Side load ambulance

[Dale]

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.

[Dustdevil]

How about we reverse the formula and make a front-loading ambulance? We can put the cab on the back of the vehicle and drive from a rear mounted pod, like on a tiller truck.

[zippyRN]

Last week, I was in Houston with Flight-LP, touring one of the local agencies' ambulance. I forget the manufacturer, but their brand new ambulance had a sliding door on the side, instead of a hinged door. It was awesome! Same size as a normal door, but allowing you to open it easily when other vehicles are parked right beside you, or when inside a cramped garage. Great idea! That's the kind of innovation I like to see from manufacturers. But I can't imagine loading through that door.

not innovative

20 year old idea in the UK when van body ambulances were reinvented and 15 + years in coach builts