NIST Technical Note 1772

Survey Report for Ambulance Patient 

Compartment Design

Jennifer Marshall

Y. Tina Lee

Allison Barnard Feeney

Deogratias Kibira

http://dx.doi.org/10.6028/NIST.TN.1772
NIST Technical Note 1772

Survey Report for Ambulance Patient 

Compartment Design

Jennifer Marshall

Law Enforcement Standards Office

Special Programs Office

Y. Tina Lee

Allison Barnard Feeney

Deogratias Kibira

Systems Integration Division

Engineering Laboratory

http://dx.doi.org/10.6028/NIST.TN.1772

January 2013

U.S. Department of Commerce 

Rebecca M. Blank, Acting Secretary

National Institute of Standards and Technology 

Patrick D. Gallagher, Under Secretary of Commerce for Standards and Technology and Director
iii

ABSTRACT

NIST conducted a nationwide survey (Office of Management and Budget, Control No. 1090-

0007) of emergency medical services (EMS) professionals in December 2011. The objective of 

the survey was to aid in the development of design standards for the patient compartment in 

ambulances and to measure customer satisfaction with current design standards. A total of 2537

responses were collected and provided insight into the EMS work environment such as seating, 

occupancy, ergonomics, restraint systems, and communications. The survey provides 

information regarding the EMS professional’s ability to provide care to an injured patient in the 

patient compartment of ambulances with the current reach and usage of equipment and supplies. 

This report summarizes the data collected from the survey responses. 

The survey supports a larger effort to develop standards to address performance and safety issues 

associated with the design of patient compartments in EMS vehicles (i.e., ambulances).

ACKNOWLEDGEMENTS

The U.S. Department of Homeland Security Science and Technology Directorate Human 

Factors/Behavioral Sciences Division and First Responder Resources Group sponsored the 

material presented in this document under interagency agreement #HSHQDC-11-X-00049. We 

would also like to thank BMT Designers and Planners for their assistance in technical support 

and editing, the Department of Interior for guidance and securing Office of Management and 

Budget clearance of the survey in compliance of the Paperwork Reduction Act, and the CFI 

Group for the hosting and collection of results and summation, which formed the basis of this 

report.

Most importantly, we want to thank those who participated in the survey. Your input has been 

truly valuable to this entire effort.

KEY WORDS

ambulance; standard; EMS; EMT; seating; patient compartment; ergonomics; safety; Box I and 

III; restraint systems; ASCI; CPR seat
iv

TABLE OF CONTENTS

Abstract .......................................................................................................iii

Acknowledgements .......................................................................................iii

Key Words...................................................................................................iii

Table of Contents......................................................................................... iv

Terminology................................................................................................. v

Introduction and Methodology........................................................................1

Background – Work-Related Information.........................................................3

Work Environment........................................................................................4

Performance – Usage and Reach of Equipment/Supplies....................................8

ASCI Results..............................................................................................15

Summary....................................................................................................16

Appendix A: Survey Questionnaire ...............................................................18
v

TERMINOLOGY

ACSI American Customer Satisfaction Index

ALS Advanced Life Support

BLS Basic Life Support

EMS Emergency Medical Services

EMT Emergency Medical Technician

CPR Cardiopulmonary Resuscitation

PPE Personal Protective Equipment
1

INTRODUCTION AND METHODOLOGY

Background

The National Institute of Standards and Technology (NIST) provides research-based input to 

standards initiatives in criminal justice, public safety, emergency response, homeland security 

and many other areas. Recently, the U.S. Department of Homeland Security (DHS) Science and 

Technology Directorate’s Human Factors/Behavioral Sciences Division and First Responder 

Resources Group sponsored NIST, the National Institute of Occupational Safety and Health 

(NIOSH), and BMT Designers and Planners (BMT) to form the Ambulance Patient

Compartment Design Project. The purpose of this Project is to develop standards to address 

performance and safety issues associated with the design of patient compartments in emergency 

medical services (EMS) vehicles (i.e., ambulances).

A survey of EMS professionals was conducted in December 2011. These professionals included 

emergency medical technicians (who ride in the back of the ambulance performing emergency 

medical care), dispatchers (those who coordinate EMS activities), and national emergency 

medical services association officials. The survey complements the prior Project efforts, which 

include conducting focus group meetings, practitioner interviews and ambulance ride-alongs 

with emergency medical technicians (EMTs) and representatives within the ambulance industry

during rescue missions. The objective of the survey was to aid in the development of design 

standards for the patient compartment in ambulances and to measure customer satisfaction with 

current design standards. 

NIST worked closely with the CFI Group who administers surveys using the American 

Customer Satisfaction Index (ACSI). The ASCI is the national indicator of customer evaluations 

of the quality of goods and services available to U.S. residents. It is a uniform, crossindustry/government measure of customer satisfaction. This allows benchmarking between the 

public and private sectors and provides information unique to each agency on how its activities 

that interface with the public affect the satisfaction of customers. The effects of satisfaction are 

estimated, in turn, on specific objectives (such as public trust).

Data Collection

The data collection was a collaborative effort between NIST and the Department of the Interior

(DOI). A contractor for DOI (i.e., CFI Group) conducted and hosted the online survey. The U.S. 

Office of Management and Budget, Control No. 1090-0007, per the Paperwork Reduction Act of 

1995, authorized the survey. NIST made the survey link available to respondents via the NIST 

website, the DHS Responder Knowledge Base, EMT organizations (e.g., National Association of 

Emergency Medical Technicians) and through communications directly to individual EMTs. 

Data were collected November 29, 2011, through December 28, 2011. A total of 2537 responses 

were collected and used in analysis. The analysis of the survey is presented in the text and tables 

that follow. The data in the tables include percentages, which may sum 99 % or 101 % because 

of rounding. In addition, the data include frequency of response, for which the totals may be less
2

or more than the number of survey respondents (2537) because some respondents did not answer 

a particular question or because multiple responses were allowed since the options are not 

mutually exclusive, respectively.

Reporting

The questionnaire used is shown in Appendix A. The questionnaire was developed through a 

collaborative effort between DOI, CFI Group, NIST, and BMT Designers and Planners. 
3

BACKGROUND – WORK-RELATED INFORMATION

The survey showed that 72 % of respondents are career EMS providers affiliated with ambulance 

service. Twenty percent (20 %) are volunteers, i.e., skilled persons but not paid for their 

emergency medical services, while 3 % are trainers. Most respondents (89 %) work in a Box 

type ambulance (Type I and Type III). Only 9 % of the EMS providers work in a Van type 

ambulance (Type II). The services typically performed by EMS providers are initiated by a 911 

call as shown by 84 % of respondents. Regarding level of service, advanced life support (ALS) is 

the service typically performed by 76 % while basic life support (BLS), as the typical service, is 

mentioned by 61 % of respondents. Just under half (47 %) of the respondents report that they 

typically simply transport the patient without emergency medical care performed in transit to a 

medical facility.

With respect to the average transit time of patient to a hospital, approximately three-fourths of 

respondents say their transit time is between 6 minutes and 20 minutes. A further breakdown 

shows that the 11 minute to 15 minute transit range occurred 29 % of the time, while 24 % fall 

into the 6 minute to 10 minute range and 21 % are in the 16 minute to 20 minute range. 

Response Count

Percent Frequency

Affiliation with ambulance service

EMS Provider – Career 72 % 1825

EMS Provider – Volunteer 20 % 507

Other 5 % 138

Trainer 3 % 67

Number of Respondents 2537

Average transit time with a patient to a hospital

5 minutes or less 3 % 88

Between (6 and 10) minutes 24 % 604

Between (11 and 15) minutes 29 % 742

Between (16 and 20) minutes 21 % 538

Between (21 and 30) minutes 14 % 362

More than 30 minutes 8 % 203

Number of Respondents 2537

Type of ambulance do you usually work in

Box (Type I and III) 89 % 2269

Van (Type II) 9 % 216

Other 2 % 52

Number of Respondents 2537

Type of service typically performed *

911 84 % 2122

ALS 76 % 1924

BLS 61 % 1546

Transport 47 % 1202

Number of Respondents 2537
4

WORK ENVIRONMENT

Seating

The most commonly used seat by EMS providers is bench seating with 72 % of the mentions, 

while bucket seats are used by one-quarter (25 %) of respondents. Side-facing seating in the 

patient compartment is preferred by over half (54 %) of respondents and just under one-quarter 

(23 %) prefer rearward-facing seating. Forward facing is only preferred by 9 % of the 

respondents, while 14 % had no preference. Eighty percent of the respondents recommend a CPR 

seat in the patient compartment. 

Response Count

Percent Frequency

Type of seat do you currently use

Bench 72 % 1816

Bucket 25 % 626

Other 4 % 95

Number of Respondents 2537

Seating orientation you prefer in the patient compartment

Side-facing 54 % 1373

Rearward-facing 23 % 591

Forward-facing 9 % 221

No preference 14 % 352

Number of Respondents 2537

Recommend a CPR seat in the patient compartment

Yes 80 % 1721

No 20 % 443

Number of Respondents 2164

Occupancy/Transport

It is rare to transport more than one patient at a time because just 2 % of respondents report that 

transporting more than one patient occurs more than one-quarter of their trips. On the other hand, 

eighty-six percent (86 %) of the EMS providers either never transport more than one patient or 

have done so less than 10 % of the time. With respect to the capacity of their ambulance, 78 % of 

the EMS providers can safely transport two patients and another 14 % can safely transport three 

patients. Safely, in this context, refers to transporting a person that is using some form of 

restraint systems to reduce risk of injury in case of a vehicle crash or sudden turn. The capability 

to transport more than three patients is reported by only 9 %. 
5

Response Count

Percent Frequency

Percent of time you transport more than one patient

Never 7 % 176

Less than 10 % 79 % 2011

Between 10 % and 25 % 12 % 304

Between 26 % and 50 % 1 % 30

More than 50 % 1 % 16

Number of Respondents 2537

Number of patients you have the capability to safely 

transport

2 78 % 1986

3 14 % 343

4 6 % 146

5 2 % 45

More than 5 1 % 17

Number of Respondents 2537

Ergonomics

The capability to reach controls by EMS personnel, especially from a seated or restrained 

position, is a major concern for ambulance services. Approximately half of respondents cannot 

reach at least one of the major controls, i.e., lighting, ventilation, or radio. Just 37 % can reach all 

needed controls, but nearly 39 % indicate that they cannot reach all of the three major controls

mentioned. Two-thirds (65 %) of the respondents had no concerns about the gurney/stretcher. 

Security of the gurney/stretcher is an issue for one-quarter (25 %) of respondents, while its 

location is a concern for 14 %. Orientation is much less of a concern since only 8 % think it is an 

issue.

Response Count

Percent Frequency

Cannot reach from seat *

Lighting 50 % 1260

Radio 49 % 1242

Ventilation 50 % 1275

I can reach all needed controls 37 % 951

Other 11 % 282

Number of Respondents 2537

Gurney-stretcher concerns *

Location of the gurney/stretcher 14 % 344

Orientation of the gurney/stretcher 8 % 197

Security of the gurney/stretcher 25 % 624

I have no concern about the gurney/stretcher 65 % 1650

Number of Respondents 2537
6

Restraint Systems

Lap belts are in 79 % of ambulances, while nearly one-third (32 %) have lap and shoulder belts. 

Four-point, five-point and seven-point restraints are relatively uncommon with only 16 % having 

one of these types in their ambulance. Respondents are split on wearing restraints when not 

treating the patient with just over one-third (36 %) claiming they nearly always wear them (more 

than 90 % of the time) and the same percentage (36 %) saying they rarely wear restraints (less 

than 15 % of the time). However, when treating the patient, respondents were more consistent 

since just over three-quarters (76 %) rarely wear them (less than 15 % of the time). Only 3 % of 

respondents indicate that they nearly always (more than 90 % of the time) wear their restraints 

even when treating the patient. 

Regulations on seatbelt usage are somewhat common with nearly half (48 %) having either State 

or Organization regulations requiring the usage of seatbelts. District (9 %) and County (13 %) 

regulations were less common. Awareness of regulations is not very extensive, since one-quarter 

(25 %) of respondents did not know if there were regulations on seat belt usage. 

Response Count

Percent Frequency

Restraints in patient comp *

Lap belt 79 % 2012

Lap and shoulder belt 32 % 821

4-point 7 % 184

5-point 9 % 229

7-point 0 % 11

Other 2 % 56

Number of Respondents 2537

Time wearing restraint system in patient compartment when 

NOT treating patient

Less than 15 % 36 % 917

Between 15 % and 40 % 10 % 249

Between 41 % and 65 % 7 % 189

Between 66 % and 90 % 11 % 277

More than 90 % 36 % 905

Number of Respondents 2537

Time wearing restraint system in patient compartment when 

treating patient

Less than 15 % 76 % 1933

Between 15 % and 40 % 11 % 276

Between 41 % and 65 % 7 % 175

Between 66 % and 90 % 3 % 82

More than 90 % 3 % 71

Number of Respondents 2537
7

Response Count

Percent Frequency

Regulations seat belt usage *

District 9 % 221

County 13 % 318

State 48 % 1206

Organization 48 % 1219

Don ́t know 25 % 632

Other 7 % 168

Number of Respondents 2537

Communications

The majority of ambulances (62 %) are equipped with a computer system. As to how 

respondents would like to receive information from the driver, verbal is most preferred with 54 

% of mentions. Visual displays are the second most preferred with 37 % and notification lights 

are close behind with 31 % of mentions. Very few (9 %) would want to receive information from 

the driver by radio. In fact, the same percentage would not want to receive information at all.

Response Count

Percent Frequency

Ambulance equipped with a computer system

Yes 62 % 1552

No 38 % 942

Number of Respondents 2494

Receive info from driver *

Verbally/yelling 54 % 1381

Radio 9 % 225

Visual Displays 37 % 941

Notification lights 31 % 785

Would not want to receive information 9 % 229

Other 7 % 186

Number of Respondents 2537
8

PERFORMANCE – USAGE AND REACH OF 

EQUIPMENT/SUPPLIES

Respondents were asked how frequently they use the following equipment/supplies and how 

easy the equipment/supplies are to reach. 

Ventilation/Respiration Equipment

Stationary oxygen is used a majority of the time (50 % or more) by 81 % of respondents, while 

portable oxygen is used a majority of the time by 65 % of respondents. Most of the other 

ventilation/respiration equipment is used infrequently. Only 21 % use resuscitator with oxygen 

inlet and masks a majority of the time. Non-manual suction devices, portable suction devices and 

mouth-to-mask ventilators are used a majority of the time by 10 % or fewer of the respondents. 

In the case of the mouth-to-mask ventilator 41 % never use it.

Frequency of use

Portable oxygen Stationary oxygenResuscitator with oxygen inlet masksMouth-to-mask ventilator with oxygen inletNon-manual suction devicePortable suction deviceOther

100 % 5 % 7 % 2 % 1 % 1 % 1 % 4 %

75 % to 99 % 31 % 45 % 8 % 3 % 3 % 2 % 7 %

50 % to 74 % 29 % 29 % 11 % 5 % 6 % 5 % 7 %

25 % to 49 % 16 % 13 % 18 % 10 % 16 % 12 % 4 %

1 % to 24 % 16 % 5 % 50 % 40 % 67 % 71 % 7 %

0 % 3 % 1 % 10 % 41 % 7 % 9 % 71 %

With respect to difficulty of reach for ventilation/respiration equipment, those equipment most 

frequently used, stationary and portable oxygen, are difficult to reach for most. Half (51 %) need 

to leave their seat to reach the portable oxygen and 18 % can reach it with strain. Slightly fewer 

need to leave their seat (40 %) to reach the stationary oxygen, but another 20 % can only reach it 

with strain. The rarely used portable suction device is the most difficult to reach 

ventilation/respiration item since 71 % need to leave their seat to reach it.
9

Difficulty of reach

Portable oxygen Stationary oxygenResuscitator with oxygen inlet masksMouth-to-mask ventilator with oxygen inletNon-manual suction devicePortable suction deviceOther

Reach without strain 32 % 40 % 26 % 26 % 36 % 14 % 15 %

Reach with strain 18 % 20 % 20 % 20 % 20 % 14 % 17 %

Unable to reach without 

leaving seat 51 % 40 % 54 % 55 % 44 % 71 % 68 %

Diagnostic Equipment

Stethoscopes and blood pressure monitors are the diagnostic equipment most used. Nearly all 

respondents (96 %) use a stethoscope a majority of the time and nearly as many use the blood 

pressure monitor (95 %). The oximeter (88 %), blood glucose meter (68 %) and diagnostic light 

(59 %) were all frequently mentioned as being used a majority of the time as well. Thermometers 

were somewhat less frequently used since only 30 % use them a majority of the time and 28 %

never use them.

Frequency of use

OximeterStethoscopeThermometerBlood glucose meterDiagnostic lightBlood pressure monitorOther

100 % 36 % 59 % 8 % 12 % 19 % 62 % 5 %

75 % to 99 % 41 % 30 % 10 % 30 % 22 % 28 % 6 %

50 % to 74 % 11 % 7 % 12 % 26 % 18 % 5 % 4 %

25 % to 49 % 5 % 2 % 14 % 16 % 16 % 2 % 2 %

1 % to 24 % 2 % 1 % 27 % 8 % 12 % 1 % 2 %

0 % 4 % 1 % 28 % 8 % 13 % 3 % 82 %

Stethoscopes are relatively within reach since 77 % can reach them without strain. The majority 

of respondents (57 %) can reach the blood pressure monitor without strain and one-fifth (21 %) 

of EMS workers have to get out of their seat to reach it. The oximeter can be reached without 

strain by 51 %, while one-quarter (26 %) need to get out of their seat to reach it. The 

thermometer, a rather infrequently used diagnostic equipment, requires 41 % to leave their seat 

to reach it. The blood glucose meter, however, was frequently used by 68 % but was difficult to 

reach with one-third (32 %) having to leave their seat to reach it.
10

Difficulty of reach

OximeterStethoscopeThermometerBlood glucose meterDiagnostic lightBlood pressure monitorOther

Reach without strain 51 % 77 % 36 % 46 % 59 % 57 % 33 %

Reach with strain 23 % 12 % 23 % 22 % 18 % 22 % 19 %

Unable to reach without 

leaving seat 26 % 11 % 41 % 32 % 22 % 21 % 48 %

Infusion Material or Equipment

Infusion solutions and equipment for injections and infusions are somewhat frequently used 

since 57 % use infusion solution a majority of the time, while 53 % use equipment for injections 

and infusions a majority of the time. Infusion mounting is used frequently by 43 % of 

respondents, while one-quarter (26 %) never use them. Pressure infusion devices and infusion 

system for administration of warm fluid are infrequently used since only 13 % and 19 %, 

respectively, mention using them a majority of the time. Additionally, the infusion system for 

administration of warm fluid is not used at all by half (51 %) of EMS workers.

Frequency of use

Infusion solutionsEquip for injections infusionsInfusion sys for admin warm fluidInfusion mountingPressure infusion deviceOther

100 % 4 % 4 % 2 % 4 % 2 % 2 %

75 % to 99 % 23 % 20 % 6 % 16 % 4 % 2 %

50 % to 74 % 30 % 29 % 11 % 23 % 7 % 3 %

25 % to 49 % 19 % 19 % 10 % 18 % 8 % 2 %

1 % to 24 % 8 % 11 % 20 % 12 % 42 % 3 %

0 % 16 % 16 % 51 % 26 % 37 % 89 %

The infusion materials and equipment that are more frequently used are difficult to reach since

only one-fifth (20 %) can reach infusion solutions without strain and nearly three-fifths (58 %) 

need to leave their seat. Similarly, the equipment for injections and infusions is nearly as difficult 

to reach with only one-quarter (24 %) able to reach them without strain while 55 % need to leave 

their seat. Those rarely used infusion materials and equipment are the most difficult to reach 

since 71 % are unable to reach pressure infusion devices or infusion systems for administering 

warm fluid without leaving their seats.
11

Difficulty of reach

Infusion solutionsEquip for injections infusionsInfusion sys for admin warm fluidInfusion mountingPressure infusion deviceOther

Reach without strain 20 % 24 % 14 % 16 % 13 % 21 %

Reach with strain 22 % 22 % 15 % 25 % 15 % 14 %

Unable to reach without 

leaving seat 58 % 55 % 71 % 59 % 71 % 66 %

Equipment for Managing Life-Threatening Situations

In general, much of the equipment for managing life-threatening situations is used less 

frequently. While cardiac monitors are used a majority of the time by 69 % of respondents, the 

next most used is the defibrillator with rhythm and patient data recording since 41 % of 

respondents use this equipment a majority of the time. The nebulization apparatus (23 %), 

capnometer (20 %) and external cardiac pacing (20 %) are the only other equipment with at least 

20 % using them a majority of the time. 

Central vein catheters, volumetric infusing devises and thorax drainage kits are the least used 

equipment since a sizable majority report never using these.

Frequency 

of use

Defibrillator with rhythmand patient data recordingCardiac monitorExternal cardiac pacingPortable Resuscitation SystemNebulization apparatusThorax drainage kitVolumetric infusing deviceCentral vein cathetersPEEP-valveCapnometerOther

100 % 7 % 13 % 4 % 3 % 2 % 1 % 1 % 1 % 2 % 3 % 1 %

75 % to 99 % 18 % 33 % 8 % 3 % 5 % 1 % 2 % 2 % 1 % 6 % 1 %

50 % to 74 % 16 % 23 % 8 % 6 % 16 % 2 % 3 % 3 % 4 % 11 % 1 %

25 % to 49 % 13 % 11 % 10 % 9 % 27 % 2 % 5 % 3 % 7 % 15 % 1 %

1 % to 24 % 38 % 7 % 50 % 34 % 37 % 27 % 25 % 11 % 30 % 36 % 4 %

0 % 8 % 12 % 19 % 45 % 13 % 66 % 64 % 79 % 56 % 30 % 91 %

The more frequently used cardiac monitor and defibrillator are easier to reach than other 

equipment in this category, but many struggle to reach them. Forty-one percent of respondents 

had to leave their seat to reach the defibrillator and 37 % had to get up to reach the cardiac 

monitor. Rarely used equipment for managing life-threatening situations were the most 

unreachable. Seventy-one percent (71 %) cannot reach the thorax drainage kit and 70 % cannot 

reach the volumetric infusing devises without leaving their seat.
12

Difficulty of 

reach

Defibrillator with rhythmand patient data recordingCardiac monitorExternal cardiac pacingPortable Resuscitation SystemNebulization apparatusThorax drainage kitVolumetric infusing deviceCentral vein cathetersPEEP-valveCapnometerOther

Reach without 

strain 36 % 38 % 37 % 22 % 22 % 13 % 12 % 20 % 18 % 33 % 23 %

Reach with 

strain 23 % 24 % 24 % 19 % 24 % 16 % 18 % 17 % 20 % 22 % 15 %

Unable to reach 

without leaving 

seat 41 % 37 % 39 % 59 % 54 % 71 % 70 % 63 % 62 % 45 % 62 %

Supplies/Bandaging/Nursing/Personal Protective Equipment

The most commonly used supplies include non-sterile gloves for single use, sharps containers

and blankets. Eighty-three percent (83 %) use non-sterile gloves a majority of the time, while 69 

% use sharps containers and 67 % use blankets a majority of the time. Less frequently used 

supplies include materials for treatment of wounds, vomiting bag and sterile surgical glove pairs. 

Materials for treatment of wounds are used a majority of the time for 34 % of respondents, while 

22 % mention using vomiting bag and sterile surgical gloves a majority of the time. The kidney 

bowl, bedpan, non-glass urine bottle and hazardous material suits are the least frequently used 

supplies.

Frequency 

of use

BlanketsMaterial for treatment of woundsMaterial for burns and corrosivesKidney bowlVomiting bagBedpanNon-glass urine bottleSharps containerSterile surgical gloves pairsNon-sterile gloves for single useHazardous materialsuitsOther

100 % 16 % 3 % 3 % 2 % 3 % 2 % 2 % 11 % 13 % 62 % 1 % 1 %

75 % to 99 % 28 % 8 % 4 % 2 % 5 % 2 % 2 % 30 % 5 % 16 % 1 % 1 %

50 % to 74 % 23 % 23 % 8 % 6 % 14 % 4 % 3 % 28 % 4 % 5 % 2 % 1 %

25 % to 49 % 18 % 37 % 15 % 11 % 26 % 6 % 6 % 16 % 5 % 4 % 2 % 1 %

1 % to 24 % 14 % 29 % 67 % 46 % 48 % 59 % 56 % 12 % 41 % 6 % 42 % 3 %

0 % 1 % 1 % 4 % 33 % 5 % 28 % 31 % 3 % 32 % 7 % 52 % 92 %

The frequently used sharps container is the only item that can be reached without strain by a 

majority of respondents (56 %). Two-thirds of EMS workers use blankets a majority of the time

and 59 % have to leave their seat to reach them. One-third (35 %) of the respondents had to leave 

their seat to reach the frequently used non-sterile gloves. Rarely used items are out of reach for 
13

most EMS workers. Fewer than 10 % can reach the bedpans or non-glass urine bottles without

strain and only 6 % can reach their hazardous material suit.

Difficulty 

of reach

BlanketsMaterial for treatment of woundsMaterial for burns and corrosivesKidney bowlVomiting bagBed-panNon-glass urine bottleSharps containerSterile surgical gloves pairsNon-sterile gloves for single useHazardous materialsuitsOther

Reach 

without 

strain 23 % 16 % 11 % 13 % 28 % 9 % 9 % 56 % 23 % 45 % 6 % 21 %

Reach with 

strain 18 % 25 % 21 % 18 % 24 % 12 % 12 % 25 % 18 % 20 % 8 % 12 %

Unable to 

reach 

without 

leaving seat 59 % 59 % 68 % 69 % 48 % 78 % 79 % 19 % 58 % 35 % 87 % 67 %

Medicine Storage

The jump bag is used a majority of the time by 78 % of respondents, while locked narcotics are 

only used a majority of the time by one-quarter (25 %) of respondents.

Frequency of use

Jump bagLocked narcoticsOther 

100 % 39 % 5 % 2 %

75 % to 99 % 25 % 6 % 1 %

50 % to 74 % 14 % 14 % 2 %

25 % to 49 % 9 % 22 % 2 %

1 % to 24 % 9 % 36 % 3 %

0 % 4 % 18 % 91 %

Despite its frequent use, nearly half of respondents cannot reach the jump bag without leaving 

their seat. Locked narcotics are only accessible without strain to 17 % of EMS workers.

Difficulty of reach

Jump bagLocked narcoticsOther

Reach without strain 27 % 17 % 24 %

Reach with strain 23 % 12 % 12 %

Unable to reach without 

leaving seat 49 % 71 % 64 %
14

Communications

Mobile radio transceivers are always used by 44 % of respondents and three-quarters (75 %) use 

them a majority of the time. Portable radio transceivers have slightly lower usage with one-third 

(34 %) using them all the time and two-thirds (65 %) using them a majority of the time. 

Intercoms are used with much less frequency; only 12 % report using them a majority of the time 

and three-quarters (74 %) never use them. Cell phones are used somewhat frequently in 

ambulances, but less so than mobile or portable radios since only 54 % use cell phones a 

majority of the time

Difficulty of reach

Mobile radio transceiverPortable radio transceiverIntercomCell phoneOther 

Reach without strain 47 % 73 % 49 % 72 % 45 %

Reach with strain 15 % 9 % 15 % 9 % 13 %

Unable to reach without 

leaving seat 38 % 18 % 36 % 19 % 42 %

Although they are not quite as frequently used as mobile radios, portable radio transceivers are 

much more accessible. Nearly three-quarters (73 %) can reach portable radio transceivers 

without strain, while just under half (47 %) can reach mobile radio transceivers. Surprisingly 19 

% cannot reach a cell phone without leaving their seat. 

Frequency of use

Mobile radio transceiverPortable radio transceiverIntercomCell phoneOther 

100 % 44 % 34 % 6 % 24 % 3 %

75 % to 99 % 22 % 20 % 3 % 18 % 1 %

50 % to 74 % 9 % 11 % 3 % 12 % 1 %

25 % to 49 % 6 % 8 % 3 % 10 % 1 %

1 % to 24 % 10 % 15 % 10 % 19 % 1 %

0 % 9 % 12 % 74 % 18 % 94 %
15

ASCI RESULTS

Respondents were asked about their satisfaction with the current design standards in ambulances 

using the ACSI methodology. The ACSI asks three questions which include overall satisfaction, 

satisfaction compared to expectations and satisfaction compared to the ideal. Scores indicate that 

EMS workers are quite unsatisfied with the current design standards with a CSI (Customer 

Satisfaction Index) of just 49. This value is 18 points below the federal government average of 

67 and indicates a strong need to revamp the design standards.

In addition to asking respondents to rate their satisfaction with design standards, they were asked 

to rate their work environment, ergonomics, restraint systems and communications. The scores 

in the table are ratings on a 0 to 100 scale and not percentages.

Three questions were asked to gauge how well the work environment allowed EMS workers to 

do their jobs. Questions were asked on a scale of 1 to 10, where “1” is “strongly disagree” and 

“10” is “strongly agree.” Scores are reported on a 0 to 100 scale. The location and height of seats 

providing reach was somewhat of an issue with a rating of 61. However, seating allowing EMS 

workers to do their jobs rates even lower (55) and seat location/height providing sufficient reach 

to equipment/supplies (46) is even a greater issue.

With respect to ergonomics, respondents somewhat agree with the statement that there is enough 

room and general mobility around the ambulance patient compartment when taking care of the 

patient (64). The ergonomic features scored 50 on a “poor” to “excellent” scale with “0” being 

“poor” and “100” being excellent. Clearly, the feeling is that there is room to improve the 

ergonomic features.

In conjunction with the feelings about ergonomics, with a score of just 28, the overwhelming 

feeling was that the restraint system features do not allow EMS workers to do their jobs. EMS 

workers did feel rather strongly that moving within the ambulance unrestrained is just an 

inherent risk that comes with caring for patients (77).

While scores for communications systems were not strong, respondents felt somewhat more 

positive about communication systems allowing them to do their job with a score of 63. 
16

SUMMARY

The survey of over 2,500 EMS workers provides insights into their attitudes and behaviors with 

regard to ambulance design. Most of the respondents are career EMS providers who work 

primarily in Box Type I or III ambulances. While just under half perform transport, they 

generally perform 911, ALS, BLS or a combination of these services.

Bench seating is the most commonly used seat type and side facing is the most preferred 

orientation. Eighty percent would recommend a CPR seat in the patient compartment. It is 

somewhat rare for an EMS to transport more than one patient since 86 % report doing so less 

than 10 % of the time. Although over three-quarters can safely transport two patients and nearly 

one-quarter can transport three or more.

In the work environment reaching controls is an issue since half of EMS workers reported not 

being able to reach at least one of the following controls: lighting, ventilation or radio. While 

gurney or stretcher security is an issue for one-quarter of respondents, nearly two-thirds have no 

concerns about the gurney or stretcher.

Lap belts were in nearly four-fifths of ambulances, while lap and shoulder restraints were in onethird. Four, five and seven-point restraints are somewhat uncommon since only 16 % have these 

systems in their ambulances. When not treating a patient, just over one-third of respondents said

they always wear their restraint system and the same amount said they almost never wear it. 

However, when treating a patient only 3 % said they almost always wear it, while three-quarters 

never or almost never wear it. Seatbelt regulations are in effect at the state and organization level 

for nearly half the respondents. However, one-quarter did not know if there are any such 

regulations.

With respect to communications, almost 60 % of ambulances have a computer system. As far as 

receiving information from the driver, over half of EMS workers prefer verbal. The mobile radio 

transceiver is most frequently used, however, well over one-third cannot reach it without 

standing. The portable radio, while used slightly less than the mobile, is much more accessible 

with nearly three-fourths reaching it without strain.

The ventilation and respiration equipment most often used is stationary or portable oxygen. 

However, these are difficult to reach with half having to leave their seats to reach portable 

oxygen. Diagnostic equipment that is most frequently used includes stethoscopes, blood pressure 

monitors and oximeter. While stethoscopes are within reach for over three-quarters of EMS 

workers, oximeters and blood pressure monitors are slightly more difficult to reach in a seated 

position.

Infusion solutions and equipment for infusions and injections are used a majority of the time by 

over half of EMS workers. However, these are mostly difficult to reach since over half need to 

leave their seat to reach them. Cardiac monitors and defibrillators are the equipment for 

managing life-threatening situations that are most commonly used. Reach is somewhat 

problematic since just over one-third can reach these devices without strain. Other supplies that 
17

are frequently used include blankets, non-sterile gloves and sharps containers. Nearly threefifths of the time EMS workers need to leave their seats to reach a blanket. Sharps containers are 

somewhat reachable since four-fifths can reach them, including those who can do so with strain. 

The satisfaction index of EMS workers with ambulance design standards is quite low (49) and 

indicates a need to revise the current standards. Rating questions show that EMS workers feel 

that the work environment in terms of seating is not very conducive to treating patients, nor does 

it provide sufficient reach to equipment or supplies. Ergonomics are poor and somewhat limit 

mobility around a patient when treating them. Most of all, EMS workers strongly believe that 

restraints do not allow them to do their job and that moving within the ambulance while 

unrestrained is an inherent risk in treating the patient.
18

APPENDIX A: SURVEY QUESTIONNAIRE

NIST - Ambulance Design Standards

2011 Customer Satisfaction Questionnaire

Final

Introduction

The U.S. Department of Homeland Security Science and Technology Directorate Human Factors and Behavioral 

Sciences Division is teaming with the National Institute of Standards and Technology (NIST), the National Institute 

for Occupational Safety and Health (NIOSH) and BMT Designers and Planners to aid in the development of 

standards for the design of patient compartments in ambulances. In conjunction with that goal, this survey is also 

measuring satisfaction with current design standards.

This survey is being administered by CFI Group. All information you provide will be combined with information 

from other respondents for research and reporting purposes. Your individual responses will not be released. This 

survey will take about 15 minutes of your time.

If you have any questions about this survey, please contact (CONTACT EMAIL).

This survey is authorized by the U.S. Office of Management under Budget Control No. 1090-0007.

Work-related Information

Please tell us a bit about your work background. The following questions will be used for categorizing your 

responses only:

1. What is your affiliation with ambulance service?

1. EMS Provider – Volunteer

2. EMS Provider – Career

3. Trainer

4. Other (Please specify) 

2. What is your average transit time with a patient to a hospital? 

1. 5 minutes or less

2. Between 6 minutes to 10 minutes

3. Between 11 minutes to 15 minutes

4. Between 16 minutes to 20 minutes

5. Between 21minutes and 30 minutes

6. More than 30 minutes

3. What type of ambulance do you usually work in?

1. Box (Type I and III)

2. Van (Type II)

3. Other (Please specify)
19

4. What type of service does your ambulance typically perform? (Select all that apply.)

1. Transport

2. 911

3. BLS

4. ALS

Work Environment

Please tell us about your preferences for ambulance seating.

5. What type of seat do you currently use? 

1. Bench

2. Bucket

3. Other (Please specify)

6. What seating orientation do you prefer in the patient compartment?

1. Side-facing

2. Rearward-facing

3. Forward-facing

4. No preference

7. Do you recommend a CPR seat in the patient compartment?

1. Yes

2. No

3. No preference

Please indicate the extent to which you agree or disagree with the following statements. Use a scale from “1” to 

“10”, where “1” is “strongly disagree” and “10” is “strongly agree.”

8. The location and height of the seats provide me with sufficient reach to the patient.

9. The location and height of the seats provide me with sufficient reach to equipment and supplies.

10. Thinking about the type of ambulance you typically work in, please rate the seating in the patient 

compartment in terms of allowing you to do your job. Use a 10-point scale, where “1” means “poor” and 

“10” means “excellent.”

10a. Please provide any comments you have on ambulance seating.

Occupancy

The following questions ask about your experiences with ambulance occupancy and patient transport.

11. What percent of the time do you transport more than one patient?

1. Never

2. Less than 10 % 

3. Between 10 % and 25 %

4. Between 26 % and 50 %

5. More than 50 %
20

12. How many patients do you have the capability to safely transport?

1. 2

2. 3

3. 4

4. 5

5. More than 5

13. Thinking about the type of ambulance you typically work in, please rate the how the level of ambulance 

occupancy and patient transport features allow you to do your job. Use a 10-point scale, where “1” means 

“poor” and “10” means “excellent.”

13a. Please provide any comments you have on ambulance occupancy and/or patient transport.

Ergonomics

Please indicate the extent to which you agree or disagree with the following statement. Use a scale from “1” to “10”, 

where “1” is “strongly disagree” and “10” is “strongly agree.”

14. There is enough room and general mobility around the ambulance patient compartment when taking care of 

the patient.

15. Please indicate if there are any controls, such as lighting, radio and ventilation, that you cannot reach from 

your seat as you provide patient care? (Select all that apply.)

1. Lighting

2. Radio

3. Ventilation

4. Other(s) (Please specify)

5. Not a problem. I can reach all needed controls

16. Please indicate if you have concerns about any of the following as they relate to the gurney/stretcher. 

(Select all that apply.)

1. Location of the gurney/stretcher

2. Orientation of the gurney/stretcher

3. Security of the gurney/stretcher

4. I have no concern about the gurney/stretcher

(IF 16=1, 2 or 3 ASK Q17)

17. What are your concerns? Please describe.

18. Thinking about the type of ambulance you typically work in, please rate the ergonomic features of its 

patient compartment on a 10-point scale, where “1” is “poor” and “10” is “excellent.”

18a. Please provide any comments you have on the ergonomic features of ambulances.

Restraint Systems

19. What kinds of safety restraints are currently in your patient compartment? (Select all that apply.)

1. Lap belt

2. Lap and shoulder belt

3. 4-point

4. 5-point

5. 7-point

6. Other (Please specify)
21

20. Think about the times when you are in the patient compartment and NOT treating the patient.

What percentage of the time do you wear the restraint system in the patient compartment when NOT 

treating the patient?

1. Less than 15 %

2. Between 15 % and 40 %

3. Between 41 % and 65 %

4. Between 66 % and 90 %

5. More than 90 %

21. Think about the times when you are in the patient compartment treating the patient.

What percentage of the time do you wear the restraint system in the patient compartment when treating the 

patient?

1. Less than 15 %

2. Between 15 % and 40 %

3. Between 41 % and 65 %

4. Between 66 % and 90 %

5. More than 90 %

(IF Q20 or Q21 =1, 2, 3 or 4 ASK Q22)

22. What is the main reason for not wearing restraints? (Please describe.)

Please indicate the extent to which you agree or disagree with the following statement. Use a scale from “1” to 

“10”, where “1” is “strongly disagree” and “10” is “strongly agree.”

23. Moving within the ambulance while unrestrained and caring for the patient is an inherent risk of EMS 

work.

24. Please indicate if you have any of the following regulations for seat belt usage. (Select all that apply.)

1. District

2. County

3. State

4. Organization

5. Other (Please specify)

6. Don’t know

25. Thinking about the type of ambulance you typically work in, please rate how well its safety restraint 

features allow you to do your job. Use a 10-point scale, where “1” means “poor” and “10” means 

“excellent.”

25a. Please provide any comments you have on the restraint systems in ambulances.

Communications

26. Is your ambulance equipped with a computer system?

1. Yes

2. No

3. Don’t know

(IF Q26=1 ASK Q27)

27. What is your computer system’s primary use?
22

28. If you could be given information regarding what the driver is going to do next (e.g., stop, turn, change in 

speed), how would you want to receive it? (Select all that apply.)

1. Verbally/yelling

2. Radio

3. Visual display

4. Notification lights

5. Other (Please specify)

6. Would not want to receive that information

29. What is the most effective form of communication between the driver and patient compartment? (Please 

describe.)

30. Thinking about the type of ambulance you typically work in, please rate its communication system in terms 

of allowing you to do your job. Use a 10-point scale, where “1” means “poor” and “10” means “excellent.”

30a. Please provide any comments you have on communication systems in ambulances.

Performance

The following tables list some of equipment/supplies provided in the ambulance patient compartment. Please 

indicate how easy it is to reach the item (equipment or supply), and the frequency of using the item.

31. Ventilation/respiration 

equipment

Difficulty of reach 

from the seated 

position: (Reach

without strain; Reach 

with strain; Unable to 

reach without leaving 

seat; N/A)

Frequency of use: (100 %; <100 % to >75 %; 

<75 % to >50 %; <50 % to >25 %; <25 % to >0 

%; (0 %)

a) Portable oxygen

b) Stationary oxygen

c) Resuscitator with oxygen 

inlet and masks 

d) Mouth-to-mask ventilator 

with oxygen inlet

e) Non-manual suction device

f) Portable suction device

g) Other (Please specify)

32. Diagnostics Equipment Difficulty of reach 

from the seated 

position: (Reach 

without strain; Reach 

with strain; Unable to 

reach without leaving 

seat; N/A)

Frequency of use: (100 %; <100 % to >75 %; 

<75 % to >50 %; <50 % to >25 %; <25 % to >0 

%; (0 %)

a) Oximeter

b) Stethoscope

c) Thermometer

d) Blood glucose meter

e) Diagnostic light

f) Blood pressure monitor

g) Other
23

33. Infusion material or equipment 

(e.g., intravenous therapy)

Difficulty of reach 

from the seated 

position: (Reach 

without strain; Reach 

with strain; Unable to 

reach without leaving 

seat; N/A)

Frequency of use: (100 %; <100 % to >75 %; 

<75 % to >50 %; <50 % to >25 %; <25 % to >0 

%; (0 %)

a) Infusion solutions

b) Equipment for injections and 

infusions

c) Infusion system for 

administration of warm fluid

d) Infusion mounting

e) Pressure infusion device

f) Other

34. Equipment for managing of lifethreatening situationsDifficulty of reach 

from the seated 

position: (Reach 

without strain; Reach 

with strain; Unable to 

reach without leaving 

seat; N/A)

Frequency of use: (100 %; <100 % to >75 %; 

<75 % to >50 %; <50 % to >25 %; <25 % to >0 

%; (0 %)

a) Defibrillator with rhythm and 

patient data recording 

b) Cardiac monitor 

c) External cardiac pacing 

d) Portable Resuscitation System 

e) Nebulization apparatus

f) Thorax drainage kit

g) Volumetric infusing device

h) Central vein catheters

i) PEEP-valve

j) Capnometer

k) Other

35.Supplies/Bandaging/Nursing/PPE Difficulty of reach from 

the seated position: 

(Reach without strain; 

Reach with strain; Unable 

to reach without leaving 

seat; N/A)

Frequency of use:

(100 %; <100 % to >75 %; <75 % to >50 %; 

<50 % to >25 %; <25 % to >0 %; (0 %)

a) Blankets

b) Material for treatment of 

wounds

c) Material for treatment of burns 

and corrosives

d) Kidney bowl

e) Vomiting bag

f) Bed-pan

g) Non-glass urine bottle

h) Sharps container

i) Sterile surgical gloves, pairs
24

j) Non-sterile gloves for single 

use

k) Hazmat suits

l) Other

36. Medicine Storage Difficulty of reach 

from the seated 

position: (Reach 

without strain; Reach 

with strain; Unable to 

reach without leaving 

seat; N/A)

Frequency of use:

(100 %; <100 % to >75 %; <75 % to >50 %; <50 

% to >25 %; <25 % to >0 %; (0 %)

Jump bag

Locked narcotics

Other

37. Communications Difficulty of reach 

from the seated 

position: (Easy; Reach 

with strain; Can’t reach 

without leaving seat; 

N/A)

Frequency of use: ((100 %; <100 % to >75 %; 

<75 % to >50 %; <50 % to >25 %; <25 % to >0 

%; (0 %)

Mobile radio transceiver

Portable radio transceiver

Intercom

Cell phone

Other

ACSI

Think about how satisfied you are with the current design standards in ambulances in terms of safety and allowing 

you to do your job.

38. On a scale from 1 to 10 where “1” means Very Dissatisfied and “10” means Very Satisfied, how satisfied 

are you with the current standards of design in ambulances.

39. Using a 10-point scale on which “1” now means Does Not Meet Expectations and “10” means Exceeds 

Expectations, to what extent do the design standards meet your expectations.

40. Forget for a moment your experiences with ambulances and current design standards. Now imagine the 

ideal design standards for ambulances. How well do you think the current design standards compare with 

that ideal? Please use a scale from “1” to “10”, where “1” means “very far from ideal” and “10” means 

“very close to ideal.”