Safe access/egress systems for emergency ambulances

Objective: To comparatively evaluate the three most widely used ambulance stretcher loading systems; easiloader, ramp/winch and tail lift to identify a preferred system based on safety and usability evidence. Methods: Three data types were collected in the field, the laboratory and from a national questionnaire. Field data were collected using the qualitative methods of observation (link analysis and hierarchical task analysis) and interview (critical incident technique) over 12 months during 2004–5. Laboratory data were collected for detailed postural analysis. A national ranking questionnaire was used to prioritise the resulting design issues. Results: The field study data were analysed, triangulated and summarised in a taxonomy to identify the design and operational issues. A list of 14 criteria was used in a national ranking exercise with 134 ambulance staff and manufacturers. Patient and operator safety was ranked as the highest priority, followed by manual handling. The postural analysis found that the easi-loader system presented the highest postural risk. Conclusions: The tail lift was found to be the preferred and safest loading system from both the field and laboratory research and is the recommended option from the evaluated loading systems.