Ambulance drivers often travel under stressful conditions at high speed while using vehicles with poor high-speed maneuverability. The occupant safety of ambulance vehicles has not yet been addressed by the automotive safety paradigm; particularly for the rear patient compartment. This study had two objectives: (1) to assess by survey the French Emergency Medical Services (EMS) to determine the layout of the vehicle most often used and the EMS personnel's behavior during transport; and (2) to conduct a crash test to analyze the injuries which may affect EMS personnel and patients in the rear patient compartment.

Firstly, a survey was distributed to the 50 largest metropolitan French EMS programs. Secondly, a crash test was performed with a Mobile Intensive Care Unit (MICU) in conditions closest to reality.

Forty-nine of the 50 biggest metropolitan French EMS programs responded to the survey. This represents 108 French MICUs. During the last three years, 12 of 49 EMS programs (24%) identified at least one accident with an MICU, and six of these 12 (50%) suffered at least one death in those accidents. A crash test using a typical French EMS MICU showed that after impact of a collision, the ambulance was moved more than five meters with major consequences for all passengers. A study-approved human cadaver placed in the position of a potential patient was partially thrown from the stretcher with a head impact. The accelerometric reaction of the anthropomorphic manikin head was measured at 48G.

The crash test demonstrated a lack of safety for EMS personnel and patients in the rear compartment. It would be preferable if each piece of medical equipment were provided with a quick release system resistant to three-dimensional 10G forces. The kinetic changes undergone by the “patient” substitute on the stretcher would probably have an effect of causing injury pathology. This study highlights the need for more research and development in this area.

FournierM, ChenaitiaH, MassonC, MicheletP, BehrM, AuffrayJP. Crew and Patient Safety in Ambulances: Results of a Personnel Survey and Experimental Side Impact Crash Test. Prehosp Disaster Med. 2013;28(4):1-6.

To study the role of amoeba-associated alpha Proteobacteria as infecting agents in intensive care units (ICUs).

Amoeba-associated alpha Proteobacteria were isolated from water samples taken from ICU taps and general hospital reservoir tanks using an amoebal co-culture procedure. Isolates were identified by 16S rDNA gene sequence comparison, and one isolate of each species was used as an antigen in a microimmunofluorescence assay to test the sera of the patients in the ICUs and compare them with those of control subjects.

The four university hospitals in Marseilles, France.

The sera of 85 patients in the ICUs with nosocomial pneumonia were tested.

We isolated 64 bacterial strains that were identified as Afipia species or close relatives within the Rhizobiaceae subgroup of alpha Proteobacteria. These bacteria were assigned to 8 different species. Eleven patients were found to have an elevated antibody titer to either Afipia genospecies 1, or 3 still unnamed bacteria. No specific antibodies were detected in 100 control subjects (P<.01).

These preliminary results support the hypothesis that ICU patients are exposed to amoeba-associated alpha Proteobacteria.