Safety – Security – Injury
Regardless of whether you are working on a DSA, Bariatric or PTS/NES ambulance, the requirements with regard to the use of seat belts and the security of persons is the same, as are the possible consequences if the requirements are not fulfilled. If the vehicle you are working in becomes involved in an incident or accident, which causes the vehicle to stop in any manner other
than in a normal controlled braking manoeuver,loose items and incorrectly secured persons may be subjected to increased forces that may propel them in any directions, with the result that serious or fatal injuries may be sustained.
Single Seats: These should always be facing forward when occupied and the person occupying the seat must be wearing the provided seatbelt. We know that it takes time to rotate the seat and we know that we can’t always manage our patient easily if we turn our seat to face forwards, but that is an exemption that we can claim for ourselves, but we cannot claim any exemption for any patient or relative that is occupying a single seat; they must be facing forward with the seatbelt engaged, when the vehicle is in motion.
The stretcher: The Trust is currently investigating how our ambulance crews can better secure small people and paediatrics on our stretchers, which is a concern that has been voiced by many clinicians in many ambulance services, and we hope to have a safe and acceptable solution in the very near future. However, ambulance crews should be able to secure most patients using the provided straps and harnesses.Currently the number of straps that must be attached to the stretcher and used on every patient, to meet CENrequirements is EIGHT. That number includes the two straps for shoulders, abdomen, upper legs and lower legs.
Our ambulance stretchers have been provided with 8 strapsand these must be checked during the MRCs / VDIs to ensure that they are in situ and the buckles function correctly. Ifproblems or defects are identified with the seatbelt or stretcher harness straps / buckles during the MRCs / VDIs then they must be rectified before going out on the road. If a strap or buckle fails while the crew are with a patient, then the onus is on them to carry out a dynamic risk assessment as to whether they should convey or not. They should inform control of the situation, record the fault in the Vehicle Defect Log Book and also make an entry in the MDT system to ensure that the information is recorded electronically and contemporaneously. Afterwards, when the crew come clear from that patient, they should return to their base or nearest appropriate location to rectify the situation.
The SHOULDER HARNESS is also an integral part of the stretcher and must be employed when securing the patient to the stretcher. If a situation exists whereby the use of the shoulder harness may worsen the patient’s condition, such as traumatic injuries to the shoulders, the senior clinician must carry out a dynamic risk assessment. If having taken this risk assessment they genuinely believe that to use the shoulder harness would seriously and significantly worsen the patient’s condition, the DRIVER must enter a message into the MDT system to this effect, to ensure that the information is recorded electronically and contemporaneously before they depart from scene.
The decision to not employ the shoulder harness must not be taken lightly and the crew must be aware that their decision may result in the patient sustaining further harm, even fatal injuries, if the ambulance is subject to sudden rapid deceleration or a roll over. It is not acceptable to make a note on the paper prf because it cannot be proven that the reason and decision to not use the harness were made prior to the incident occurring. Using the MDT system will time line and electronically record the decision.
There is currently one agreed exemption to the use of the shoulder harness and that is when the patient is being conveyed on the stretcher whilst still secured to the orthopaedic “scoop” stretcher. In this situation, the three lateral pairs of stretcher straps must be threaded under /through the side bars of the “scoop” stretcher and secured over the patient before the stretcher side panels are raised into position. By employing the stretcher side straps in this manner it prevents any movement of the “scoop” stretcher along the length of the main stretcher.
On the occasions that this method is utilised, the crews should ensure that the medics at the receiving hospital are made aware during the handover so that the straps can be released in the correct order while still maintaining the patient securely to the “scoop” stretcher.
The HEAD BLOCK extension is also an integral part of the stretcher and must remain in its intended position at all times. To remove or fail to employ any part of a CEN certificated stretcher, head block or straps, creates a situation where the stretcher is no longer CEN compliant and this means that the person being conveyed on that stretcher is not being afforded the correct level of security that they would have been, if the stretcher was being used in the manner which the manufacturer had intended and specified to meet and achieve the CEN compliance.
East of England Ambulance Service
Branch Health and Safety Officer
Re-issued on 22 January 2017