# Do you think van ambulance's should be outlawed ?



## eynonqrs (Jan 3, 2011)

I would like to ask everyone's opinion. Do you think van ambulances should be outlawed ? I feel they are only a glorified version of the caddy ambulances from the early days. No room, too top heavy, no good in winter weather. What do y'all think ?


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## usafmedic45 (Jan 3, 2011)

Any evidence to back up any of your claims or are we supposed to just take your word on this stuff?


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## eynonqrs (Jan 3, 2011)

*From my personal experience.*

1) Van vs mod in winter weather. Drove mods in blizzard conditions no roads plowed, no chains, did not get stuck once. Vans stranded all over the place. 

2) Critical care transports, RN on board, pumps, equipment. No room for anything. 

3) High winds: I've got blown into other lanes on a two lane highway with out turning the wheel.

4) Reaching over a pt if you need supplies when transporting. 

5) Limited space for equipment.


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## emtashleyb (Jan 3, 2011)

In private ambulance? No we mainly run sprinter vans where I work they are designed to take the beating we put on them. I personally don't care for the ford type vans but I don't see a reason for them to be outlawed. The box unit we have is top heavy actually I don't think I've been in a unit that isn't top heavy.


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## usafmedic45 (Jan 3, 2011)

> High winds: I've got blown into other lanes on a two lane highway with out turning the wheel.





> 1) Van vs mod in winter weather. Drove mods in blizzard conditions no roads plowed, no chains, did not get stuck once. Vans stranded all over the place.


I've had the same things happen in both of the other types of ambulances.  Granted, I know it's not something most EMS personnel expect when facing such a request, but when I say "evidence", it's a request for more than "in my experience" because statistically n=1 is worthless. 



> 4) Reaching over a pt if you need supplies when transporting.



Since when do you not have to reach across the patient in a box?



> Critical care transports, RN on board, pumps, equipment. No room for anything.





> 5) Limited space for equipment.



You in the mood to outlaw most aeromedical helicopters and a large number of fixed-wing air ambulances as well? 

Granted, I do have a preference for box type ambulances, but you're on shaky ground to have them "outlawed".


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## TransportJockey (Jan 3, 2011)

I have worked in boxes (both standard and medium duty) and vans.. I prefer vans. Easier to drive, easier to maneuver in urban environments, can stay strapped in even while dealing with a critical patient. Plenty of room if you know how to place things so they stay out of your way.

EDIT: And I picked up fixed wing flight crews from the airport all the time to take them to hospitals and never ran into a problem of having no room (2-3 member flight team + their equipment + me + patient + standard ambulance gear (all buses stocked as ALS level)) in the back


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## usafmedic45 (Jan 3, 2011)

> And I picked up fixed wing flight crews from the airport all the time to take them to hospitals and never ran into a problem of having no room (2-3 member flight team + their equipment + me + patient + standard ambulance gear (all buses stocked as ALS level)) in the back



I think it has to do with what you were originally trained in and have spent most of your time working in.  If you start out on a box ambulance and "downgrade" then you're going to feel like you're working in a phone booth.  It's the same as how EMS personnel who go into the hospital setting don't complain as much when working a code in a hospital room because once you've been one of 5 people to code someone in a very small bathroom, nothing seems quite so bad.


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## rescue99 (Jan 3, 2011)

eynonqrs said:


> I would like to ask everyone's opinion. Do you think van ambulances should be outlawed ? I feel they are only a glorified version of the caddy ambulances from the early days. No room, too top heavy, no good in winter weather. What do y'all think ?



Oh gosh no! If you've ever worked in an area where there are multiple lakes, the vans are preferred over bulky trucks, because of all the narrow winding roads. Besides, I'm 5'3. I can stand up and move in any unit


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## MusicMedic (Jan 3, 2011)

i say nay... 

as an attendant i prefer the Mods(box) Ambulances
as a Driver i prefer the Vans


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## HotelCo (Jan 3, 2011)

jtpaintball70 said:


> easier to maneuver in urban environments



This. It sucks trying to get around in Tue downtown areas with vans, its near impossible to do with the boxes.

.


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## usalsfyre (Jan 3, 2011)

eynonqrs said:


> 1) Van vs mod in winter weather. Drove mods in blizzard conditions no roads plowed, no chains, did not get stuck once. Vans stranded all over the place.



I've seen a 4x4 type I box stuck. Just make sure you don't take it where it shouldn't go.



eynonqrs said:


> 2) Critical care transports, RN on board, pumps, equipment. No room for anything.



I've done these. It's mainly about design and thinking through where to locate things.  



eynonqrs said:


> 3) High winds: I've got blown into other lanes on a two lane highway with out turning the wheel.



The worst I've ever been blown around was in a medium duty. 



eynonqrs said:


> 4) Reaching over a pt if you need supplies when transporting.



Not sure why this is a problem.  



eynonqrs said:


> 5) Limited space for equipment.



Again it's about design, not to mention most ambulances carry too much $h!t anyway.

Once you've tried to do EMS in a small helicopter, even a van seems cavernous. Mostly it's about proper design and being careful.


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## DarkStarr (Jan 3, 2011)

yes







that said, i also have a picture of our box type (the above is a different service provider in the area) stuck in a rut due to a nasty freak blizzard.  our new box is a 4x4 road rescue though, so hopefully thatll do the trick


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## rescue99 (Jan 3, 2011)

HotelCo said:


> This. It sucks trying to get around in Tue downtown areas with vans, its near impossible to do with the boxes.
> 
> .




Yeah, nursing facilities in Detroit. Parking is always such fun, fun, fun too.


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## Shishkabob (Jan 3, 2011)

Outlaw?  No.  But I hate the damn things.

Straddling the patient to try and start and IV on their right side is not fun, especially when in motion.  



I'm spoiled now though... I have a med duty truck with 14ft box.


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## LuvGlock (Jan 3, 2011)

Linuss said:


> Outlaw?  No.  But I hate the damn things.



+1

I much prefer a box, but vambulances beat a root canal.


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## thegreypilgrim (Jan 3, 2011)

I don't know about outlaw, but I absolutely despise the things and would rather we just get rid of them by professional standardization. Mods or bigger is the way to go, IMO. Boston EMS (as in many other ways) got it right:


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## jjesusfreak01 (Jan 3, 2011)

All Boston EMS got was the worlds ugliest ambulance, with that huge black bumper, the visible siren housing, and a tacky paint job. I'd have to be unconscious to let you transport me in one of those things...


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## thegreypilgrim (Jan 3, 2011)

It may not be the prettiest thing, but it's designed correctly.


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## TransportJockey (Jan 3, 2011)

Our medic 1 is like that. I hate working in the damn thing and I hate driving it. Give me a van and I'd be happy.

EDIT: Our unit Medic 1 (medic 2 is a IH medium, Medic 3 is a Chevy Type II, Medic 4 is an old Ford E350 box which is our backup)


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## rwik123 (Jan 3, 2011)

jjesusfreak01 said:


> All Boston EMS got was the worlds ugliest ambulance, with that huge black bumper, the visible siren housing, and a tacky paint job. I'd have to be unconscious to let you transport me in one of those things...



I totally disagree. I think these things look like tanks, not ugly at all.


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## usalsfyre (Jan 3, 2011)

thegreypilgrim said:


> It may not be the prettiest thing, but it's designed correctly.



Just because it's big doesn't mean it's correct. Sitting secured at bedside in a couple of our medium duty units I'm _5 FREAKIN' FEET_ from the cardiac monitor. I'd much rather have a smaller box where everything is within arms's reach. Are you familiar with the inside layout of the Boston trucks? If so, can you be secured and still reach everything?

As to rolling the truck, our service has put two Kodiaks on their roof. So driving with some sense will keep the rubber on the road long before type of truck will.


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## Veneficus (Jan 3, 2011)

I think it is like anything else.

If you buy something cheap you get something cheap.

I have worked in the back of Sprinters and I have never wanted for room. There seems to be plenty when the layout is right.

I like being seatbelted in a forward facing seat at the patients side. 

I know that speed rarely if ever makes a difference in pt outcome, but the acceleration and maneuverability seem fine for the rather narrow roads, high traffic winter weather and mountain conditions of Central Europe.

If you are working with fords of stripped down whoever is building sprinters in the US, then you got what you paid for.

I never stand or stradle a patient, in addition to being a deathwish, I am left handed and sitting on the pt right side works out perfect for me.

I also like how the cot sits at almost chest level. It is all around a fine piece of equipment. Especially intubating in the rig.

As for the boxes and medium duties, yea, been there, done that, nothing special. Just something hard to drive in very urban conditions, too much wasted space in the back, and dangerous to work in when you have to leave the seat. (which seems damn near always when the cot is so far.)

If you are doing compressions during transport, fail. Join the 21 century and work your codes on scene.

Outlawed certainly not. If I had my way, Mercedes Sprinter would be the rule, not the exception.


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## Outbac1 (Jan 3, 2011)

We do not have any sprinters here. We had Ford type 2 vans for years. They were OK to work out of. A bit cramped at times. I've gotten several of them stuck in snow over the years. We had a few modular units but now most of our trucks are what we call a "mini mod". Personally I like them as a reasonable compromise on size. They can still get stuck, I know. 

 Here is a link to our units. Just click on an icon and then click on a door to open it. The interior layout has changed a little since these pictures were taken about 5 years ago.

http://www.emci.ca/community/Pages/ambulance.aspx


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## Smash (Jan 3, 2011)

Started out in ford and gmc boxes, went to Mercedes sprinters some years ago and couldn't be dragged back to the others by a team of Clydesdales. Mercedes also do a very chunky 4x4 sprinter to get to wherever Brown's next scenario is.


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## Medic2409 (Jan 3, 2011)

I've worked in Vans, Sprinters, and Boxes.  IMHO, Sprinters are quite possibly the worst idea my old service ever had.  The fuel tanks were so small that one IFT trip from an outlying facility was all that could be handled without filling up.  I know that the crews at this particular station had to fill there truck up after each call before they could run another.  Plus the O2 tanks were much too small.  Poor, poor design for Rural medicine.

OTOH, the side of the service that is in a Urban area has no issues with them.

Personally, these and the vans may be ok for IFT's in the city.  However, for running 911, especially in a more Rural/Suburban area, a bigger box with capabilities to double load is much better.  I say this after having to double load pt's. in both a Van and a Box.  As far as the Sprinter...I hate them with a passion.  Far too cramped, and being right handed just makes it more difficult.

Thing is, what works for a rural county in Texas may not work for an inner-city in the Northeast, and vise-versa.


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## emtpche (Jan 3, 2011)

Lets see I have worked in Chevy's, Fords, and GMC's, configured as Type I, Type II and Type III.  No one rig is perfect.  I agree with the sentiment you get what you paid for. 

For those of you that are Fire based, yeah a Type III works great for carrying all that equipment.  

For those that are ALS/IFT in a Urban/Suburban area vans/Type II work great, especially getting into tight spaces.  They are great for us out here as we have some tight space due to geography and old builds.  Take a look at Kaiser San Francisco's ED lot sometime, gives tight space a new meaning.  

What is really boils down to is that management takes input from those in the field prior to purchasing.  Also EMS agency need to consider that as well when systems are put out to bid.  Santa Clara County has mandated that Rural/Metro purchase GMC Type III GL4500 for the new contract.  Oh yeah they required 55 of them.

It comes down to what you need for your system.  There is no one size fits all.


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## JJR512 (Jan 3, 2011)

eynonqrs said:


> 1) Van vs mod in winter weather. Drove mods in blizzard conditions no roads plowed, no chains, did not get stuck once. Vans stranded all over the place.


No vehicle is infallible. Look on Youtube if you think Type I, III, or IV (medium duty) ambulances always do just fine in winter. 



> 2) Critical care transports, RN on board, pumps, equipment. No room for anything.


Type IIs would be cramped, that's true. But CCT is one specific purpose. You're question is should Type IIs be banned, period. For BLS stable-patient IFT transports, for one example, Type IIs are fine. 



> 3) High winds: I've got blown into other lanes on a two lane highway with out turning the wheel.


If you got blown into another lane without turning your steering wheel, then YOU ARE DOING IT WRONG. If you're getting blown into another lane while holding the wheel straight, then TURN THE WHEEL. It's really not that complicated. There is no demigod of EMS that's going to get angry at you because you had to turn the wheel to go straight. If you get blown into a car in the other lane, what are you going to tell them—"Sorry, but I was holding the wheel straight?"



> 4) Reaching over a pt if you need supplies when transporting.


In all the Type II units I've been in, the stretcher is oriented longitudinally on the floor, with cabinets on the left wall. In all the other kinds of ambulances I've ever been in, the stretcher is oriented longitudinally on the floor, with cabinets on the left wall. Oh, there are a few cabinets above the bench and behind the passenger seat, too, but the stuff that gets regularly used is almost all in a cabinet on the left wall. In my experience, in ANY kind of ambulance I've ever been in. So it seems to me that I'd be reaching over the patient in ANY kind of ambulance. 



> 5) Limited space for equipment.


Isn't this just a repeat of #2? No ambulance has infinite space, therefore every ambulance has limited space. Some have more, some have less. If you work for a service that has so much stuff they need more space than a Type II can offer, then your service should buy bigger ambulances. Seems like a pretty simple solution to me.

*I don't see why Type IIs should be banned for everyone just because they're not perfect for all situations.*


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## the_negro_puppy (Jan 3, 2011)

On the contrary I work in a big city and prefer vans. The only other vehicles we have other than sprinters is old Ford F350 with a box on the back. We dont have high winds or cold (snow) in my state and our biggest obstacle in traffic. Im quite happy with the room in them


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## usafmedic45 (Jan 3, 2011)

> our new box is a 4x4 road rescue though, so hopefully thatll do the trick



Only if the driver is competent.  Most are not.


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## DarkStarr (Jan 3, 2011)

usafmedic45 said:


> Only if the driver is competent.  Most are not.



yeah, we are using it in driver training this weekend :crossesfingers:


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## usafmedic45 (Jan 4, 2011)

DarkStarr said:


> yeah, we are using it in driver training this weekend :crossesfingers:


I have my doubts about the true benefits of most driver training programs.  They are a lot like EMS training:  just enough to get you out on the streets where you can be dangerous.


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## looker (Jan 4, 2011)

Every single ems provider from small to the biggest uses van ambulance and you want to outlaw it because you do not like it? Try driving box ambulance around la compare to van and you will soon realize why van is being used much more. Top heavy van is no problem unless you are having really , really high winds in which case you likely would not be going out as it will be to dangerous.


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## Hockey (Jan 4, 2011)

[YOUTUBE]6IaqKfPQUHs[/YOUTUBE]


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## Sasha (Jan 4, 2011)

> I think it has to do with what you were originally trained in and have spent most of your time working in. If you start out on a box ambulance and "downgrade" then you're going to feel like you're working in a phone booth.



Nope, I started in a van. I still think they're small. We have some boxes (our 24s and our brand new critical care truck that just has most of us standing there, whining "man couldn't we have just gotten a raise?" Mind you we already do critical care transfers in our regular ALS trucks. grumblegrumblegrumble.)

I mainly don't like the vans because we have started to get newer ones, and I find myself sitting in the back on long transports telling myself "please don't throw up please don't throw up please don't throw up." while listening to the patient going "Ow ow ow ow ow".. Bottom line, those things are SUPER bumpy in the back. You feel every single little bump in the road.

Maybe it was all in my head, but when I was on one of our box trucks the ride seemed so much smoother.


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## spike91 (Jan 4, 2011)

I'll vote yes as soon as you offer a plan for making the extra money to pay for the box styles.


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## JJR512 (Jan 5, 2011)

spike91 said:


> I'll vote yes as soon as you offer a plan for making the extra money to pay for the box styles.



You don't need to spend a lot on box units. You can do what my first EMS employer did and buy them used. They were _very_ proud of the deal they got on *three* Type III units for $6,500 _total_.


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## usafmedic45 (Jan 5, 2011)

> They were very proud of the deal they got on three Type III units for $6,500 total.



Nice.  

BTW, you've never seen cost until you try to buy a WWII vintage ambulance.


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## lightsandsirens5 (Jan 5, 2011)

Sasha said:


> Nope, I started in a van. I still think they're small. We have some boxes (our 24s and our brand new critical care truck that just has most of us standing there, whining "man couldn't we have just gotten a raise?" Mind you we already do critical care transfers in our regular ALS trucks. grumblegrumblegrumble.)
> 
> I mainly don't like the vans because we have started to get newer ones, and I find myself sitting in the back on long transports telling myself "please don't throw up please don't throw up please don't throw up." while listening to the patient going "Ow ow ow ow ow".. Bottom line, those things are SUPER bumpy in the back. You feel every single little bump in the road.
> 
> Maybe it was all in my head, but when I was on one of our box trucks the ride seemed so much smoother.



I love this post! Especially the please don't throw up part.

Do you know how embarrassing it is to try to quietly toss your cookies in the garbage can while the pt keeps asking you if you are ok? :unsure:

We run all Type Is and I love them. Plus, out here with all the wildlife, it is nice to have a bigger rig. And, with nothing but two lane undivided county road and US highway, the bigger my rig is, the better. Most stuff on the road is going to take the worst of it (I hope).


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## Ridryder911 (Jan 5, 2011)

There are times I wish we could get Caddy's back! Seriously, most EMS transports do very little in patient care and majority of the time all the patient needs is a comfortable ride! 

Okay, from one who has worked in almost every configuration (vans, suburbans even a modified bread truck)... vans have their place. One's that should be banned are those large trucks (i.e. Boston EMS pic). Twice the price as most EMS units, have a higher incidence of poor performance on ice, wind and bad roads and bumpy OMG! I don't care how many "air ride" you have on them! We have several that have to be parked everytime ice appears and you know it's bad when the Paramedics prefer the smaller trucks because of the jarrring and rough rides. 

I drove and rode in vans over 10 years... never once had a problem and yes, I live in area of ice storms and a state with one of the highest wind speed average. Room... yes, their limited to a degree, then when you look at the large units many of the cabinets are empty or double stocked. For critical care transports, I would love to have a designated critical care van. Mount IV pumps and vent on board with a large LED screen for the ECG/bio. Take all the "EMS" crap out, the bench seat and redesign it. It would be much smoother, and more economical.


R/r 911


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## jjesusfreak01 (Jan 5, 2011)

lightsandsirens5 said:


> Do you know how embarrassing it is to try to quietly toss your cookies in the garbage can while the pt keeps asking you if you are ok? :unsure:



I avoid this problem by not having time to eat anything during my shifts.


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## DrParasite (Jan 5, 2011)

Ridryder911 said:


> Seriously, most EMS transports do very little in patient care and majority of the time all the patient needs is a comfortable ride!


and this is probably the smartest thing I have ever read on EMTLife. Someone else finally gets it.  the majority of the time the patient needs a comfy ride to the hospital. 

 Don't get me wrong, not EVERY person who calls 911 needs just a comfy ride.  The sick ones need a lot more help, and in the sick ones, the ones where you end up with 3 people in the back of the ambulance, the vans are too cramped.

I prefer boxes.  I'm 6'3", and like being able to be able to move in an ambulance, especially when I have to step over someone else to get something from the ambulance.  

However, for IFTs, NETs, and the majority of calls that only get a 2 person crew response, a van is perfectly fine.  and significantly cheaper than the boxes.


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## boingo (Jan 5, 2011)

I think the boxes are big and expensive when compared to a van, however with the amount of crap we are required to carrry they are a necessary evil.  There is no way to fit all that stuff in a van.  

As for the ride, our newest trucks actually ride great in the back, so far.  My truck has 3,000 miles on it, so I'll get back to you at 30K.

I work in a city who's traffic design was based on cow paths which has led to terrible congestion, traffic secondary to very narrow streets.  If a heavy rescue or ladder can make it, then there is no reason a box ambulance can't.


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