# Ambulance Design Questions...



## simonID (Apr 6, 2008)

Hi, everyone. I am a Senior Industrial Design (product design) student at Ohio State University. At our school, our last quarter is dedicated to a thesis project which gives each student the opportunity to research and develop their own project. Ive been working on re-designing the interior of an Ambulance. Specifically interactive aspects, storage space, and other related items.

Ive interviewed a guy at our local fire department who uses Horton rigs. Some things he pointed out were lighting, and communication issues. Cleaning (lots of crevices to worry about). And some other detail related items.

As I have been doing some other research, Ive discovered how broadly different Ambulances can be. So I joined here to see if I could get a more broad spectrum on current issues EMTs might have. I've been skimming through existing threads, and have gathered some ideas from that, but would like to get a more open collection of ideas from the community here.

What issues do you guys/gals currently have with the Ambulance you work in?

Are there specific ideas that have come across your mind? Is so, please explain.

Are there things you have worked with in one Ambulance, and wished they were available in another, etc?



If you can, please provide which model Ambulance you are working with and/or have issues with.

Thanks for your time. I will post up the final product when I have completed it for you all to see. And may post up concept ideas for feedback. For anyone local to the Ohio State University, our Senior show will be June 3rd - 14th with the main reception on June 4th.


Simon


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## certguy (Apr 7, 2008)

I've been out of a rig for a while , but it'd be great if you could design one with the ultra smooth ride and speed of the old cadillac ambulances and the pt. access and storage space of a modular . Combination of mechanical / electronic sirens work pretty well as do Grover air horns . For mt. or snowy areas , 4 wheel drive would also be a plus .


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## rmellish (Apr 7, 2008)

A few ideas immediately come to mind. 

1. Safe mobility in the back - patients are belted in but many of us still are not. A harness system which allowed for simple movement around the compartment would be nice. 

2. A monitor shelf - using the cpr seat gets old

3. Safe mounting for portable oxygen cylinders - under the bench seat doesnt cut it for me

4. Air ride suspension or something to cut down on the bouncing for the patient

5. A decent platform to write the PCR on. (I'm dreaming now)

6. Privacy in the rear windows. I'm sick of the lady behind me in rush hour traffic looking in on me and my patient at a stoplight.

I'm sure I can think of more. I'll get back to you after my next shift.


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## paramedix (Apr 7, 2008)

You guys are fortunate to have factory built ambulances. In SA we use "taxis" which they convert into ambulances... not working at all...

you are more than welcome to check on the following sites:

www.ete.co.za and www.er24.co.za

Some of our vehicles are visible on these sites.


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## JPINFV (Apr 7, 2008)

A lot of the safety issues that you would imagine would be standard issue (safe storage of spare O2 tanks) aren't standard. I know that Leader type 2's have a locking mecanism for storage under the bench seat. Similarly, I know Horton ambulance has a system where the windows could be blocked similar to blinds using a switch. Similarly, I'm surprised that traffic control lights (amber arrow stick band) is not standard issue on ambulances considering how often an ambulance has to sit in a roadway. 

Probably the stupidest thing I've seen in ambulance design is diamond plateing in the back. Diamond plating itself is a great idea for improving tracting in vehicles that operate in all forms of weather. That idea ceases to be good, though, when the rear loading plate is placed OVER the diamond plate so that there is a gap. Essentially the only way to clean under it would be to take the plate off. Something that isn't going to happen most places unless mandated by law.


A few years ago there was an article, including pictures, on Merginet about AMR's prototype ambulance. Does anyone know if anything resulted from it?

http://merginet.com/index.cfm?pg=vehicles&fn=conceptamb


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## CFRBryan347768 (Apr 7, 2008)

rmellish said:


> A few ideas immediately come to mind.
> 
> 1. Safe mobility in the back - patients are belted in but many of us still are not. A harness system which allowed for simple movement around the compartment would be nice.
> 
> ...


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## JPINFV (Apr 7, 2008)

CFRBryan347768 said:


> i think it would take a long time for people to get used to the idea of wearing a harness, sure you would have the people who use it 100% of the time, but otehrs would have to adjust, just like when they changed seatbelt laws.
> But all in all very good suggestionsB)



Simple solution:

1st offense: Warning
2nd offense: termination of employment

You (generic "you") don't like using the safety devices that are required, then you can go screw up someone elses liability insurance. B)


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## medicdan (Apr 7, 2008)

JPINFV said:


> A few years ago there was an article, including pictures, on Merginet about AMR's prototype ambulance. Does anyone know if anything resulted from it?
> 
> http://merginet.com/index.cfm?pg=vehicles&fn=conceptamb



A direct link:
http://www.aev.com/scv2/

There have been, over the past year or so, been a few efforts to improve the internal layout of ambulances-- most recently, there was a feature in JEMS about it. 
Some priorities I see for improvement include:
-- Increasing safety for the provider. If you can find a way for us to be belted/secured in, yet still have access to all critical supplies, and equipment, that would be great.
-- For those of us taller then 5' 11", a way for there to be legroom and headroom without wasting space, and without increasing the size of the box. (i'm a little sore after spending too much time in an ambulance that was actually designed for caretakers shorter then 5' 10".  
-- Placement of trash and sharps bins that makes sense
-- Communication with the driver, and the capacity to see forward (to tell where we are). 
-- Simplicity (KISS)

Be sure to show us your final designs, I look forward to seeing your ideas.


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## KEVD18 (Apr 7, 2008)

JPINFV said:


> Simple solution:
> 
> 1st offense: Warning
> 2nd offense: termination of employment
> ...




if they fired everybody who didnt wear their seat belt, there wouldnt be anybody working on a rig.

i wear min about 75% of the time.


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## ffemt8978 (Apr 7, 2008)

Not to mention that there is no way to restrain a provider effectively against the 3 axis of movement required and still allow the required mobility to provide treatment.


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## rmellish (Apr 7, 2008)

ffemt8978 said:


> Not to mention that there is no way to restrain a provider effectively against the 3 axis of movement required and still allow the required mobility to provide treatment.



I did not stipulate that any of my ideas had to be workable....they're just ideas...you're crushing my dreams man, crushing my dreams..

But really, our type IIs have lap belts that aren't even ergomatically correct. Our airchair has a lap belt as well. I know that six point harnesses are available as well, but certainly not on our trucks. Three axis protection is unrealistic in an ambulance and this makes our jobs very risky. I guess thats why we're paid *so *much...


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## JPINFV (Apr 7, 2008)

ffemt8978 said:


> Not to mention that there is no way to restrain a provider effectively against the 3 axis of movement required and still allow the required mobility to provide treatment.



The question is, though, how often do you really need a lot of movement? You shouldn't have to get out of your seat to administer a drug via IVP. Similarly, you should be able to do V/S while seatbelted. I firmly believe that most providers refuse to use seatbelts not out of necessity, but out of want. The vast majority of patients do not fit immediate transport criteria (transport ASAP, but still provide immediately needed treatments onscene), and even few meet 'trauma immediate' (do nothing unnecessary (including starting IVs) that delays transport).


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## Airwaygoddess (Apr 7, 2008)

*Ambulance design!*

A design for the gurney to be inside of the ambulance but be able to get access to both side of the gurney.  That would make it easier on the back!


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## medicdan (Apr 7, 2008)

JPINFV said:


> The question is, though, how often do you really need a lot of movement? You shouldn't have to get out of your seat to administer a drug via IVP. Similarly, you should be able to do V/S while seatbelted. I firmly believe that most providers refuse to use seatbelts not out of necessity, but out of want. The vast majority of patients do not fit immediate transport criteria (transport ASAP, but still provide immediately needed treatments onscene), and even few meet 'trauma immediate' (do nothing unnecessary (including starting IVs) that delays transport).



I think the key to this is a change in design, not generalizations. Although I have limited expierence, I have yet to work in an ambulance where everything I need to take vitals, or start treatment is within reach. I have always been forced to stand up to get a BP cuff, or bandages, or paperwork, adjust the monitor, etc. Can we design an ambulance where there are two seats where everything is accessible?


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## simonID (Apr 7, 2008)

Excellent imput everyone. I can see there are a lot of issues and ideas for me to address. With only about 12 weeks to work on it, I wont be able to address them all, but I will be addressing some of the key issues that seem to be the most apparent and/or frequent.

Thanks to those who were on live chat with me last night as well. I will be organizing all your imput and other research this week and begin ideation over the next couple weeks. I will definitely post up the final concept and will be posting up some ideation sketches for feedback.

Keep the ideas and issues coming as you think of them.


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## Flight-LP (Apr 7, 2008)

KEVD18 said:


> if they fired everybody who didnt wear their seat belt, there wouldnt be anybody working on a rig.
> 
> i wear min about 75% of the time.




Funny, we have our trucks fully staffed and there is a very clear seat belt policy in place. Simply put, the first time you are caught without a belt, either directly or by camera, you're terminated. Seems to work just fine for us........................

I have heard every excuse in the book about restraint systems and why we don't need to wear them. The "we can't acces our pt. excuse" is the most widely used. Ask yourself this..........How often do you TRULY NEED to move around in the back of the truck when en-route to the ER. With the addition of hands free CPR devices, mechanical ventilators, and a little common sense, the answer is very rarely. I find it humerous how everyone just has to move around to save their pts. life when the air medical community, i.e. usually the highest level of pre-hospital care, ceases ALL pt. care (including CPR if applicable) when lifting off and landing and also is responsible for remaining vigilant for outside VFR air traffic. Ironically, their pts. tend to make it there o.k. 

In other words, by taking the necessary steps to ensure the crew safety, which comes BEFORE pt. care, they are able to effectively do their duties. So again, why do you need to move around sooooo much?????????


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## Flight-LP (Apr 7, 2008)

emt-student said:


> I think the key to this is a change in design, not generalizations. Although I have limited expierence, I have yet to work in an ambulance where everything I need to take vitals, or start treatment is within reach. I have always been forced to stand up to get a BP cuff, or bandages, or paperwork, adjust the monitor, etc. Can we design an ambulance where there are two seats where everything is accessible?



No design change is needed. I can do exactly this every shift in my Braun ambulance. Why not bandage on scene, get an automatic BP device that is integrated into the cardiac monitor, and keep your documentation source next to the seat. It can be done, people just have to put a little thought into it. As far as drugs go, if you have a cardiac pt. have your cardiac drugs out and ready to go. Possibly need an airway, have that equipment out and ready to go. This really is not difficult in my mind, again just requires a little thought..........

sorry JPINFV, I duplicated your post, didn't see it. But you are spot on!


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## JPINFV (Apr 7, 2008)

Flight-LP said:


> sorry JPINFV, I duplicated your post, didn't see it. But you are spot on!



No problem. It's hard being a voice alone in the wilderness at times anyways.

Now I'll admit, I rarely wore a seatbelt in the back when I first started. After a while I started to try to wear a seat belt and, as with most changes, it was a bit awkward. After a while, though, I found it was actually easier to do some things (like writing the PCR) because I didn't have to worry about bumps and turns as much. The other things, like taking a BP, wasn't significantly hampered. If I needed to move (I prefer the captain's chair over the bench seat) or retrieve something I tried to wait till the ambulance was stopped. Even then, the last thing I did before getting up was unbuckle the seat belt and the first thing I did upon sitting down was buckle back up.


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## ffemt8978 (Apr 7, 2008)

Flight-LP said:


> How often do you TRULY NEED to move around in the back of the truck when en-route to the ER. With the addition of hands free CPR devices, mechanical ventilators, and a little common sense, the answer is very rarely.



That would be great if every agency has that equipment, but not all do.  I'm not saying that every patient requires the provider to move around, but some do.  While rare, it does happen.


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## Flight-LP (Apr 7, 2008)

ffemt8978 said:


> That would be great if every agency has that equipment, but not all do.




A very true statement, but again it is a personal decision that each of us has to make every shift as to what level of potential personal harm we choose to self inflict. All too often agencies fail to promote safety in an effort to watch their bottom dollar. The choice is in our hands, we choose our own destiny......................

If you are willing to take the increased risk, thats your choice..................


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## mikie (Apr 7, 2008)

Airwaygoddess said:


> A design for the gurney to be inside of the ambulance but be able to get access to both side of the gurney.  That would make it easier on the back!



We can get to both sides of the pt. in ours.  Mind you, it takes a little squeezing in and "excuse me's" when moving around

I like that though ^ , being able to get to the pt. from 360degrees.  

-Another thing would be better built in scene lighting, at night it can often be hard to find things and work in the dark, with the aid of flashlights.  

-A fixed and a portable monitor/AED.  

-Communications: I think we should be issued more handhelds for when on scene.  Like have sitting in chargers in the back waiting for us to grab as we egress.  

-Navigation (GPS w/ mappign software that shows the area and information (hydrants (more for firetrucks), landmarks, bridges (capacity), allies, 'short cuts', TRAFFIC)

-This may sound weird, but I thought this would be cool: surfaces that could be written on (and easily erased). Like near the jump seat, the 'desk' area could be made from the same surface as a white-board.  Scribbling vitals/Hx can be hard, and this would just make things more accessible.  

...just a few ideas.

Edited: MORE SAFETY!  Not just restraints, but roll protection, airbags (?), warning devices, etc


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## ffemt8978 (Apr 7, 2008)

My first suggestion was to remember that our patients and EMS providers are getting larger...why not design for the 250 lb patient, and the 250 lb provider.

And I'm not saying that everyone is overweight, but it is becoming a growing (pun intended) problem.


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## certguy (Apr 8, 2008)

Our medics here have gone to LED warning lights on the rigs . They're very bright without the flash and dazzle of strobes . Side scene lights and a pole mounted light on the back that can elevate also work pretty good .


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## simonID (Apr 8, 2008)

mikie333 said:


> We can get to both sides of the pt. in ours.  Mind you, it takes a little squeezing in and "excuse me's" when moving around
> 
> I like that though ^ , being able to get to the pt. from 360degrees.
> 
> ...




Interesting suggestions. That writing board makes sense. So your issue is that when in a hurry, or gathering vitals, its hard to write on the small patient sheet, especially when moving?

Maybe even a screen that you can write on that transfers it for electronic use? So, maybe the screen is an enlarged (or zoomed in) portion of the info sheet for the patients. You can right down those vitals on the screen, etc.

Can you elaborate a little more on what your issue is when writing the vitals down?


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## ffemt8978 (Apr 8, 2008)

certguy said:


> Our medics here have gone to LED warning lights on the rigs . They're very bright without the flash and dazzle of strobes . Side scene lights and a pole mounted light on the back that can elevate also work pretty good .



Let's not get started on the debate about LED's vs. other types of emergency lighting.  They have their place, but they have some issues also.  They're not the end all, be all that some people believe.


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## rmellish (Apr 8, 2008)

ffemt8978 said:


> My first suggestion was to remember that our patients and EMS providers are getting larger...why not design for the 250 lb patient, and the 250 lb provider.
> 
> And I'm not saying that everyone is overweight, but it is becoming a growing (pun intended) problem.



I had forgotten about weight considerations. While I've never used a ramp and winch system for our morbidly obese patients, I've certainly dreamed about it!

Anything that could make it easier to load and unload our patients would be great.


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## mikie (Apr 8, 2008)

simonID said:


> Interesting suggestions. That writing board makes sense. So your issue is that when in a hurry, or gathering vitals, its hard to write on the small patient sheet, especially when moving?
> 
> Maybe even a screen that you can write on that transfers it for electronic use? So, maybe the screen is an enlarged (or zoomed in) portion of the info sheet for the patients. You can right down those vitals on the screen, etc.
> 
> Can you elaborate a little more on what your issue is when writing the vitals down?



A lot of EMT/Medics I know use their gloves to write down vitals and such.  I've tried and either I can't read my own handwriting or I tear the glove with the pen.  Also, there is always a pen shortage!  We usually have a clipboard that we record vitals and other info (history, allergies, etc) on, but it can be hard to get too depending on how much work we're doing in the back.  

I've even see someone use the 'bag' of a large trauma dressing to write on (which had to be pitched afterwards because it punctured the sterile seal).  

I was just thinking that perhaps on some surfaces of the ambulance, there could be room to record things, like a whiteboard surface or something (erasable), and perhaps the markers or w/e could be magnetically mounted to the board so they don't get lost/fly away.  

Also, when someone is calling the receiving hospital with our report, if they don't have all of the numbers in front of them, it can be hard to give a fluid report.  So perhaps these larger surfaces that we could write on would allow for more visibility.  

As for technology, since we do all of our reports on the computer, it would be 'neat' if once we record a vital, it automatically goes into the proper section of the report.  Just in case after the call we lose the glove or sheet of paper that we recorded everything on.  

just some thoughts


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## ffemt8978 (Apr 8, 2008)

We use dry erase markers on the cabinet surface in our rigs...cleans up pretty easy too.


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## mikie (Apr 8, 2008)

ffemt8978 said:


> We use dry erase markers on the cabinet surface in our rigs...cleans up pretty easy too.



Nice, that's pretty much what I'm talking about!


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## simonID (Apr 8, 2008)

^Ahh, ok. I see what you mean. I'll take that into account.


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## MedCoast Ambulance (May 15, 2008)

*Side Loading Ambulance*

I saw information on a prototype that loads on the side leaving the back third for storage.....the main safety idea was to have the EMS people would facie either the front or back to reduce injury during a head on or rear end impact

The patient in a 4 point harness was safer and tested to 7Gs impact.  This is of course a bigger mod and it had a lift gate

Further safety since all passengers are in the center of the rig even on side impact

I liked the design enough to call and they are going to bring the unit by when it comes to the west coast


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## JPINFV (May 16, 2008)

^
Major design flaws in the concept:

Increased foot print for loading/unloading (most ambulance bays I've seen stack ambulances in like sardines. This is fine since you leave the back clear for loading/unloading).

Loading/unloading has the potential to put providers into active lanes of traffic. 

Not enough room for airway management.


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## NJWhacker (May 17, 2008)

rmellish said:


> A few ideas immediately come to mind.
> 
> 1. Safe mobility in the back - patients are belted in but many of us still are not. A harness system which allowed for simple movement around the compartment would be nice.
> 
> ...





 i bolded all my replies


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## Short Bus (May 18, 2008)

Many of the medics that get killed in the backs of these trucks when in a wreck are killed from flying objects.  I know people are supposed to STRAP everything down, but it does not happen.  We carry our E cylinders in an outside compartment on the driver's side.  That takes care of the O2 bottles.  Now, if you had a quick clip type of system that was attached to all of your loose items.  Something that when you put a monitor on a bench seat, you could easily and quickly clip it it, that would help a bunch with safety. 

Now, jump 20 years.  I have always thought it would be very cool if you had a fighter pilot type helmet to wear in the back.  The only draw back (but could be worked around I am sure) is using your scope for pressures and lung sounds.  What it will do it give you a HUD (heads up display) on your clear shield.  You could get any amount of data on there from the time to what your monitor is showing to how much oxygen is in the main tank.  It would also have a on board communications system so that you could talk with your partner in the front of the truck without yelling.  If would provide protection for your head as well as a good face shield to protect your eyes.  All of these components are already out there, they just need to be put together and made to were they work and are not $20k a set.  OK, that is my million dollar idea.  Next.:wacko:


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## Jeremy89 (Jul 2, 2008)

simonID said:


> Hi, everyone. I am a Senior Industrial Design (product design) student at Ohio State University. At our school, our last quarter is dedicated to a thesis project which gives each student the opportunity to research and develop their own project. Ive been working on re-designing the interior of an Ambulance. Specifically interactive aspects, storage space, and other related items.
> 
> Ive interviewed a guy at our local fire department who uses Horton rigs. Some things he pointed out were lighting, and communication issues. Cleaning (lots of crevices to worry about). And some other detail related items.
> 
> ...



Are you close to the final product yet??  It's far past June 14th....Just curious.


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## mycrofft (Jul 9, 2008)

*Yeah, late assignment!*

"NASA-OSIS" and the "universal ambulance".
I was lucky enough to work in an urban/rural area ("greater" Lincoln Nebraska) during the period when modulars were just getting going strong, but five other types were still lingering: "semi-mods" (modified small to medium motor homes), Caddy's, vans, station wagons, and Surburbans. (I'm leaving out military "crackerboxes", they deserve seperate consideration but not necessarily here).

STATION WAGONS: basically laydown transport, but in areas where they cannot afford a true ambulance, a possibility. No longer legal, I believe.

SUBURBANS: with a cap and a "slide in" ambulancve interior, a little crowded but good for long-distance transport with a good ride and fast as blazes. Trouble is that the interiors tended to seperate from the rest of the vehicle and eject everyone/ everything in a rollover, and rollovers were not uncommon at speed due to wheelbase versus CG issues. I don't think these are legal either, but, again, could be very useful where money and distance are a factor.

CADDY'S: the F-104's of the ambulance world, derived from hearses, good ride, fast, low, hard to move around in but not impossible. Little ground clearance. Little capabilites for electric outlets, scene lighting, etc due to engine compartment being FULL, and little storage. I do not think they are legal, are they?

VAN's: a stretch (add eighteen inches) Ford Econoline (has new name) with a cap and walkthrough to the front seat area could be a very nice ride, an excellent compromise between a modular and a Caddy, big enogh to carry some serious stuff yet narrow and light enough to go places a modular can't.

"SEMI-MODS" (as we called them): BIG Dodge van cab, cutaway behind and a motor home rear compartment grafted on and faired onto the cab. Cheaper than modulars but tended to have the independent substructures start coming apart with time and twisting (whereas a modular has everything fastened within the module, then to the frame, more or less). The front seat pedestals were vulnerable to shearing (they were stamped sheet metal), and cabinetry would start falling apart. New ones were great. Under-suspended, needed to be replaced and beefed up, and power train could be undersized too.

Why not devise a fairly simple bare-bones rapid deployment ambulance module you can drop into a pickup truck and SECURELY fasten down in the event of a disaster? 

Why go for more and more complexity and built-ins, often to meet very rare or semi-mythical possibilities, when what you really need is GOOD storage and loadouts or kits to help keep the load to a manageable minimum, REAL climate control and commo, etc.?


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