|Horton Emergency Vehicles built this Type III ambulance for the Huron (OH) Fire Department with HOPS (Horton Occupant Protection System) inside the crew area, including high-tech air bags, restraint systems, and advanced head protection. (Photos courtesy of Horton Emergency Vehicles.)|
|This Type III ambulance built for Lauderhill (FL) Fire Rescue by Horton Emergency Vehicles includes an occupant protection system of customized restraints, head protection systems, and high-technology air bags.|
|Braun built this Patriot multipurpose ambulance for the West County (MO) EMS and Fire Protection District. The rig carries a Waterous 500-gpm CAFS, 300-gallon water tank with 30-gallon integral foam cell, rescue compartment space, and an ambulance transport body on the back. (Photo courtesy of Braun.)|
|The design of this Wheeled Coach ambulance features a five-point attendant seat and two five-point positions on the squad bench. (Photos courtesy of Wheeled Coach.)|
Several related trends are affecting how ambulances are designed and built these days, according to manufacturers, including the desire for more safety elements inside the crew space, reconfigured working and transport areas inside the box, additional compartment space on the entire rig, and multifunctional design of the vehicle.
Chad Brown, executive sales manager for Braun, says he’s seen more hybrid vehicles being built during the past year where fire departments and EMS squads are combining two or three vehicles into one in an effort to do more with less. “The economy is driving the trend at the department level where they may need to replace an engine, rescue, and ambulance but don’t have the funds to buy all three,” Brown says. “Fire-based EMS services are in a unique spot where money is being taken out of their budgets, but they can’t sacrifice their level of service to the community.”
The response of many departments is to carry more equipment on vehicles that can be more versatile and flexible at the scene of an emergency, he says, adding that Braun builds its Patriot to fill that niche. “Patriot is purpose-built on a Spartan MetroStar or Furion chassis, carries a Waterous 500-gallon-per-minute (gpm) compressed air foam system (CAFS), has a 300-gallon water tank with a 30-gallon foam cell inside it, and has a true ambulance transport body on the back with rescue compartment space,” Brown points out. He adds that Braun also is seeing more departments moving toward multiuse vehicles by carrying firefighting equipment such as forcible entry tools and extrication equipment on traditional ambulances.
In the Name of Safety
Dave Lamon, president of Horton Emergency Vehicles, says the buzzword in the ambulance industry these days is “safety,” especially as it pertains to occupant safety inside the vehicle. Horton has put a lot of effort into occupant safety, Lamon says, crash testing rigs with instrumented dummies located in the traditional attendant seat at the head of the cot, in the squad bench area beside the cot, and in the CPR seat built into a cabinet wall. “We found that head strikes in crashes were very violent and in most cases fatal, which led us to develop air bags to protect against head strikes in the large open area in the back of the ambulance,” Lamon notes.
Horton uses head-cushion and side tubular air bags to protect the crew in case of a crash. The head cushioning air bag is made of a material that provides progressive resistance protection to absorb more energy and slow the head down as it passes into the bag. The tubular air bags are cylinders about 14 inches in diameter and three feet long that come out at an angle from beside the seat and rise to protect the occupant, stopping the crew member from impacting a cabinet or the solid wall of the rig. Horton also uses three-point seat belts in all its seats and offers the belts and air bags as standard equipment in all its ambulances.
Lamon says Horton also is finding new ways to store equipment and materials in the back of ambulances and making that equipment crash-stable by developing new types of brackets. “It might not be the crash that kills you,” Lamon observes, “but it might be the defibrillator that flies across inside and hits you. That’s why crash-stable equipment mounting is so important.”
Another safety element Horton is building into its ambulances is in the realm of biological safety. “Think about all of the surfaces a crew member might touch with a bloody glove,” Lamon says. “All our switch plates, grab rails, cabinets, upholstery, and head liners are made with anti-microbial materials, so it’s integral in the finish and part of the manufacturing process. That gives it an indefinite life.”
Paul Holzapfel, national sales manager for Wheeled Coach, agreed that safety is a key concern among ambulance buyers. “Customers are concerned about safety in terms of accidents, and especially of the crew and patients in the back of the vehicle,” he says. “Recent statistics show that 82 percent of injuries to medics in the back of an ambulance are unrestrained person injuries, so we suggest that at least wearing a lap belt and helmet would prevent many of those injuries.”
Wheeled Coach has designed a rig where the patient cot is placed in the center of the back of the box and the medics are placed in five-point harnesses around the patient, allowing full access. “Even in the five-point harness in the captain’s chair at the head of the cot or in the side seat that slides four feet from front to rear and side to side, the seated medics have everything within reach,” Holzapfel says. “Everything, from the patient to equipment, is accessible. So, there’s no need to unbuckle to get up and go to another cabinet.”
But, ambulance design is a customer preference, Holzapfel observes, and 90 percent of the ambulances that Wheeled Coach builds are designed for two patients instead of one. “Most of the customers don’t want to give up the ability to have a secondary patient on the squad bench,” he says.
Holzapfel points out that the Insurance Institute for Highway Safety (IIHS) has validated Wheeled Coach’s vehicles on how well they hold up in side-impact crashes. Wheeled Coach puts full length aluminum crash rails in the upper and lower sides of the ambulance body—the upper about 12 inches below the box’s top and the lower at about the squad bench height. “IIHS has tested our cabs and bodies for crash integrity by crush testing, and we’ve done drop testing to 120 feet where we drop them on the corners to simulate a 30-mph collision, as well as sled testing to help improve the vehicle’s safety,” he says. “None of these things are required to be done at the present, but we do them anyway.”
Brown says his company has seen changes to the interior of ambulances being driven by safety concerns. “A lot more customers are choosing five-point seating harnesses,” Brown says, “and some are eliminating the traditional CPR seat and squad bench layout. There’s a move toward protecting the greatest fire department investment, which is the crew, by putting in restraint systems.”
Brown notes that limiting mobility in the back of a rig means creating more simplicity in the layout by changing ergonomics. “We’re getting rid of heavy equipment above the crew’s heads and putting it down lower,” he says. “That eliminates heavy lifting, twisting, and turning because the equipment is now down below shoulder level height. So we’re seeing more customization and ergonomic design in the back.”
Customers also are requesting safety equipment on ambulances that aren’t required by the upcoming National Fire Protection (NFPA) 1917, Standard for Automotive Ambulances. “There’s a growing trend for seat belt monitoring, and we have so many customers asking for rear chevrons that we put them on about 35 percent of the ambulances we build,” Holzapfel says. “And, LED lights are standard now for warning, dome, and compartment lights, which lowers the requirements on the 12-volt electrical system.”
Holzapfel adds that ambulances are getting bigger these days, mostly because they need to carry more equipment. “People always want more room in the vehicle, which is how we got up to an ambulance that’s 180 inches long,” he notes. “In the 1980s, we were building ambulances that were 60 inches high, 140 inches long, and 95 inches wide. Now we’re building them 75 inches high, 180 inches, long and 95 inches wide.” The larger payloads being carried by ambulances mean there is a need for a beefier vehicle, he says, meaning more vehicles are being built on chassis by Freightliner and International.
Custom vs. Stock vs. Refurb
Chad Newsome, national sales manager for PL Custom Emergency Vehicles, says his company has seen a couple of trends gain traction in the past 18 months—buying stock units straight off the line and remounting older ambulance boxes on new chassis.
“So many customers have had their budgets cut that they’ve had to focus on stretching out the life of a vehicle,” Newsome says. “Instead of buying a new ambulance, some choose to remount an old box on a new chassis because the departments can get into a different funding source in their budget instead of using a capital expenditure. That way they see a tremendous return on investment for the dollars used.”
Newsome adds that while there will always be a market for custom ambulances, many customers are focusing on functional needs-driven rigs. “We have a new stocking program with stock units being built with no end-user defined,” he says. “These are limited-option units, but for the customer who has to make an emergency appropriation, they can still get a PL Custom, but with fewer bells and whistles.”
He points out that often a customer will purchase a stock unit that’s on the line and have PL Custom make modifications if it’s not too far along in the manufacturing process. “In our stocking program,” says Newsome, “about 90 percent of the stock units get sold before they get completed and come off the line.”
ALAN M. PETRILLO is a Tucson, Arizona-based freelance writer and is a member of the Fire Apparatus & Emergency Equipment editorial advisory board. He served 22 years with the Verdoy (NY) Fire Department, including in the position of chief.