Ambulances & Vehicle Ops, Cardiac & Resuscitation

Extreme Ambulance Makeovers

Issue 10 and Volume 33.

Two months ago, I decided to buy a new car. As I searched Web sites and visited local dealerships for pricing and packages, it quickly became apparent that the auto industry has changed drastically„since I purchased my last vehicle eight years„ago. An array of options, accessories and safety features were available to enhance the driving experience. So, armed with knowledge, I went in search of the ultimate vehicleƒone that offered safety, comfort and style, while still being affordable and reliable. I wanted all the latest gadgets to make each trip behind the wheel an exhilarating one.

As EMS chief of Littleton (Colo.) Fire Rescue, a busy fire/EMS agency, the car-buying experience got my wheels spinning: These are the same vehicle qualities that every EMT or paramedic wants when they climb into their ambulance to go save lives. Their ambulance is their workspace, their “office,” where they’ll spend much of the day and part of their night. First responders deserve nothing less than the best safety innovations and accessories. After all, a safe, happy responder will be more inclined to offer high quality patient care and “wow” customer service.

So, I set out in search of some of the best„accessories available in the ambulance industry. My mission took me on a five-day road trip through four states to visit three ambulance-manufacturing facilities. I took along one of Littleton Fire Rescue’s brightest paramedic firefighters, who actually rides in an ambulance every day, as my technical adviser.

First Things First
Although the focus of this article is really on ambulance accessories, it’s necessary to spend a minute on ambulance construction. Before you can consider add-ons, you’ve got to have a safe and reliable vehicle.

After you kick the tires and take an ambulance for a test drive, ask the manufacturer what’s behind the walls that will increase occupant safety and security. How well built is the model? How do they design each unit, build the walls, construct the floors, support the roof, heat and cool the treatment area, troubleshoot the electrical system, attach the box to the chassis and test for safety? Is your vendor testing every box that rolls off their manufacturing floor according to the KKK-A-1822F static load test specification, or simulating those forces with a computer program?

It’s time responders and managers start educating themselves on product design, construction methods and electrical systems before they think about the frills.

Cruisin’ Safely
Many of the high-tech accessories on the market will increase safety for EMS personnel. The latest navigation system incorporates a mobile data terminal (MDT), which can display the quickest route to a call. The hardware is from Data 911 and the software is VisiNet Mobile from TriTech. A computer screen mounted in the front passenger’s seat area allows the user to access response maps and pre-plans with the touch of a finger. The MDT gives turn-by-turn directions to the call while showing the location of other responding units using an automatic vehicle locator (AVL). The MDT communicates through a wireless telephone card or the ambulance radio system and can send real-time data from the communication center to all responding units. Pre-plan information and emergency response guidebook data can be accessed quickly using the MDT to alert responders of hazardous conditions or special circumstances related to a patient, residence or business to which they’re responding.

Rear-vision cameras with video and audio features take the guesswork out of backing a unit without a rear guard. The video screen can drop down from the headliner in the cab, appear as part of the rearview mirror or be incorporated into a multiplex electrical system. Not only do you get a great view of the rear, but cameras mounted on the sides of the ambulance and in the patient-care area enable the driver to see hazards in a blind alley alongside the vehicle or look at what’s happening in the treatment area.

The EZ Glide sliding side door offered by Braun Industries is another practical safety accessory. The door is well engineered, with a strong welded track assembly integrated into the ambulance body, and it opens and closes effortlessly. A sliding door eliminates opening a door into traffic, reduces space needed to park on congested urban streets and hospital parking lots, and allows for an unrestricted line-of-sight for people exiting the ambulance. In addition, the door isn’t affected by wind or gusts created by passing traffic.

Braun also uses Eberhard door latches on its ambulances. These deep pocket, beefy door latching handles make it easy to grip and open doors, even with gloves on. The “free floating” handles disengage the tie rod from the handle mechanism when the doors are locked, preventing damage to the handle or rod by someone trying to force open a locked door.

Another option many manufacturers offer is a mechanical step that extends and retracts from under the step well of the side door when the door opens or closes. This is a nice safety feature for older patients who may have to step up into your ambulance.

Most companies are also installing multiple grab rails on the inside and outside of the doors to help patients and responders get in and out safely. Some rails are painted yellow, making them easy to locate in low light conditions. An overhead grab rail in the patient care area can also be recessed into the ceiling, so it’s out of the way during a collision. Horton’s rails are even covered with a special antimicrobial material that kills germs and prevents cross-contamination.

The Zico Oxygen Lifting System from Ziamatic Corp. takes the hassle out of changing onboard oxygen cylinders. Mounted in a compartment, the electric-hydraulic lifting system lowers itself to floor level, allowing the user to roll the tank onto the lift and easily raise it into the compartment. Although this lifting system adds weight to the vehicle (90 – 110 lbs.), it can help you avoid back injuries that can occur while wrestling cylinders into a compartment.

The Tank Boss from I-Tec is an alternative to a fixed onboard lifting system. One Tank Boss can work for a whole fleet, and it not only lifts the cylinder into the compartment but carries the tank from the storage location without having to roll it by hand. It doesn’t take up compartment space or use voltage from the vehicle’s electrical system. I’s easy to use and maintains control of the tank at all times.

Kickin’ Back
Some EMS managers may not feel the need to equip their ambulances with comfort accessories because they see patient trans_port simply as “point A to point B.” But anyone who rides in the back of an ambulance knows how important these features can be, especially on a sweltering day or freezing winter night.

Ducted air-conditioning and heating installed through ceiling vents can cool or heat the treatment area quickly and efficiently as opposed to a unit with just a few vents at the front of the box. Some manufacturers began including this heating and cooling system upgrade years ago, and it’s now becoming more common.

Pay close attention to what type of controls are used to regulate the environment. Some manufactures are still using a round thermostat that_s prone to malfunction and failure. Ducted heating and cooling systems controlled by a digital thermostat or an integrated multiplex electrical system are more accurate and reliable.

Privacy, especially with HIPAA, is equally important to the comfort level of our patients. An innovative feature from Horton Emergency Vehicles solves the problem of people looking into the treatment area. Although some manufacturers offer a window curtain or privacy decal, Horton’s answer is its exclusive Electronic Privacy Windows, which go from clear to opaque at the push of a button. The design uses a liquid crystal in the window that causes the glass to become opaque when electricity to the window is turned off. But once on the road, the window clears in seconds. This privacy feature can be engineered into any window.

The interior cabinets and useable workspace of an ambulance’s treatment area can also be engineered to add comfort and efficiency in a tight workspace. Most manufacturers offer cabinets in wood or aluminum. However, aluminum is stronger and lighter in weight than wood cabinetry and will add to the structural integrity of the box.

You can specify to have your cabinet door fronts lift up and out of the way, making it much easier to restock medical supplies. Some companies use a plastic latching mechanism on the door but you should insist on metal clasps, which will last longer and keep the doors tightly closed. A convenient feature is a pull-out tray table in front of the captain’s chair. This tray can be used to write reports or secure your laptop when typing electronic patient care reports.

Another factor that plays a part in the comfort and efficiency of an ambulance is the chassis. Braun Industries now offers the Sterling Bullet Chassis, which allows for a more spacious cab. (Read more in Hands On.)

Corian countertops are a practical, classy addition to the workspace and offer some advantages over wood laminates or stainless steel tops. Unlike wood laminates, Corian is seamless and resistant to penetration of blood or body fluids, making it easy to clean and maintain. Some manufacturers have begun producing similar countertops with alternative materials to reduce the cost associated with name brand Corian tops.

Ridin’ in Style
Some of the biggest changes in the ambulance industry have been in style and appearance. Everyone, including management and those in the field, want an ambulance that_s not only safe, comfortable and reliable, but one they can be proud of from the day it arrives until its last transport.

Lighting can have a big impact on the efficiency and attractiveness of an emergency response vehicle. Many changes in lighting have resulted from the evolution of the light-emitting diode (LED). LED lights have two electrodes that emit a narrow spectrum of light.„They were first used in electronic displays but are now becoming more commonin high-power applications, such as flashlights and emergency lighting. LED lights produce more light per watt than incandescent bulbs and can produce a variety of color without a colored lens cover or filter. LED lights also use significantly less energy, reduce maintenance costs and have much better intensity than their predecessors.

Littleton Fire Rescue has replaced its front and rear lightbars with LED lights that utilize clear outer lenses. Lightbars are hard to keep clean and tricky to disassemble when you need to change a bulb. Using Whelen Engineering’s 900 Series lights, a single light with a clear lens can be split into two separate colors, doubling the lighting capacity.

Littleton has engineered two lighting modes into its ambulances following a recommendation by FEMA in its 2004 Emergency Vehicle Safety Initiative, FA-272. This initiative recommends two distinct lighting modes: “Calling the right of way,” using red and blue emergency lighting while responding; and “blocking the right of way,” using only amber lighting once on scene. Meeting this recommendation is easily accomplished using the 900 Series light because the top and bottom rows can be different colors under a clear lens.

The lighting system can also be programmed to emit an array of different lighting patterns. Littleton Fire also installed amber LED lighting in the top and bottom of every exterior compartment and entry door of its ambulances. This makes it easier to identify a parked ambulance with open compartment doors. High-intensity white LED lighting can also be installed under each shelf in the exterior compartments, enabling equipment to be located quickly in the dark. Purple LED lights installed under interior shelving accent the treatment area nicely. Littleton has also installed high-intensity LED lighting in the ceiling of the treatment area controlled by a three-way dimmer switch, eliminating older, less brilliant fluorescent fixtures. The lighting intensity is exceptional when there_s a need to perform detailed skills or assessments and can be dimmed for a relaxing ride to the hospital.

The back of the ambulance has drastically changed in recent years with the addition of a safety “barricade,” or a herringbone pattern. FEMA’s Emergency Vehicle Safety Initiative now recommends conspicuous, con_trasting colors of lime-yellow as the reflective background, with six-inch red diagonal stripes (read ˙Safety or Marketing?Ó September 2007JEMS). This design has been shown to improve driver recognition of emergency vehicles on the road. This passive safety system can now be seen on police cars, fire trucks, mail delivery vans and even private vehicles.

Even siren sounds are becoming a unique accessory. For more than 50 years, Federal Signal has been making beautiful, streamlined, chrome-plated sirens. The sounds they make are distinct and unmistakable for anyone who has been in„EMS for a while.

Well, now they make an electronic version of the traditional electro-mechanical “Q-siren.” The E-Q2B electronic siren speaker can be mounted in the grille or bumper of ambulances with just a chrome-plated cover showing and reproduces the sound of the Q-siren, using little current draw on the electrical system.

Another exclusive pro_duct from Federal Signal is a revolutionary concept in audible warning systems — the Rumbler. Designed as a secondary siren, the Rumbler is activated by pressing the horn ring and is intended to literally shake vehicles in traffic to let drivers know that an emergency vehicle is approaching. This technology uses„low-frequency tonesthat penetrate and shake solid materials, allowing drivers to feel the sound waves and even see their effects through the shaking of the rearview mirror. It’s most effective when used as an intersection-clearing device where heavy traffic is present.

Rollin’ Onward
The future of ambulance accessories is endless and limited only by your imagination. Ask any manufacturer; if you can dream it, they can build it. With the push of a button, you may find yourself running a cardiac arrest with an onboard ventilator, a mechanical CPR device, an automatic defibrillator and a remote control that administers cardiac drugs while you’re safely secured in your seat.

Although these high-tech products and accessories have made our„EMS journey a little more comfortable and a lot more fun, the industry continues to wrestle with inadequate safety designs, unreliable restraint systems and the absence of industry or government regulation on ambulance construction. Before you buy, get educated, visit factories, ask questions and think safety first.JEMS

Learn more from Wayne Zygowicz at the EMS Today Conference & Expo, March 2 – 6 in Baltimore.

This article originally appeared in October 2008 JEMS as “Extreme Ambulance Makeovers: Bells, whistles, sirens & more.”