Though it might see incongruous, ambulances can be made safer but still be affordable. All it takes is the right mix of experience, practicality, innovation, persistence and forward thinking — both inside and outside of the box (pun intended).

Backed by Winter Garden (Fla.) Fire Department Chief John Williamson and working with a budget under $200,000, I led a small committee of EMTs and paramedics with some very innovative ideas on a journey to bring a new style of EMS transport unit to our rescue department.

At the end of the two-year journey, a unique ambulance built by Medtec emerged that boasted significant advancements in eight specified areas: attendant safety; patient safety; lay public safety; bariatric transport; dual-patient transport; functional ergonomics; unit decontamination; and future technology. This is in addition to a dozen industry firsts (see “Key Milestones” on next page) and numerous design details that were intended to assist crew members in every phase of EMS delivery: readiness; response; transport; decontamination and return to service.

Of the eight areas we targeted for improvement, the ones that received the most attention were attendant safety, functional ergonomics, and unit decontamination. Every attendant, up to four, is seated in an EVS sled-tested, five-point restraint seat and harness. The attendant area is measured and built for the ergonomics of function, balance and reach. Each seat is 19 inches off the floor for good attendant circulation and stability. All equipment, radios and items needed during transport are accessible to the attendant while seated and restrained.

Additionally, this unit and all of its compartments can be completely decontaminated both inside and outside the vehicle in 25 minutes using the Zimek Micro-Mist decontamination system, thanks to a plug-and-play, rapid decontamination port that we designed and Medtec fabricated for our unit. This item now is available to the ambulance industry as a new or retrofit feature. While complete unit decontamination like this is not intended to replace the routine cleaning and decontamination that should occur after each call and after each transport, it does provide a scientifically proven and definitive decontamination that provides an unquestioned level of protection for employees and patients alike in this age of ever-changing pathogens.

First Steps

Our journey started with visits to four ambulance manufacturing plants, and a review of hundreds of units in person, on Web sites and on paper. During our research it became clear that things had not changed much in my 28 years in EMS. There was still an action area full of switches and controls that were a stretch to reach, there remained a seat at the patient’s head that was seldom used, there was a CPR seat crammed between cabinets that causes injuries to attendants in accidents, and there was still the bench seat — where we all know the attendant really sits — that is equipped only with a wrap-around lap belt that isn’t always used.

Given all of this, the specification committee concluded that it didn’t want or need more of the same. Ironically, our far-reaching quest led us right down the street to our neighbors, the Winter Park Fire Department, where they had been successful in pushing the envelope on ambulance design by specifying an attendant seat with a five-point restraint system and then re-working the interior around the attendant. What stood out to our committee was Winter Park’s genuine desire to make things safer for the attendant and their willingness to share their experiences and information.

At the end of our visit came the take-home message. “These are our ideas, [but] we challenge other agencies to build upon these concepts and we look forward to seeing what the next generation of safe attendant units will look like,” we were told. With that, the seed was planted and we knew then that we wouldn’t be driving our next ambulance home right off the dealer’s lot. We needed to design our own.

Next Steps

Starting with a blank sheet of graph paper, with a 96-inch by 170-inch rectangle, the rescue truck committee went to work to design a safe, spacious, multi-functional, ergonomically based and technologically equipped transport unit. We didn’t want to go bigger; we didn’t want to make it more expensive; instead, we wanted to design something that would build upon Winter Park’s concept of safety, and at the same time create an innovative open layout that would allow us to address each area the committee had targeted for enhancement.

As each area of the truck was considered, there was a series of questions that we asked ourselves: Is it safer for our personnel, the patient and the public? Does it make sense? Is it functionally better? Will it work? Is it practical? Can we afford it?

On paper we designed a combination fire vehicle and ALS transport vehicle. Wanting to spend our budget wisely, we incorporated almost all of the customization into the rear box and not into the cab. There is no elaborate extended cab, nor any custom chassis modifications. The leading 22 inches of the box is dedicated mainly to firefighting, with opposing 20-inch roll-up doors and pull-out panels for storing backboards, fire PPE, fire tools and the SCBAs. The rest of the box is dedicated to ambulance space.

Building an ambulance on paper proved to be more challenging than we anticipated. The first ambulance company we worked with turned us away after three months of design meetings and drawings. They said that they were unable to meet our unique requirements. (That usually means that they think you’re crazy.) We already had come to the conclusion that this unit was going get some attention. Either people were going to be talking about it or they were going to be scratching their heads. This is when we turned to Medtec, which embraced our ideas and was able to model almost everything we had dreamed of into a working set of engineered drawings. Now we were on our way.

Final Steps

Once construction commenced, the real test began, i.e., does everyone down the line understand the concept and the reasoning behind building something different? In the beginning, things move quickly as the vendor starts building your unit just like all the others. Then you start to feel and see tension on the assembly line develop when your unique specifications force them to stray from the way they always did things. This is about the time that we were identified as customers that wanted a “highly interactive process.” This was a label that we readily acknowledged and did not back down from. Those who experienced our five plant visits during the construction phase can attest to this.

Truly, the best interactive process is the one in which you reach an understanding with those who have their hands on the wrenches that, when they find something that isn’t coming together as planned, they pick up the phone and discuss the alternatives with the customer. If this doesn’t happen, then they will build the vehicle the way they think it will work — which may not be the customer’s preference and later may require the plant to redo it. The payoff is when things start to take shape and those working on your unit come to the realization that they are creating something new and different. This realization seems to energize them with more determination and pride to go above and beyond. We experienced this phenomenon several times with those who worked on our unit to bring it to reality.

Our experience may or may not seem typical. The fact of the matter is that the ambulance industry cannot and will not pioneer industry-changing advancements based on speculation alone, as experimentation is not cost effective. It takes forward-thinking end users and supportive administrators willing to make the necessary investments in new ideas and concepts that allow the industry to offer better and safer options to their customers.

Let me be very clear: by no means is the Winter Garden Fire Rescue Department saying that this is the way that ambulances must be built, or that its changes represent any new standards that should be adopted. The department’s only aspiration is to leave you with the same challenge that motivated them: “These are our ideas and we are happy to share them; we look forward to the next generation of these designs that will serve to make our personnel and the industry safer — both inside and outside of the box!”

Matt McGrew is the deputy fire chief for the Winter Garden (Fla.) Fire Rescue Department.

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Sidebar: Key Milestones

• The new ambulance is one of the first to provide up to four attendants with five-point restraint seating.
• One of the first to introduce an EVS, 4-inch-high, sled-tested, swivel seat pedestal.
• One of the first to pioneer a built-in, plug-and-play port for inside and outside decontamination.
• One of the first to specify an exterior grade, positive seal, pass-through window.
• One of the first to reinvent the code-seat concept by creating a safe seating option.
• One of the first to pioneer a completely ambidextrous patient compartment.
• One of the first to use an integrated power cot charger for the Ferno Stat-Trac.
• One of the first to introduce full-width (92-inch) traffic advisors on the front and rear of the unit.
• One of the first to incorporate a four-camera monitoring system for operator safety.
• One of the first to introduce a directional chevron concept on the rear of the unit.
• One of the first to use directional chevrons on the interior of all rear-facing compartment door surfaces.