Article parut en 1998 Buckle Up! Kicker Vest Attendant Restraint System protects providers http://www.emsmagazine.com/articles/emsarts/BUCKLEUP.html By Mike Spivak Senior Editor/Staff Writer Most people know the dangers of riding unbelted in a passenger vehicle. If that car is involved in an accident, any number of things could happen to an unrestrained passenger. He or she could be tossed around inside the vehicle, or at the worst, be thrown out of the car through the windshield. The chances of major injuries or death are high, especially if the vehicle is involved in a high-speed collision or rollover. What most people don't realize is that the same thing holds true for EMS providers who ride unbelted in the back of an ambulance. While all ambulances have lap belts for providers to wear during patient transport, these restrict movement and make patient care virtually impossible. In a critical situation, providers need to be mobile in order to care for a patient in the back of the ambulance. However, if the ambulance is involved in a collision, the unbelted provider is just as unsafe as an unsecured passenger in a car, perhaps even more so, due to equipment cabinets that can seriously injure a provider who is tossed around during an accident. The dilemma of treating the patient vs. protecting the provider during an emergent call has plagued EMS for years. A few individuals have taken a step toward resolving this conflict by offering a product that acts as a bridge between patient treatment and provider safety. The Kicker Vest System You don't have to tell Ben Nixon what can happen to an unbelted ambulance attendant during an accident. "I've been involved in investigating ambulance accidents and I've seen some bad things happen to people who were riding unrestrained in the back. They would go through the bulkhead," says Nixon, division chief and fleet manager for the Phoenix (AZ) Fire Department. In response to these incidents and a reluctance among some providers to wear lap belts which restrict their movements, several members of the department brainstormed as to how they could help protect providers, while still allowing them to treat patients in the back of an ambulance. Pat McCue, engine captain at Phoenix Fire Department's Station 24, and Ned Dunnington, Battalion Chief with Phoenix Fire Department's South Fire District, Battalion 5, came up with the idea to create a harness-type restraint system that would hold a provider snugly in place while still giving him the ability to move around the ambulance. McCue and Dunnington went through several design models before completing a finalized version, called the Kicker Vest Attendant Restraint System. The system consists of a harness that the provider straps himself into. The harness is connected by a cable to a rod that is mounted to the ceiling of the ambulance. The device works through the use of three anchors, or inertia reels; two are mounted on the wall of the ambulance, while one is mounted at the ceiling. During sudden, jarring movement of the vehicle, these reels lock up, holding the medic in place wherever he may be at the time. Because the medic is standing while wearing the harness, and because his legs are not restricted, he is free to move about the cabin far enough to cover treatment of the patient. "It's a fixed harness, but it allows movement," says McCue. "With the system, the medic can treat most injuries and illnesses from head to toe, reach all positions and intubate as well." In 1993, after completing the final design, McCue and Dunnington formed their own company, Allied Service Systems, in Phoenix, AZ, and obtained patents on the product's design and anchor system. The product meets OSHA and ANSI standards and is also rated as a Class III Rescue Harness by the National Fire Protection Association (NFPA). McCue says it is the first device of its kind. "I know that, because when we applied for the patent, there was nothing else in that category," he says. He and Dunnington decided to make the device as strong as possible, even if it meant extra expense. This means that everything was built to military specifications, including the stitching on the harness. "Every stitch is accounted for, and the joints on the harness can pull up to 6,000 lbs.," says McCue. This is similar to the construction of helicopter parachute straps, which undergo rigorous construction to ensure they meet the most stringent standards, he adds. McCue, who used years of experience as a skydiver to help him develop the product, says the device can also be used outside of an ambulance, in mountain climbing or helicopter applications. Retrofit or Factory Installed McCue's company has currently sold the device to state EMS departments and 35 private ambulance companies across the country, including manufacturers Wheeled Coach Industries of Winter Park, FL; Marque, Inc. of Goshen, IN; and Southern Ambulance Builders of LaGrange, GA. The device can be retrofitted into existing ambulance designs or installed in ambulances right off the factory line. Most ambulances can carry two of the restraint systems in back. Because of space constraints in the average ambulance, this is about all they can hold, according to McCue. Each unit costs $1,079, and consists of the harness/vest, the three anchors, and the equipment to connect these devices, such as the rod and cable system. Nixon has used a combination of retrofitting and factory installation to get the devices into ambulances operated by his department. "Because of the cost of the harnesses, we would buy so many at a time and retrofit. The last three groups of ambulances that we bought had them installed at the factory." What Users Say Most who have used the device like it, once they become accustomed to putting it on and taking it off. "The only drawback from people I've talked to is that it takes a few more seconds to get into the harness," says Nixon. "It's kind of a knack learning how to get in and out of it." The Phoenix Fire Department encourages its ambulance personnel to use the devices, but gives them the option of sticking with lap belts. Pat Rudolph, a captain/paramedic on the technical rescue FEMA team at Phoenix Fire Department's Station 48, has used the device and likes it. "I like the way it's set up. It gives me an additional amount of support around my rib cage and abdomen because you're padded pretty well there. If you should hit an object inside a vehicle during a rollover or frontal collision, at least your torso, rib cage and abdomen are protected." In his experience, Rudolph says the device does not restrict most movements around the cabin. "It's flexible enough to allow you to treat 90%—95% of the cases you will come across, whether it be attending an IV, maintaining an airway, suctioning, delivering meds, etc. It doesn't seem to impair the mobility that you would need for these tasks." And Rudolph isn't fazed by the extra time it takes to put on and take off the device: "Once you get used to it, it's a quick process," he says. He even feels safer in the harness system than in the traditional lap belt system because of its ability to reduce the horizontal or lateral motion that can still occur in lap-belted attendants during certain impacts. "During an accident, when you're riding on the bench seat with a lap belt secured, you're still going to move one way or the other," notes Rudolph. "This device makes me feel a bit more protected." Nixon, who says he has not heard of any problems so far with the device, concurs: "With a lap belt on, if you get hit, your upper body could jerk, but the kicker vests basically hold you like a glove. You might be injured in an accident, but they're going to prevent you from going anywhere." Rudolph says providers need to try out the device before deciding whether or not to use it. "If you don't give a piece of equipment a chance, you're not going to know how it will do," he says. "I've been here 32 years, during which time I've tested a lot of equipment for the department. I gave it a chance, and I felt good about it." Nixon sums it up this way: "I think it's practical for most ambulances. Do you want to spend a bit of time to restrain someone in order to help save their life, or do you want them to go through the bulkhead and possibly lose them? Our bottom line in the Phoenix Fire Department is that we send our crews out at 7 a.m. one morning and we want them to go home the next morning. Each department has to look at what they want to do for their members and what the cost ramifications are."
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