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May 29, 2015

More than just a litter: Advances in patient transport

Being a patient in an ambulance is rarely a relaxing or enjoyable experience. Advances in patient transport are geared towards making the process of ambulance transport simpler, easier, and more comfortable for patients and providers.

As technology develops, the advances to patient transport principles and equipment provide safer, more comfortable transport options. Modifications designed to ease the physical workload of responders, safer ambulance restraints, telemedicine, and equipment geared toward specific patient populations are all areas where state of the art technologies advance patient transport practices.

State of the art gurneys and lifting assistance

Many work-related injuries responders sustain are related to the physical aspects of the job such as lifting and loading patients.[1] The simplistic ambulance cot of years past has been replaced with gradually more advanced patient transport gurneys. The latest from Ferno is the iN∫X™, which has multiple power operated movement options as well as 360 degree lighting for nighttime use.[2] The addition of power cots, particularly those that can be loaded into the ambulance by one responder, allow for safer patient transport while minimizing risks to paramedics and EMTs.

Ambulance mounted lifts provide further assistance in lifting and loading patients into the ambulance. The Mac Ambulance Lift™ platform works similarly to a traditional vehicle wheelchair lift with a larger, cot-sized platform. The Mac Ambulance Lift™ platform stows under the rear bumper of the ambulance and can accommodate loads up to 1,000 pounds.[3] The automatic stretcher lift by Rossbro works in a similar fashion, and can accommodate loads up to 1,100 pounds.[4]

While particularly useful for bariatric patients, mechanical lifts can also accommodate isolettes, and both Ferno and Stryker cots. Lifts are particularly versatile, as the standard gurney mounting system remains in the ambulance while the lift is stowed under the vehicle for use when needed.

The Stryker Power-LOAD™ lift system is mounted to the floor of the patient compartment and can accommodate up to 700 pounds.[5] Designed to work specifically with other Stryker products, the Power-LOAD™ system takes the entire weight of the patient and gurney during lifting and lowering, allowing for very little physical exertion while loading or unloading from the ambulance.

Ambulance safety

The risk of EMS personnel dying in a vehicle accident while working is higher than in any other profession.[6] Over a 20-year period, the average number of vehicle crashes involving an ambulance was 4,500 per year. In accidents where injury or death occurred, the victim was an occupant of the ambulance who was not the driver.[7]

Many advances in patient transport involve creating ambulances that are safer for both responders and patients. Onboard reporting systems that provide weekly data to drivers regarding speed and hard braking have been shown to improve driving habits by slowing average speeds and reducing the number of hard braking events.[8]

In addition, restraint systems for both patients and providers are evolving to provide better security during transport while allowing responders to provide care. Some ambulances are now equipped with mobile restraint harnesses which allow providers to stand up while restrained during transport.[9]

Another design features a forward facing seat next to the patient that slides easily forward and back so the provider can access equipment and provide care while staying seated and restrained.[10]

Ambulance chassis

Although ultimate control over a comfortable ambulance ride rests in the hands of the driver, advances have been made in ambulance suspension that can help minimize bumps and roughness during transport. MOR/ryde™ suspension systems utilize rubber springs to help absorb road shock and create a smoother ride.[11] This system can be installed after market, or installed new by some manufacturers.

The hydraulic Liquid Spring™ CLASS (Compressible Liquid Adaptive Suspension System) includes electronic controls which allow for maximum handling as well as a smooth ride.[12] The CLASS™ microprocessor controls spring stiffness and damping at each wheel, reducing ride harshness while maintaining stability. As a supplement to smooth, safe driving practices, advances in ambulance chassis allow for a more comfortable experience for patients and an easier work environment for providers.

Telemedicine

In-ambulance telemedicine, although not yet widely used, is real-time bidirectional video and audio communication which allows emergency physicians to see and question patients prior to arrival at the emergency department.[13] Telemedicine devices, such as the LifeBot ™, allow for in-ambulance video and audio communication, data transmission, patient data recording, and other integrated features.[14] The addition of telemedicine applications to patient transport could potentially streamline decision making and expedite care for critical or atypical patients.

Pediatric patients

Transporting pediatric patients in an ambulance on a gurney designed for adults can create an unsafe environment for infants and children. One study suggests that there is no satisfactory method to restrain an infant, 3-year old, or 6-year old patient safely using an adult gurney with no additional pediatric-specific equipment,[15] such as Ferno's Pedi-Mate Child Restraint.

Specialized neonatal and pediatric critical care transport ambulances have been in use for some time, however standard ambulances may soon be better equipped to safely transport infants and children. Standard sized seats are now able to be manufactured with concealed child and infant safety seats that can be quickly set up to allow infants and children to be transported securely.

Bariatric patients

Transporting morbidly obese patients via ambulance can be challenging for both the patient and providers. The prevalence of obesity is recognized as a national health crisis, with obesity related health problems also on the rise.[17]

Advances in equipment designed to transport bariatric patients continue to make the care and transport of this patient population more comfortable for all involved. Polyethylene sleds, like the Bariatric Sked™ Stretcher from Skedco, are useful when transporting a patient out of their home or to a safer location at a trauma scene, as the smooth plastic slides easily across many surfaces and very large patients can remain on the sled once hoisted onto a bariatric gurney.[18]

Ambulances equipped with standard gurneys can also carry a bariatric board attachment, which sits on top of the standard gurney and converts it into a wider platform for bariatric use.[19] Bariatric gurneys, specialized ambulances with mechanical lifts, and bariatric specific protocols all allow for safer transport of obese patients.

Transporting patients is the heart of emergency medical service worldwide. With continued focus on utilizing technology and engineering innovation to create equipment designed for patient comfort and safety, patient transports can be focused on providing care in an optimal environment. Easy-to-use gurneys, safer ambulances, integrated technology and specialized equipment all combine to create a patient transport experience designed to cause less stress and discomfort for everyone involved.

References

1. Prairie, Jérôme, and Philippe Corbeil. “Paramedics On The Job: Dynamic Trunk Motion Assessment At The Workplace.” Applied Ergonomics 45.4 (2014): 895-903.

2. “Ferno INX - INX.com.” Ferno INX - INX.com. Web. 16 May 2015.

3. "Mac's Ambulance Lift." (n.d.): n. pag. Mac's Lift Gate Inc. 2011. Web. 18 May 2015.

4. "Bariatric Automatic Stretcher Lift by Rossbro." Bariatric Automatic Stretcher Lift by Rossbro. N.p., n.d. Web. 18 May 2015

5. "Power-LOAD™." Power-LOAD™. N.p., n.d. Web. 18 May 2015.

6. N. R. Levick and J. Swanson, “Managing risk and reducing crashes: implementing a driver performance-measuring device in ground ambulances,” Prehospital Emergency Care, vol. 9, no. 1, p. 108, 2005.

7. National Highway Traffic Safety Administration. “Fatality Analysis Reporting System (FARS) Encyclopedia. www-fars. nhtsa. dot. gov.” Main/index. aspx,(Accessed July, 2008) (2013).

8. De Graeve K, Deroo KF, Calle PA, Vanhaute OA, Buylaert WA. How to modify the risk-taking behaviour of emergency medical services drivers? European J of Emerg Med 2003;10:111-6.

9. Slattery, David E., and Annemarie Silver. “The hazards of providing care in emergency vehicles: an opportunity for reform.” Prehospital emergency care 13.3 (2009): 388-397.

10. “FERNO’s New ‘Proof of Concept’ Ambulance Has the EMS Industry Talking.” - Journal of Emergency Medical Services. 24 Apr. 2015. Web. 16 May 2015.

11. www.morryde.com. Web. 18 May 2015.

12. "CLASS® ." CLASS or Compressible Liquid Adaptive Suspension System by Liquid Spring of Lafayette, Indiana. Web. 18 May 2015.

13. Yperzeele, Laetitia, et al. “Feasibility Of Ambulance-Based Telemedicine (FACT) Study: Safety, Feasibility And Reliability Of Third Generation In-Ambulance Telemedicine.” Plos ONE 9.10 (2014): 1-9. Academic Search Complete. Web. 15 May 2015.

14. “The LifeBot 5: The Most Advanced Mobile Integrated Healthcare in the World.” LifeBot. 2014. Web. 16 May 2015. <http://www.lifebot.us/lifebot5/>.

15. Bigham, B. L., et al. “Patient Safety in Emergency Medical Services.” (2008).

16. “Serenity Safety Products.” Serenity Safety Products. Web. 16 May 2015.

17. Menke, Andy, et al. “Associations Between Trends In Race/Ethnicity, Aging, And Body Mass Index With Diabetes Prevalence In The United States: A Series Of Cross-Sectional Studies.” Annals Of Internal Medicine 161.5 (2014): 328-335.

18. “Bariatric Sked® Stretcher.” Skedco ICal. 2015. Web. 16 May 2015.

19. “LBS Jr. Bariatric Board.” LBS Jr. Bariatric Board. Web. 16 May 2015.

About the Author

Shawna Renga, AS, NREMT-P, currently works as an instructor for the United States Coast Guard Medical Support Services School in Petaluma, Calif., providing EMT training for helicopter rescue swimmers and Coast Guard corpsmen. She also works part-time for a private ambulance company, and lives with her husband and two sons in Sausalito.
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