Land transportation safety

recommended practice
Guidance note 16
September 2014

Emergency Response Vehicles

Emergency response team members run a high risk of getting killed or seriously injured as a result
of vehicle crashes. Emergency Response Vehicles (ERV) have high crash fatality rates per kilometre,
well above those of passenger vehicles, or when compared to similarly-sized vehicles.
The factors that increase the risk of ERV transport operations can be grouped into:
• driver-related risks
• journey-related risks
• vehicle-related risks.
This document is based on OGP Report No. 365, Land transportation safety recommended practice.
It provides further guidance and recommendations on how to reduce and quite possibly eliminate
significant risks associated with the operation of Emergency Response Vehicles.

Contents

1. Drivers 2

2. Seatbelts 2

3. Vehicle specification and upfitting 2

1. Drivers
ERV drivers should attend an accredited defensive driving
course that addresses the challenges of driving ERVs in an
emergency situation. In some countries, such training is a
legal requirement.
ERV drivers should not exceed speed limits and should not
use unconventional driving tactics (e.g. driving through
red traffic lights and overtaking on road shoulders). Any
exception to this should be managed as such.
The reasons are three-fold.
• Company-owned or contracted ERV drivers typically
differ significantly from hospital ambulance drivers in
terms of training, experience, vehicle familiarity, and
route familiarity.
• Company-owned or contracted ERV operations
differ from hospital ambulance operations. Medical
emergency response plans typically do not require
rushing a first responder from the hospital to the
accident site. Instead, ERVs are used to transfer
patients who have been stabilized on-site.
• Judicious use of flashing lights and sirens significantly
reduces delay, even in the absence of speeding and
unconventional driving.
Overall, in the context of typical ERV operations and in
the context of a stabilized patient arriving a few minutes
early at the hospital through speeding and unconventional
driving, the high risk of an ERV crash outweighs the small
improvement in morbidity.
Load securement
ERV drivers should ensure all load items are stowed or
secured when in transit. For ambulances, all medical
equipment onboard should be also secured. Unsecured
equipment, such as defibrillators and oxygen cylinders
pose a significant injury hazard if launched as projectiles
during a collision.
2. Seatbelts
Use of restraint systems
All ERV occupants should be secured while the vehicle
is in motion. Lack of the use of restraints, as identified in
Report No. 365, 2.1 (Seatbelts), is frequently cited as a
cause for the high injury and fatality rate of occupants in
ERV crashes.
For ambulances, three-point inertia reel seatbelts allow the
ambulance personnel free movement for patient care and
medical procedures. If additional mobility is needed, the
ERV should pull over and stop.
2
Side-facing seats
Consider having front/rear facing seats only. Personnel
in side-facing seating positions, such as squad benches
and CPR (Cardiopulmonary Resuscitation) seats, are
subjected more to serious injury or death, even when
seat-belted, than personnel in frontward or rearward
seating positions.
If side-facing seating is considered imperative, use four-
point seatbelts.
3. Vehicle specification and upfitting
This guidance supports guidance note 365 14, 2.8 (Vehicle
specification and upfitting).
ERVs are typically used infrequently so they are subjected
to vehicle maintenance procedures that are time-based and
not kilometre or engine-hours based.
Pay particular to vehicle parts that can seize such as brakes,
wheel bearings, clutch/gear linkages and steering. The
vehicle(s) should be ‘exercised’ weekly.
Parts that degrade include fluids (brake, engine oil and
fuel) and rubber-based parts such as hoses and tyres.
ERV tyres should be replaced every four years. Tyre
manufacturers do not have a uniform criterion for tyre
lifetime. For most other vehicles, this is not an issue
because they normally wear and are replaced before the
maximum lifetime. For special vehicles like ERVs that do
very little actual driving, it is an issue.
Vehicle specifications
All ERV upfitting to should be approved by a suitably
recognized authority and completed by suitably reputable
and experienced service providers.
ERVs are typically automotive industry-designed and
manufactured vehicles with specialized after-market
additional upfits. These additional features change the
crash-worthiness and stability of the vehicle. ERV upfits
might not share the safety performance of the original
automotive manufactured vehicle.
As a minimum, ERVs should meet the vehicle
specifications as presented in Report No. 365, 2.8 (Vehicle
specification and upfitting) and in guidance note 365-14,
Vehicle specification and upfitting.
Ambulances should also:
• be suitable for stretcher recovery work – the doors
should fully open to allow free and unrestricted access
• have harnesses to secure the casualty
• have a seat belt for the emergency medical technician
in the stretcher cabin
 • have a rotating or pulsing emergency beacon
• have beam spotlights at the rear of the vehicle, to
support casualty stabilization and stretcher handling
behind the vehicle
• have reliable real-time voice communication with the
hospital to which the casualty will be transported
• be designed so that the medical technician is able to
issue instructions to the driver during the transport.
The patient compartment of the ambulance should have:
• climate control
• adequate lighting
• all surfaces padded
• all equipment, cupboards and doors with proper
securement devices
• no sharp or protruding objects
• fixture for IV drip
• water bottle(s) for drinking and hand washing.
The stretcher should be securely fastened to a vehicle
anchor point and preferably have locking wheels. It should
be possible to load the vehicle with the casualty’s head
towards the front, and the medical technician should be
able to sit next to the patient’s head.

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