# I'm trying to learn as much as I can about ambulances



## RSMS (Jul 28, 2017)

Hello to all:
  This might be a little bit of an odd request but I'm trying to become much more educated in the pros and cons of various ambulances and specifically in the different brands and layouts of the patient modules.  I have a very good grasp on the actual chassis as far as powertrains and reliability.   I see many more type 1-3's than I do medium duties and this is also of interest to me as in why this might be.  This is all a personal learning experience for me and any input would be appreciated.   thanks in advance and be safe


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## MonkeyArrow (Jul 28, 2017)

Medium duties are much more expensive and much bigger. Most non-fire departments don't have the budget to buy them. Maneuverability, ride quality, and reliability are debately also issues with medium duties. They provide a lot of space, which may be good for fire departments that need suppression/rescue/PPE on the ambulance, but not so much for everyone else.


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## RSMS (Jul 28, 2017)

I can definitely see the added initial cost but I would think the maintenance would be very similar to possibly less depending on powertrain options seeing on how they are more designed to be used for strictly commercial use.  In my area Ford type 2's always seemed the most prevalent but ever since 2004 they have been a maintenance/reliability nightmare.  Would most medium duties be riding on air ride and does that do much for the ride quality or is it more for the ability to have a dump valve on the suspension to help in loading?  I can definitely see where the larger size could be an issue in maneuverability in tight areas even though any freightliner I've ever driven had a pretty tight turning radius, the international and chevy chassis not so much.


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## DesertMedic66 (Jul 28, 2017)

Ford changed from the 7.3 motor which is known as a great motor to the 6.0 motor in 2004. The 6.0 is known for its many many many many issues and being unreliable


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## RSMS (Jul 28, 2017)

Yes, very true.  That was my point   I have been starting to see a switch on some of the type 2's now to Chevy chassis with gas power.  I would think with the extended idle times though this would not be the best option.  I guess time will tell on this


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## CALEMT (Jul 28, 2017)

DesertMedic66 said:


> the 7.3 motor



And the 5.9 Cummins are the two best diesels IMO.


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## NPO (Jul 28, 2017)

RSMS said:


> Would most medium duties be riding on air ride and does that do much for the ride quality or is it more for the ability to have a dump valve on the suspension to help in loading?  I can definitely see where the larger size could be an issue in maneuverability in tight areas even though any freightliner I've ever driven had a pretty tight turning radius, the international and chevy chassis not so much.



It depends who builds the ambulance. Our older CCT unit has air ride, and the new one has liquid ride suspension. Both for ride and kneeling ability. I'll say I've never been limited in access in my CCT unit compared to a Type 3 ambulance, but I realize I don't live in some of the older cities that have small streets like Boston. 

Pictured is our new CCT unit. It's an international chassis, but otherwise operationally nearly identical except for some crew comfort additions. 









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## NPO (Jul 28, 2017)

RSMS said:


> Yes, very true.  That was my point   I have been starting to see a switch on some of the type 2's now to Chevy chassis with gas power.  I would think with the extended idle times though this would not be the best option.  I guess time will tell on this


With modern diesels, idling is worse than back in the good old days of the 7.3 and 5.9. new diesels dont like it nearly as much because of the numerous EPA fittings, all of which get clogged with soot when idling for extended periods. 

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## NPO (Jul 28, 2017)

RSMS said:


> layouts of the patient modules.



Ambulances have used the standard cot along a wall, bench on the side layout for years. 

It's awful. 

The best layout IMO is a centered gurney with a centered airway chair. One chair on the driver's side (patient right) and one or two on patient left. Cabinets on patient left, and convenient access drawers or pockets on patient right. 

Bench seats are death traps, and are exactly why "the net" was invented which is a pathetic bandaid to fix a bigger problem. 5 point harnesses with Capitans chairs for everyone. Anything less is unacceptable IMO. 

We used bench seats for years because of backboards, so we could take 2 patients (or 4 if you hang people). But as we all know, backboards are voodoo magic. 


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## RSMS (Jul 28, 2017)

I agree, both the 5.9 & 7.3 are awesome engines and will last for a very long time with basic preventive maintenance.  The biggest issue I would see now is finding something with-out a bunch of hours on it.  I'm guessing the only way to get a 5.9l would be to go with a Freightliner chassis as I don't ever recall seeing a dodge chassis on service.   All of the new emission standards have really started taking there toll on diesel powered vehicles both in added cost and reliability issues


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## CALEMT (Jul 28, 2017)

NPO said:


> With modern diesels, idling is worse than back in the good old days of the 7.3 and 5.9. new diesels dont like it nearly as much because of the numerous EPA fittings, all of which get clogged with soot when idling for extended periods.
> 
> Sent from my Pixel XL using Tapatalk



I don't mind the new 6.7 in the Rams. You can tow a lot more because of the insane amount of torque. I'm not a fan of the emissions on the pickups. Diesels tend to run fairly clean and the soot is just unburnt carbon (aka diesel fuel). What I don't like aside from the emissions crap is the reliability of the new motors. The 6.7 Cummins is the best in my opinion over the 6.7 power stroke and the 6.5 duramax. But you can't beat the reliability of the 7.3 or the 5.9. I'd sacrifice torque to have the reliability of those motors any day.


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## RSMS (Jul 28, 2017)

What modules will have a center gurney without being medium duty?


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## RSMS (Jul 28, 2017)

Has anyone had any experience with the Ward Diesel's No Smoke exhaust systems to combat exhaust fumes during extended idle?


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## NPO (Jul 28, 2017)

CALEMT said:


> I don't mind the new 6.7 in the Rams. You can tow a lot more because of the insane amount of torque. I'm not a fan of the emissions on the pickups. Diesels tend to run fairly clean and the soot is just unburnt carbon (aka diesel fuel). What I don't like aside from the emissions crap is the reliability of the new motors. The 6.7 Cummins is the best in my opinion over the 6.7 power stroke and the 6.5 duramax. But you can't beat the reliability of the 7.3 or the 5.9. I'd sacrifice torque to have the reliability of those motors any day.


I don't have a problem with modern diesels either. But none of them like soot. 

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## NPO (Jul 28, 2017)

RSMS said:


> What modules will have a center gurney without being medium duty?


I've had many models with center gurneys in Type 3. They have less leg room than a wall mount for, but more room than a Type 2. 

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## RSMS (Jul 28, 2017)

Curious also what if any differences there are in a ALS & BLS ambulance other than the equipment they are stocked with?


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## NPO (Jul 28, 2017)

RSMS said:


> Curious also what if any differences there are in a ALS & BLS ambulance other than the equipment they are stocked with?


Usually nothing. In fact, our BLS units are are stocked to an ALS level. All they are missing is the monitor and a first in ALS bag, which has duplicates of the most important stuff in the ambulance anyway. The idea is a medic can grab his monitor and bag and jump in a BLS unit and be ready to go to work, either for MCIs or ALS intercept. 

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## CALEMT (Jul 28, 2017)

NPO said:


> I don't have a problem with modern diesels either. But none of them like soot.



800 foot pounds of torque is absolutely insane for a pickup truck. I love how the new motors have more than enough torque for my lifestyle (hunting trips) but they don't get near as good mpg as my dad's 5.9. I've driven that truck (05 2500 short bed 4x4) and have seen 25mpg empty and before the new trailer we would tow and get around 17. The new trailer were getting around 11/12. Smoke I could care less about, diesels are known for it but I'm not all about turning day into night with a diesel. I'm just not a fan of the DPF filter, catalytic converter, and the DEF fluid. More crap to break and expensive fixes. When I move to a state with no emissions laws is when I'll get a diesel.


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## NPO (Jul 28, 2017)

CALEMT said:


> I'm just not a fan of the DPF filter, catalytic converter, and the DEF fluid. More crap to break and expensive fixes. When I move to a state with no emissions laws is when I'll get a diesel.



Which is my point. I don't like smoking either, because it makes the diesel community look bad. 

My point was, at idle, the engine isn't hiring very hot, which creates soot build up in things like the turbo (especially CHAT turbos) and particulate filters, which is why they have those burn off modes. I haven't had a Chevy do it, but I know the Fords can lock you out of driving if it needs to burn off the filters. 

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## RSMS (Jul 28, 2017)

modern technology is producing some pretty impressive results in both gasoline and diesel engines but......they are no fun to work on and way too expensive when you start having issues.  I love the 5.9's as they are very reliable and efficient but if so desired can make great power.  The 7.3's cant easily make the same power or produce the MPG's but they are extremely reliable.  Ford really was the top dog in the light and medium duty diesel market until the CAFE and emission standards started getting crazy.  I'm around a lot of heavy duty diesel and all this DPF equipment scares me, it's really pushing me to stay old school whenever possible.


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## CALEMT (Jul 28, 2017)

NPO said:


> Which is my point. I don't like smoking either, because it makes the diesel community look bad.
> 
> My point was, at idle, the engine isn't hiring very hot, which creates soot build up in things like the turbo (especially CHAT turbos) and particulate filters, which is why they have those burn off modes. I haven't had a Chevy do it, but I know the Fords can lock you out of driving if it needs to burn off the filters.
> 
> Sent from my Pixel XL using Tapatalk



I've heard of the Fords doing that. Haven't heard anything about the Chevy or the Ram doing that. Either way I would ride out the warranty and once its up is when I would delete all that crap. Impossible to do for work vehicles but where I'm at the select few diesels we have are older models (I wanna say 6.0 but I'm not sure). Diesels are slower but in the summertime out here the AC is way better than the gas mods we run. Wonder if that would have any affect on the newer motors.


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## NPO (Jul 28, 2017)

CALEMT said:


> I've heard of the Fords doing that. Haven't heard anything about the Chevy or the Ram doing that. Either way I would ride out the warranty and once its up is when I would delete all that crap. Impossible to do for work vehicles but where I'm at the select few diesels we have are older models (I wanna say 6.0 but I'm not sure). Diesels are slower but in the summertime out here the AC is way better than the gas mods we run. Wonder if that would have any affect on the newer motors.


The Chevy's we have limit their speed if we don't drive enough. Usually it's limited to 55mph, but I've had it limited to 15mph once. 

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## CALEMT (Jul 28, 2017)

NPO said:


> The Chevy's we have limit their speed if we don't drive enough. Usually it's limited to 55mph, but I've had it limited to 15mph once.
> 
> Sent from my Pixel XL using Tapatalk



Forget that.


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## RSMS (Jul 28, 2017)

no kidding!!!


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