NIST Technical Note 1766

Workshop Report for

Ambulance Patient 

Compartment Design

Allison Barnard Feeney

Deogratias Kibira

Yung-Tsun T. Lee

Jennifer Marshall 

http://dx.doi.org/10.6028/NIST.TN.1766
ii
iii

NIST Technical Note 1766

Workshop Report for

Ambulance Patient 

Compartment Design

Allison Barnard Feeney

Deogratias Kibira

Yung-Tsun T. Lee

Systems Integration Division

Engineering Laboratory

Jennifer Marshall 

Office of Law Enforcement Standards

Special Programs Office

http://dx.doi.org/10.6028/NIST.TN.1766

November 2012

U.S. Department of Commerce 

Rebecca Blank, Acting Secretary

National Institute of Standards and Technology 

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

Certain commercial entities, equipment, or materials may be identified in this

document in order to describe an experimental procedure or concept adequately.

Such identification is not intended to imply recommendation or endorsement by the

National Institute of Standards and Technology, nor is it intended to imply that the

entities, materials, or equipment are necessarily the best available for the purpose. 

National Institute of Standards and Technology Technical Note 1766

Natl. Inst. Stand. Technol. Tech. Note 1766, 19 pages (November 2012) 

http://dx.doi.org/10.6028/NIST.TN.1766

CODEN: NTNOEF
v

Abstract

Recently, the U.S Department of Homeland Security Science and Technology Directorate’s 

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

formation of the Ambulance Patient Compartment Design Project. Project participants are NIST, 

the National Institute of Occupational Safety and Health (NIOSH), and BMT Designers and 

Planners (BMT). The purpose of this Project is to develop standards to address performance and 

safety issues associated with the design of ambulance patient. NIST hosted the Ambulance 

Patient Compartment Design Workshop to allow leaders in the EMS community to review and 

validate the preliminary set of user design requirements, The workshop, facilitated by Energetics 

Incorporated, was held on February 29, 2012, during the EMS Today Conference and Expo 2012 

at the Baltimore Convention Center in Baltimore, Maryland. This document presents the raw 

output collected by Energetics and NIST at that workshop. It includes participants combined 

ratings and comments. It is being published without analysis to keep stakeholders informed as 

our work progresses. The input we received is currently feeding the analysis and selection of the 

requirements for evaluation and validation prior to modeling.

Key words

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

III; restraint systems
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Table of contents

1. Introduction 1

2. Workshop approach 1

2.1 Workshop structure 1

2.2 Assessment from three perspectives 2

2.3 Rating format for assessment of design issues 3

3. Workshop raw results 3

3.1 Seating and restraints and communications 4

3.2 Work environment 7

3.3 Patient care and general equipment and storage 12

3.4 Patient care and special equipment and storage 15

3.5 Workshop summary session – Crosscutting comments 18

List of tables

Table 1. Safety rating – Seating and restraints................................................................... 4

Table 2. Safety rating – Communication systems.............................................................. 5

Table 3. Functionality rating – Seating and restraints........................................................ 5

Table 4. Functionality rating – Communication systems................................................... 6

Table 5. Safety rating – Work environment....................................................................... 8

Table 6. Functionality rating – Work environment............................................................ 9

Table 7. Safety rating – Patient care and general equipment and storage........................ 12

Table 8. Functionality rating – Patient care and general equipment and storage............. 13

Table 9. Safety rating – Patient care and special equipment and storage ........................ 15

Table 10. Functionality rating – Patient care and special equipment and storage ........... 16
1

1. Introduction

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

standards initiatives in many areas, including criminal justice, public safety, emergency 

responder, and homeland security. Recently, the U.S Department of Homeland Security Science 

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

Resources Group sponsored formation of the Ambulance Patient Compartment Design Project. 

Project participants are NIST, the National Institute of Occupational Safety and Health (NIOSH), 

and BMT Designers and Planners (BMT). 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). 

The Ambulance Patient Compartment Design Project undertook a human factors approach to the 

design of patient compartments in ambulances. Using multiple data gathering methods, including 

practitioner interviews and ride-alongs, a web-based survey, and focus group meetings, the 

project identified potential performance and safety concerns to drive development of a 

comprehensive set of patient compartment user design requirements. These requirements will be 

assessed using rigorous analytic tools, including emergency medical provider task analysis and 

modeling and simulation in the next phase of the project. The validated requirements and design 

guidance will be the basis for input into current and emerging ambulance design standards. 

NIST hosted the Ambulance Patient Compartment Design Workshop to allow leaders in the

EMS community to review and validate the preliminary set of user design requirements, The 

workshop, facilitated by Energetics Incorporated, was held on February 29, 2012, during the 

EMS Today Conference and Expo 2012 at the Baltimore Convention Center in Baltimore, 

Maryland. The input to this workshop was the initial set of user design requirements compiled 

from the numerous interviews, ride alongs, focus group meetings, and survey results. This 

document presents the raw output collected by Energetics and NIST at that workshop. It 

includes participants combined ratings and comments. It is being published without analysis to 

keep stakeholders informed as our work progresses. The input we received is currently feeding 

the analysis and selection of the requirements for evaluation and validation prior to modeling.

2. Workshop approach

This section discusses how the workshop was organized, how participants were asked to 

prioritize potential requirements, and the rating system used.

2.1 Workshop structure

The workshop was structured to promote dialogue and knowledge sharing among a diverse set of 

practitioners and assess the collective priorities for the design of patient compartments in 

ambulances. Information collected during the workshop will be used to inform ambulance design 

and help NIST identify key requirements to recommend for inclusion in the next release of the 

National Fire Protection Association (NFPA) 1917 standard. 
2

The workshop used breakout sessions to initiate focused discussions on safety and functionality, 

help establish consensus on technical issues, identify gaps in current practices, and prioritize 

requirements. The breakouts were focused on design issues in the following domains: 

• Breakout 1: Seating and restraints/communications

• Breakout 2: Work environment

• Breakout 3: Patient care and general equipment and storage

• Breakout 4: Patient care and special equipment and storage

Given that the patient compartment is a single space, the domains represent somewhat artificial 

divisions. They were used to help focus the discussion and present participants with a 

manageable set of design issues to assess at any one time. 

2.2 Assessment from three perspectives

Each breakout session was structured to assess the subset of design issues in terms of their 

importance for inclusion in the next release of NFPA 1917. Typically, standards and 

requirements for the design of EMS vehicles are established to ensure safety and functionality. 

However, these two imperatives do not always correspond. For example, the restraints that keep 

an EMS provider safe also impair his or her movement and access to the patient. Maximizing 

safety may thus be incompatible with maximizing functionality in terms of patient care. Given 

the potential conflict, participants were asked to consider the design issues from the following 

three distinct perspectives: 

2.2.1 Safety point of view

Participants looked at the design issues solely in terms of their importance for protecting both the 

patient and the caregiver. The safety considerations included risks ranging from unsecured 

objects hitting the patient or caregiver to the unsecured caregiver and patient encountering sharp 

objects, hard surfaces, and sharp edges. Considerations also included the risk to the caregiver 

from the strain of lifting and/or working in an awkward or bent-over position. 

2.2.2 Functionality point of view

Participants looked at the design issues solely in terms of their importance in enabling or 

enhancing the caregiver’s ability to deliver the necessary care to the patient. This included issues 

of access to both the patient and to equipment and supplies. 

2.2.3 Combined point of view

After assessing the items separately from the safety and functionality perspectives, participants 

then considered them from a combined point of view. In particular, participants were asked to 

identify the top priority items across both points of view. 

At the beginning of each breakout session, participants reviewed the design issues for the 

particular domains and identified any gaps or missing issues. After completing both the safety 

and functionality ratings, participants were again asked to identify missing issues. They were 
3

also asked to discuss any difficulties they had in rating particular items and to provide 

suggestions. 

2.3 Rating format for assessment of design issues

To conduct a systematic assessment of the design issues for each breakout, participants were 

given a list of the issues in the form of a written survey. The survey asked participants to rate 

each issue, first from a safety point of view, and second from a functionality point of view, using 

a three-point scale of Essential, Conditional, and Low.

For the functionality perspective, the scale points were defined as follows:

Essential – A critical requirement for safety that would significantly improve patient and 

EMS provider safety if implemented; strongly recommended for inclusion in the next 

release of the NFPA 1917 standard

Conditional – An important requirement that would improve safety, but could wait until a 

later release of the standard if necessary

Low – Not an important requirement for safety at this time

For the functionality perspective, the scale points were defined as follows:

Essential – A critical requirement for functionality that would significantly improve patient 

care if implemented; strongly recommended for inclusion in the next release of the NFPA 

1917 standard

Conditional – An important requirement that would improve functionality, but could wait 

until a later release of the standard if necessary

Low – Not an important requirement for functionality at this time

It is important to keep in mind that the design issues were presented to participants as precursors 

to potential requirements, not as actual requirements. They identified specific conditions, 

features, or design elements of the patient compartment around which a requirement or standard 

item would be written, but they did not quantify specific threshold levels to be included in the 

standard. Thus, participants were asked to rate the importance of each issue, given that it was 

translated into an actual standard item or requirement. 

3. Workshop raw results

The remainder of this document presents the raw results of the workshop. It is broken up into 

four sections corresponding to the four breakout sessions. Each section presents the following:

• Scope of the breakout session

• Rating results from the safety point of view

• Rating results from the functionality point of view
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• Results of the combined prioritization

• Summary of participant comments 

The rating results are presented in this report exactly as presented to workshop participants. In 

several cases participants sought clarification of the statements on the written surveys. In a small 

number of cases, participants agreed upon alternative wording. Such discussion is captured in 

the summary of participant comments, not in the rating results. Similarly, the tabulated ratings 

are presented here exactly as tabulated and presented by the workshop facilitators. We recognize 

that in some cases the sum of the ratings on a given item differ from the majority of the item 

totals on a rating sheet. The ratings served as a tool to focus discussion and drive agreement on 

combined priorities, they are not to be viewed as definitive results. The survey ratings do not 

directly correlate to the group consensus on combined priorities.

3.1 Seating and restraints and communications

This breakout covered two domains. The Seating and restraints domain concerns the extent to 

which the patient compartment/workspace enables the EMS provider to provide (a) safe and 

effective patient care from a seated position in the ambulance patient compartment, and (b) safe 

and effective patient care while in a restrained position within the ambulance patient 

compartment. The Communication systems concerns the extent to which the patient 

compartment/workspace (a) enables efficient and effective communications between the patient 

compartment, the driver, and others; (b) facilitates driver awareness of activity in the patient 

compartment; and (c) allows the EMS provider to be more aware of the driver’s actions.

3.1.1 Raw data sheets

The tables in this section presents the raw output collected by Energetics and NIST at that 

workshop. Table 1 and Table 3 present the safety and functional ratings for candidate 

requirements in the area of Seating and Restraints. Table 2 and Table 4 present the safety and 

functional ratings for candidate requirements in the area of Communications.

Table 1. Safety rating – Seating and restraints

Low Conditional Essential

1. The EMS provider is able to reach the patient's full body length while in a 

seated position. 0 7 7

2. The EMS provider is able to reach common and critical 

equipment/supplies from a seated position. 0 7 7

3. Seating is quickly adjustable if needed to reach the patient or 

equipment/supplies from a seated position. 0 5 9

4. The EMS provider is able to face and interact with the patient while in a 

seated position. 0 7 7

5. Seating has the ability to be forward or rear facing. 2 8 4

6. The EMS provider is able to reach common and critical 

equipment/supplies from a restrained position. 0 2 12
5

7. The EMS provider is able to operate equipment controls from a seated 

and restrained position. 0 3 11

8. The EMS provider is able to quickly move in and out of being in a restraint 

system. 0 6 8

9. Restraints are comfortable. 0 6 8

10. The restraint system incorporates ergonomic/anthropometric design to 

minimize risk of injury and support safe and comfortable use by the 

diverse EMS provider populations.

0 2 12

11. Each seat is equipped with its own restraint system. 1 2 11

12. The EMS provider is able to reach the patient's full body length from a 

restrained position. 0 4 10

13. The EMS provider is able to face and interact with the patient from a 

restrained position. 0 6 9

Table 2. Safety rating – Communication systems

Low Conditional Essential

1. Means for communicating between the EMS provider, the driver, and third 

parties, such as the hospital, are provided and accessible from all EMS 

provider workstations.

2 4 8

2. Communication systems support the EMS provider's ability to continue 

providing safe and effective patient care. 0 2 12

3. EMS providers in the patient compartment are able to establish 

communications quickly with the driver or other third party. 0 2 12

4. The EMS provider or patient's status can be communicated to the driver nonverbally 2 8 4

5. The driver can visually communicate driving actions to the EMS Providers in 

the patient compartment. 5 5 4

Table 3. Functionality rating – Seating and restraints

Low Conditional Essential

1. The EMS provider is able to reach the patient's full body length while in a 

seated position. 2 6 6

2. The EMS provider is able to reach common and critical equipment/supplies 

from a seated position. 4 2 8

3. Seating is quickly adjustable if needed to reach the patient or 

equipment/supplies from a seated position. 1 5 8

4. The EMS provider is able to face and interact with the patient while in a 

seated position. 1 6 7

5. Seating has the ability to be forward or rear facing. 5 4 5

6. The EMS provider is able to reach common and critical equipment/supplies 

from a restrained position. 0 4 10

7. The EMS provider is able to operate equipment controls from a seated and 0 4 10
6

restrained position.

8. The EMS provider is able to quickly move in and out of being in a restraint 

system. 2 3 9

9. Restraints are comfortable. 2 5 7

10. The restraint system incorporates ergonomic/anthropometric design to 

minimize risk of injury and support safe and comfortable use by the diverse 

EMS provider populations.

1 4 9

11. Each seat is equipped with its own restraint system. 2 6 6

12. The EMS provider is able to reach the patient's full body length from a 

restrained position. 0 4 10

13. The EMS provider is able to face and interact with the patient from a 

restrained position. 0 4 10

Table 4. Functionality rating – Communication systems

Low Conditional Essential

1. Means for communicating between the EMS provider, the driver, and third 

parties, such as the hospital, are provided and accessible from all EMS 

provider workstations.

2 2 10

2. Communication systems support the EMS provider's ability to continue 

providing safe and effective patient care. 0 1 13

3. EMS providers in the patient compartment are able to establish 

communications quickly with the driver or other third party. 0 4 10

4. The EMS provider or patient's status can be communicated to the driver nonverbally 1 9 4

5. The driver can visually communicate driving actions to the EMS Providers in 

the patient compartment. 5 6 3

3.1.2 Combined prioritization

In the Seating and Restraint Systems/Communication systems breakout session, the group 

identified the following design issues as most important across both safety and functionality:

• The EMS provider is able to reach common and critical equipment/supplies from a seated 

position. (Item 2)

• The EMS provider is able to reach common and critical equipment/supplies from a 

restrained position. (Item 6)

• The EMS provider is able to operate equipment controls from a seated and restrained 

position. (Item 7)

• The EMS provider is able to reach the patient’s full body length from a restrained 

position. (Item 12)
7

3.1.3 Participant comments

The following comments were offered during the discussions following the separate ratings and 

the combined prioritization. The comments were collected in a non-attribution manner and are 

paraphrased.

Although the ability to reach the patient from a restrained position is a combined priority, the 

participants felt that they do not particularly need to have access to the full body length of the 

patient.

Regarding seating requirements, participants expressed concerns about the possibility that new 

seat designs could infringe on space for equipment and storage. Participants did not perceive that 

forward-facing or rear-facing seating arrangements were functional enough to address the 

patient’s needs. The group suggested investigating best practices and designs used in other 

countries.

Concerning restraint systems, the group felt that the ability to reach the patient is just as 

important as the ability to reach equipment. Comfort was identified as an important requirement 

for restraint systems because lack of comfort hinders widespread use of systems by practitioners. 

The group identified that existing retractable restraints do not work efficiently, and that there is a 

need to clarify the difference between restraint systems and seat belts. It was noted that restraint 

systems could differ according to specific needs; for example, an advanced restraint system 

would not be needed for “walking wounded,” but such patients would still need to be subjected 

to some form of restraint. 

With regard to communication requirements, items 2 and 3 scored high for both safety and 

functionality however the group felt that it did not surpass items 2, 6, 7 and 12 (from Seating and 

restraints). They indicated that communication is important. Participants expressed concern 

about item 4 regarding the use of non-verbal Communication systems, which they felt could 

cause distractions. Hands-free verbal devices were perceived as safer options. The group noted 

that new technologies could be readily available before the next release of NFPA 1917. 

Participants also perceived that means of communicating between the EMS provider, the driver, 

and third parties (e.g., hospitals) do not need to be provided in, and accessible from, all EMSprovider workstations.

3.2 Work environment

This domain concerns the extent to which the patient compartment/workspace (a) enables the 

EMS provider to safely and effectively treat patients and perform patient care through 

environmental controls (i.e., air flow, temperature, humidity, lighting, and noise control are 

accessible); (b) allows for easy cleaning and restocking after each trip; (c) provides an effective 

means of sanitizing/cleaning; (d) enables quick and safe ingress/egress; (e) includes safety 

mechanisms to reduce hazard risks such as securing portable equipment; and (f) provides for 

securing and accessibility to trash disposal. 
8

3.2.1 Raw data sheets

The tables in this section present the raw output collected by Energetics and NIST at that 

workshop. Table 5 and Table 6 present the safety and functional ratings for candidate 

requirements in the area Work Environment.

Table 5. Safety rating – Work environment

Low Conditional Essential

1. HVAC system maintains a comfortable and appropriate environment. 0 2 5

2. Lighting system provides appropriate illumination to support task performance. 0 2 5

3. The patient compartment has enough power supply to power/charge all 

necessary equipment. 1 4 2

4. Power outlets in the patient compartment meet the needs of the EMS provider 

with respect to powering equipment or recharging batteries during patient care 

and transport.

2 2 3

5. IV bags that are administered to the patient are placed and secured in a manner 

that allows them to remain accessible to the EMS provider while not introducing 

risks to the safety of the patient or EMS provider.

1 5 1

6. O2 port placement allows for the EMS provider to readily access and use O2 for 

patient care while not introducing risks to the safety of the patient or EMS 

provider.

0 4 3

7. Workspace provides appropriate space to allow the EMS provider to securely 

and safely place and use equipment, papers, and supplies. 1 0 6

8. There are no head strike obstacles when the EMS provider is in a restrained 

position. 0 0 7

9. Pathways are clear of obstacles. 0 3 4

10. Equipment and compartment design minimizes the risk of injury during evasive 

maneuvers and accidents. 0 0 7

11. EMS providers can quickly identify and replace consumable supplies like light 

bulbs and filters. 4 3 0

12. The interior of the patient compartment can be quickly sanitized and cleaned. 0 3 4

13. All potentially exposed surfaces can be reached for sanitization and cleaning. 0 2 5

14. Individuals are able to quickly ingress and egress the ambulance patient 

compartment in all weather conditions. 2 3 1

15. Individuals are able to safely ingress and egress the ambulance patient 

compartment in all weather conditions. 0 1 6

16. The design of the entrances/exits of the patient compartment considers best 

practices in ergonomic/anthropometric design. 0 2 5

17. Doors do not intrude on an EMS provider's workspace or be a potential striking 

hazard. 0 2 5

18. EMS providers are able to egress the patient compartment with a patient loaded 0 2 5
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on a patient transport device from the main loading/unloading doors and one 

other door(s).

19. Interior height of patient compartment ergonomically supports task performance. 0 4 3

20. Flooring supports patient care while reducing injury risk to EMS provider and 

patient. 0 1 6

21. Patient compartments include devices, such as handholds and grab bars, to aid 

the EMS provider in moving around the space safely. 0 1 6

22. Safety measures, such as padding, nets, and airbags, are included in the patient 

compartment to reduce the likelihood of injury to EMS providers & patients during 

crashes or evasive maneuvers.

0 0 7

23. Disposal containers are secure. 0 2 5

24. Disposal containers are accessible from a restrained position. 0 4 3

Table 6. Functionality rating – Work environment

Low Conditional Essential

1. HVAC system maintains a comfortable and appropriate environment. 0 2 6

2. Lighting system provides appropriate illumination to support task performance. 0 1 6

3. The patient compartment has enough power supply to power/charge all 

necessary equipment. 1 2 4

4. Power outlets in the patient compartment meet the needs of the EMS provider 

with respect to powering equipment or recharging batteries during patient care 

and transport.

1 3 3

5. IV bags that are administered to the patient are placed and secured in a manner 

that allows them to remain accessible to the EMS provider while not introducing 

risks to the safety of the patient or EMS provider.

1 3 3

6. O2 port placement allows for the EMS provider to readily access and use O2 for 

patient care while not introducing risks to the safety of the patient or EMS 

provider.

0 5 2

7. Workspace provides appropriate space to allow the EMS provider to securely 

and safely place and use equipment, papers, and supplies. 0 2 5

8. There are no head strike obstacles when the EMS provider is in a restrained 

position. 1 2 4

9. Pathways are clear of obstacles. 0 2 5

10. Equipment and compartment design minimizes the risk of injury during evasive 

maneuvers and accidents. 0 1 6

11. EMS providers can quickly identify and replace consumable supplies like light 

bulbs and filters. 3 3 1

12. The interior of the patient compartment can be quickly sanitized and cleaned. 0 3 4

13. All potentially exposed surfaces can be reached for sanitization and cleaning. 0 3 4

14. Individuals are able to quickly ingress and egress the ambulance patient 

compartment in all weather conditions. 2 2 3
10

15. Individuals are able to safely ingress and egress the ambulance patient 

compartment in all weather conditions. 1 1 5

16. The design of the entrances/exits of the patient compartment considers best 

practices in ergonomic/anthropometric design. 0 2 5

17. Doors do not intrude on an EMS provider's workspace or be a potential striking 

hazard. 0 4 3

18. EMS providers are able to egress the patient compartment with a patient loaded 

on a patient transport device from the main loading/unloading doors and one 

other door(s).

0 0 7

19. Interior height of patient compartment ergonomically supports task performance. 0 4 3

20. Flooring supports patient care while reducing injury risk to EMS provider and 

patient. 0 2 5

21. Patient compartments include devices, such as handholds and grab bars, to aid 

the EMS provider in moving around the space safely. 0 1 6

22. Safety measures, such as padding, nets, and airbags, are included in the patient 

compartment to reduce the likelihood of injury to EMS providers & patients during 

crashes or evasive maneuvers.

0 3 4

23. Disposal containers are secure. 0 4 3

24. Disposal containers are accessible from a restrained position. 0 4 3

3.2.2 Combined prioritization

In the Work environment breakout session, the group identified the following three design issues 

as most important across both safety and functionality:

• Workspace provides appropriate space to allow EMS provider to securely and safely 

place and use equipment, papers, and supplies. (Item 7)

• EMS providers are able to exit patient compartment with a patient loaded on a patient 

transport device from the main loading/unloading doors and one other door. (Item 18)

• Safety measures, such as padding, nets, and airbags, are included in the patient 

compartment to reduce the likelihood of injury to EMS providers &patients during 

crashes or evasive maneuvers. (Item 22) This priority was seen as also subsuming three 

additional items:

o There are no head strike obstacles when the EMS provider is in a restrained 

position. (Item 8)

o Pathways are clear of obstacles (e.g., pathway should not be used to store 

equipment or loose items). (Item 9)

o Doors do not intrude on an EMS provider’s workspace or be a potential striking 

hazard. (Item 17)
11

3.2.3 Participant comments

The following comments were offered during the discussions following the separate ratings and 

the combined prioritization. The comments were collected in a non-attribution manner and are 

paraphrased.

Participants felt that “Pathways are clear of obstacles” should mean “Pathways are clear of 

portable patient care equipment” (e.g., pathway should not be used to store equipment or loose 

items).

Participants commented that air ambulance design would be a useful model for ambulance 

design. They noted that ambulance design is often viewed from the perspective of designing the 

inside of a large automobile. They suggested that the patient compartment be viewed more as a 

cockpit.

Participants commented that the National Institute for Occupational Safety and Health accident

trend data and no-strike zones will help prioritize implementation (spending).

Participants suggested that Item 1 should include airflow and filtration as well as temperature.

With regard to Item 23, participants indicated that a key issue is minimizing exposure or injury 

when emptying the disposal containers.

For Items 5 and 6, participants suggested including the term “restrained.”

For Item 6, the participants suggested including onboard suction.

With regard to Item 9, participants reported that it is difficult to require pathways to be totally 

clear. They suggested that the requirement should apply to loose, portable equipment (i.e., 

pathways should not be used to store equipment, and all portable equipment should have a place 

where it can be secured). 

With regard to Item 10, it was noted that maintaining a balanced payload is a critical component 

of reducing this risk.

With regard to Item 22, participants noted the reference to “nets” as a safety measure and 

commented that nets are not currently strong enough to qualify as safety equipment.

Participants noted that the requirements to access and operate equipment should carry the 

additional requirement that the equipment is accessed and used while the EMS provider is 

restrained.

Participants suggested including hand sanitizers for infection control in the interior of the 

compartment, and minimizing the handling of infectious materials.

Participants noted that reducing back injury to EMS providers should be emphasized. 
12

3.3 Patient care and general equipment and storage

This domain concerns the extent to which the patient compartment/workspace provides 

accessibility to general equipment and storage such that (a) equipment allows the EMS provider 

to safely and effectively treat the patient, (b) storage supports the ability of the EMS provider to 

safely and effectively perform patient care, (c) facilitates the ability of EMS providers to perform 

inventory management, and (d) the compartment allows for ability to stow additional equipment.

3.3.1 Raw data sheets

The tables in this section presents the raw output collected by Energetics and NIST at that 

workshop. Table 7 and Table 8 present the safety and functional ratings for candidate 

requirements in the area Patient care and general equipment and storage.

Table 7. Safety rating – Patient care and general equipment and storage

Low Conditional Essential

1. The location of equipment while in use in the patient compartment minimizes the 

likelihood of introducing additional risks to EMS provider and patient safety. 0 0 9

2. Placement of equipment, including the monitor, that requires EMS provider 

interaction allows EMS providers to complete this interaction from a restrained 

position. 0 2 7

3. Placement of equipment, including the monitor, that requires EMS provider 

interaction allows EMS providers to complete this interaction from a seated 

position. 0 2 7

4. Equipment stored outside of a cabinet is secured such that it does not become a 

hazard to the EMS provider or patient. 0 1 8

5. Mechanisms for securing equipment stored outside of a cabinet that is required 

for patient care allows the EMS providers to access the equipment. 2 1 6

6. Equipment, supplies, and controls are easily identifiable. 1 4 4

7. Storage compartments provide adequate storage space for all required 

equipment and supplies. 2 4 3

8. Interior storage compartments whose contents are used frequently or are critical 

to patient care are accessible from a restrained position. 0 1 8

9. Interior storage compartments whose contents are used frequently or are critical 

to patient care are accessible from a seated position. 0 4 5

10. Equipment/supplies stored within a storage compartment will remain secured 

while in transit, but are accessible to EMS provider when needed. 0 1 8

11. Lockable storage compartment for equipment/supplies (e.g., narcotics) is 1 4 4
13

provided. 

12. Storage compartment doors do not intrude on an EMS provider's workspace or 

pose a potential striking hazard. 0 2 7

13. EMS providers are able to quickly determine the inventory of equipment and 

supplies on-board the ambulance. 4 5 0

14. EMS providers are able to quickly resupply the ambulance. 5 4 0

15. The patient compartment design allows for secure and safe storage of specialty 

equipment not normally carried on the ambulance and used infrequently for 

special calls.

1 6 2

16. Temperature controlled storage is accessible from a seated position. 1 4 4

17. Temperature controlled storage is accessible from a restrained position. 0 6 3

Table 8. Functionality rating – Patient care and general equipment and storage

Low Conditional Essential

1. The location of equipment while in use in the patient compartment minimizes the 

likelihood of introducing additional risks to EMS provider and patient safety. 0 1 8

2. Placement of equipment, including the monitor, that requires EMS provider 

interaction and allows EMS providers to complete this interaction from a 

restrained position. 0 1 8

3. Placement of equipment, including the monitor, that requires EMS provider 

interaction and allows EMS providers to complete this interaction from a seated 

position. 1 2 6

4. Equipment stored outside of a cabinet is secured such that it does not become a 

hazard to the EMS provider or patient. 0 4 5

5. Mechanisms for securing equipment stored outside of a cabinet that is required 

for patient care allows the EMS providers to access the equipment. 0 1 8

6. Equipment, supplies, and controls are easily identifiable. 0 3 6

7. Storage compartments provide adequate storage space for all required 

equipment and supplies. 0 3 6

8. Interior storage compartments whose contents are used frequently or are critical 

to patient care are accessible from a restrained position. 0 1 8

9. Interior storage compartments whose contents are used frequently or are critical 

to patient care are accessible from a seated position. 1 3 5

10. Equipment/supplies stored within a storage compartment will remain secured 

while in transit, but are accessible to EMS provider when needed. 0 3 6
14

11. Lockable storage compartment for equipment/supplies (e.g., narcotics) is 

provided. 0 7 2

12. Storage compartment doors do not intrude on an EMS provider's workspace or 

pose a potential striking hazard. 1 2 6

13. EMS providers are able to quickly determine the inventory of equipment and 

supplies on-board the ambulance. 1 7 1

14. EMS providers are able to quickly resupply the ambulance. 2 5 2

15. The patient compartment design allows for secure and safe storage of specialty 

equipment not normally carried on the ambulance and used infrequently for 

special calls.

1 6 2

16. Temperature controlled storage is accessible from a seated position. 3 3 4

17. Temperature controlled storage is accessible from a restrained position. 0 6 3

3.3.2 Combined prioritization

In the Patient care and general equipment and storage breakout session, the group identified the 

following design issues as most important across both safety and functionality: 

• The location of the equipment while in use in the patient compartment minimizes the 

likelihood of introducing additional risks to EMS provider and patient safety. (Item 1)

• Placement of equipment, including the monitor, that requires EMS provider interaction 

and allows EMS providers to complete this interaction from a restrained position. (Item 

2)

• Placement of equipment, including the monitor, that requires EMS provider interaction 

and allows EMS providers to complete this interaction from a seated position. (Item 3)

• Equipment stored outside of cabinet is secured such that it does not become a hazard to 

the EMS provider or patient. (Item 4)

3.3.3 Participant comments

The following comments were offered during the discussions following the separate ratings and 

the combined prioritization. The comments were collected in a non-attribution manner and are 

paraphrased.

Participants expressed that the first three design issues depend on each other and should be 

coupled together. 

The group identified the need to reword some requirements for clarity and pointed out that some 

requirements are related to internal policy requirements rather than safety and functionality; for 

example, the ability to quickly determine inventory and resupply the ambulance. Participants 
15

also expressed that the speed at which inventory can be assessed and resupplied is not as 

important as the ability to complete those tasks with ease.

The group felt that the availability of a lockable storage compartment for equipment and 

supplies, such as for narcotics, was not an important need. 

Participants mentioned the ability to transport more than one patient as a possible requirement to 

add to the list.

Participants noted that equipment storage locations should take into account ergonomic issues 

such as weight and lifting height.

3.4 Patient care and special equipment and storage

This domain concerns the extent to which the patient compartment/workspace accommodates 

locations such that (a) cots and cot locking mechanisms allow the EMS provider to safely and 

effectively treat the patient, (b) special equipment allows the EMS provider to safely and 

effectively treat the patient, (c) EMS providers can safely and readily access secured jump bags 

while providing patient care, and (d) storage of the patient’s equipment/belongings can be safe 

and secure.

3.4.1 Raw Data Sheets

The tables in this section presents the raw output collected by Energetics and NIST at that 

workshop. Table 9 and Table 10 present the safety and functional ratings for candidate 

requirements in the area Patient care and special equipment and storage

Table 9. Safety rating – Patient care and special equipment and storage

Low Conditional Essential

1. The EMS provider has access around the entire cot. 5 5 0

2. Cot allows for the patient to be comfortably restrained without hindering the ability 

of the EMS provider to provide safe and effective patient care. 0 6 9

3. Cot allows for the patient to be securely restrained without hindering the ability of 

the EMS provider to provide safe and effective patient care. 0 0 9

4. The cot guidance and securing mechanism allows for the cot to be quickly

secured and released. 0 8 1

5. The cot guidance and securing mechanism allows for the cot to be safely

secured and released. 0 0 9

6. The cot has sufficient storage locations for all required equipment that is carried 

with the cot and patient. 1 5 3

7. Where the ambulance is designed to use a powered cot, the powered cot can be 3 3 3
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charged in the ambulance.

8. Cot loading mechanisms are quick to set up, load/unload the cot, and stow. 0 4 5

9. The cot loading system allows for the patient to be loaded or unloaded safely with 

minimal risk of injury to the patient or EMS provider. 0 0 9

10. Cots are capable of securing children of any age for transport. 0 1 7

11. Backboard has a quick method of fully securing the patient to the backboard. 0 6 3

12. The EMS provider is able to perform CPR with minimal risk of injury to the patient 

and him/herself. 0 0 9

13.When being used for patient care, the placement of secured jump bags allows 

EMS providers to quickly and safely access them. 0 2 7

14.When being used for patient care, jump bags are designed to allow the EMS 

provider to organize stored supplies and equipment to allow quick access. 0 4 5

15. Jump bags are designed to allow EMS providers to quickly transport them to and 

from the patient care scene and the patient compartment while minimizing their 

risk of injury.

0 2 7

16. Space is provided to accommodate patient equipment and belongings without 

compromising EMS performance and safety. 0 5 4

17. Secure storage is available for patient belongings. 1 3 5

Table 10. Functionality rating – Patient care and special equipment and storage

Low Conditional Essential

1. The EMS provider has access around the entire cot. 4 3 3

2. Cot allows for the patient to be comfortably restrained without hindering the ability 

of the EMS provider to provide safe and effective patient care. 0 6 4

3. Cot allows for the patient to be securely restrained without hindering the ability of 

the EMS provider to provide safe and effective patient care. 0 4 6

4. The cot guidance and securing mechanism allows for the cot to be quickly

secured and released. 0 9 1

5. The cot guidance and securing mechanism allows for the cot to be safely

secured and released. 0 2 8

6. The cot has sufficient storage locations for all required equipment that is carried 

with the cot and patient. 1 3 6

7. Where the ambulance is designed to use a powered cot, the powered cot can be 

charged in the ambulance. 1 2 7
17

8. Cot loading mechanisms are quick to set up, load/unload the cot, and stow. 0 3 7

9. The cot loading system allows for the patient to be loaded or unloaded safely with 

minimal risk of injury to the patient or EMS provider. 0 0 10

10. Cots are capable of securing children of any age for transport. 0 3 6

11. Backboard has a quick method of fully securing the patient to the backboard. 0 3 7

12. The EMS provider is able to perform CPR with minimal risk of injury to the patient 

and him/herself. 0 1 9

13.When being used for patient care, the placement of secured jump bags allows 

EMS providers to quickly and safely access them. 0 1 9

14.When being used for patient care, jump bags are designed to allow the EMS 

provider to organize stored supplies and equipment to allow quick access. 0 2 8

15. Jump bags are designed to allow EMS providers to quickly transport them to and 

from the patient care scene and the patient compartment while minimizing their 

risk of injury.

0 1 9

16. Space is provided to accommodate patient equipment and belongings without 

compromising EMS performance and safety. 1 5 4

17. Secure storage is available for patient belongings. 1 4 5

3.4.2 Combined prioritization

In the Patient care and special equipment and storage breakout session, the group identified the 

following design issues as most important across both safety and functionality: 

• The cot guidance and securing mechanism allows for the cot to be safely secured and 

released. (Item 5)

• The cot loading system allows for the patient to be loaded or unloaded safely with 

minimal risk of injury to patient or EMS provider. (Item 9)

• When being used for patient care, the placement of secured jump bags allows EMS 

providers to quickly and safely access them. (Item 13)

• Secure storage is available for patient belongings. (Item 17)

• Cot allows for the patient to be securely restrained without hindering the ability of the 

EMS provider to provide safe and effective patient care. (Item 3)

3.4.3 Participant comments

The following comments were offered during the discussions following the separate ratings and

the combined prioritization. The comments were collected in a non-attribution manner and are 

paraphrased.
18

Item 10 was revised before voting to read “Patient restraint devices are capable of securing 

children of any age for transport.”

Participants indicated that protecting the EMS provider is of paramount importance. This would 

help to control insurance costs, which are out of control. More importantly, however, is the 

human cost. Participants indicated that they care about their employees, and that protecting them 

from injury is their primary concern.

Participants indicated that designers need to think broadly about safety. Although crashes are the 

leading cause of EMS fatalities, lifting/loading patients is the leading cause of EMS injury. 

Lifting heavy equipment is also a major cause of back and muscle strain. 

Participants mentioned that patients who are aggressive or move unpredictably represent a safety 

consideration that should be added to Item 3. 

Participants commented that there should also be a space provided to accommodate EMS 

providers’ belongings.

Participants recommended not using the adult cot equipped with child restraints, noting that a 

child safety seat is a better option.

Item 11 states “Backboard has a quick method of fully securing the patient to the backboard.” 

Participants expressed that they are not especially concerned with doing things quickly 

(however, for medical care reasons there might be a need for speed). 

Participants stated that they do not usually duplicate items in the jump bag and ambulance 

storage; however, there is variation across companies.

Participants recommended revising Item 1 because the intent was not clear. They interpreted the 

statement to mean that the provider has access to the patient around the entire cot.

With regard to the loading of patients, participants noted that hospitals are increasingly 

prohibiting EMS providers from lifting patients, due to the rate of back injury claims and patient 

injuries.

Participants expressed concern that there is no available data on EMS provider injuries, or the 

causes, severity, etc., of those injuries.

Participants commented on the possibility of introducing specially designed helmets that are easy 

to use.

3.5 Workshop summary session – Crosscutting comments

The following are a number of items that were mentioned during the breakout summary session:

• There is a need to start from scratch on patient compartment design, with no legacy.
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• To avoid head strike, EMS providers could wear a helmet when entering or leaving the 

compartment.

• There is a need to address the items carried by EMS providers.

• There is a need to address requirements for individual equipment items.

• There is a need to address training in the standard.

The results collected from the workshop participants are driving adjustments to the requirements 

that include rephrasing as well as addition/deletion of requirements. The workshop provided 

invaluable insight into priorities and confirmed that no significant gaps exist in the requirements 

presented. The next step is to evaluate the data from this workshop and finalize the 

requirements. These requirements will be assessed using rigorous analytic tools, including 

emergency medical provider task analysis and modeling and simulation in the next phase of the 

project. The validated requirements and design guidance will be the basis for input into current 

and emerging ambulance design standards.

Acknowledgements 

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

Factors/Behavioral Sciences Division sponsored the material presented in this document under 

IAA HSHQDC-11-X-00049. We would like to thank BMT Designers and Planners for their 

assistance in technical support and editing and Energetics Incorporated for facilitating the 

workshop and providing the raw data as the basis of this report.

In addition, we want to thank those who participated in the workshop. We had practitioner 

representation from: departments in Alabama, Colorado, Connecticut, Delaware, District of 

Columbia, New York, North Carolina, Pennsylvania, South Carolina, and Virginia; practitioner 

organizations from the National Association of Emergency Medical Technicians (NAEMT), the 

National Association of State EMS Officials (NASEMSO), the International Association of EMS 

Chiefs (IAEMSC), and the International Association of Fire Fighters (IAFF); and Federal 

representatives from NIOSH, Department of Defense, Department of Transportation, and 

Department of Homeland Security.