# Dream Ambulance



## MonkeyArrow (Mar 3, 2014)

Let's collectively design a dream ambulance. The requirements are- must be reasonable to have in ambo in next 20 years, cannot GREATLY exceed your scope, your training is a 4 year college BS with 2 years of college classes (micro, bio, chem, phys, humanities, organic chem, A&P, english), 1 year of didactic classroom (teaching you how to apply all the pre-learned stuff), and 1 year of clinical rotations through a trauma center and FTO. Your training will teach how to use everything that's on the ambo as long as it does not exceed your scope (ie. no surgery). No budgetary restrictions. List out all the goodies you would want (anything from devices to paint schemes to specific brands of angiocaths if thats what your into). 

I'll get us started. 
2 medics both having gone through the aforementioned training.
A medium duty type rig with an extended box.
Stryker power cot with power load system
Lucas CPR device
iSTAT portable blood lab
Oxylog ventilator
Lifepak 15
GE LOGIQ E9 with XD clear (hey, what can I say?)
Handheld MRI scanner (or roof mounted, I don't really care )(Hey, it could happen in the near future. We already have handheld ultrasound)
An integrated patient care computer that will automatically connect and chart all stats from LP, images, labs, Hx, etc. All patient care, reports, etc. done through this computer.

NO BACKBOARDS - I'd prefer full body vacumn splints please. Of course, with advanced imaging on rig, we can make a Dx right on scene.


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## Av8or007 (Mar 4, 2014)

Ill take sonosite please . Lol jk
Cardiac, abdo and linear probes.

Anyways, add to that an extended drug box, both emergency care and primary care drugs (i.e. abx).
Abx are both po and iv. 

Clinical practice guidelines and autonomy for the medics, including tx and release or alternative referral pathways including a gp follow up.

Specifics:

All acls drugs, including other antiarrhythmic meds for special cases.

Calcium chloride, hypertonic saline .etc and the education to use them safely.

Blood products (1-2 units of O- prbc's)

Infusion pump and various pressor options including dopamine, norepi, epi .etc. 

That iStat better have both blood gas and chem panels. I'd also like to see lactate and troponin capabilities.

Surgical cric capabilities as well as the ability to place a chest tube (if indicated).  Possibly pericardiocentesis for trauma codes.

RSI meds and aggressive training to ensure excellent performance and safety. Standard guidelines would be used to ensure its kept safe.

Meds would include: 
Sedatives: etomidate, ketamine, (propofol - post procedure if safe or mixed as ketofol)
Paralytics: roc and sux.

Opiates (for pain mgmt and rsi/sedation): morphine (po solution and injectable), fentanyl, codeine/acetaminophen, tramadol.
Enough would be carried to manage pain extremely aggressively if needed. Very liberal pain guidelines would be implemented allowing a medic to use their judgement. Abdo pain would be managed aggressively.

Non opiate analgesics: entonox (50/50 n20/o2 mix, would be both bls and als), ibuprofen, naproxen, acetaminophen, ketorolac.

Sedatives: ketamine (indicated for most sedation cases, normal contras would be relative allowing judgement). Midazolam and diazepam. Propofol (for post eti sedation, or procedures requiring deep sedation. Airway must be controlled). Protocols allowing ketofol (ket propofol mix in various ratios depending on desired effect)

Id probably switch out the vent for one that isn't dependent on an oxygen supply to run. Ltv series is one option.

Video laryngoscopy. Intubation drills and checklists to ensure safety (not the same as restrictive protocols). 
-------
Maybe in the future, ability to call for an ecmo intercept from an emerg doc as well as a physician response for onscene thoracotomy.


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## emt11 (Mar 4, 2014)

MonkeyArrow said:


> Let's collectively design a dream ambulance. The requirements are- must be reasonable to have in ambo in next 20 years, cannot GREATLY exceed your scope, your training is a 4 year college BS with 2 years of college classes (micro, bio, chem, phys, humanities, organic chem, A&P, english), 1 year of didactic classroom (teaching you how to apply all the pre-learned stuff), and 1 year of clinical rotations through a trauma center and FTO. Your training will teach how to use everything that's on the ambo as long as it does not exceed your scope (ie. no surgery). No budgetary restrictions. List out all the goodies you would want (anything from devices to paint schemes to specific brands of angiocaths if thats what your into).
> 
> I'll get us started.
> 2 medics both having gone through the aforementioned training.
> ...



Just make sure the rig has air ride seats in the front and the airbags so the back of the truck lowers when the rear doors open and I'm good. Though a lighter monitor would be nice, those LP 15s get to be cumbersome after a while(that's all we have where I work). A new Zoll monitor would be nice to play with.


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## MonkeyArrow (Mar 4, 2014)

emt11 said:


> Just make sure the rig has air ride seats in the front and the airbags so the back of the truck lowers when the rear doors open and I'm good. Though a lighter monitor would be nice, those LP 15s get to be cumbersome after a while(that's all we have where I work). A new Zoll monitor would be nice to play with.



I would have gone with the new Zoll X series but the I've heard bad things about their artifact detection and EKG accuracy, or lack thereof, due to bad reads. Its always better to go with ole faithful over at Physio Control. And, as soon as you get into the rig, you will plug into the integrated ambo patent care system and it will all be done through the interactive monitor. Therefore, the only time you will need the LP is when you are out of the rig.


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## mycrofft (Mar 5, 2014)

*Another take*

A long distances transfer, IFT, with Hugh Laurie driving and Olivia Wilde as relief back seater; the vehicle is a modified Suburban with forward facing jump sats in the rear and a DVD player.


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## CANMAN (Mar 7, 2014)

I prefer to dream about things I would take up if not in a line of work such as this like cocaine and hookers.


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## Jim37F (Mar 7, 2014)

Since so many have to post 10, 11, 12+ hours a day in the ambulance, how about some crew comfort items? Say seats that actually have enough room to scoot back AND recline? How about a cooler sized mini fridge, microwave and/or hotplate? Oh, a coffee maker? Heck, we probably have enough room under our bench seat right now for those (but considering the rigs at my current company don't have cup holders and your lucky if the front power outlets work...)


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## emt11 (Mar 7, 2014)

Jim37F said:


> Since so many have to post 10, 11, 12+ hours a day in the ambulance, how about some crew comfort items? Say seats that actually have enough room to scoot back AND recline? How about a cooler sized mini fridge, microwave and/or hotplate? Oh, a coffee maker? Heck, we probably have enough room under our bench seat right now for those (but considering the rigs at my current company don't have cup holders and your lucky if the front power outlets work...)



Our old type II don't have cup holders, well I don't count the factory one in the door. The Mercedes sprinters we have now have cup holders galore. Theirs a total of at least 6 cup holders that I can think of.


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## Underoath87 (Mar 8, 2014)

Comfortable bucket seats that recline.
Arms rests
Cup holders
Radio with 2 functioning speakers and an auxiliary jack.
A reliable turbo diesel engine that doesn't rattle or break down.
A Lifepack 15.
Stryker power stretcher with that power hook thing.
Air horn.
Good suspension. 

There's my dream ambulance


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## Kevinf (Mar 8, 2014)

A quiet ride with legroom.


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## Ace 227 (Mar 9, 2014)

Why do you want all those meds and equipment? Then you have to actually treat people... I want a good sound system so I can drown out dispatch.


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## DerekC (Mar 9, 2014)

All I want is something that doesn't ride like a lumber wagon, doesn't rattle and squeak, something thats more than a single cab so you can recline the seats, a box that i can stand up in,  EFFING CUPHOLDERS,


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## Rin (Mar 29, 2014)

YES PLEASE to power cots & power load, reclining seats! Mini fridge & microwave *sobs* That would be so beautiful.

Doors that can be opened/closed without the application of specialized technique.

Windshield wipers that don't leave a foot-wide streak uncleaned directly in front of the driver.

Heating & cooling that works on settings other than "High."

Radio stations & partners that play something other than country pop.

Integrated GPS


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## TransportJockey (Mar 29, 2014)

Type III Sprinter mod, power load and cots, LP15, good seats, good radio w/ aux or BT, dispatch radios you can actually hear, room behind the seat for personal gear, a good layout in the box that makes sense for treating people w/ harness on.


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## Rick Tresnak (Sep 9, 2014)

King Cab!!!  So you can lay down in the front seat.


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