Alan M. Petrillo
Ambulance makers are stressing safety in their vehicles, both for patients and attendants in the rigs, as well as providing more easy-to-use storage and equipment space for responders-inside and outside of the patient box.
David B. Cole, vice president of sales and marketing for Horton Emergency Vehicles, says that his company has been testing vehicles by sled tests and dynamic tests since 2007 and roll testing since 2009. “Every test we do provides us with additional information that we use in making a safer vehicle,” Cole says. “For instance, our VI-Tech vibration isolation technology isolates the body of the ambulance from the road and enhances handling with less bounce and sway. The vibration reduction gives a firmer ride and means less noise penetrates the box, so it’s a quieter ride.”
(1) The Horton Occupant Protection System (HOPS), standard on all
Cole also points to the Horton Occupant Protection System (HOPS) as a technology that has made its rigs what he calls “some of the safest ambulances in the industry.” HOPS starts with a three-point seat harness system used in conjunction with barrier seat bolsters to confine the occupant. A detachable feature on the over-the-shoulder part of the harness allows the medical responder to move forward to access a patient without removing the seat belt.
HOPS also includes progressive resistance headrests at all seating positions that dissipate energy throughout a laminated protective surface that eliminates the bottoming effect and offers additional protection much like that provided by high-impact sports and racing helmets, Cole says. In case of a side impact rollover, HOPS deploys two types of air bags-an inflatable head curtain and a tubular structure air bag. The head curtain protects the attendant from the inhalation area cabinet while the tubular air bag is used in the main attendant area and at the CPR seat for additional head protection.
The fourth element designed into HOPS, he notes, is a roll sensor that calculates the speed at which the vehicle is rolling to determine when to fire the air bag restraints. Cole points out that HOPS is standard on all of Horton’s current custom models.
(2) PL Custom Emergency Vehicles uses radiused corners, blunted
Chad Brown, vice president of sales and marketing for Braun Industries, believes the biggest strides made in safer ambulance design relate to seating. “Seating is a big safety issue,” Brown says. “We put medics in a seated position and make sure they are harnessed yet still are able to perform their duties from that seated position.”
Brown notes that different configurations are being developed in ambulances instead of the typical captain’s chair, CPR seat, and squad bench. “We see ambulances with a captain’s chair at the head of the cot, and where the CPR seat was located there’s a box cutout for a seat cushion with cabinetry on both sides,” he says. “We’ve also put a second captain’s chair in that location. Sometimes, we’ll remove the squad bench and put one or two captain’s chairs on the curb side of the box.”
Brown points out that many agencies are saying that the primary care position shouldn’t be at the head of the cot but rather at the curb side. “The key is to allow the medic the ability to work on the patient without getting up,” he says. “That means putting cabinets and drawers at waist level for a more ergonomic design. We want the attendant to be able to sit belted in a chair and slide out a drawer with access to everything.”
Chad Newsome, national sales manager for PL Custom Emergency Vehicles, says that everyone involved in the industry is concerned about providing the safest environment possible in their ambulances. “Our Medic in Mind concept came out of talking with customers and potential customers,” Newsome says. “In order to plan on keeping folks in their seats while working on patients, we focused on getting them to always wear their seat belts. With Medic in Mind, we also changed the interiors, so we used radiused corners and blunted strike points, kept necessary patient care equipment and switches within arm’s reach, and added thick padding on the walls.”
Other safety features of PL Custom ambulances, he adds, are dual crash rails built into the sides of the vehicle. “We use five- by two-inch aluminum frame members that are welded high and low into the truck, including across the doors, to give the vehicle added strength,” he says.
Mark Schwartzbauer, sales manager for Road Rescue, says his company has made a number of changes for safety purposes in how it lays out and constructs a vehicle. “We’ve developed a hidden hinge door design for our external compartment and module entry doors,” Schwartzbauer says, “so there’s a seamless transition between the body and door skin, meaning no snag points.”
(3) Instead of a squad bench on the curb side of the patient box, Life
In addition, more departments are asking for forward-facing seating, he says, so Road Rescue developed a mobility track that allows a medic’s seat to slide fore and aft of a patient on a cot inside the box. “It also frees up compartment space on both the street and curb sides of the vehicle,” he adds.
Typically on the curb side, the head of the squad bench has a workstation and defibrillator monitor, while the mobility seat in its forward position also can access that equipment. It also has the reach to pull out drawers for gear, a laptop, and suction controls, Schwartzbauer says. On the street side of most Road Rescue models, there is a seat that can be tilted forward to a flat position to allow carrying a backboard on it.
Life Line Emergency Vehicles has designed a number of ambulances without squad benches, Randy Smith, production process engineer, points out, instead, fitting in side-facing seats with countertops and drawers on each side of the seating position. “They’re putting in slide-out drawers and trays so the equipment they need is within easy reach,” Smith says.
About five years ago, Brown notes, Braun began using all rounded and padded corners in all of its ambulances. “Also, we use aluminum cabinetry instead of wood, which is welded into the structure of the ambulance so that it becomes one with the box. It’s much stronger that way too.”
He adds, “In 2008, when the revised KKK specs (KKK-A-1822 specifications issued by the federal General Services Administration) came out, the requirement to carry a second patient was dropped, which allowed for some of this unique design.”
Brown says that Braun currently builds ambulances on 37 different platforms in extended, crew cab, super, and medium duty models, as well as on Freightliner’s new Sprinter chassis. “We also introduced a new oxygen lift system that’s incorporated into our box,” he notes, “which we plan to unveil next year at the Fire Department Instructors Conference. It will be built into an outside compartment and be accessible from both inside and out.” Brown adds that lifting a patient on a cot and lifting an oxygen bottle in or out of the truck are the two biggest causes of workers’ compensation claims.
(4) Life Line Emergency Vehicles builds many ambulances on Ford F-
Newsome notes he thinks the days of two-patient transport rigs have come to an end. “The Health Insurance Portability and Accountability Act (HIPAA) expectation of privacy means you don’t have two patients in close proximity,” he observes. “Some insurance companies are denying claims when that happens. So, ambulance companies are moving away from it. The customers who use two-patient transport do so because they don’t have the resources to put two ambulances on a scene, so they have to ‘stack and rack ’em.’ ” But, single-patient transport is best for multiple reasons, he adds, especially for the efficient quality care provided by a safely seated medic.
Smith agrees that the two-patient rig has fallen out of favor. “I think it’s fallen by the wayside, but it really depends on the state-if an agency doesn’t require it, we don’t see it. But in the more rural areas of some states, especially western states like Wyoming, Montana, and others, we find the two-patient ambulance is more common.”
Other elements inside the box that are gaining in popularity, according to Smith, include environmentally controlled and lockable cabinets for medications and the Stryker Power Pro cot lifting system.
Schwartzbauer notes that Road Rescue has seen an increase this year in ambulances built on Ford E-450 and E-550 chassis, as well as on International and Freightliner chassis. “But the Ford chassis are the most popular ones we build on,” he notes.
Smith says more municipalities are getting money for ambulances, and they have been spending it this year. “A lot of buyers of Type 1 vehicles are going with Ford E-450 and E-550 series chassis, while some are choosing the Dodge 4500 and 5500 chassis,” Smith says. “And, they are going toward taller headroom trucks, in the 72-inch to 74-inch range.”
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.