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Location and restraints

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The risk of morbidity and mortality has been shown to differentiate based on the EMSP's seated position within the EV. Specific to ambulance, most severe and fatal injuries occur in the rear compartment (ORfatal/severe=2.7 [95%CI=2.0-3.7] [5]; RRfatal= 5.3 [95%CI=2.1-10.1] and RRsevere=1.2 [95%CI=1.0-1.4] [16]) compared to the frontal compartment. The rear compartment of an ambulance is traditionally where the patient is treated and transported and as a result, the EMSP has to perform medical procedures within this compartment, often improperly restrained or unrestrained. Unrestrained or improperly restrained occupants compared to properly restrained occupants are 2.5-times higher odds for a fatal injury (95%CI=1.8-3.6). Properly restrained occupants within the rear compartment do not differ for severe/fatal injury compared to properly restrained occupants in the front compartment; however, occupants without proper restraints who are in the rear compartment have almost a 3-fold (95%CI=1.8-4.2) higher odds of severe/fatal injury compared to occupants without proper restraints who are located in the front compartment [5]. In a review for hazards associated with EMSP providing care within EVs, Slattery and Silver [8] documented that 40% of the time health care providers are unable to use restraints during the transport of a patient and that 16% of transports the providers are unrestrained throughout the entire transport.