Ambulance Design Questions...

[simonID]

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

 

[certguy]

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 .

 

[rmellish]

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.

 

[paramedix]

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.

 

[JPINFV]

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

 

[CFRBryan347768]

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 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)

 

[JPINFV]

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)

 

[medicdan]

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.

 

[KEVD18]

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)

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.

 

[ffemt8978]

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.

 

[rmellish]

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...

 

[JPINFV]

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).

 

[Airwaygoddess]

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!

 

[medicdan]

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?

 

[simonID]

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.

 

[Flight-LP]

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?????????

 

[Flight-LP]

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!

 

[JPINFV]

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.

 

[ffemt8978]

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.

 

[Flight-LP]

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..................