SAFETY

[Dale]

the "cargo net" you describe has actually been around in some form for quite some time but like many items, it is slow to catch on in some areas, especially with traditionalists. You will find many strong opinions either for or against it. It does provide an additional level of occupant protection for those that may be sitting on the squad bench who are not wearing the provided seat belt for whatever reason.

Many ambulance dealers and manufacturers specifically refrain from calling it anything but a cargo net since they don't want to imply that it provides any kind of occupant protection or restaint. Ain't that grand- so why provide something that you don't otherwise endorse for occupant safety? There are reasons- see below.

Be warned that some of these so-called "nurse catchers" are actually poorly-designed and consist of questionable-strength webbing that may be fabricated with stitching that does not meet FMVSS standards (like those required for the seat belts.) The nets can also be constructed of much smaller webbing sizes with large "gaps" between the horizontal and vertical "bands that provide questionable "restraint.". Lastly, the attachments for the nets at ceiling and squad bench level can be questionable so in a major deceleration by someone, the fasteners may not be able to handle the impact load.

The best nets are ones manufacturered using the same kinds of webbing, stitching methods, and assembly as those used for seat belts (and not backboard straps!) Look for nets that use quick-connect seat belt hardware to allow for ease of cleaning, secure attachment, and the necessity of removing the net when necessary to access the head of any supine patient on the squad bench (i.e. intubation, BVM ventilation.)

The recent revisions to the AMD (Ambulance Manufacturers Division) of NTEA now include specific performance and testing criteria for such nets to provide an acceptable level of restraint. It requires specific strength testing to demonstrate its ability to handle typical deceleration incidents.

One can only presume that this long needed standard was developed in response to input and experiences by EMS personnel that may have had "less than optimal" experience with some of these net designs on some vehicles.

[Just Plain Ruff]

so who wants to be the test dummy for these nets?

especially the ones of questionable value.

[Richard B the EMT]

For just the reasons Dale posted, it gives a false sense of security. "I don't need a seat belt while in the back, the nurse catcher will get me."

Also, even a well constructed net? Someone will be hitting that net, with momentum, and mass. Will they be hitting it at an angle that won't cause whiplash, or other injuries?

What about a second crewperson in the back, crashing into the first? My girlfriend is a small person, barely weighing 100 lbs, and I tip the scales at north of 350. I do NOT want to think of what would be left of her, were I to be thrown into her at 60 miles an hour.

Just some points to ponder.

[Dale]

actually, the testing is done with a very specific device and parameters as described in the AMD standard. You can find those listed on the NTEA web site under member resources. Go to AMD section to find those revised standards (#1-25) and the new Federal Specification KKK-A-1822 Revision "F" which was just issued.

As for testing "dummies", I have found it unfortunate over the years to have see real folks be the "real" test dummies for products and items installed on ambulances that did not work as expected. As a retired 20-year Paramedic, I have seen many circumstances where something did not provide the level of expectation be it a safety net, oxygen bottle mount, cabinet door latch, etc. It all goes with what someone is willing to invest to buy quality. That goes for anything in life be it a car, clothing, food, etc. You only get what you are smart enough to ask for and willing to pay for!

As a side note, the "new" KKK ambulance standards now offer EMS providers a wider array of "approved" customization and the ability to design a vehicle to suit there requirements (such as occupant seating, locations, warning lights, paint scheme, etc. There are already several different "designs" being built that take advantage of some of these "ideas". Oddly, ambulances under this new specification are only "required" to carry one litter patient. This goes along with some of the European-designed ambulances I have seen. Of course, necessity in rural areas may require that you be able to carry more than one litter patient if you only have one or two available ambulances in your community and respond to an incident with multiple patients that need litter transport.

Speaking of vehicle safety, while Type II ambulances are still "allowable" (even though they have questionable payloads, high centers of gravity, and limited storage capacity) in the new "KKK" spec, it is interesting to note that single-rear-wheel modular ambulances are not longer recognized for new ambulance production. Those were typically a Type II chassis without the integral rear van body.

So the days of the overweight "minimods" are over! Some folks who originally bought those over the years have extended the life of those modules by having the modules remounted onto suitable dual-rear-wheel chassis for much better payload and handling!

[Just Plain Ruff]

Why do we call the ambulance standards KKK?????

that's just a charge of racism waiting to happen.

[Dale]

Yes- I quite agree that the net is not a substitute for adequate occupant restraints and depending upon how you are seated on the bench, the net may not provide much protection at all, much less do anything about adjacent seated occupants "piling on".

Personally, I have always been a big fan of individual high-back adjustable sliding seats with restraints. You can stay buckled in and adjust your seat to be as close or far away from the patient as you need. We have been doing that for many years, mainly with hospital-based vehicles for mobile ICU, CCU, and Neo-natal transport units. Many of those organizations also use aircraft in their operations and see the value of dedicated seating with proper restraints for each crew member. Thank goodness that at least one ambulance seating manufacturer now offers high back seats that can be adjusted to permit a second litter patient to be carried if necessary- of course, it also means that they typical ambulance interior layout will now only permit one medic to ride restrained in the back of the rig unless they also have the left-side "CPR" seating area. You still must get up and work unrestrained on that second litter patient if needed so reassessment of vital signs, etc. becomes a challenge.

The only problem with high-back seating is performing chest compressions during CPR- it is durn near impossible to perform adequate compressions from the seated position. Of course, the ultimate would be to use a mechanical compression device that now seem to be making a comeback in some EMS systems. Anyone recall the old Michigan Instruments "Thumper" or the SurTech "HLR" CPR machines of decades past?

You must admit that if the patient doesn't respond adequately to several rounds of ACLS treatment while on the scene, a mad dash to the hospital in the back of a moving ambulance with questionable CPR by a standing medic isn't really going to make much of a difference, is it? Thank goodness some areas now recognize the futility of such efforts and now allow a code to be "d/c'd" in the field after aggressive resuscitation efforts and consultation with the on-line medical control.

[Dale]

KKK" is shorthand for Federal Specification KKK-A-1822-F. The Federal Government has codified standards using a combination of alpha-numeric designations for everything from toilet paper, computers, and even ambulances. The "KKK" designation simply falls into an section addressing vehicles and simlilar items with the subsequent additional letters and numbers referring to specific items for procurement and revisions of each "standard."

Most folks in the "industry" usually refer to the standards by saying "KKK" or "Triple K" when talking about these standards. They didn't create this "designation" label.

There is nothing racist about it!

[Just Plain Ruff]

come on, you can't tell me that if you were talking to someone about the KKK standards and a person not knowing what you were talking about wouldn't question this?

I mean when even the most miniscule thing can be brought back to racism happens then why wouldn't the uneducated person think this?

We in the business know what the KKK standards are referred to but you can't tell me that someone hasn't questioned this.

It's similar to the argument that you no longer document someone having SOB because it is construed negatively so why is it not feasible that KKK would harken back to racism.

I'm not saying it's racist but I'm not the only one in the services I've worked for that have questioned the initials KKK as not being the most bright set of initials.

[Dale]

hey, I didn't create them. Everyone uses abbreviations, shorthand, etc. for a variety of items in their everyday business activities, including SOB. Many of us do refer to it as "triple KA" when referring to it to be more "politically correct" but no one takes the time to speak the whole thing. That would be really crazy.

As for abbreviations and their meanings, I recalled the first time I heard a control tower at a major airport use the term "SOB" when calling out the crash trucks for an aircraft incident by calling out on the hotline intercom or PA system, "Inbound 727, Engine Fire, Runway 36, 5,000 pounds of fuel (on board), 118 SOBs (souls on board), ETA 10 minutes." That does cause you to ponder until it is explained to you. They may still be using that at airports for all I know.

I recall that lawyers use to love seeing that particular reference on run reports until they were handed a booklet or handout orienting them as to the use of all kinds of medical abbreviations.

Of course, there are some folks think there is something vulgar when the term "Penal Code" is used.

And you are right, there are some folks who will always take offense at the slightless little thing (be it real or perceived) simply so they have some kind of soapbox issue to bring attention to themselves. Maybe their quest for political correctness in the world and the adoption of "neutral" words and expressions should also have a lesson included for themselves called "social tolerance" along with the words "get a life!"

Guess if some folks feel "offended", they should contact their Congressman to express their indignation and suggest all of those millions of documents, etc. with the current references be changed to something less volatile. I am sure they will get right on and spend more of your hard-earned tax dollars righting a perceived "wrong!" Maybe along with changing all of the restroom signs from the gender-specific "MEN" and "WOMEN" that could be taken as offensive to a small group to maybe something more socially-correct, like maybe, "Human"?

[Just Plain Ruff]

Dale, I am in total agreement with you.

It's amazing how little it takes to get someone to pull out the "Woe is me" card.

Not much anymore.

I could go on and on and on but it would do no good.