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“Crashworthiness issues in
EMS Asia 2012Symposium B, 12.00 – 13.00,
September 10, 2012
Nadine Levick, MD MPHResearch Director, EMS Safety FoundationCEO, Objective Safety, New York, USA
ambulance design”
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Integrating crashworthiness into Ambulance design, NAEMSP 2012
http://www.emssafetyfoundation.org/NAEMSP2012poster.pdf What does crashworthiness mean?
That a vehicle has been tested to meet standards that demonstrate that under crash circumstances occupants will be
Essentially… crashworthiness is -
crash circumstances occupants will be protectedBut….. to what standards and which crash circumstances???
Important…
Ergonomics and automotive safety issues are interrelatedCrashworthiness priorities override theCrashworthiness priorities override the ergonomic issues
Any testing that meets a standard – is only as valuable as the standards capacity to reflect the real world scenario
Important Concepts
p yComputer models are only as good as the data entered into them – garbage in.. garbage out!
60 kph into a tree or pole60 kph into a rocky wall60 kph into deformable roadside hardware60 kph roll into a soft shoulder
These are very different… but are all crashes….
60 kph roll into a soft shoulder
And in which vehicle, and what occupant configuration or restraint system use….
ALL are different G- forces and energy transfer and injury outcomes
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And will have very different vehicle and occupant
outcomesThe testing must be guided by:
Real world crash scenariosReal world vehicle and occupant
Key issues
Real world vehicle and occupant configurationsReal world crash injury mechanisms
What is a safe speed and how do we identify that?
What is a survivable impact ?
12 mph (20 km/hr)?IRMRC
What is a survivable impact?E= ½ mv2 v2 = 2as
IRMRC
What is a survivable impact?E= ½ mv2 v2 = 2as
IRMRC ~ 30 mph - survivable
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What is a survivable impact?E= ½ mv2 v2 = 2as
IRMRC ~ 60 mph – not survivable
Vehicle Safety Dynamic Testing Types
Deceleration Sled Tests (not usually a full vehicle) – no intrusionBarrier impact tests – intrusionBarrier impact tests intrusionFull vehicle to vehicle tests – intrusionComputer predictive modeling - must be based on real world injury and vehicle crashworthiness data
Deceleration Sled Tests (not usually a full vehicle) – no
intrusion
Deceleration Sled Crashworthiness testing
Europe - 2007 to meet CEN
Pre crash sled test configuration(view of captains chair and patient area)
Uninstrumentedrestrained CTD
Instrumented restrained child
CTD
Pre crash sled test configuration(view of squad bench)
Instrumented unrestrained SID
Uninstrumentedrestrained CTD
‘man saver’ device
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And this all takes place in 60 millisecs –the blink of an eye
Post impact (from rear door)
PPE from the stationary environment can be highly hazardous in the automotive setting
XXXXSystems safety failure AND dangerous
Overwhelming existing evidence these practices are HIGHLY dangerous
NO evidence whatsoever that these practices are NOT dangerous, let alone XXsafeXX
NOT new technical data…
Richardson S.A., et al, Int. J. of Crash., 4:3, 239 – 259, 1999Side facing 4-point harnesses demonstrated to be lethal, even at
slow ground vehicle speeds
Beware some provider restraint systems are dangerous
Side facing 4-point harnesses demonstrated to be lethal, even at slow ground vehicle speeds
Richardson S.A., et al, Int. J. of Crash., 4:3, 239 – 259, 1999
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Being seated IN an automotive seat is what will protect you
Anything that allows or encourages you to get up out of your seat will also encourage you to be injured or killed – it is potentially lethal to be out of your seat in any fashiony y4 or 5 point harnesses over both shoulders for sidefacing occupants are potentially lethal –and in NO WAY SUPPORTED BY ANY DATA OR INDEPENDENT AUTOMOTIVE SAFETY EXPERTISE
Dynamic Sled Testing
ofof Ambulance
Pediatric Restraints
Deceleration Sled test (upon impact) 24 G, 30mph
Levick NR, et al. Development and Application of a Dynamic Testing Procedure for Ambulance Pediatric Restraint Systems, SAE Australasia 1998;58:2:45-51
If we know this – and its published….
Why do we do this?ALL patients need shoulder straps!!
Barrier impact tests - intrusionSprinter v Ford Transit crash test
http://www.youtube.com/watch?v=C3kN6WF5vAA&feature=related
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Full vehicle to vehicle crashworthiness tests
Intrusion and occupant dynamics
Intersection crashes are associated with high injury and
fatality rates
And very Predictable…y
Intersections are lethal environments
So.. The real world for an EMS vehicle approaching a red light
You think they heard you…You know they must have seen you..And maybe they didAnd maybe they did….. But..There is NO way humanly possible that they could stop…..
The real worldIntersection passenger car stopping distance* at 40 mph dry
and wet
44 feet
P ti R ti ti V hi l B ki ti (d )
DryStopped at 176 feet
+
Perception + Reaction time Vehicle Braking time (dry)
40 mph
Wet Stopped at 220 feet
Perception + Reaction time Vehicle Braking time (wet)
* Stopping distance:Perception time + Reaction time + Vehicle braking time (varies with age, skill, agility, alertness + vehicle type, tire pressure, road etc)
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Testing the real worldTest 1 – Right side impact
1 2
What is actually happening during an ambulance crash
Johns Hopkins University
1 – Target vehicle, Type I ambulance
2 – Bullet vehicle, Type II ambulance
Closing speed 44 mph
Pre-impact CTD positioning
Preparation of test vehicles
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And this all takes place in 60 millisecs – the blink of an eye
Impact residue
CTD dynamics
During impact
Post impact
Computer predictive modeling -
must be based on real world injury and vehicle
h thi d tcrashworthiness data
Valuable that Malaysian ambulances are OEM vehicles – structurally unalteredKey importance of occupant restraint
Relevance
Key importance of occupant restraint use and configuration in determining safety outcome
Use of standard seat belts by providersUse the patients stretcher shoulder belts for ALL patients
Important!!!
ALL equipment must be secured If hazardous driving is deployed – ALL occupants and equipment MUST be optimally retrained during that time
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Vehicle StandardsVehicle– AMD– KKK– NFPA– ASTM– ASTM– FMVSS– SAE– International - CEN/ASA
International Ambulance Design Safety and Occupant Protection
Standards
In existence since 1999Australia – ASAEurope - CEN
“Restraint systems shall apply to all equipment and people carried in an
Australia & New Zealand Ambulance restraint standard
AS/NZS 4535:1999restraint systems only
q p p pambulance…” -Dynamic Testing - 50th & 95th percentile manikins24G in Forward and Rearward10G in Transverse
CEN – EN 1789:2007+A1 2010E*Medical vehicles and their equipment –
Road ambulances “Without exception, all persons, medical devices, equipment, and objects normally carried on the road ambulance shall be maintained to prevent them from becoming
j til h bj t t f ”a projectile when subject to a force…”Dynamic testing - 50th percentile manikins10 G in Forward, Rearward, Transverse, & Vertical directionsCertified by Notified Body & Ambulance Mfg*Also is EN-1865:2000, for stretchers and patient handling equipment used for road ambulances
SAE Ambulance Equipment mounting testing standards
Frontal Impact SAE 2917, published May 2010Side Impact SAE 2956, published June 2011
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USA KKK ambulance purchase specifications
GSA:KKK-A-1822F, Aug 2007to retire October 2013
Specifications for purchase of Star of Life AmbulanceStatic Pull test2200 Lbs static stretcher test in2200 Lbs. static stretcher test inlongitudinal, lateral & vertical No dynamic test for vehicle, occupants or equipmentNo automotive test manikinVoluntary
www.ntea.com/WorkArea/downloadasset.aspx?id=1352
USA Ambulance Manufacturing Division (AMD)
Ambulance Standards– August 2007
(being integrated into NFPA 1917)No dynamic or impact testNo automotive test manikinMandates NO ‘crumple zone’ No impact tested anchorages for occupant restraint or equipmentInternal, not independent & not a standardizing body
http://www.ntea.com/WorkArea/showcontent.aspx?id=1350
Current 2012 USA ambulance ‘safety testing’ – Is NOT consistent with accepted automotive
safety practice…!?!?No ‘a’… then NO ‘F’ !!!!!
F = ma
where F – forcem – massa – acceleration
Yes a “nationally recognized testing lab” – BUT - NOT an automotive/occupant
safety crash test lab!!
NFPA 1917, August 2012(based on KKK, AMD)
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AMD 2007 - 025 ‘static occupant safety testing’
Accepted automotive safety dynamic occupant
testing
- Compared with -
Meets CEN-1789 - High speed crash, rolled and the occupants (patient and medics) had only
minor scratches
this vehicle is safety crash tested by automotive experts
Unlike this vehicle
Which does meet KKK, and AMD…
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April 30, 2009 - Tennessee A survivable impact??
Just because it has been ‘Tested’ does not necessarily mean it has been crash tested – nor that it is crashworthy and/or going to protect you
Caution!!!
Even if it has been ‘Crash tested’ – it depends upon to which standard, whether or not it is actually safe under real world crash conditionsAppropriate technical expertise is key!!
Appropriate crashworthiness testing is the primary guide as to whether a vehicle and restraint configuration is actually safe Independent and specialized technical
ti i t ti f t i k t
Summary
expertise in automotive safety is key to guide interpretation of any manufacturer claimsUse of proven occupant safety design saves lives
Thank you! Any Questions??
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