Dale

For a vehicle that is only two years old and with that little mileage, make sure you let the seller know you want it taken care of under WARRANTY. Of course, that is the curse of some ambulance builders who try to use "all ecompassing" circuit board systems for the ambulance wiring. No one locally can troubleshoot or repair the problem. And you have no volt or ammeter? Gee, they must have sold you one of those "low bid" spec rigs where it is not required by Federal purchasing specifications. Manufacturers will install whatever you request but you must pay for it in some cases.

The lif that is incorporated as part of the rear doors is something done in Great Britain. My understanding is that is it a mandated feature for ambulances (maybe by their union?) When a device such as that is incorporated into a vehicle design as "standard" equipment, the overall developments costs can be absorbed by a large quantity of vehicles. This is especially true when someone like an ambulance service trust in Great Britain orders a large quantity of vehicles. They only have a few manufacturers over there and most tend to only last a few years until they are liquidated or sold to another firm. Very unstable marketplace where the government orders large quantities of vehicles and vendors really try to claw for those "deals." Most end up being unprofitable. Cot lifts are available in the US and I see a good many installed, especially on critical care units and bariatric transport units. I only know of one firm in CA that provides these to most of the ambulance industry. The "run of the mill" street ambulance normally doesn't have one due to extra cost, weight, service issues, etc. Additional weight is a significant issue on many ambulance chassis- they become overloaded quite easily. Many are opting for an electric cot that seems to have more practical value to many EMS systems.

many of the suggestions mentioned here are already being installed in ambulances- at least in the USA. The problem is the cost- many purchasers of ambulances are traditionalists and are not openingly acceptable to adding high-back seats, extra padding, safety nets, etc. that will all inprove occupant safety and versatility. Many of these "suggestions" are not new- we have been providing some of them for over two decades to clients wanting upgraded safety. However, so many purchases of ambulances are done on the basis of "cheapest" which means you will only get what you are willng to pay for. With about 15 manufacturers to choose from, there are varying ranges of quality and safety among those builders. Some attract clients wanting the "best" while others seem to cater to production-line "commodity-type" products that are cheap to build and sell, thus catering to clients wanting those. I have stated many times that if I could get a wheelbarrow certified with warning lights and a mattress, someone would want to buy it because it was "cheap."

1) Ford does have chassis with Cummins engines. They are considered a medium-duty chassis (F650/F750 series.) 2) The Chevrolet Kodiak/GMC Topkick chassis do have an Allison transmission mated to their Duramax 6.6L Turbodiesel engine. 3) Most of the truck manufacturers (all sizes) are developing their own engines to work with their chassis. there are strategic alliances taking place where certain brands of engines are being offered on an "exclusive" basis (i.e. Detroit Diesel engines from Daimler Trucks North America DTNA)- formerly known as Freightliner), will be available on Oshkosh and Pierce vehicles as well at DTNA branded chassis. 4) International has annnounced an alliance with Caterpillar to build a new "off road" heavy-duty chassis for them since Caterpillar has announced it will no longer be building engines for "on road" vehicles that will meet upcoming 2010 EPA standards. 5) I know of no US Federal mandate for diesel ambulance chassis. It may be a suggestion in some operations or training manual but nothing is Mandated. Gasoline engined ambulances are even a selectable alternative in Federal Ambulance Specifications where the client needs that option(due to environmental concerns, fuel availability, etc.) 6) GM does now offer the G4500 series cutaway chassis for Type III ambulances. It's rated GVWR is 14,200# versus the recently upgraded Ford E450 chassis with a 14,500# chassis. Oddly, the GM bare chassis (without a module installed on it) actually weighs several hundred pounds less than the comparable Ford (with both having the diesel engine.) That is signficant since the exact same module can be installed on either chassis and provide some "buffer" to reduce the potential overloading of the front axle.

1) Early diesel engines from GM were simply a converted gasoline model and they suffered from poor performance. 2) Gasoline engines have improved designed and now use fuel injection instead of carburators for much better performance, less heat, etc. 3) Gasoline engines are built to be lighter in weight than comparable diesel engines. On many ambulance chassis such as E-series, reducing the front end "dead" weight of 600-800# by using a gasoline engine versus a diesel version means less potential from overloading the rated front axle weight limit, which is a big problem for many organizations not to mention a violation of Federal Motor Vehicle Safety Standards (FMVSS.) I know of several agencies that have switched to gasoline engine chassis from diesel. Some of this is the initial cost savings in the chassis purchase price, better fuel economy in the new design gasoline engine, and the reduced purchase price for gasoline versus diesel fuel. 4) Contrary to rumor, diesel engines are not "mandated" by Federal law for ambulances. After a series of ambulance fires in the 1980's, primarily with Ford-chassis ambulances, Ford established the QVM (Quality Vehicle Modifier) program for body builders to address good engineering practices, which were determined to be lacking in many vocational body builder types such as ambulances, school buses, RVs, etc. At the same time, Ford "mandated" that diesel engine chassis would only be allowed for use as ambulances to reduce the problems they were having at the time with gasoline engine chassis (fires, fuel spillage and overflow, etc.) Now, for 2010 Model Year, Ford will once again be introducing a new Gasoline engine for optional selection for ambulance chassis use.

It is a shame that you were treated poorly. Anytime someone takes the time to actually go the to factory to learn more about their expensive investment, there should be some mechanism in place to take care of the folks that pay the bills- the customer. You will find that not all ambulance manufacturers are like that. The truly enlightened ones want a client (or prospective client) to visit their facilities and learn more about the product. I do know of builders that really don't encourage client visits. They have issues with cleanliness, process controls, labor issues, etc. that can be observed by a client and reflect negatively on their decision to purchase that particular brand. I always encourage factory visits to at least perform a final inspection of the complete vehicle(s) before you accept and pay for them. Any problems (real or perceived" can be addressed faster while the vehicles are still at the factory. You can always leave the vehicle at the factory after your inspection for any necessary "fixes" that will guarantee quick attention. If you have a local dealer involved, I know they will be anxious for your vehicle to be completed to your satisfaction, especially if they need to deliver the vehicle to your organization (they want to get paid for their efforts, too!) If you have doubts about the quality control process, it is best to ask these questions up front before you award a contract. Require copies of the inspection reports, test sheets, process control documents, work orders, etc. to evaluate how they "should" be building your life-saving product. Some of the ambulance now cost more than many homes and you should be getting what you pay for. Unfortunately, too many folks buy something based upon a cheap price, how many lights it has on it, or how shiny the paint is without really considering how it is built (materials, design, workmanship, experience.) Many fire apparatus folks feel it is a necessity to visit potential fire truck builders in advance of any bid process or award to determine a "feel" that the firm can actually do what they say. Many have learned from experience that there are all kinds of "custom" builders, including some who low-ball a bid and hope to negotiate their way to adding more money later on thru change orders to address things that were "overlooked" in the original bid/quote proposal. Bids are nothing but ink on paper but an in-depth tour will reveal the skills and quality of the craftsman, the determination and commitment of the firm's leadership, and the willing to make sure your visit is a positive experience that reinforces the ability to do what you require. A better-informed customer makes better decisions. I could share numerous horror stories told to me by clients and component vendors about some experiences they have had at some emergency vehicle manufacturers' plants. A few hints- determine if factory visits are encouraged. Do they have a formal procedure for visits, a customer lounge, courtesy cars, assigned staff to assign you during your entire visit, a dedicated customer inspection area, etc.? Are you treated as a VIP or just another "nuisance?" Are you picked up at the airport if required? Do they organize your hotel, meals, local siteseeing, etc. when you have some downtime? Does the staff look like they are in constant turmoil and in a hurry to get things done or do they act like you are the most important thing they can do today? Do they ask about the money early in the final inspection/delivery process or wait until you are totally satisfied to even talk about "doing the paperwork when you are there to pick up a completed unit?" McCoy-Miller is a firm that was in bankruptcy until it was bought out a few years back by a local rival firm in Indiana, Marque. I understand that production of both competing product lines is now done under the same roof. That can lead to quality issues and product differentiation among the two competing brands. Why pay more for one product built in the same plant by the same folks, some may ask? What differences am I really getting? Some public officials may even disqualify bids offered by these two "family" firms under the guise of potential bid collusion. I know that has happened before with other manufacturers of products.

Many interesting points brought up here- the vehicle is probably more of a "concept" vehicle than anything else to gauge interest and explore ideas. The feedback noted here is valuable. Here are some things that should also be considered: 1) Most organizations need to carry more than one supine patient at times since most of use don't have the luxury of calling out enough transport resources for 3-5 patient MVAs. How do you carry a second patient- if not- then your costs just doubled to do the exact same job that your current single ambulance was capable of performing. 2) I question the integrity of the cot mounting system. Even the Ferno Stat-trac has limitations when it comes to "side loading" stress on it. The thing was designed to retain a cost where the majority of the forces are applied fore/aft on the vehicle, not perpendicular. And the stat-trac system is only designed to allow loading/unloading the cot from a single direction (unless they have some special modification that has been done to allow this- has it been crash-tested to industry standards for cots/restraint systems?) I also wonder if the cot is "rated" to take the additional "side loading" forces that could be applied to it in a front/rear impact since the cost is now sideways to the direction of travel. 3) Patient restraints- the typical shoulder harness now installed on cots to keep the patient from coming off the front end of the cot during a front/rear impact is now ineffective. Even worse, the waist/leg straps will need to be applied very snugly to remove any slack in those restraints, causing the patient discomfort during the entire trip. To do otherwise would mean that any slack in those straps would allow the patient to become a "ragdoll" in a front/rear impact or rapid deceleration. 4) How do you think a patient will feel riding "sideways"? Can you imagine the sensation of "rolling" on the cot they will feel each time the vehicle accelerates or brakes, especially with some of the lead-footed partners we all seem to inherit! Oh, imagine how hip and rib injury patients will feel enduring this repetitive motion? 5) Yes, the problem of aedequately accessing the head of the patient on the litter is a big problem. How do you intubate or even ventilate via a BVM properly? I know there were some helicopters (both civilian and military) that over the years loaded patients on litters in a perpendicular manner to the direction of travel. You are finding fewer of those in service any more due to patient access and related motion problems. The cargo cabinets are redesigned to allow for transporting the patient on the "long axis" of the aircraft (just like on ground ambulances) There are some organizations out there (mostly hospitals- it seems prevalent in North Carolina) that feel they must have dual roll-in cot transport capability so they have a transversely-mounted cot installed across the front of the module with the cot being loaded via the side entry door. They encounter the same problems as listed above- while some folks think it is cool/neat to do that, once they have some experience working in that environment, they conclude that trying to transport two patients in this manner is not very efficient and potentially harmful. 6) Recall that this "concept" had been tried on fire engines either as a separate "add on" module behind the cab of the pumper or integrated into the expanded cab of the fire engine. There was an article in Fire Apparatus magazine a while back that explored the pros/cons of such vehicles and it was wise to heed its advice. Most states have regulations as to the design and layout of "certified" ambulances and none of these "odd" designs meet the minimum requirements. I recently ran across a CAD drawing from a Fire Truck manufacturer advertising a "compliant ambulance" design on a fire pumper with rear and side doors, etc. Hmm, at some point, capabilities must be compromised (headroom, equipment space, water tank capacity, etc.) While a 2-dimensional CAD drawing might create some interest, it is how the thing actually turns out and how ergonomic it is actually is becomes the real concern, otherwise you have a very expensive vehicle that can do neither job well! 7) How do you load/unload cots at most ERs where vehicles are typically parked close to each side by side in the Ambulance parking area? Look at any Wal-mart parking lot to see how handicapped parking places are designed with additional space marked off to provide for deployment of side-mounted wheelchair lifts. Does that mean the ERs will now only be able to accommodate half as many vehicles at a time if we all got to side-loading cots. Side-loading is not new- study some of the ambulance history books where many of the early ambulances had wide doors (or suicide style doors) to allow loading of cots. These were usually converted passenger cars that did not have custom bodies with rear doors. Even hearses had the option of side or rear loading of caskets depending upon the situation but they did not have the cot retention mechanisms in place, usually just some rollers on the floor and some friction-fit brackets to keep the casket from sliding around. Finally, the latest revision of KKK-A-1822 (F version) allows some creativity in ambulance design now only requiring a single litter accommodation and two seating places in the patient compartment. There have been a few creative designs or "concepts" developed for smaller EMS transport providers (typically the "fire" guys since they will experiment with the taxpayer's money) but most of those will not seen widespread acceptance since EMS transport requirements vary in communities coast-to-coast. Baton Rouge has an entire fleet of dual squad bench ambulances that even have hanging litter hardware so they can tranport multiple litter/seated patients when necessary (Can you say Hurricane Katrina?) While some may laugh at that capacity, it does have its place in some response areas where you have a limited number of transport vehicles. I know that at least two EMS transport agencies in the metro Charlotte area have multiple vehicles with dual benches that are used to transport up to three litter patients at multi-patient scenes or are used for rehab situations as well. I think there are also some similar design vehicles in the Northwest US. So, what works well for one agency may be impractical for others. There is no "perfect" design- even when walking through the plants of some ambulance manufacturers (especially the ones that do lots of "custom" work), you will find many variations in the way equipment is stored, seating designs, etc. And remember, none of these "upgrades" and changes come cheap. Be prepared to pay a good bit more for "experimentation" and engineering changes that will come as a sticker shock especially to some who are used to buying "low bid" vehicles.

Well, you have me there. I have never of a size designation of "MT" and I have been in EMS since 1970. However, I am familiar with the term "MT" which is used to mark any cylinder which has been totally depressurized (open to the atmosphere eiher intentially or by accident.) This marking means that it must be subjected to a vacuum test to "purge" the cylinder of any atmospheric contents/contaminants before it is refilled with the appropriate pressurized gas. Cylinders that are to be destroyed for whatever reason will have similiar markings applied. I believe there are also additional procedures performed for any cylinder that must hold "medical grade" gases.

actually, the second color photo has an illustration of a Jumbo "D" cyllinder. It is mislabeled as an "M" cylinder. A jumbo D holds the same quantity as an E cylinder but is less cumbersome to store or carry. Some cylinders are also referred to by numbers referring to the quantity in cubic feet that each will store. Some folks tend to use these interchangeably referring to a cylinder as a 108, 122, etc. The "G" cylinder also has a close cousin called an ""H". Depending upon the specific oxygen supplier, you may find a mix of cylinder sizes they supply to various clients that may have slightly different dimensions (diameter, length) that hold approximately the same usable amount of compressed gas. As for high pressure cylinders, there are various breathing apparatus that have 3000 or 4500 PSI ratings. I believe there were some small oxygen cylinders developed decades ago for closed-circuit SCBA that were typically used in mine rescue, high-rise, tunnels, etc. where they were rated anywhere from 1-4 hour duration. The oxygen was added to the exhaled breath of the wearer after it was "scrubbed" of carbon dioxide by replaceable filters. Most oxygen suppliers do not have refilling equipment to refill cylinders to higher pressures so you normally don't see many higher pressure cylinders offered for sale. Some firms do have a high pressure "booster" pump to service some of the long-duration SCBA but they also charge a lot more per cylinder when they are refilled.

remember that you cannot make a silk purse out of a sow's ear. I have seen folks spend almost as much to remount a module than it cost them to buy a new comparable one (of course, there are wide ranges of prices depending upon manufacturers- there are those that build "cheap" and those that build "better." Investing a large amount of money in an attempt to overcome design and material flaws that were built into the original module is not a smart move. You might have a new chassis but the old module may still have recurring problems with structural integrity, wiring, door latches, etc. that were not addressed during the remount process simply to save money. I find this to be true among clients that have little experience with remounting. An independent remount shop is only going to do the work that the customer is smart enough to specify and willing to pay for. I have seen situations where a "cheap" remount ended up being very expensive when a module is finally disassembled at the remounter and a lot of "hidden" items are now requiring repair or replacement. While some of that cannot be predicted, I am aware of situations where someone knew from experience that certain items would probably need attention but did not price that to the customer in their initial quotation in fear that the total price might scare off the customer. Of course, once someone has your body torn apart in their shops, it is kind of hard to disregard their "recommendation" for additional cost work to correct those "missed" items. There are very good remounters out there that do it as their primary business and others that perform remounts as a sideline (basically another profit center among various product lines among their firm.) Some manufacturers remount "in-house" while others won't address it, preferring to either let independent shops or their own dealers deal with it (with varying results in quality and satisfaction.) Some manufacturers will only remount the modules they built while a few will address other brands on a case by case basis.

Be careful when considering a firm to remount your ambulance module. Most firms offering remounts are not Ford QVM certified nor are they registered as a NHTSA-approved final-stage manufacturer (taking bare chassis and installing a body on them.). That means they cannot document adherance to good engineering practices, compliance to chassis manufacturer recommendations, don't typically have sufficient liability insurance, and normally don't have proper engineering documentation about the work they perform. If someone claims the perform to QVM standards, ask for their current certification document. If they produce one from an ambulance manufacturer they may represent but the work won't be done by that ambulance manufacturer (and many of those don't do any remounting), then you have a big problem. As for changes you want to have done to your existing body, remember that at some point you will reach diminishing returns for your investment. As someone who has been involved in spec'ing, buying, and selling ambulances for over 30 years, be careful you don't invest more money in trying to correct shortcomings in an existing modular body where it may be more cost effective to buy a new vehicle and trade-in or sell off the old one. It really depends on the the brand of vehicle, the care it has received, and what items you want to have replaced.

motorcycles have their uses in getting "into" a congested area quickly. That is why police use them in many areas where traffic stops a normal size vehicle from traveling. I think there are even a few European fire departments (and Hong Kong, too) that have FD response on "bikes" for first responders. They can do a quick assessment and either cancel or upgrade the follow-up response to that call depending upon what they find. I recall some areas in the Metro Chicago area using motorcycles years ago as a method to overcome massive road construction and delays on the freeways in that area. As for uniforms, I note that many of the European motorcycle crews wear brightly colored heavy-duty "safety-style" clothing with reflective/fluorescent striping so they are highly visible be it riding the bike or standing in the roadway. No one confuses them for anything else. Makes sense to wear that versus a shortsleeve shirt so if you have to take a "skid", it lessens the potential for road rash (or worse.)

looks like you used ingenuity and creativity to fit the situation. Nothing is ever like what is taught in a classroom where you always have all of the right tools, lighting, etc. BTW, KED instruction sheets (depending upon what "brand" you have), used to show using this device for all kinds of applications including using it as a leg splint, hip splint, pediatric immobilizer, etc. Kind of like using pillows, blankets, and even magazines at times to improvise for splinting, immobilization, etc. Too many folks tend to rely on gadgets at times and forget to think about the basics! Good Job!

Oh, you are so right. While some of us may be techno-geeks and understand every component and brand of equipment we us, I have found a surprisingly large number of folks in "the business" who have no idea what "brand" of ambulance they drive, what brand of defibrillator they use, etc. We can put large labels over the fuel fills stating "diesel fuel only" and they will still attempt to put "gasoline" in the tank. Who knows- maybe they are inattentive and simply running on "autopilot." I definitely don't want any of those responding to a call for anyone I know or care about. While that might be minutiae to some, It does make me wonder how much attention (or maybe the lack of) they pay to other things they need to know. As for Federal Specifications and how they are classified, I am sure they have letters and numbers for everything.

hey, I didn't create them. Everyone uses abbreviations, shorthand, etc. for a variety of items in their everyday business activities, including SOB. Many of us do refer to it as "triple KA" when referring to it to be more "politically correct" but no one takes the time to speak the whole thing. That would be really crazy. As for abbreviations and their meanings, I recalled the first time I heard a control tower at a major airport use the term "SOB" when calling out the crash trucks for an aircraft incident by calling out on the hotline intercom or PA system, "Inbound 727, Engine Fire, Runway 36, 5,000 pounds of fuel (on board), 118 SOBs (souls on board), ETA 10 minutes." That does cause you to ponder until it is explained to you. They may still be using that at airports for all I know. I recall that lawyers use to love seeing that particular reference on run reports until they were handed a booklet or handout orienting them as to the use of all kinds of medical abbreviations. Of course, there are some folks think there is something vulgar when the term "Penal Code" is used. And you are right, there are some folks who will always take offense at the slightless little thing (be it real or perceived) simply so they have some kind of soapbox issue to bring attention to themselves. Maybe their quest for political correctness in the world and the adoption of "neutral" words and expressions should also have a lesson included for themselves called "social tolerance" along with the words "get a life!" Guess if some folks feel "offended", they should contact their Congressman to express their indignation and suggest all of those millions of documents, etc. with the current references be changed to something less volatile. I am sure they will get right on and spend more of your hard-earned tax dollars righting a perceived "wrong!" Maybe along with changing all of the restroom signs from the gender-specific "MEN" and "WOMEN" that could be taken as offensive to a small group to maybe something more socially-correct, like maybe, "Human"?