Background: According to the National Highway Traffic Safety Administration, the risk of accident-related fatalities in the rear of an ambulance is more than five times greater than it is in the front seat. The main objective of this research was to assess ambulance design safety and identify limitations that endanger emergency medical service (EMS) providers in Saudi Arabia during their day-to-day work, especially in the rear cabin. Methods: An observational cross-sectional study was conducted via online surveys filled by EMS providers and a checklist filled out by supervisors, section heads, and chiefs, in Saudi Arabia, from March 2020 to April 2020. Additionally, a retrospective review was also conducted on reports by various US and international safety organizations. Results: A total 861 participants (832 surveys and 29 checklists) were enrolled. EMS providers expressed significant challenges in terms of ensuring their own safety as well as that of the patients due to the current ambulance design, where 79% (22/29) of checklist participants and 87% (718/861) of survey participants indicated dissatisfaction with the current ambulance designs. Conclusion: Practically, the design of the current ambulances is often unsafe for providing emergency medical treatment, and therefore the rear cabin is a dangerous environment for both the patient and the EMS provider.

Keywords: Ground ambulance, rear cab, emergency medical services, injuries, safety system, cabin design