A Fresh Outlook on Ambulance Design

My first ambulance was a 1984 Ford van, a high-top Type II conversion we bought used for $5,000 and outfitted with second-hand refurbished equipment my bosses had rescued from their previous employer’s scrap heap.

It had a 460 cubic inch gasoline engine, worn-out tires, brakes and suspension, and steering so loose I looked like a little kid driving one of those coin-operated toy cars you used to find in front of supermarkets.

I drove it like I stole it.

I can vividly remember hurtling down twisty country roads at oh-dark-thirty in the morning with my foot buried in the carburetor, pulling on gloves as I drove. Officially, the fastest any of us ever drove it was 85 mph, because my boss allowed us to exceed the legal limit by no more than 15 mph, and that’s as far as the speedometer went, anyway.

Unofficially, we were once clocked by a State Trooper at 130 mph, en route to the hospital with my very first trauma code as a paramedic.

It took age and hard-won experience to realize just how foolish we were back then. I lost a partner in an ambulance rollover in 1996, and attended plenty of other funerals in the years since.

It’s a dangerous business, driving an ambulance. That’s one reason I don’t bristle much at being called an ambulance driver. According to NHTSA crash data, ambulances are involved in 3,200 crashes per hundred million miles traveled. That’s 4 times as often as motorcycles, 8 times as often as cars and light trucks, and 15 times as often as heavy trucks.

And some of you guys chided me for buying a bike for my daily commute!

After 17 years in an ambulance, I wear paranoia like a second skin. If you think a motorcycle rider is invisible to inattentive drivers, you’ve obviously never driven an ambulance or fire truck.

Nowadays, we have sophisticated accelerometers that measure pitch and yaw in ambulances, and record driving habits of individual EMTs. We have drive cams, and engine governors, and fancy reflective paint jobs, and agencies are starting to take a long, hard look at the risks of lights and siren responses and transports. God knows the vehicles themselves are safer and more sophisticated.

And of course, none of that matters much unless the individual EMTs at an agency buy into the idea of a safety culture, a fact I alluded to in this column.

Some of my fellow Borg drones would rather run a red light than risk a 50% force count on their driving record, and we still have a few that will talk on a cell phone while driving Code 3 – even though they know they’ll be summarily banished from The Hive if caught.

Gradually, thanks in no small part to people like Nadine Levick, industry leaders have begun to pay more than lip service to provider safety, particular within the realm of ambulance transport. But one thing that has lagged behind is the ambulance design itself.

Greater structural integrity of ambulance modules, padded cabinetry, gee-whiz lighting systems and psychedelic paint schemes will only be of limited benefit as long as we still have unbelted providers working in the back of rigs, or sitting on side-facing bench seats. Modern restraint systems were designed for front-facing occupants. They’re far less effective when the provider is turned to one side.

That’s why I was intrigued to hear of Careflite’s new custom ambulances that eliminated the side-facing bench seat. Careflite’s CEO, Jim Schwartz, was at EMS Expo, and lectured on the egregious lack of safety standards for providers working in the back of an ambulance:

“The United States has more safety standards in place for the transport of cattle on a truck than it does for crew members in the back of an ambulance…”

True, and utterly inexcusable.

Careflite’s new rigs were built by Crestline Coach, developers of the Herb Tarlek/Ralph Furley paint scheme.

Their rigs, built on the increasingly popular Sprinter chassis, feature pivoting bucket seats equipped with 4-point restraint systems that are designed to be locked into the forward-facing position whenever the vehicle is in motion.

The interior was redesigned for maximum ergonomics, placing everything within reach of a belted occupant. Gone are any heavy equipment cabinets that open inward, minimizing the chance of ballistic projectiles in an ambulance crash. Every piece of equipment has its place, and a hard mount to dock it to. That’s an important feature, all by itself. After my ex-partner’s fatal crash, we found IV catheters and alcohol preps underneath the ceiling light fixtures. Crap flies everywhere in a rollover.

Last year, The Borg bought forty-something new Sprinter ambulances. From  a fleet-management standpoint, they’re a no-brainer: 50% better (or more) fuel economy, leg room and headroom to spare, substantially decreased maintenance costs, longer service life, and a lower overall price tag make it a very attractive option for a light-duty ambulance fleet.

Some of our kids, primarily the younger ones spoiled by working in large, roomy boxes for their entire careers, gripe about the lack of room in a Sprinter, but truthfully they’re far roomier than any Type II rig I’ve ever worked in, and the headroom in back and legroom up front can’t be beaten. If you’re a big guy working 12 hour shifts in a SSM system, they’re much more comfortable than our current Type I Chevys.

Currently, The Borg still uses Type I boxes for their critical care transport trucks, so I don’t work out of the Sprinters that often. In the configuration that we ordered, there simply isn’t enough room for our critical care equipment. That may change, however. Rumor has it that we have a couple of Type III Sprinters in the fleet, presumably being used as a test bed for future CCT rigs.

Just looking at the Careflite rig displayed at EMS Expo, however, I see no reason we couldn’t fit all of our critical care gear in that rig, and have room to spare. There’s a rack to hang my ventilator, room for poles to mount IV pumps on, a dock for my cardiac and vital signs monitors, and floor tie-downs suitable for mooring an IABP or something of similar size. A neonatal transport isolette would fit in there as well.

The Crestline-built rig of Careflite’s was a single seat version set up for Critical Care Transport, but Careflite’s web site boasts photos of their new rigs with a dual seat configuration as well.

Across the exhibit hall floor, coach maker Miller Coach Company had a competing version on display that boasted a dual seat configuration, with reclining seats that allow transport of a second supine patient, if necessary.

Al Miller of Miller Coach, demonstrating their new forward-facing configuration.

The McCoy Miller rig featured a more conventional cot placement and cabinet layout, but for my tastes, I think I’d prefer the Crestline Coach rig built for Careflite. It makes very efficient use of available space.

Still, either rig demonstrates that an ambulance without a side-facing bench seat has definite potential. Only time will tell if they are truly safer, but placing providers sitting forward is probably a good start.

But hey, that’s just my opinion. What do you guys think? In which rig would you rather work? Do you think you can adapt to working in a rig without a bench seat, or a side-facing seat at all?

One thing’s for sure, though. If these designs take off, that’s gonna spell the death of the old “Armor All the bench seat when your paramedic partner pisses you off” trick.