RETTmobil may be the most important EMS conference and trade show you've never heard of. If you haven't, don't worry: In this special feature, several top North American attendees will fill you in.

The conference and trade show, which showcases the latest in safety and rescue innovations for EMS providers from across Europe (it translates to mobile rescue), filled 13 exhibition halls and drew 23,000 people to this year's incarnation at a former military base in Fulda, Germany, to see advances in equipment, clothing and vehicles. The EMS Safety Foundation led a delegation of North American providers, who supplemented their show experiences with a special workshop featuring speakers on vehicle safety and ergonomics and EMS head protection. The Foundation also conducted a pair of Webinars, one of which is available at Objective Safety.

In this series of articles, three members of the Foundation's RETTmobil delegation discuss their impressions and what they found most interesting and potentially helpful to their own jurisdictions. Next year's show is May 5-7. For more: www.rettmobil.org.

Innovations From RETTmobil--Part 3: Secure Stretchers and Safer Seating

By Kevin W. Peters, AAS, NREMT-P

After almost 30 years in EMS, I felt fairly confident I'd experienced most of the spectrum of equipment and technology in this industry. For two years I have served as full-time safety and compliance officer for Carilion Clinic Patient Transportation (CCPT). CCPT is a regional transport and EMS agency in southwest Virginia, with 240 employees providing care through 35 ambulances and two helicopters. My 15-year affiliation with Carilion Clinic and its dedication to a culture of safety introduced me to Dr. Nadine Levick, CEO of Objective Safety and research director the EMS Safety Foundation. Levick has helped bring attention to the lack of evidence pertaining to ambulance transport safety for the provider, patient and public. In the U.S. there are very few standards that specify how an ambulance is built and engineered for occupant safety. The standards in many other developed countries, including most of Europe and Australia, are much higher. This could help explain these nations' significantly lower ambulance-crash fatality rates compared to the U.S.

The EMS Safety Foundation coordinated a group of 24 individuals from across the United States and Canada to attend this year's RETTmobil 2009 event and see what Europe is doing in the name of safety. One of the largest EMS conferences in Europe, RETTmobil has been held for the past nine years in Fulda, Germany, on the site of an old U.S. Army helicopter base. With 13 exhibit halls and more than 70,000 square yards of exhibit space, there was plenty of room for exhibitors to show their wares. While there were many brand names we didn't recognize, there were many we did. In addition, two outside tracks allowed people to experience the handling characteristics of different vehicles in paved and off-road environments.

One interesting aspect was the vast differences in equipment available in Europe that is not available in the United States. One example is EMS stretchers. Here, stretcher and mounting systems are designed to only withstand 2,200 foot-pounds of force prior to their locking system failing--roughly equivalent to 74 pounds moving at 30 mph. The empty stretcher weighs more than that! In Europe, seats, seatbelts, stretchers, medical equipment and their mounting systems are able to endure loads 10 times the force of gravity over a crash impulse window of less than 100 milliseconds without failure. In the U.S., we tend to secure our stretchers with a single point of contact and a rack that only prevents the wheels from rolling too far forward. In Europe, there are three points of contact, each of which restrains motion on at least two axes.

Some stretcher mounts even allow minimal-lift or lift-free loading into the ambulance. Others offer patients a more comfortable suspension system to ride on. Of all the stretcher mounting systems I saw, only one vendor had the typical hook-and-rack system we are familiar with. It was part of a display on what not to use.

Another difference involved seating arrangements. Almost every ambulance displayed utilized rear- or front-facing automotive-style seats in the patient care area, with shoulder harnesses and lap belts. Everything in the ambulance was reachable from a seated and secure position.

European vehicle color selections and emergency lighting are determined based on scientific and objective information. They use colors and combinations of colors found to be the most visible during day and night hours. Many organizations use reflective and fluorescent materials on their duty uniforms to maximize visibility on roadways and in crowds.

Helmets for EMS providers are common in Europe but unheard of in the U.S. Why is this? Many of our firefighting brothers and sisters wear helmets every time they're on the apparatus.

By organizing this trip, the EMS Safety Foundation helped open some eyes to safety in the field of EMS. Joining with this organization has permitted a large network of international industry executives and leaders to compare best practices and discuss our challenges in a safe and educational environment. I hope, through such efforts, we can begin to gather valuable data that will result in quality research to implement valid and supportable changes that help save lives and preserve families.

Kevin W. Peters, AAS, NREMT-P, is safety and compliance officer for Carilion Clinic Patient Transportation in Roanoke, VA.

Innovations From RETTmobil--Part 2: Less Lifting and Efficient Interiors

By Charlene Cobb, NREMT-P

I recently had the good fortune of accompanying Dr. Nadine Levick, founder of the EMS Safety Foundation, along with 32 other delegates from the U.S., Australia and New Zealand, on an expedition to RETTmobil, an EMS safety expo and trade show held in Fulda, Germany. RETTmobil is the largest EMS expo in Europe, with close to 20,000 attendees from all corners of the world.

The EMS Safety Foundation delegation's main goal in attending was to broaden its members' perspectives regarding EMS safety, and bring back information and knowledge to share. Here in the United States, we have some of the most sophisticated, state-of-the-art equipment in the world to help us take care of our patients, and although our system is in no way broken, there is always room for improvement when it comes to the safety of EMS personnel. In the 25 years I've worked in this field, I have seen many good clinicians leave the industry due to on-the-job injuries. At RETTmobil, I found some truly amazing technology and innovations the Europeans have developed to prevent career-ending injuries. I hope the information we've collected will enlighten manufacturers and EMS organizations to the types of equipment that can help cut down on disabling EMS injuries.

One of the things I found interesting: It appears our counterparts across the Atlantic do very little lifting. Not only do they have stretchers that go up and down with the push of a button, but they go a step further and have platforms that act as lifts that move the stretcher up and into the ambulance. The products I surveyed were crash-tested to 10 Gs and stayed mounted in their tracks, which are integrated into the floor as well. Another great feature is that they can move the platform up or down in the ambulance to bring the patient to an ergonomically correct height for the medic to perform interventions--no more bending over to start an IV or kneeling on the floor to intubate.

They also use forward-facing attendant seats where our bench seats are located. These swivel toward the patient for performing care and turn forward when the ambulance is transporting. Therefore, clinicians can spend more time secured in their seatbelts. Levick's research has shown that a majority of injuries and deaths occur in the patient compartment due to unrestrained attendants. Our goal should be to keep medics secured as often as possible. The seats also lie down to accommodate a second patient. The ambulances are indeed smaller, but that's not necessarily a negative. Ergonomics consultant Chris Fitzgerald explained how the closer you are to your equipment, the less likely you are to get up and move about the rig. It's all in the design and outfitting of the interior.

I had the opportunity to test-drive a Mercedes Sprinter and was pleasantly surprised at the stable ride it provided. The Mercedes representative explained the ambulance has "ESP," a load-adaptive electronic stability program that uses steering angles and wheel speed to calculate the direction you're intending to steer. If the ESP detects wheel spin, understeering or fishtailing, it stops individual wheels and reduces engine power to correct and stabilize the vehicle.

On our last day in Fulda, Levick held a breakfast workshop where each of the delegates presented information in their areas of expertise. I found this to be especially beneficial. There were presentations and suggestions from automotive safety engineers, ergonomic specialists and ambulance manufacturers, to name a few. The workshop was also broadcast via Webinar for Foundation members who could not attend.

There is a good deal of technology and information already in existence. Perhaps we should spend less time trying to reinvent the wheel and more time exchanging ideas with our EMS counterparts. The EMS Safety Foundation opens the window to share such knowledge.

Charlene Cobb, NREMT-P, is education and safety coordinator for Sunstar Paramedics in Pinellas County, FL.

Innovations From RETTmobil--Part 1: Conspicuous Colors and Cheaper Chassis

By Matthew G. Crossman

Earlier this year I attended the RETTmobil emergency rescue congress, trade show and symposium in Fulda, Germany. The RETTmobil event was founded in 2001 by Dr. Peter Sefrin, and this year was attended by nearly 22,000 people from all areas of the world. I was asked to attend as a delegate with an amazing group of innovators and EMS safety experts belonging to the EMS Safety Foundation, led by Dr. Nadine Levick.

I work as the manager of vehicle safety programs for Medavie EMS' New Brunswick Emergency Medical Services in Canada. We provide land and air ambulance management services for Ambulance New Brunswick (ANB). My main purpose in attending was to collaborate with other EMS safety experts in researching new and innovative ideas for ambulance safety and vehicle designs.

The three-day conference was jam-packed with events, including 13 workshops, numerous expert discussions, medical rescue service training sessions and even a hands-on driver training course. There were 13 large tents housing exhibitors from all areas of the world, including Europe, Australia and North America. Many excellent outdoor exhibits and displays, ranging from clothing to equipment and vehicles, were present from the emergency medical services, military, aeromedical and fire industries.

Many things I observed at RETTmobil were quite different than what we're accustomed to in Canada. The first interesting thing I noticed was vehicle conspicuity. In North America, our ambulances are typically white, with some type of striping package in various colors and sizes. At RETTmobil, the vehicles were primarily white or yellow, but with very bright and large orange or yellow striping. I had the opportunity to see some emergency vehicles working in Fulda, and they were very easily identified.

The overall vehicle design concept at RETTmobil was also somewhat different. Primarily, the type of vehicle used was the Mercedes Sprinter. When manufacturers were asked why they used the Sprinter, their typical answer was that they're generally much cheaper to operate compared to typical North American ambulances, and require less overall maintenance. They also explained that all units are dynamically tested for both exterior stability and interior construction constancy.

Another unique design involved the exterior storage door. Many of the units had side-sliding doors on the exterior that housed the oxygen tanks and served as an extra storage compartment. The benefit of storing the extra equipment on the exterior of the vehicle is that it makes it safer for the attendant and patient inside.

The biggest difference in comparing the RETTmobil vehicles to ambulances in North America was the rear compartment seating. Most rear compartment seating in North American ambulances is side-facing and utilizes a squad bench. In the vehicles found at RETTmobil, almost all the rear compartment seating involved forward- or rear-facing single seats, with over-the-shoulder seatbelts. The seats are molded and look to be ergonomically friendly, with almost all operational equipment within arm’s reach. The stretcher also moves on most units to allow for the attendant to position themselves in a comfortable and safe working environment. In most cases, the attendant can stay secured while treating the patient. What a great idea!

With all the state-of-the-art equipment and devices we use on ambulances in the New Brunswick system, electrical draw on our batteries is always a concern. One product that was particularly interesting was the lithium battery made by Germany's LEAB Automotive. This particular type of battery lasts four times longer than most commercial batteries, is eight times smaller, and can handle five times the electrical load of a leading North American battery. What's more, the cost is very comparable.

With an increasing number of paramedics suffering musculoskeletal injuries, lift-assisting devices are becoming much more common. RETTmobil showcased many of these devices. With the simple push of a button, the powered stretchers made by Stryker and Ferno can lift a patient from the lowest position to the highest in a matter of seconds. There were also a number of powered stair chair devices that made transporting patients down stairs look easy. The biggest downfall I noticed was the added weight; each stretcher weighed around 100 to 150 lbs.--more than a non powered unit--and their batteries need to be recharged on a regular basis.

Overall, RETTmobil was an experience of a lifetime. The contacts, connections and friendships I made at this event are priceless. The exhibits, displays and dedicated people helped make this event a huge success. I would highly recommend attending this event to anyone who is interested and has a stake in improving ambulance safety.

Matthew G. Crossman is manager of vehicle safety programs for New Brunswick EMS.