Dale

We have been installing 3-and 4-pt. harness systems along with adjustable high-back seats for at least 15 years. Unfortunately, many clients do not appreciate the value of such safety items and will focus more attention on how many warning lights they want instead of occupant protection. And even some of those agencies that do offer an upgraded level of protection still have issues with getting their staff to consistently use these items on a routine basis. Old habits die hard and you can't be everyone's mother all of the time. We also see EMS providers installing little "cups" on their own in the floor or stepwell of ambulances to "hold" portable oxygen cylinders. Those tanks are held in by gravity and single thumbscrew! Very dangerous! I wonder why the manufacturers of those products still sell those items when they are not compliant with any existing standard. I know of only one manufacturer that makes a "compliant" crash-worthy portable cylinder restraint system. The new KKK "F" standard coming out will adopt by reference the newly revised AMD (Ambulance Manufacturing Division) testing standards that will require, for the first time, actual performance standards for small cylinder mounting systems and safety nets, just to name a couple of new items. There have been a lot of "questionable" things done for years by some builders that will finally have a "quantifiable" standard applied so such items are supposedly meeting minimum requirements. Of course, customers must depend on the honesty of a vendor to ensure that what they had "tested" to meet these new standards is actually what gets installed on each vehicle.

there are lots of US ambulance with rear lifts on them but most are ordered by hospitals that typically run critical care or neonatal transports involving heavy cots, isolettes, etc. Some of those only send a single EMT with the nursing staff so there is really no way to adequately lift or roll a normal cot into the rear of the vehicle. The most common lift is made by a firm called Mac-Lift in California. They make a wide range of lifts for ambulances that be specifically ordered in either a two or three section style to handle wheelchairs, isolettes, or full adult cots. They also make a higher rated capacity version for bariatric transports. Some brands and makes of cots do seem to work better with this lift when it comes to clearance issues with the front of the cot. However, all cots must still be lowered to the ground (retracted frame) before they should be placed on the lift. Otherwise, the cot becomes wobbly when the lift is raised and there can also be clearance issues with the ambulance door header if the cot is in the raised position (and maybe if the backrest is also raised.) So someone (actually two) have to still lower the cot to the ground first before it can be placed on the lift for loading into the ambulance. And the reverse is also true when unloading unless you like to stay hunched over trying to pull a cot in the full low position around a hospital (like what used to be depicted on the TV show EMERGENCY when the "ambulance attendants" did the low crawl dragging the litter and patient into the ER hallway! The biggest issues with this lift are its cost of around $7-9 thousand installed. It also must be custom-built to accomodate the exact chassis (and not all chassis are capable of accomodating this lift) it will be installed on (and the ambulance manufacturer must make certain allowances in the design of the rear of the ambulance to get it to operate correctly.) There is a back-up hydraulic hand-pump that must also be located in an exterior compartment conveniently close to the rear of the vehicle. The lift assembly is also heavy and it can overload some vehicles so it is not really practical for Type II van ambulances. Finally, the lift must be manually deployed (pulled out of its cradle and any sections unfolded) and stowed which can be difficult for those who don't have much hand strength. If one were to do this several times a shift, they might get tired of it quickly. The lift design where it is actually part of the rear door assembly is intriguing. However, there are few manufacturers of ambulances that will be willing (if at all) to invest the time and effort for what would be a low-volume option that would require crash testing and endure all kinds of other tests for a relative handful of orders. I've read where the lifts on some European ambulances are actually mandated by the Medic's Union contract so that is really a no brainer for the ambulance manufacturer since he has a steady repeat market for that product so they can invest the resources in developing the product. It would be nice to hear from some folks from across the pond who have actually used that style of lift and tell us the pros/cons of it. Everything looks nice at a trade show, magazine article, or web site but it's much better to actually hear from those who have had hands-on experience with the product.

The strap/harness idea has been tried before. Some fellows from Phoenix offered a harness system with retractors. The problem is getting someone to walk-around in it all day (or worse, an entire 24 hour shift.) One of the seating manufacturers has once again resurrected the idea and a few departments are buying it in the name of "safety." Time will tell if the crews continue to use that item a year from now. There are some other seating/restraint ideas that have merit but as long as folks won't even use the existing seat belts in the cab, what personal incentive will they have to use them in the back. Some of the problem stems from those good old Federal Ambulance Specifications that pretty much mandated interior design for decades. The lack of adequate seating to allow for easy reach of patients during transport has contributed to injuries and deaths since it is impossible to sit on the bench while sitting correctly and wearing the seatbelt snugly as designed. The more innovative agencies have adopted sliding high-back seats that will permit someone to "slide" towards a patient for easier access while wearing a seatbelt securely. This is a common feature in most European ambulances for years but only slowly being adopted in the US. The new ambulance specification revisions expected later this year will finally address the idea of having more secure seating and actually only requiring the capability to transport one supine patient on a primary litter. No more squad bench (or even the streetside "CPR" seat) will be required but it can still be a customer-selected "option" if required for local circumstances. Amubulance cots are supplied with shoulder-style restraints to keep patients from sliding off the head end of the cot during a rapid deceleration. Accident investigaions have revealed this problem to be a cause of injury/death to patients. The cot manufacturers strongly urge users to fasten these straps on patients. But you would be surprised as to the number of cots I see where they have either been removed (sometimes for cleaning and never replaced) or the crew thinks they are cumbersome and either removes them from the cot frame or tucks them under the mattress. Another issue has to do with loose items placed in the patient compartment. Keep everything enclosed with crash-worthy brackets (not some flimsy piece of velcro straping or jury-rigged strapping created at your station) or contained within cabinets with good latches. Imagine sitting in the pt. compartment and having it rotate 360 degrees (on its long axis.) Now imagine what happens to all of the items that are sitting exposed and depending upon gravity to keep them in place. Next imagine what happens during a violent impact with a car, tree, building, ditch, etc.? That deceleration creates instant missiles out of those same items (med kits, oxygen bottles, defibrillators, pulse oximeters, etc.) I had a friend killed over 3 decades ago by a small oxygen cylinder that literally "flew" from its horizontal mounting bracket in the patient compartment and hit him in the head while sitting in the driver's seat when they were in a head-on collision. Check out your own rig to see if you have kits lying loose on top of the cot or squad bench. Is there an oxygen cylinder lying behind the squad bench cushions? Is the defib unit sitting unrestrained on the floor or countertop? Driver training is another area that probably doesn't get the attention it deserves. This is especially true for those that don't have the opportunities to drive the ambulance on a daily basis and respect its handling characteristics (like in a volunteer rescue squad.) Even the career folks can run into problems if they are using a variety of vehicles instead of standardizing by only driving one kind of vehicle (i.e. a van versus a modular.) Each kind of vehicle has significant differences in turning, braking, center of gravity, etc. It is no different in some fire departments where their accident rate seems to be higher where a crew is operating a spare rig that is radically different than their normally assigned vehicle. Crew visibility at the scene is also important. In many countries, high-visibility clothing seems to be the norm but we still see many agencies here in the US that adopt darker clothing that can make crew members virtually invisible during low light conditions. And flashing lights really don't offer you much protection when there are a multitude of vehicles sitting at a scene. Approaching drivers are distracted by all of the different flashing lights and may not pay attention to the person actually standing in the roadway. I believe there are some new hi-viz clothing standards being adopted soon that should apply to construction workers and others that actually have to operate on roadways. You may want to do some research on these items. In my former department, we wore those hi-viz vests routinely at scenes that were not a "house call." And this was over 15 years ago!

Sorry to hear about your squad's problems with wiring for the camera. I suggest that your leadership review the warranty documents that were provided (or should have been) with your new ambulance. They are probably located in the "owners manual" that should have been provided with your vehicle. If the manufacturer actually installed the camera system (and not your local dealer for that brand), then the manufacturer's standard conversion warranty should cover the necessary repairs if, in fact, it failed or malfunctioned after a "couple of months." Some warranties do have specific time limits and exclusions so read the documents thoroughly. If the problem is related to one of the camera components instead of a wiring/installation issue, then you may have to deal with the camera manufacturer directly but your local ambulance dealership should assist you with that problem (if they expect to keep your squad's business.) If the dealership installed the camera system, you may actually have more leverage with them since they should be a "local" firm and you usually have more potential avenues of applying pressure on them to resolve this issue. I have heard stories where some volunteer squads are really "taken" at times when a repair that really should be a warranty obligation is denied and the squad now has to pay more money to fix something that should be covered by a warranty because it "needs to be fixed." If you have and written records that show the first notice of warranty problem (date, problem, etc.) with the camera, you may want to provide that along with the warranty documents and consult the legal counsel your squad uses for its legal issues. A simple letter from your lawyer may spur the necessary repairs (or even a refund if you paid to have this repair work done.) Don't accept some kind of offer such as a "credit" or other consideration when you buy another vehicle from them in the future- I guarantee you will "pay" for it. That is a silly way to negotiate- you simply want your existing vehicle to operate correctly in the manner as originally expected. Some vendors are expecting that changes in leadership over time will "forget" about that "generous" offer made in the past to correct a "wrong." If you can't get a satisfactory response from the manufacturer and/or dealer, then I would not even consider them for another vehicle purchase the next time. And you should tell them that in written form, too! And you can always file a complaint with the local better business bureau, state consumer affairs agency, etc. As for chassis selection, make sure that whatever chassis is "spec'ed" for your next vehicle is properly equipped. Too many folks are influenced (or sucked into) buying a "cheaper" chassis that is better suited for a delivery truck instead of a performance-based emergency vehicle. Take the time to review the available options for each brand of chassis. You may find it advantageous to visit with a couple of local truck chassis dealers (versus a car dealership that also sells some trucks) that sell the brands you are considering so they can review the options with you (ask for their vocational truck specialist or simliar person). Remember that they are not used to ordering ambulance chassis and there are some low-volume modifications that are done by speciality installers (i.e. rear air ride suspension) on a "ship-thru" basis after the chassis is actually built by the manfacturer.

The vehicle brand mentioned shares a common problem with some of the other ambulance manufacturers. Namely, they use an "outsourced" electrical system (not built by them) that incorporates PC boards and/or multiplexing technology. Why? Some feel that it saves them costs by reducing the amount of wiring, purchasing of separate components from different vendors, and ease of installation. Some clients also like all of the "gee whiz" features on a neat-looking panel that looks like something out of a science fiction movie. Nothing wrong with that if you use it everyday but folks who only operate a vehicle on an occasional basis (like many volunteers) can become overwhelmed by all of the crazy switching and logic circuits that can be programmed into most of these electrical systems. They want something simple where they hit a switch and know what it will do. Problems can arise due to voltage spikes and other problems that typically can occur with any vehicle. While we all use to be able to repair our own personal car with tools we typically had in our garage, today it takes many thousands of dollars of sophisticated diagnostics and years of training in some cases to work on vehicles that contain all kinds of "on-board" computers. Oddly, most of them are really necessary to operate a vehicle but folks once again like having all of those fancy creature comforts and gadgets found in most know automobiles. Even the ambulance dealers need special equipment and training to service some of the brands. Many large fleet EMS systems shy away from such "complex" items since they either have already had experience with them or don't feel that the system will be user friendly to their requirements. In defense of such systems, it can be difficult to build a single system that is adaptable to a wide range of chassis that can be selected by a customer (i.e. Ford, GM, International). Each of those chassis has an electrical system that can operate in a different manner and trying to get another system to function perfectly every time in conjunction with the chassis electrical system can be a problem, especially if you want some specific logic requirements to occur (i.e. shutting down some lights when the transmission is placed in park, activating the high idle). Remember, the more complicated the system, the more likelihood for problems. Technology is a wonderful thing. We rely on it every day. However, when technology fails, it usually fails us in a spectacular manner. Not a very reassuring thought when you are stranded on the side of the road with a patient going down the tubes or you are even unable to respond out of your station due to a "dead" vehicle that may have a problem that is as simple as a broken or corroded contact on a circuit board. I find EMS folks at trade shows that seem to be getting informed about such items. Where they used to look at all of the lights and sirens first, they know seem to be just as concerned and ask important questions abut the electrical system, service issues, accessiblity, etc. Sounds like some of them have already learned their lesson in the past or have good advice from a peer about avoiding such problems. My advice if you are in a position to buy vehicles- study what is out there. Don't be distracted by the gingerbread which may be presented to you in a way to simply distract you from a particular product's shortcomings. There are some good manufacturers out there and then there are some that build whatever they can get a customer to accept.

Our firm has built several 4x4 version GM C4500 series ambulances. As with all 4x4 designs, the chassis will typically ride rougher due to the design of the suspension. Remember, the truck has at least a 16,000# GVWR (just like an F-450 4x4). The vehicle will also have a higher center of gravity. You can smooth out the ride somewhat by installing all-season tread tires for most of your seasons and then installing a "winter" set of "all-terrain" tires (having these ready on a set of spare rims is the way to go) for the really bad weather (if that is the reason you are considering a 4x4 chassis.) An air-ride rear suspension is pretty much mandatory (to lower the rear end for cot loading/unloading and to smooth out the ride) unless you really have some big folks willing to lift cots into the back of the rig.

There are several styles of "reflective" vinyl available from several manufacturers. And each of those may offer specific "grades" for a particular use (like road signs.) Some are easier to install than others depending upon the surfaces where it is applied. It is true that some "vendors" may offer you a cheaper price for striping but it is usually the cheaper grade that has a much shorter life span. I recall a local department that bought a truck and thought the manufacturer was too expensive for the striping and lettering package. They got a local sign shop to quote them something less expensive. Of course, what they did not know was that they got the cheap vinyl that literally fell off the truck within 2-3 years. Yep, they had to go back and have it redone again. So they spent over 100% more to get the same thing they should have gotten originally for 20-30% more the first time if they had listened to the manufacturer that puts its on their vehicles as a business. Look up Avery Dennison, Reflexite, and 3-M to review the options. Some offer reflective vinyl while others offer striping that also has fluorescent or luminescent qualities (which is favored by those in Europe.) Some of they vinyls are only available in specific widths and can be costly, especially when a vendor must buy a large roll of a color to maybe only use 30-50 feet on your rig. Someone ends up paying for the whole roll (or two or three) for some special striping that may never get another customer request to use. Ifyou have to pay for the whole, maybe ask the vendor to provide you with the balance of the roll for any future repairs or upgrades to that vehicle (or maybe another one in your fleet?) Most of the damage I see to striping and lettering involved the use of a stiff bristle wash brush that tends to force bristles beneath the edge of the vinyl striping, especially when the striping is hard due to cold weather or has a year or two of use on it. The edges tend to get chipped away, just like some pinstriping can get damaged. The second thing that can damage vinyl striping is the use of strong or full-strength cleaning solutions like Simple Green or Formula 409 that have not been diluted to the recommended strength (full strength must be better than diluted strength- works faster?- yeah, right!) It can damage the coating or even cause some of the ink dyes to run. Leaving a cleaning solution on the surface for too long can also damage just about any surface so a thorough rising is necessary.

The GM C4500/5500 series chassis is gaining in popularity. It offers heavier duty components and handling versus the typical light duty pick up truck chassis normally used (i.e.- Ford F-350, GM C3500) with better engines, transmissions, brakes, and maneuverability. There are trade-offs on any kind of chassis one may select. I will not go into a detailed engineering comparison here (unless someone wants me to) but the GM C4500 chassis can be spec'ed to have as little as a 16,000# GVWR (Gross Vehicle Weight Rating) which is comparable to the Ford F-450 chassis with the same size of tires and wheels (19.5"). The GM C4500 has a multitude of chassis options not available on the F-series chassis (nor even offered by International, Freightliner, Sterling) when it comes to a medium-duty chassis application. The C4500 can be ordered as a 2-door "cutaway" chassis design (like the Ford E-series chassis), a 2-door Cab/Chassis model (with a closed cab back), and a 4-door Cab/chassis model (also with a closed back.) The cab/chassis models are also available with factory-installed 4x4 for applications requiring it. And the GM chassis offers a multitude of wheelbase options to accommodate anything from a 10' long body for a small rescue truck, 12' ambulance body, 14' ambulance or rescue body, etc. There have been a good many of these rigs built by a couple of manufacturers on 4-dr. chassis for special uses like hospital neonatal and critical care units. Mecklenburg County EMS (MEDIC) based in Charlotte is converting their entire 40+ fleet of vehicles to a 4-dr. chassis. Their crews work 12-hour shifts and carry many ride-a-longs, students, etc. during those shifts. Comes in handy for a clean place to relax between calls, too! Customers order this size of chassis when they want extra durability, longevity, and handling but it does come at a trade off when it comes to ride. They are built to be a "truck" but with certain factory-installed modifications for the specific "vocation", it can provide great service. Some unsuspecting folks are still "sold" a chassis that is a stripped down freight truck version by am ambulance vendor that may be trying to keep down the initial cost of the vehicle (units with this size of chassis do cost more initially.) First, order 12 ply tires. They provide a much better ride without the stiffness of 14 or 16 ply tires. We don't need the bigger must be better mentality here. And keep the correct "loaded" air pressure in those tires. Don't decrease the air pressure thinking you will get a better ride- you only worsen handling and can cause premature wear and even failure of those tires!!! Ensure that when you order the optional rear air ride suspension system (mandatory for the vehicle to be "KKK" compliant for cot loading height in most states), you order the air ride with "dual" height control valves so each air bag can be independently adjusted based upon your final loaded weight of the finished vehicle once you have it in service. Folks tend to load one side of the rig more than others and this can create handling and premature suspension problems when crossing rough railroad tracks, potholes, etc. There are several available air rides for this particular chassis so order the one that provides you with the smoothest ride. And remember that you will have to "adjust" the height control valves once you get the vehicle loaded so the rear air bags maintain their proper inflation for each side. If you keep each air bag inflated to its maximum height, the vehicle will "bounce" and folks will develop the wrong image about the rig and complain. Dual "ping" tanks can also be installed that provide additional air reservoirs for each rear air bag. When the bags are compressed (like when crossing a set of railroad tracks), the air is released from each bag into the "ping" tank, thus providing more available air for compression, thus softening the ride even more. Okay, some of you ask why all of this is not made standard on any such vehicle they order. Simple- Price. Some folks don't understand that a chassis such as this (along with the International, Freightliner, etc.) are really spec'ed from the ground up from a basic set of minimum requirements To develop a chassis that has the ride, handling, and responsiveness needed for ambulance, some optional cost items must be added. Some vendors will attempt to keep the price down on such a chassis by not offering the customer these options or even informing them that they are available (usually a first time customer for this kind of chassis.) See if they can really "talk" truck chassis- most ambulance dealers can't and simply try to offer the "same" chassis to all customers no matter what the application (road trips, local responses, mountains, cold weather, payload, ride, etc.) I can park two of the same brand of medium-duty chassis side by side in a parking lot and most folks can't tell the difference between the two externally. Yet, those same two chassis can have a $10-30,000 cost difference between due to the features and options installed on each truck to make it more applicable to the duties they are expected to perform. Everything from axle ratings, tires, engine, transmission, alternators, air ride, framerails, etc. will affect the final price. I have heard many horror stories over the years by folks such as yourselves who either feel "taken" or distrustful after being "sold" a medium-duty truck that does not perform like they expected. Some ambulance manufacturers either "stock" or order a single chassis spec package and may push that onto their dealers to sell for all customer applications. that is usually what I find has occurred. Find a reputable dealer who has good support from the ambulance manufacturer when it comes to designing a chassis for your specific needs. It all depends on your needs and how the chassis is spec'ed. Is it spec'ed for show (they all look alike so they must be alike mentality) or is it spec'ed for go (with user friendly options, responsiveness, superior handling, heavier duty components) needed for emergency service response?