.
Enhanced cabinet lighting and dual-intensity interior lights improved working conditions in the patient compartment. Storage for equipment was increasing, keeping life-saving devices secure and within arm’s reach. Redesigned response bag cabinets included dual interior and exterior access, saving paramedics a trip back into the unit at a scene.
EMS colleagues on the American side led the way with the adage, “Go big or go home.” US emergency vehicle manufacturers introduced multiple versions of a custom modular ambulance. EMS chassis became universally identified as Type I, II, III and IV; each offering features suited to the application and community they served. The medical equipment industry continually introduced new and improved patient care and lifting devices, providing more treatment options. Ambulance conversion vendors responded in kind—finally, a place to store and secure the tools of the trade.
Advanced Life Support (ALS), a fixture in the United States, began spilling over the border. Starting with our provincial air ambulance helicopter as a pilot project in the '70s and then as a research project for the land ambulance service in the '80s. The higher level of care was firmly embedded across Ontario during the 90s. The enhanced equipment and supplies validated the added space provided by evolving ambulance body styles. Medications and equipment used in ALS identified a new concern and responsibility: environmental control.
Critical equipment and supplies for the paramedical profession had to be kept cool in the summer and warm in the winter within a temperature range that excluded vehicles previously abandoned outdoors. Anti-theft worked in the past, but by the early 2000s, the low-tech concept outlived its usefulness. Idling ambulances outside emergency rooms drew unwanted attention from hospital staff, cost-conscious EMS administrators and environmentalists.
Sometimes, when you want to save money, you have to spend it. Leaders experienced in the profession and industry talked up the latest technology to unfamiliar ears with the proposition that the changes would save money and improve efficiency. We needed endorsement of the improvements to fund the leap into the future of EMS. Controlling costs on the fleetside and preserving the environment were significant selling points. The right sales pitch would change everything.
Once parked outside stations connected to extension cords and space heaters, extra ambulances fell short of the latest response standards and physical limitations of the onboard high-tech medical devices and supplies. Units parked inside environmentally stable stations utilized their shorelines to keep the medical devices charged and ready. Over ten years ago, thanks to our forward-thinking EMS Chief, our existing county ambulances were retrofitted, and the latest units arrived with environmental and power management monitoring systems, effectively ending the prospect of supplies lost to heat and cold and maintaining response-ready patient compartment temperatures. Middlesex County was the first fleet-wide conversion aimed at helping the environment. This move marked the end of constantly idling vehicles waiting for an assignment. Finally, by default, the results that stole the show were documented fuel cost savings. A win, win for all!
The demand for efficiency, fiscal responsibility and evidence-based design for vehicles and fleet operations drove conversion companies and the emerging industry of peripheral technology into a frenzy. Operational costs were historically seen as a matter of fact. One contributing factor to budgets that had stayed under the radar was responders’ driving habits. Cumulatively, expenditures for fuel, repairs and preventable collisions surfaced with renewed importance. With the latest technology, monitoring the driver’s and vehicle's behaviour provides real-time information to manage the operation. Now, with the science behind the fleet, nothing escaped review.
It should come as no surprise. The most prominent critics of any issue in EMS are the front-line professionals, so the pitch had to hit the mark with paramedics. Sharing the benefits of the new technology and tapping into their experience and passion invited their engagement and support. As we continue to move further into the future, technology will become even more critical to daily EMS operations. We were headed into a new frontier. Stay tuned for the final chapter.