I actually quite like the look of that German ambo's layout, at least at first glance. It looks like the person in the folding airway seat could reach damn near everything without having to get up. It's hard to tell based just off the one picture, but the layout of cabinets is almost always sub-optimal from both a convenience and safety perspective.
No matter how good the crash and crumple features are, providers are supposed to be strapped in at all times. Sadly, the only time this ever seems to be the case is during the most mundane/non-emergency calls, when the provider is mostly just asking questions. During a Priority 1/Code 3 emergency transport, the medic is probably all over the place grabbing tubes, lines, meds, O2..... I don't know if it's actually the case, but one would logically assume that ambulance accidents are more likely during priority responses (despite the lights & sirens), which is when the provider in the back is generally most likely to be unsecured. Designing the layout to make it so everything is focused on the medic's needs is a good first step.
Bigger isn't always better.
Continuing along the "unsecured" route, I am troubled by the amount of large, heavy, unsecured items in the ambulance. Specifically in Howard County, we have our large BLS and ALS bags - which sit wherever there is free space - as well as the LifePaks. Normally, the LifePak is at least secured to the bench with a seat belt, but if it is taken out on scene and in use during a call, many medics fail to re-secure it after the pt is loaded. Also, the only place in our ambos to put the LifePak is on said bench, which means that all of the leads, cuffs, and SP02 wires are snaking across between the bench and cot. I've seen these get pulled out/tripped on many times. Again, the German ambulance appears to excel in this area as it appears the LifePak is secured in its own spot, which also puts it in a position where the leads and other wires are not blocking traffic or likely to get yanked out unintentionally. In the event of an accident, I would really hate to be killed, but it would be even worse if I was belted but went out due to a flying LifePak to the face.
I think a use case needs to be established first. Is this an ambulance that is designed for a single provider in the back, providing all necessary patient care? What happens when you have the luxury of a second person aiding in care? What happens if you need to transport a 2nd patient? Figure out which case is your most likely/important, and design to that, allowing concessions to others when possible. Personally I would probably start out by securing the items mentioned before somehow, then identifying where the primary provider is going to spend most of his time (probably at the patient's side, around the torso). From there I am going to put the most used items as close to him as possible, keeping in mind that if I have a second provider sitting at the head, I want her to be able to reach the necessary items as well without needing 2 sets. Things that require the provider(s) to stand or unstrap themselves should be things that are removed/prepped on scene or before transport - an OB kit, CPAP, splints. If I have to unbuckle, stand up, and shuffle to the rear of the compartment to grab more trauma dressings or another 500/1000mL bag, the layout should probably be re-examined.
Don't forget about trash, especially sharps. There had better be somewhere close at hand to put used sharps that isn't jamming them into the seat cushion. Another lovely tidbit about Howard County - the ALS bags have a little sharps container, but they aren't big enough to hold the Epi's that we carry; if you force an Epi in, the needle will push out the bottom right through the plastic. Not cool. I realize that particular issue can't be fixed in ambulance design, but come on.
Another feature that I like that doesn't seem to be in widespread use (or is it?) is the ability of the provider in the back to communicate with the driver surreptitiously. Yes, you can try to use codes/medical jargon, but especially in cases where you have a relative riding in the seat up front, you might not want to say "Her BP is bottoming out" or anything even remotely unsettling/alarming like that. The control panels in our ambos have buttons for all the lights, heating, etc, but also 3 little switches to notify the driver of patient condition. Of course, we don't actually use them because each one sets off an ear-splitting klaxon that is more distressing than just saying "She's going to die" in front of the pt. But the idea is worth exploring I think.
Aesthetics are irrelevant.
Also, if you can design a chassis and/or suspension that will last longer than 50k or so miles of hard responses MTTR/MTBF, I reckon a lot of folk won't much care how poorly laid-out the interior is.
Lastly, I will leave you with one word. OK, two: concealed kegerator.
