Dec. 3, 2019

New ambulances in Alberta safer thanks to UCalgary research collaboration

Eye-tracking technology helps uncover where design changes should be made, benefiting patients and paramedics
In this simulation Greg Sikora, EMS paramedic, is wearing the eye tracking glasses that assisted in the study.
Greg Sikora, EMS paramedic, is wearing the eye-tracking glasses that assisted in the study. Photo by: Alex Baron, W21C

New ambulances in Alberta are safer than ever for patients and paramedics thanks to a joint study evaluating how paramedics work inside an ambulance during patient transport. The research was a collaboration between members from the O’Brien Institute for Public Health’s W21C Research and Innovation Centre at the University of Calgary, Alberta Health Services (AHS) and Emergency Medical Services (EMS). Results of the study led to significant improvements to the rear patient compartment of Alberta ambulances.

Providing clinical care in a moving vehicle presents some unique design challenges. A number of previous studies have found that emergency personnel and patients in the rear of the ambulance have higher rates of injuries and fatalities than the general driving public.

Better ambulance design to improve patient and provider safety and care quality

The study was conducted in real-time, in moving ambulances. Researchers used patient simulators during the scenarios, equipped to look and act like a real patient. This allowed the paramedics to deal with realistic patient responses to a variety of medical procedures. Additionally, eye-tracking technology fitted to the paramedics during specific task simulations, like providing CPR to a patient while the ambulance was in motion, let researchers see and experience the patient interactions through the eyes of the paramedics while they were providing care. Data from the eye trackers provided a more detailed understanding of physical and cognitive interactions that took place in the ambulance. 

“This is the first study to examine the complex interactions of paramedics with the patient compartment,” says study co-author Dr. Jeff Caird, PhD, professor in the Department of Psychology at the University of Calgary and W21C human factors and simulation lead. “Specific areas of focus included whether paramedics used their seatbelts and how accessible supplies and devices were used during patient resuscitation.

We made a number of recommendations to redesign the patient compartment to make things more accessible to the paramedics while seated.

During the study, dozens of frontline paramedics contributed through patient simulations and training scenarios conducted in all five AHS zones.

“We spent nearly two years working with frontline paramedics, studying how they moved around in an ambulance; where they looked, where they tended to reach, or where they supported themselves when they were moving around,” says Mike Plato, EMS associate executive director of business standards and operations support.

This is the first major study in Canada to re-evaluate ambulance design. Results are being shared with other provinces and jurisdictions across North America and Europe.

“When we are able to reduce the likelihood of the paramedic needing to navigate around a moving vehicle – even carefully navigate – there’s less risk of the paramedic being injured during a sudden stop or evasive manoeuvre, and thus less risk to the patient,” explains EMS chief paramedic Darren Sandbeck.

Study co-authors from left: Jeff Caird, Professor at the University of Calgary and W21C Human Factors and Simulation Lead, and Ian Blanchard, EMS research Lead.

From left: study co-authors Jeff Caird, UCalgary, and Ian Blanchard, EMS research Lead.

Photo by Alex Baron, W21C

Design recommendations for safer ambulances

“We know that it’s safest when paramedics can provide care from one of the three seats in the patient compartment, safely belted in,” says Mike Plato. “So part of what we wanted to do was determine how to reconfigure the area around the seats to limit how frequently paramedics need to get up.”

Thanks to this study, several key changes are already in place in newly delivered ambulances:

  • Improved overall layout and seat design to encourage seatbelt use
  • Rounded corners on interior surfaces to prevent injuries
  • Adding lips or rounded edges to counters to prevent falling objects
  • Putting most-used tools and equipment in easy reach of the primary caregiver seat
  • Placing garbage and sharp containers in better proximity to the primary seat
  • Additional grab handle added for stability
  • Added a hydraulic lift for main oxygen tank
  • Additional work surfaces added (drawers, pullout shelving).

Findings are published in the spring issue of Applied Ergonomics.

Dr. Jeff Caird is a professor in the Department of Psychology at the Faculty of Arts and is an adjunct professor in the departments of Anesthesiology, Perioperative and Pain Medicine, and Community Health Sciences at the Cumming School of Medicine and a member of the O’Brien Institute for Public Health.

About Alberta Health Services
Alberta Health Services is the provincial health authority responsible for planning and delivering health supports and services for more than four million adults and children living in Alberta. Its mission is to provide a patient-focused, quality health system that is accessible and sustainable for all Albertans.

About W21C Research and Innovation Centre
W21C is a research and innovation initiative based in the University of Calgary’s O’Brien Institute for Public Health and the Calgary Zone of Alberta Health Services. W21C conducts health systems research to make care better by focusing on improving patient safety and quality of health care delivery. For more information, visit




Two paramedics are working on a patient in this simulation that was part of the UCalgary/EMS study. One paramedic is wearing the eye tracking technology.

Paramedics Ryan Lee, left, and Greg Sikora demonstrate a simulation in the study.

Alex Baron, W21C