Existing Science on Human Factors and Ergonomics in the Design of Ambulances and EMS Equipment

Abstract

Background: Emergency medical services (EMS) personnel face a disproportionally high risk for fatality and injury due to the nature of their work; and current ambulance and EMS equipment design standards do not adequately safeguard EMS personnel from sacrificing personal safety for patient care, a known human factors and ergonomic (HFE) design challenge. Despite the desire to include HFE interventions or considerations into a standard, the effectiveness of existing HFE interventions for EMS is unclear. Objective: Therefore, this study aimed to synthesize the peer-reviewed literature on the design features of patient compartments and EMS equipment that affect EMS personnel's performance or well-being. Methods: A scoping review methodology was applied to systematically search and screen for relevant articles, and extract data. Three databases (EmBase, Scopus and PubMed) were searched, and search results were screened for articles that pertained to the performance or well-being of EMS personnel when interacting with the patient compartment or its associated equipment. Results and Discussion: Of the 4125 search results, 48 relevant articles were retained, and then sorted into one of three categories: general design, patient handling, and patient transport. It was concluded that, although research has progressed over the past 15 years, more research, development, and resources are needed. Newer generations of ambulances have not been shown to be safer during collisions and there is a knowledge gap in how occupants and contents of a patient compartment behave during a collision. Crash-tests have been performed with restrained occupants and supplies, however, that scenario is unrealistic in the field. While the existing literature provided initial ideas and innovations for improving the HFE of patient

Musculoskeletal health in the workplace

“…Standards and guidelines may be lacking in the following areas: evidence-based data (due to availability), full transparency (conflict of interest in development), scientifically supported methods (controlling for confounding factors, understanding combined and interactive effects), and sensitivity and specificity of threshold values for numerous potential effects [47]. However, when evidence-informed standards and guidelines are well-designed and implemented, their impact has been shown to potentially reduce workplace injuries [38,48,49] and have positive impacts on an organisation's safety, operational and economic performance [50]. For instance, a study by Yung et al [49] evaluated the impact of the new 2018 American Conference of Governmental Industrial Hygienists (ACGIH) guideline for intensive hand activities in manufacturing; authors found in a large US prospective cohort study that this new guideline, when implemented, can prevent between 11% and 25% of cases of Carpal tunnel syndrome in the cohort.…”

Medical fitness to drive, emergency service vehicles and crash risk

“…Patient care during transport is an inherent feature of driving an ambulance. However, this unavoidable element of the job puts ambulance personnel at a higher risk of crash [ 30 ], albeit that the most serious and fatal injuries occur in the rear compartment of an ambulance [ 31 ]. Ambulance design is not directed to occupant protection, and elements such as sharp edges on cabinets, poorly designed seatbelts, and the risk of projectiles put personnel and other occupants at higher risk of injury in a crash [ 30 , 31 ].…”

“…However, this unavoidable element of the job puts ambulance personnel at a higher risk of crash [ 30 ], albeit that the most serious and fatal injuries occur in the rear compartment of an ambulance [ 31 ]. Ambulance design is not directed to occupant protection, and elements such as sharp edges on cabinets, poorly designed seatbelts, and the risk of projectiles put personnel and other occupants at higher risk of injury in a crash [ 30 , 31 ]. Although concerns about the design of ambulances have been documented in earlier studies and improved design recommended [ 22 ], more recent work shows that newer ambulances are not safer for ESV personnel and occupants [ 30 ].…”

“…Ambulance design is not directed to occupant protection, and elements such as sharp edges on cabinets, poorly designed seatbelts, and the risk of projectiles put personnel and other occupants at higher risk of injury in a crash [ 30 , 31 ]. Although concerns about the design of ambulances have been documented in earlier studies and improved design recommended [ 22 ], more recent work shows that newer ambulances are not safer for ESV personnel and occupants [ 30 ]. This demonstrates the need for further investigation into the design of ambulances to mitigate the risk of injury and fatalities in the event of a crash.…”

The Effect of Operator Position on the Quality of Chest Compressions Delivered in a Simulated Ambulance

“…Understanding how paramedics work within an ambulance may address inefficiencies in design and functionality that contribute to the potential for injury to the paramedic and compromise patient care. 19 Limitations This study has a number of limitations. First, the participants were paramedic students rather than experienced and qualified paramedics.…”