The Lack of Good Paramedic & EMT Protective Equipment

I was reading the EMS News Network today, and was once again struck by the number of bodily assaults and injury accidents suffered by EMS Providers. What makes this problem worse is the lack of good protective equipment available for Paramedics & EMT’s. Every time I see a wreck, I notice 3 or 4 firefighters outside of the car wearing a couple grand in protective equipment, while the Medics inside the car are in wearing Nylon-Polyester uniforms.

Most of the protective equipment that has been developed for EMS is pretty useless, in my opinion. The NFPA Blood borne Pathogen Standards implemented for cold weather coats leave me wondering what they were thinking. This standard requires coats to be fluid impervious. I guess somebody was worried that if you got blood on your coat, it might somehow leak through the garment, and the uniform you have on under the coat, and then through your skin inside the uniform. I don’t get it. I find it most unlikely that you could acquire a blood borne disease in this manner. There is some good news.

At least we now have warm and waterproof Nylon Coats. Other than this singular protective equipment standard, the other NFPA protective equipment standards we use are those for our disposable gloves. The first round of these made just as little sense as the Coat standard. They originally required that each glove be embossed with the NFPA compliance logo. The only problem was, that is was not then nor is it now, technically feasible to emboss on a glove. They wrote a standard that no manufacturer could meet. Makes you wonder.

We are still issued hospital gowns that don’t fit ANYBODY, shoe covers, bouffant head covers and other hospital items that don’t work and rarely if ever get used. This is not new; we have also suffered with Hospital hand-me-downs for decades. We carry ANSI compliant eye protection, but where is it when you need it? We have no other standards for any other specialized protective equipment, specific to ambulance use. In Fire based EMS Systems, they do often issue Turnout Gear, but Turnouts have always been a problem on an ambulance. They are uncomfortable and heavy, bulky and cumbersome. When I did have one, I almost never wore it (maybe once, it was real cold). I had enough trouble trying to figure out where to keep it on the rig.

What we really need is better equipment to protect us from our most common causes of injury. I think one thing we need, is highly abrasion resistant protective apparel for rescue & extrication. It must be fast to don over your uniform, and easy to move in. It must not be bulky or easily snagged up during a rescue. It should offer flash protection, but I don’t see a need for structural firefighting protection. Too much protection just gets in the way, and gets worn less often. It should be ergonomically designed to work in, like when you are on your knees with your arms extended. The closest thing to my ideal is the Aerostich Roadcrafter Suit. If we could get this made in durable FR materials, it would be an awesome protective jumpsuit. It was originally engineered for high-end, mostly BMW motorcycle riders.  I would love to see this premium quality garment design modified specifically for ambulance crew use. 

A move is now underway promoting the use of apparel designed for Wildland Firefighting for use during Auto Extrication. Again, we are trying adapting a standard from a far different workplace to our use. The reason for this is that we have no standards agency looking out for the safety of Paramedics and EMT’s. NFPA is Fire focused; OSHA has too large a mandate. Military Specs are useful, but also do not translate well to our workplace. One standards group I have found useful is the Snell Foundation.

I spoke to people at Snell about Helmets, and was very impressed by their scientific standards process. These are not “consensus” standards like NFPA, where everybody from administrators to manufacturers contributes. Snell Foundation Standards are not subject to outside influence or politics. They are written based on a detailed needs assessment specific to the protective task at hand. How many times have you seen a racecar driver hit a wall and crash at 200MPH, only to get up and walk away? You can thank Snell for that. They write the helmet safety standards used in auto racing. I learned a lot about helmet design from them. I wish they would write a standard for an Ambulance Crew Helmet.

Ever notice how Firefighters always wear helmets? The last hat I saw on a Medic was a baseball cap. Many ambulance agencies in Europe have worn specialized ambulance crew helmets for years. They keep your head on when a nutcase takes a swing. They keep your brains inside when you get in a wreck. They can keep coughed up goobers from getting in your eyes. Just about every single occupation or activity that has a risk of head injury has a helmet standard. Motorcycle riders have helmets, industrial workers have helmets, riot cops have helmets, and even your kid on their bicycle has a helmet. But the guys and gals getting thrown around in the back of a moving ambulance do not.

What kind of helmet do we need in EMS? One interesting standard to review is the military spec for a CVC Helmet (Combat Vehicle Crew). Bouncing around inside a tank is probably closer to the workplace needs of EMS workers than a Fire Helmet. After looking at all the current technology and speaking with several industry experts, I have put together a helmet feature set for consideration. I would appreciate any comments on it from my handful of readers out there. I think the ideal Ambulance Crew Helmet needs to offer the following,

  1. It must offer a full impact liner. It must able to provide protection from not just vertical impacts (like a hardhat), but also lateral impacts caused by hitting the ambulance interior.
  2. It should have a reflective 2" blue Star of Life on the front, and at least 1" high AMBULANCE lettering around the back and sides. The lettering should be applied onto at least a 2" tall yellow retro-reflective surface so that it can be seen at night. 
  3. It should come down low on the back to reduce frontal injuries. It should offer as much head coverage as possible, and still permit use of a stethoscope. 
  4. It should have an integrated task light. The light should not sit on top, or hang outside where it can get hung up. It should also be able to be quickly removed and used by hand.
  5. It should have a retractable safety face shield designed for both splash and impact protection (Spit or Fist). The shield should retract inside the helmet rather than flip over on top. It should be easily replacable.
  6. It should be highly visable and possess both active (photo luminescent), and passive (retro-reflective) nighttime visability enhancements. Refective trim should be at least 2" tall around the sides and back.
  7. It must not have long overhangs that get in the way when working in tight spaces.
  8. It should be as lightweight as possible, and remain securely fastened under load.
  9. It should be resistant to flame, chemicals, and non-conductive.

This is exactly the type of helmet quickly gaining popularity among EMS Providers abroad. The Europeans are now on their second-generation ambulance helmet design, and we should learn from their experience.

Other than those standards that are poorly conceived or specific to firefighting, nobody seems to care much about protecting EMS workers. Not even the Fire Services that employ over half the Medics on the street today. What works firefighting, is not the same thing as what works on the ambulance. What works in the Hospital, is not the same thing that works on the street. What we really need is some new protective equipment standards written by and for experienced EMS professionals, which reflect the realities of our work and the dangers that we face.

I just received the most recent JEMS e-newsletter. It features an article about this very topic

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About Dan White

I'm a retired Paramedic and EMS Instructor with 35 years EMS and emergency medical product experience. I love canoes, cars and EMS. I write about EMS Technology on the Paramedic Blog, the Insights on Innovation column for EMS1.com, on AmbulanceWorld.com and Multibriefs.com. I work for Intersurgical, Inc. managing EMS sales and distribution. I can be reached directly at 573-240-0002. Follow me @Paradan on Twitter
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6 Responses to The Lack of Good Paramedic & EMT Protective Equipment

  1. Kiwicrog says:

    Cheers for the interesting read Dan. I like your insights on ambulance gear and procedure and it often applies even a few continents away! I enjoy looking at how to improve systems and finding equipment to match.I also find it interesting to see the firey\’s working in full protective gear at the same scene as an ambulance officer with a short sleeve polyester uniform.

  2. Robert says:

    This kind of restarts the old us vs. them debate. I have always thought the fire services incorporated the EMS services like a city annexing more land. Not because it was a good idea, but because it brought more revenue and there was no resistance. It\’s a difficult task to make citizens pay for an ultra modern fire service where the majority of the employees sit for 24 hours and don\’t put out fires. Throw a couple of Ambulances in the mix, make fire-fighters respond with them, and suddenly you\’re seen earning your pay all the time. Unfortunately, the new revenue is put into new pumper trucks, ladder trucks, and BIG, bright red Ambulances, as well as a new fire academy, instead of funding and research in EMS. I have never understood the reasoning behind 8 people being on the scen of a diabetic emergency, but every time that fire truck rolls, it\’s another run in the log book, which translates to a bigger budget for the fire department. What money is put back into EMS is done with a Fire Fighters perspective. Give the Paramedic and EMT bunker gear for protection? Thats ridiculous. The winter jacket that meets NAFTA standards is great during the winter in Indianapolis. It isn\’t so great in June in Florida. The CVC helmet is a great idea. The technology exist. Here in the Army we call that using COTS. Commericial, off the shelf. Utilizing something that exist elsewhere without going through the R&D nightmare. We also have lightweight, kevlar gloves, body armor, non-permeable suits that fit, protective mask, and non-lethal munitions. All of which I would have loved to have had at one time or another in the back of an ambulance or on a scene. All in all, I simply believe a third-service setup with a big budget is in all of our best interest. We can\’t keep getting gear with our protection in mind that does not protect and hampers our ability to care.

  3. Ty says:

    Your site always makes for an interesting read, and I appreciate your thoughts on the various issues. We joke umongst each other about using the "rule of thumb" method for distance with any potentially hazardous incident, even the "rule of pinky". We are not provided with the PPE which would allow us to even be on scene of a hazarous incident. We have wildland brush pants as our "protection" when onscene of any potentially hazardous incident, and that is about it. I recall being first onscene of a traffic accident where I had to climb in back to hold c-spine while my partner worked to maintain an airway with nothing to protect from glass, sharp metal, etc. When fire arrived on scene, they gave me a helmet and covered me with a turnout coat while they removed the roof. While such an incident is the exception and not the rule, the proper PPE would have been nice to have available. (not sure I want to look like a giant banana in that suit though…eek)I work in a system where fire responds to all medical calls, and we on the ambulance are subserviant to them. BLS calls are transferred to us for care and transport, while fire rides in and maintains paitent care on all ALS transports.

  4. Unknown says:

    I think a helmet is pushing the edge of too much PPE.  the weight of a helmet puts a lot of strain on your neck when being tossed around in the back of your truck and tends to limit peripherial vision and ability to hear what is going on.  It would also be very uncomfortable in a long transport sittuation where stress is high enugh with out getting med at your helmet.  I can\’t see keeping it on offton enugh to do any more than satisfy my supervisor. 

  5. Dan says:

    Thanks to Everyone
    for the good comments. James, your concerns are well taken. I know the idea of
    wearing a helmet is tough to swallow. I hope by listening to your concerns, we
    can design a helmet for EMS that makes sense. If you want to learn more about
    the risks we face, check out the free Webinar by Dr. Levick from Objective Safety. Over 25% of those
    who die in the line of EMS duty – die of head injuries in the back of the
    rig.  Any decent helmet designed to mitigate these injuries must be
    lightweight, and very comfortable. It must not restrict peripheral vision or
    hearing. As I mentioned in my original post, you must be able to use a
    stethoscope & communications gear, so access to the ear canal is critical.

    I recently found a helmet that passes Z90.1 standards at 22 ounces, with a
    comfortable liner and a well-designed form factor. I am confident that it is
    possible to responsibly design a helmet standard for EMS that does not create a
    whole new set of problems we don\’t need.

  6. bengseng says:

    Hi
    This entry that you wrote is really caught my attention
    May I approach you for some help with an Industrial Design Research Project?
    I am Developing a anti Rioting head gear for paramedics in NSW
    May be I could contact you via Email?
     
    Cheers!
    Sean
    liewbengseng@gmail.com

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