Discussion in 'EMS Talk' started by TomTheEMT, Aug 14, 2018.
Which do you prefer? Let's hear the pros and cons for both!
I can work in anything. Just ensure I have proper, current, and tested equipment, the supplies I need and a halfway decent partner.
As long as you place those things in a 0-5 year old model unit which is serviced regularly and has maintenance issues addressed promptly, then I don't care if its a box or van.
I've worked in both: vans are cheaper than boxes, vans are typically used for IFT while boxes are for 911 (although I know there are services that use vans for 911 exclusively), and never more than one provider in the back, they work fine.
I prefer a box. more space, especially when you have more than one provider in the back of an ambulance dealing with a sick patient. Boxes tend to be able to carry more equipment.
I feel cramped in a van, but it does have the advantage of having everything easily reachable if you are always the only provider in the back of the truck.
For a BLS agency like the ones i worked for and now run, theres more exterior space to hold all the extra stuff we carry. Various rescue, HazMat and firefighting tools, MCIs, ect.
As an ALS provider in a tiered system, the box is always better. Theres always going to be me, my monitor and my 2 bags, along with at least one EMT and their bag, and if its a critical call ill also have the Lucas, the ATV and the bags they come in. I could have up to 4 bags and a monitor and me and my partner and the patient and in many cases an EMT. I want the space
I want a truck that works in totality. The a/c, electrical, WiFi, lights and everything else.
I want a truck that runs. The engine, transmission, brakes all need to function as designed without undue smoking, grinding, sputtering, or failure.
I want a truck that doesn’t smell, is clean, and set up in an intelligent, easy to use manner. If i have to go through more than two steps to have anything but my drugs in my hands, somebody screwed up at the design phase.
Even as a fat man of average height, I can work to my full scope in a van. I’ve done cardiac arrests, CC level vent jobs, multi system traumas and so on in vans. I would prefer a box, but I would prefer a van that meets all the above criteria to a box that doesn’t.
It seems like the type III break down quite a bit and their features never work quite right, unless you are constantly pouring tons of cash into them. Back in the day our service had type I 4x4s that worked well enough, but we also kept them in a station and they weren't running calls/posting all day and we did our own maintenance. My experience with type II are much more limited, but they seem to work well enough for most agencies that have them.
My opinion is that first and foremost I want a vehicle that can get the job done safely. Second I want something that makes financial sense, and the type IIs are cheap and I can typically rechassis a type I once or twice. Last are the bells and whistles, chrome, and creature comforts.
I also like our commercial fire engines, they were cheaper and more capable than the customs for our district; this certainly wasn't the norm, it seems everyone wants that shiny chrome chariot.
I wanted something where I could eliminate the bench, have exterior storage, and 4x4. So that necessitated a type 1. My AMR op has the new Transits, I dig em for city work. I can sit upright in back, easy to drive, and things are within reach. Ditch the bench and give me a swiveling seat and a monitor mount and I'd be down.
So here's my take on this:
1. Mission and Location:
If you're operating in a rural environment, you really, really ought to go with a Type-1. There's a lot of reasons for this:
A) Maintenance is often easier on a truck chassis than a van (although newer Ford and Dodge chassis are making disassembly harder) in comparison to vans. This goes double for areas where local dealerships and maintenance are familiar with large domestic trucks.
B) The truck chassis does tend to provide better frontal-collision protection than a van, especially on roads where animals and errant drivers are a significant potential hazard. There's something to be said for an extra two meters of metal and an engine that isn't riding with you in the passenger space.
C) In the South, heat tends to build up in the engine bay of a van faster than a truck. This is a particular problem in the Chevy vans and the Ford E-series- the engine bay simply wasn't designed for adequate cooling in the context of prolonged idling, regardless of fuel type. Air, fluids and parts all get hotter and stay hotter, and this wears down everything from insulation to gaskets to crew members (lukewarm AC sucks!).
4) Features: it's often easier to get a *nice* set of features like cruise control, 4x4, power accessories, a nice stereo, etc with a truck than with a van. No one wants to be stuck in a converted U-haul cab.
5) 'Cool"/masculine image: Let's face it, the E-series is the face of most ambulances. It doesn't exactly look as fun as a truck.
2) If you're suburban or urban, a van starts to make a lot more sense becuase you can secure maintenance and supply chains that support those vehicles just as well as the big commercially-available trucks. With that being said, it should be acknowledged that manufactuer support for the classic E-series vans has been getting curtailed for a while (ie the discontinuation of diesel E-series) and that it is likely that the classic van designs will eventually go the way of the phaeton- ambulance manufacture is simply too small a market to keep a production line rolling for GM or Ford, especially if/when politican and economic concerns dictate fuel-economy increases. The 'new' van designs (Sprinter, Transit, Nissan, etc) are promising, and I am a huge fan of Sprinter ambulances, but they are somewhat limited in their abilities to handle a 'full' load in terms of traditional space and setup.
3) Cost and Recapitalization Plan:Are you buying a 'new' truck every few years and using it until it gets too pricy to repair (Hall, good AMRs, Medstar, etc) or are you buying one only when absolutely needed or what? The amount of recurring funding available defines a lot of what you're going to be able to buy- a one-time purchase and a cheaper remount essentially dictates a truck today, while a more modest purchase and a similar-sized replacement budget strongly drives me towards a van (or a used-and-remounted box).
Were I a fleet manager, I'd honestly go Type-1 truck overall, followed by a Sprinter or Transit, followed by a wheelbarrow- and-bike, followed by an E-series or Chevy van.
I would really, really enjoy an SUV-based ambulance.
Of course, that doesn't even touch on easy ways for vehicle service life to be improved and extended, things like defined maintenance intervals and schedules, vehicle rotation and adequate budget support...
Expanding on this, if you're in an urban environment, it is really hard to beat a vehicle with a small turn radius. This isn't necessarily a commitment to a particular chassis type, it's just an observation.
Some places do that out here that are destitute and have lots of long distance transfers. They look miserable to work out of (and be a patient in).https://www.denverpost.com/2010/11/28/colorado-rural-ambulance-services-in-a-state-of-emergency/
I actually had the opportunity to ride in one after a skiing accident many years ago, ride quality wasn't fantastic. To be fair riding on the cot in the back of any ambulance isn't really comfortable anyway, I'm not sure what is actually worse. The SUV isn't as claustrophobic as you would think since you can see out of all of the windows.
I think if you approached packaging the patient like you do for flight a lot of the space issues could be mitigated, although still not an ideal setup.
A point for vans- it seems like collision-mitigation and avoidance technology is seeping into the Sprinters and Transits faster than the trucks; or maybe it's just penny-pinching.
The advent of LiquidSpring has done a whollllle lot.
NYC is about as urban as you can get.... and FDNY EMS has been using Type 1 ambulances as their standard vehicle for decades. just an observation.
New York is one thing. That city was planned to be orderly and well layed out. Boston EMS ran medium duty trucks for over twenty years, and thats in a city that basically paved horse paths. You can spend 30 minutes going up Beacon Hill without knowing the ropes and make one wrong turn and thirty seconds later you’re back at the bottom looking up wondering what happened.
Now, it’s probably worth mentioning that most of the EMTs in the city hated their monstrous ambulances, but they worked.
My F450 has a turn radius 60% of the E450 it replaced.
Yes, yes, yes, they are a wonderful thing.
I worked a code in a transit today (yeah, I transported a code. It was refractory VF... so shoot me)
Anyway. It was small. I’m 6’ and while I’m getting skinnier, it was still tight with gear, patient, fire rider, AEMT and me. I prefer the box.
I prefer a box. Specifically a Type I.
But that's coming from a street medic.
I understand from an operational side it may not always be feasible.
If you're running a BLS agency, or have a BLS fleet, then vans are perfectly reasonable. For ALS services I think boxes should be the standard.
I understood the "everything is in reach" argument for vans, but I personally have never had that issue. I do most of my treatment on scene and stabilize as much as possible before we go (as long as that's reasonable). Even then, from my seat I can reach my monitor, drugs, oxygen and IV stuff.
Also, to hit on what someone else said, screw bench seats. Chairs please.
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