Minding The Ambulance Bay
Ambulance bays are the front door for many at a hospital. However, the design and operation of these essential spaces can be less than ideal for patients, staff, and EMS personnel alike.
Don Sharpe, a senior paramedic, emergency medical services, with Alberta Health Services in Canada, says he’s seen a lot of horrible conditions during his 30-year career, from discarded supplies left in doorways that hinder patient transfers into the emergency department to ill-placed floor drains that leave paramedics standing in pools of water while unloading stretchers.
Determined to do something about it, Sharpe teamed up with Jason Laberge, a human factors specialist with Alberta Health Services, to study ambulance bay design. The two conducted 31 interviews with urban and rural EMS personnel at a large metro hospital in Canada to identify issues and opportunities for improvement.
“For paramedics going from one hospital to another, we like everything to be the same,” he says.” What he finds, however, “isn’t working for us.”
At the heart of the issue, says Sharpe, is the fact that these are shared spaces within a hospital system and various parties—including ED staff, facility operators, and EMS personnel—aren’t on the same page about how they should function and what the necessary design elements are.
For example, the EMS staff needs to sanitize stretchers, clean out the back of their trucks, and restock supplies as quickly as possible so they’re available for their next run. But an ambulance bay without proper cleaning equipment or with supplies stored in out-of-the-way places can hinder that goal.
There’s also an issue with accountability, with EMS personnel who aren’t integrated into the hospital system squaring off against ED staff over who should clean a dirty backboard or make sure garbage or leftover Christmas decorations aren’t put in the hallway leading to the ambulance bay.
"If the door breaks, it’s a facility maintenance issue,” he says. “If the ambulance bay isn’t clean or equipment is left there, who do you call?”
For starters, he says, facilities need to identify all stakeholders, including ED, EMS, maintenance, engineering, housekeeping, and grounds, and establish accountability for issues like cleanliness, equipment storage, stocking, and resupply.
Then take a look at the ambulance bay, observe operations during a run, and make ergonomic changes needed to support those functions, such as adding or moving storage bins or equipment carts. Then keep up with stakeholders that issues are being addressed and elicit suggestions for revision.
Since first introducing his guidelines two years ago, Sharpe has met with multiple facilities and has had varying success getting them to recognize the problem and address some common design issues.
It’s a culture shift, he says, but one that must be made as part of a facility's effort to improve the patient experience, maintain a clean and safe environment, and keep staff and visitors happy.
“We can’t treat these areas like a garage when they’re really intermediate patient care areas,” he says.
For more ideas on ambulance bay design, check out Healthcare Design’s March issue.