Cardiac & Resuscitation, Equipment & Gear

From Idea to Innovation

Thirty-five years ago, my colleagues and I thought many of the advancements we were witnessing in„EMS were cool, neat and maybe even far out. Many of those concepts are still with us, but we also have a whole new crop of innovations and ˙in productionÓ items intended to enhance our capabilities in the field. By no means will this article cover the entire spectrum of everything available, but it will slice through the ever-evolving concept we call ˙EMSÓ and cover some of the products I’m familiar with in my capacity as vice president of purchasing and fleet operations for a large, progressive ambulance operation.„

Before we launch into descriptions of current trends in products and services, I wanted to take a moment to recognize the very core of our industryƒthe people. Much of the change we’ve seen stems from the needs and feedback of field providers, who sometimes are even the creative inventors themselves. And what would be the use of these innovations without all the selfless providers out there to deploy them?

It’s this tip of the hat to providers that makes some of these new products the most valuable. As a profession, we’re finally realizing that our own health and safety is important, and the manufacturers are hearing us.

Lifting & Moving
The age-old challenges of frequent lifting and tenuous navigation of stairways while carrying a patient has been made substantially easier and safer, specifically by powered cots and tracked stair chairs from Stryker, FERNO and Monster Medic.

The key to Stryker’s Power-PRO stretcher is a battery-powered hydraulic lifting system that gives the user 700 lbs. of easy-to-use cot capacity. This cot’s fully charged 24-volt DeWalt battery is designed to enable you to run 20 complete calls on a single battery. Each battery reaches full recharge in approximately one hour and will function for 700Ï800 charge cycles before you need to replace it. The Power-PRO also has infinite height adjustments within the operating range and will remain at the current height position if someone pulls one of two manual releases or if the hydraulic system loses pressure for whatever reason. The cot also features a manual back-up system.

Stryker provides optional features, such as a backrest storage pouch, permanent or removable oxygen bottle holders, and a base storage net. The stretcher comes with a generous warranty schedule that includes a three-year limited warranty on power-train components.

The ˙cost justificationÓ section of Stryker’s Web site(www.ems.stryker.com/pp-mini-site/powerpro.html)let’s you get a good feel for the potential affect within your agency. It wil calculate your agency’s projected weight savings per shift based on the number of patient transports. Customer feedback demonstrates that the products lower costs and the risk of injury to employees and patients.

Stryker’s Stair-PRO Model 6252 stair chair Stair-Tread system allows for operator-controlled descent down stairs without lifting. The extendable head- and foot-end lift handle design supports proper ergonomic lifting technique, while improving the line of sight and creating more personal space between the provider and the patient.

FERNO’s EZ-Glide Evacuation Stair Chair with Track and ABS Panels allows you to glide patient loads up to 500 lbs. down stairs without carrying or lifting. FERNO’s 1″ track-to-ground clearance and front swivel wheels provide superior maneuverability over carpet and in confined spaces, such as stair landings.

FERNO’s POWERFlexx powered cot easily lifts and lowers a 700-lb. patient without lift assistance from the operator. The lifting system utilizes a 24-volt DC power pack that works with dual lifting hydraulic cylinders and rails to provide smooth even lifts. The lead-acid battery has no ˙memoryÓ and provides power for 20 full-squad runs.

A wide wheelbase supported by 6″ wheels, proper X-frame positioning, and strategic placement of the motor and battery all create a lower center of gravity and higher stability. In its lowest position, the cot is capable of supporting 1,000-lb. loads. A release handle allows for manual operation. The POWERFlexx has a smooth anodized aluminum mainframe that eliminates collection points for blood and pathogens; the powder-coated frame is available in multiple colors.

You can eliminate the need for battery management with FERNO’s Integrated Charging System (ICS), which includes the POWERFlexx+BACS (Break-Away Charging System). With the BACS, your POWERFlexx cot charges the battery while it’s in the fastener, so your stretcher is powered every time you take it out of your unit. For more information, visitwww.ferno.com.

And recently, Monster Medic launched a family of patient transport devices designed to make your job easier and safer. Their POWERMED-X power cot has multiple new and innovative features, including a tip alert system, hand-operated cot controlling hand braking system, weight and event data capture and its own data management software. Visitwww.monstermedic.com for more.

Suspended Rides
Air suspension systems have been in use for many years in the heavy-truck and automotive industries. Approximately 80% of over-the-road heavy trucks have adopted the use of air suspension, and their use in emergency-vehicle applications is rising fast.

Air suspension not only offers a smooth ride, but it also offers the operator the ability to adjust and maintain vehicle ride-height with light to heavy payloads in the vehicle. Rugged, robust systems are required in this industry where downtime is critical. But suspension systems must be refined enough to offer the best comfort for injured patients and their caregivers. A rough ride can not only aggravate patient injuries but also reduce crew efficiency and effectiveness.

Air Lift Company has worked with me to further refine air suspension for the specific needs of the ambulance industry. The company has been providing air-suspension solutions since 1950, and it has followed the ˙keep it simpleÓ design philosophy: The least number of parts has the least number of opportunities to fail. Their products have evolved in two critical areasƒsuspensions and air control.

In terms of suspensions systems, the custom designed, solid forged steel ˙spring beamÓ trailing arms replace overly rigid and friction-plagued leaf springs to connect the axle to the frame pivot bracket. These spring-beam units offer unparalleled strength and robustness, while also allowing compliance that enables exceptional vehicle ride characteristics.

These systems are also efficient, because simple design equals fast installation and reduced cots. An easy-to-adjust Panhard Rod utilizes a Cam-bolt to quickly align the suspension system. Also, all Air Lift suspension designs have sealed, permanently lubricated Heim joints that do not require greasing.

For air control systems, Air Lift uses electronic, non-contacting, hall-effect height sensors and a magnet at each wheel. This eliminates the old pneumatic control valve with its failure-prone linkage connections. The Air Lift electronic control unit (ECU) is programmed to monitor each wheel height with intelligent algorithms that adjust the air spring pressure only when needed, increasing the life of the control system and compressors. Old pneumatic control systems adjust air pressure over nearly every bump and turn, causing considerable air consumption and wear-and-tear on the compressors.

Air Lift also offers a Suspension Kneel Control system, which is activated by a door switch or manually operated electrical switch. The Air Lift Control System quickly deflates the rear air springs to ˙kneelÓ the rear of the vehicle, easing patient+cot and paramedic ingress/egress.

Air Lift continues to innovate for the ambulance industry with the new products under development. The Maintenance-Free Air Control System will use integrated desiccant driers and exhaust valves to purge moisture from the system on every exhaust action, eliminating the need for operators to remember to drain catch tanks or additional air tank ˙spitter valves.Ó An Enhanced ECW with remote display unit will allow for increased computing power and enhanced diagnostics. Compressor failure, air spring leak and sensor failure can all be sensed and communicated to operators, reducing further system damage and repair costs. An optional cot-sensing sensor can reduce control-system cycling, thereby increasing system life.

Visitwww.airliftcompany.com for more information.

Take Your Seats
What’s new in safety seating for ambulances? For a long time, the„EMS industry has struggled with the proper balance between keeping the crew restrained in the various seating positions in an ambulance and providing them with enough mobility to perform their duties. Traditionally, lap restraints have been installed for each seating position on the squad bench, the CPR station and at the head of the cot.

Lap restraints provide some protection if the attendant buckles up. But with the necessity to reach for equipment and stand to perform various procedures on the patient, the attendant more often than not treats the patient without the benefit of being restrained. Being unrestrained may allow for better patient care, but in the event of an accident or sudden stop, the attendants are left extremely vulnerable to being tossed aroundƒor out ofƒthe ambulance, risking serious or fatal injuries.

There are currently two schools of thought on how to remedy this serious problem: Either to develop a restraint system that allows the attendant to stand and reach for their equipment and also work on the patient while remaining safely restrained, or to design the ambulance so that the attendants don’t have to get up from their seated positions and still have access to the essential instruments for attending to patients.

With the introduction of new ideas from the end users and ambulance manufacturers alike, new seating configurations are being designed and deployed. The major improvements center on advanced integrated restraint systems, such as lap/shoulder belts, five-point belts, six-point belts and the HMR. These advanced seats can be configured in several ways: free standing, mounted on the wall, and in combination with a second seat that can tilt forward to make a second transport area. An added bonus is that all of the above can be equipped with an integrated child safety seat.

One thing is for certain, a new mindset is surfacing in the industry, and questioning the safety of the ambulance will initiate change. Visitwww.evsltd.com for an abundance of information on this subject.

Body Modification
I solicited ideas from several ambulance manufacturers about what they believe are their most impressive ideas from their product lines. I pared down the list to what I believe are their most innovative items. This is just a glimpse of what you should explore with your ambulance manufacturer prior to your next ambulance purchase. Also, be sure to check the Ambulance Manufacturers Showcase on p. 52 for photos of their latest vehicles.

Frazer:Frazer’s on-board generator system provides a significant amount of clean, stable power for the module without inverting, load managing, sequencing, high idling or battery switching. On-board refrigerators (now becoming standard for„EMS systems moving into hypothermic resuscitation for cardiac arrest or spinal injury) operate off of 120 volts or 12 volts, and provide true temperature control for paralytics and fluids in a more effective manner than thermoelectric coolers.

The use of all-fluorescent lighting provides a more ED-type environment that enables the crew to more accurately assess their patient’s condition. The use of a horizontally mounted oxygen bottle that slides into place via rollers eliminates the lifting of heavy H-cylinders and also aids in lowering the unit’s center of gravity. Aluminum cabinets, fiberglass walls and composite sub-flooring enable the module to be completely wood free. All aluminum upper cabinets are only 12″ deep, and don’t intrude into the occupant head area as far as some others on the market.

A heat pump unit, which operates on 120 volts, provides an abundance of cold air for high-temperature climates. This system is located at the rear of the module, which allows cold air to be directed down to the patient. This is especially important for making patients more comfortable. And on the exterior, flush-mounted, 120-volt, 250-watt lighting provides superior scene lighting.

For additional information, visit the Frazer Web site atwww.frazerbilt.com/flash.phpwww.frazerbilt.com/flash.php.

Wheeled Coach:Federal Ambulance Specifications KKK-A-1822F and AMD Standard 001ƒAmbulance Body Structure Static Load Test require that the modular ambulance body be able to withstand 2.5 times the vehicle curb weight on the body roof. In order to pass the test, the roof cannot deflect more than 5.125Ó. The specifications also require each exterior exit door to be capable of opening and closing during the full application of the force, and after release of the force. And, no structural damage to any load bearing or supporting members can be evident during the application of the force or after the release.„

Wheeled Coach goes beyond the AMD Standard with these additional checks: a side static load test, a dynamic sled test (which applies a 22.9 G-Force to the modular body to simulate a front collision) and a drop test from 120 feet to simulate a front-corner collision.

Wheeled Coach’s increased awareness of crewmember safety is spawning a variety of interior innovations as well. The high back seating with three-point or four-point safety harnesses are now being installed on the vehicle squad bench in an effort to keep the crew seated and belted, but with access to the patient. Harness systems allow the crew to buckle into the seat safety harness, similar to those used by helicopter crews. Angled cabinets are designed to offer more protection for seated crew members. And a safety net at the head squad bench is mounted to the roof structure, as well as the floor structure (but not to the bench itself), and is 6,000-lb. pull tested in lieu of the previous 3,000-lb. test.

One of the most overlooked areas of safety is the air in the ambulance patient compartment. Filtration of the air is necessary for the protection of both the patient and the crew from airborne contaminant and pathogens. Wheeled Coach uses the PureAir Air Filtration System, a unique three-filter system that destroys microorganisms, removes odors and filters down to 0.3 microns and larger with 99.97 % efficiency.

For more information, visit the Wheeled Coach web site atwww.wheeledcoach.com.

Medtec:Providing ambulances to the industry since 1974, Medtec Ambulance Corp. aims to reduce safety risks in its vehicles. GM Pete Evans says that in a moving ambulance, paramedics often need to choose between their own safety and providing the finest in patient care. Now, a new ambulance design will eliminate the need to make that choice.

Two years ago, Medtec introduced its new ActionSafe ambulance interior design in conjunction with the Winter Park Fire Department. The agency has taken delivery of three units incorporating the concept, which includes a new side seat with five-point safety harness. The attending paramedic now has little reason to get up in transit because all of the vital ambulance controls and storage have been relocated within arms reach of the new ActionSafe seat.

The new rescue ambulances also include a hydraulic generator-powered Big Chill air-conditioning system, a self lifting Stryker Power-PRO ambulance cot, dual cameras for backing and patient area monitoring, and a large LCD screen for patient advisory videos viewed en route to the hospital. Exterior visibility and safety has also been improved with advanced LED warning lights and vivid chevron style rear body markings.

For more information, visit the Medtec web site atwww.medtecambulance.com.

AEV:Many innovative features are available as standard equipment or options on all AEV vehicles, particularly inside the patient compartment. They can install a six-point auto-retract harness on all side-facing seats; a seat-sensing alarm system to identify status of personnel, including seat location and whether they’re belted or not; turn/brake LED indicators; seat-sensing, light/siren status, which interfaces with the Road Safety system; ducted AC system with HEPA filtration for circulated air; and a recessed grab rail in the ceiling.

AEV vehicles can also feature a multiplex electrical system to monitor and record selected events, as well as a four-camera video system. The recorder (with no moving parts) can record up to four channels simultaneously.

For the exterior, an overhang anti-collision sensor for the upper front of the ambulance body, a ˙Patient on BoardÓ amber LED lighting for non-emergency transport, a backup sensor and camera system, and a high-conspicuity graphics package rounds out the deal.

Visitwww.aev.com for more information.

Mobile Network Systems
Acadian Ambulance Service’s„Mobil„Command„Center (HALO-1) is a mobile network system that provides unified communications and connectivity for medical dispatch and emergency field medics to operate almost anywhere. HALO-1 provides the unified phone services and Internet access needed for secure and reliable communications where communications are non-existentƒin remote areas where there’s no infrastructure or where service has been interrupted.

Utilizing F4W’s satellite communications, and VoIP technology, HALO-1 provides radio dispatch and mobile data terminal (MDT) communications regardless of your location. With the integrated access point, and full-featured PBX, HALO-1 utilizes multiple phone sets, allowing simultaneous incoming and outgoing phone conversations.„

HALO-1 will also support medical dispatch or multi-agency events where interoperable, secure communications are required and provides inherent scalability to expand its operations and coverage area on demand. Go towww.f4winc.com to learn more about this exciting technological advancement.

EMSresponse personnel need ˙always-onÓ communications. If your network is down, the system falls apart. In Motion Technology’s Vehicle Area Network solution is perfectly positioned to help provide a simple, seamless communications platform to ensure responders are never out of touch.

In Motion Technology provides cognitive wireless systems that enable public-safety organizations to stay connected while in motion. The company’s complete vehicle area network solution ensures that any IP device can be used in the field with no modification, connecting to locations over the most reliable communications network available. In Motion Technology solutions have been successfully deployed in high-performance EMS, police and fire departments in the„U.S. and„Canada.

The In Motion On Board Mobil Gateway (OMG) is a device that offers reliable and secure wireless access for mission-critical mobile workgroups that are using multiple mobile devices and running multiple applications over both public and private networks.

Aimed at increasing operational efficiency, the gateway allows response personnel to work with devices and applications to seamlessly connect to applications and data stored on servers. The OMG is outfitted with Bluetooth wireless capabilities. This provides you with the communication capabilities needed to transmit 12-lead ECG or cardio diagnostic information to hospitals and assist ED staff in properly preparing for your patient’s arrival.

In Motion Technology is introducing powerful enhancements to the Mobility Manager. The onBoard Tracker will enable operations command to view the entire fleetƒincluding each unit’s position, direction and speedƒon 3D Web-based maps. Operators can view the location of crews, status of vehicles and routes being taken, and identify access routes for crews prior to arrival.

OnBoard Telemetry will enable fleet management to remotely monitor vehicle diagnostics, including fuel, operating hours, engine and coolant temperatures, idle times, speed, fuel efficiency and more. Fleet managers can identify problems before they occur, reduce breakdowns, and meet maintenance schedules and warranty requirements.

Go towww.inmotiontechnology.com for additional information.

Driver Safety
An organization that uses a safe-driving program will have an effective foundation in the effort to support the safe operation of their fleet. This kind of program should include a formal educational component and monitored use of road-safety devices.

Road Safety International has pioneered technological advances in the monitoring and reporting of driver activity during emergency and non-emergency runs. The On-Board Computer System monitors and reports unsafe vehicle operation and provides immediate audible feedback to the vehicle operator as the vehicle exceeds certain safety parameters. The system also stores this information, which can be easily obtained by authorized personnel for the purposes of applying managerial intervention when needed.

Among other benefits, the Web site states the device includes event reporting of such incidents as unsafe backing, driving without the seat belt fastened, unauthorized entry of the drug box, driving with the emergency brake on, low idle speed with emergency lights on, system tampering, improper vehicle shut-down leading to premature turbo failure and many other real life occurrences. The company believes their advanced RS-3000 On-Board Computer Systems will pay for themselves in less than two years.

For more information, visit the Road Safety Web site atwww.roadsafety.com.

Conclusion
Scores of innovative people and companies are just a click away as you search for available technologies, applications and programs that provide solutions to your system needs. Take the time to search through each of the ambulance manufacturer sites listed in this issue ofJEMS and in theJEMS.com Buyer’s Guide(www.jems.com/buyersguide).

As you design your next vehicle and outfit it for service, remember that the most important cargo being carriedƒin addition to your patientƒis your crew. Take care to incorporate features and equipment that will ensure the maximum comfort, convenience and safety for your crews, who must operate the vehicle in all types of conditions and climates.

Bill Vidacovichis vice president of fleet and materials management for Acadian Ambulance Service. He served in the U.S. Marine Corps in the late 1960s and is a graduate of the University of Southwestern Louisiana, where he earned his B.S. in Industrial Technology. He’s in his 35th year of service at Acadian, and will tell you that when it comes to„EMS service, ˙The best is yet to come.Ó