Ambulances and Patient Satisfaction: Part One

Although the ambulance itself is only one part of a patient’s experience with EMS, it’s certainly an important part. A solid chassis and a good suspension system that cushion the ride and safely bear the weight of the equipment, patient, and EMTs are universally praised. But there are numerous disagreements about other issues, at least some of which have an impact on patient experience and on the results of patient satisfaction surveys.

Although patients are seldom aware of current debates about ideal chassis size, the size of the “box,” who should staff the ambulance, what equipment it should carry, or other matters of concern to EMTs, they are aware of their own comfort—physical and emotional. The patients’ experience is partly based on their bodily senses: sight, smell, sound, and touch, all of which might be highly tuned because of fear and physical discomfort.  Other elements of patient satisfaction (or dissatisfaction) may depend on the comfort of those treating them.

An ambulance that smells or that is unclean is, of course, unpleasant but also frightening: it feels unsafe. The patient may not be aware of the causes of the problem. An ambulance with conventional seats covered with upholstery is more difficult to clean than one with molded seats—but the molded seats may be less comfortable for those who ride on them all day.

From the point of view of EMTs, seats cause considerable dissatisfaction. The old bench seats leave EMTs likely to be physically thrown about and don’t always allow them access to the patient without walking around (anyone who has been an EMT for a while has surely felt the sickening feeling of sliding off a vinyl bench onto the floor or into the wheel well). Some reports recommend—very specifically—high-back, forward facing pedestal seats that include proper restraints, swivel, and, ideally, slide back and forth from the front to the back of the box allowing the EMT to reach equipment and the patient—but there are also reports of those seats breaking. The patient may sense only that the EMT is shifting about and seems uncomfortable or uncertain.

Lights need to be sufficient for patients to see where they are—the sensation of rattling around in a metal box is not a good experience. One plan calls for two separate sets of dimmable LED lights: one for the patient’s comfort and one directed down the interior sides of the compartment.  Also, the patient experience should not be that of rattling around. (As a patient, I spent one trip to the emergency room trying to block the noise of the sirens while hanging on to the edges of the gurney.) Better soundproofing and noise reduction materials (like those on an airplane) would prevent situations where the provider and patient are shouting to hear each other because of highway noise—or situations where shaking and noise interfere with the EMT’s ability to take vital signs or provide care.

Among the issues that make ambulance design difficult is that one size does not fit all. An “ideal” ambulance (if there is such a thing) is of no use in a New England village if it can’t be driven down a partly plowed road on a snowy night. The road is too narrow. And the patients—from neonates to obese adults—may be either too small or too large for “regular-sized” equipment. Ambulance design evolves for different terrain, different patients, and different situations.  The key is to find the one that best fits your needs.

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