Emergency Medical Service (EMS) vehicles, ambulances, are relatively familiar vehicles to those of us in the general community. We see them as "life savers," racing through the streets to provide emergency medical care to the public. However, what are the safety issues that pertain to this important public service and public safety industry? What do we know of the risks and hazards, how can we measure these, and how can we optimize the safety of this system? This paper provides an outline of the known hazards, some tools that can be applied to evaluating these safety issues, some of the current safety challenges and addresses some of the multidisciplinary techniques for optimizing the safety of the system as a whole.

History of EMS

EMS is a relatively new industry, an industry that has an unusual history of beginnings within the mortician industry. Actually, the first ambulances were hearses, usually Cadillacs, vehicles in which occupants could be transported in the recumbent position. Over the past 100 years, the sophistication of the medical care possible to provide in the EMS environment has advanced dramatically, with EMS providers over that short time becoming highly skilled and expertly trained emergency health care professionals-with use of high tech medications and equipment.

Statement of the Problem

The transportation and occupational safety issues pertaining to the delivery of EMS care have not kept pace with the advancement of the medical emergency care provided, nor has it kept pace with the developments of the automotive safety industry. This is possibly due to ambulance graduating from a Cadillac to a combined chassis with a mounted box, somehow outside of the purview of both the automotive safety and also occupational safety and health arenas. Compounding this also is that ambulance vehicles are a very diverse fleet: vans, light and heavy trucks and freightliners. Despite the large strides that the general automotive industry has made in the last 30 years in the safety of passenger vehicles, this expertise has not yet been translated substantively to the safety of ambulance vehicles. There are few safety standards and no crash safety testing guidelines that pertain to ambulance vehicles in the USA. Thus, ascertaining the safety of EMS transport vehicles (and products in that environment) remains limited to expert opinion and peer evaluation in a piecemeal fashion. EMS has been demonstrated recently to be a dangerous profession, and vehicles crashes have been shown to be the most likely cause of a work-related fatalities in EMS (Maguire 625). The most dangerous part of the ambulance vehicle has been demonstrated, in both biomechanical and epidemiological studies, to be the rear patient compartment (Becker 941, Levick 454. 452, 36), which currently is a part of the ambulance vehicle that is largely exempt from the Federal Motor Vehicle Safety Standards (FMVSS).

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