The Hospital Ambulance Bay is Primarily an EMS Workspace. What’s hindering Paramedic Care in yours?

1. 14
How Ideal
is your
Ambulance
Bay?
Patient and paramedic safety is at
stake
Don Sharpe
H
ospital ambulance bays connect paramedics
arriving with their patients to the tertiary
care staff and equipment of local hospital
systems.
Some view the ambulance bay as little more than a garage attached
to the emergency department, with vehicle doors that go up and down
and a personnel door that allows access to triage. To paramedics, it’s a
place to get into and out of as quickly as possible, a transitory location
that needs to be designed and maintained to be as efficient as possible
24 hours a day.
An empty ambulance bay is a sign of a success, as either there are no
patients arriving because it’s a quiet shift, or EMS is quickly transition-
ing patients from our prehospital care to the emergency room.
Our job in EMS lies primarily outside the hospital, on the streets of
the cities and towns where the people we serve are living and working;
not in the ambulance bay.. Every extra minute spent in the ambulance
bay means less time on the street.
Keeping that in mind, everything paramedics do while their
ambulance is parked on hospital property needs to be designed with
one primary goal in mind: Get us out of there and back on those streets
as quickly as possible. To that end, EMS managers will often ask
hospitals to allow them to stock supply cabinets with medical supplies
and replacement EMS equipment to enable ambulances to leave the
hospital restocked and ready to respond to another call.
Much of this expensive medical equipment needs to be secured, so
locking cabinets are often installed. As the goal is to have this equip-
ment readily available, it needs to be stored as closely to the ambulance
bay as possible, without compromising the space necessary to move
both ambulances and patients safely through the building.
Even though ambulance bays primarily serve paramedics and their
patients, they are attached to –and therefore usually administered by
– the hospital. Disaster Services recognizes the ambulance bay as a
first point of contact for large numbers of patients in a Mass Casualty
Incident, and as such, have multiple carts of disaster supplies shrink
wrapped and placed close by in the event they are needed.
Photos: Don Sharpe
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2. 15
An often-empty ambulance bay attracts all kinds of random matter
from its surroundings. In hospitals everywhere the unit staff and manag-
ers are looking for more space. Carts and equipment line the hallways
of every unit as storage and utility rooms become overfilled. Anyone
looking for more room in a hospital could look into the ambulance bay
and glimpse a solution to their own lack of space problem.
“If we just put this piece of equipment over in the corner of the
ambulance bay, it will be close by when we need it, that shouldn’t be an
issue…”
Without a thorough understanding of the compromises made and
the impact on EMS, ambulance bays can deteriorate into cluttered
spaces used for storage of hospital equipment and supplies. By looking
to fulfill hospital needs without any knowledge of the space required for
EMS to do their job, a dangerous precedent is quickly set.
A summary of research on the design and efficient function of
ambulance bays reveals very little has been done. There are still no
ambulance bay standards or design guidelines in Alberta or anywhere
else.
Research on the dangers, workflow, design, stocking and use of an
ambulance bay, if it has been done, is very poorly documented. No
comprehensive study of this space has yet been completed, and while
other patient care areas and staff workspaces within the hospital are
meticulously researched and restructured, the ambulance bay has
remained an enigma.
Specialized cleaning tools and products that work well both within
and outside the rest of the hospital have proven to be ineffective in the
ambulance bay. Neither hospital housekeepers with their mops and
vacuums, nor the hospital groundskeepers with their rakes and brooms,
are properly equipped to clean the ambulance bay.
Contaminated EMS equipment such as backboards and straps,
traction splints and extrication tools are often returned to the bay
without being cleaned. Once they’re left in the corner of the ambulance
bay, they begin to present a serious biohazard risk to both paramedics
and their patients.
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3. 16
EMS staff, who are all specially trained to cope with difficult
circumstances, might see the lack of accountability for the ambulance
bay clearly, and without receiving support from their EMS managers,
may quickly adapt – and then begin to contribute – to the cluttered and
contaminated state. This is not simply the nature of the EMS environ-
ment, it is also human nature.
Establishing accountability won’t happen without first highlight-
ing what the problem is. Gaining the attention of hospital and EMS
managers as well as paramedics may be especially difficult in a health-
care system that is currently overburdened with more immediate and
pressing problems.
Identifying who’s involved in a “garage” filled with what is essen-
tially an empty space is more difficult than you might first imagine.The
emergency department, security, housekeeping, EMS, as well as mainte-
nance and engineering all have clear responsibilities in the ambulance
bay. There may be other currently participating stakeholders who upon
reflection have no place in the ambulance bay, however over time they
may have been permitted to leave their equipment or supplies there due
to passive disregard.
Perhaps some physicians leave their bikes in the ambulance bay, or
a couple of nurses have brought a portable basketball hoop they use on
nights. Housekeeping might see it as a good place to clean and then
let dry a grossly decontaminated hospital stretcher; they may also store
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4. 17
boxes of medical supplies and floor cleaning equipment there.
Social workers may decide it’s a good place to keep extra boxes of
clothes for patients. Maintenance staff might store rolls of new hospi-
tal flooring until it’s installed. Hospital educators may store the manne-
quins they use for training. Don’t forget about the holiday decorations,
bags of recycling and spare crash cart!
From the hospital’s perspective, it’s difficult to label the ambulance
bay as a specific type of workspace. It’s not really a waiting area like
the ER waiting room, although ambulances are waiting there to be
restocked while paramedics deliver their patients to the emergency
department. It’s not really a patient care area either, although paramed-
ics could be delivering a baby or intubating an unconscious patient
there at a moment’s notice.
The ambulance bay isn’t a ‘temporary’patient care area,like the scene
of an accident or a patient’s home. Those locations are only considered
patient care areas while EMS is on scene doing treatment or extri-
cation. The ambulance bay also cannot be considered a ‘permanent’
patient care area, similar to the emergency department or other hospi-
tal inpatient units. Housekeeping could never be expected to clean
the ambulance bay up to the standard of these in-hospital tertiary care
areas; it simply would not be possible.
An ‘Intermediate Patient Care Area’standard needs to be developed
and then applied to hospital ambulance bays. Cooperation between
hospital and EMS managers to determine priorities for the design and
use of the ambulance bay first needs to be established. To accomplish
the goal of having a safe, smoothly functioning ambulance bay will
require subsequent strong leadership from senior hospital management,
as well as active participation from all of the ambulance bay stakehold-
ers. A time commitment of several meetings including all parties over
a six month period may be required in order to make the transition.
In the next issue we’ll discuss the steps necessary to take your ambulance
bay from chaos to order, including performance surveys, developing check-
lists and accessing research currently being done in a high volume Level 1
Trauma Centre Hospital ambulance bay.
ABOUT THE AUTHOR
Don Sharpe is a Paramedic with AHS in Calgary and has also worked in
Northern Alberta on many different remote assignments.
He is currently a finalist for the AHS President’s Excellence
Award for Workplace Health & Safety.
He is a past Vice President of the NAEMD and was
previously honoured with the Interphase Physicians
Award for Research for his paper on “Ambulance Fatality
Accidents”. He also was awarded the Canadian EMS
Exemplary Service Medal in 2007.
10 THINGS YOU CAN DO IN
5 MINUTES IN
THE AMBULANCE BAY
1
Pick some garbage and
paper up off the floor.
2
Change the dirty water in
the mop bucket.
3
Help a colleague clean
their truck.
4
Clean a dirty Backboard
and green tag it.
5
Sweep a section of the bay
using equipment on the
Shine Station.
6
Clean counter in the office
using the spray bottle in
the Shine Station.
7
Clear extra stock/garbage
from on top of the EMS
cabinets .
8
Check garbages, linen
bags & sharps containers.
Replace if needed.
9
Squeegee extra water off
the floor, sweep and shovel
excess gravel.
10
Introduce yourself to
housekeeping staff; let
them know you appreciate
their work. (Housekeeping
staff is always willing to
assist you when a concern
arises, if you ask!)
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