If, in moving through your life, you find yourself lost...go back to the last place where you knew who you were, and what you were doing, and start from there. Bernice Johnson Reagon.

23 October 2012

Bumpy rides

There is a report over on EMS1.com about concerns over the safety and comfort of Montreal’s new ambulances. There is even a short video that seems to show the rough ride provided. You can read that report and see the video here. There is also a report in the Montreal media here.

Well, to anyone out there who has ridden a type I, type III, or medium duty chassis ambulance over the last, oh, 20 years, this is nothing new. If you make an ambulance on a truck chassis, guess what? It rides like a truck.

Part of the answer to durability and braking issues a few years ago led to the proliferation of the Ford E450 and GM G4500 series chassis, in many cases replacing the Ford E350. Of course, when you beef up the suspensions to handle the extra weight, well, they ride rougher.And to add to that, the idea that medium duty trucks would offer better power train and brake life, plus added carrying capacity, led to their popularity.

Seems like patient comfort, much less medic comfort, has ever entered into the idea of ambulance design. I have even seen some discussion board threads about ambulance design, and it all comes down to something other than patient and medic comfort.

The whole power and weight and suspension thing was really highlighted in a couple of Freightshaker, er, Freightliner ambulances I got to enjoy back in the late 90s. One, a remount, utilized a lower horsepower engine with a lower GVWR rating. While you had to be a little patient in driving it, since it was going nowhere fast, it really did not ride too bad, relatively speaking, in the way that cup of boiling water will not burn you as bad as a pot of boiling water. Contrastingly, there was a Freightliner unit that was built new with a beefier engine, which of course had the higher GVWR and heavier springs. With the extra HP it would scoot, but the ride was horrendous. Really horrendous.

Same sort of thing with a couple of Ford E350 chassis units that I used during the 90s. They rode really well, even in the back, and they handled good. They were a little underpowered (but how fast do you really need to go?) and they had really short brake life (it seems like something around every10,000 miles they needed brake pads, and every other brake job got rotors and drums). Fast forward to now with the E450s and Powerstroke diesels (that are no longer available in the E450 for ambulances) and the GM G4500s- they have power but they have terrible rides.

And we won't even talk about type-I ambulances.

At any rate, there are some stretches of road that I would like to take ambulance designers across, while they are laying on a stretcher, or better yet, strapped to a back board. And since it is getting to the point that many hospital EDs do not switch out pillows and blankets, well, they cannot have those either for their 'test' ride.

You can tout the virtues of your ambulance all you want, but until you can design a smoother ride into them, along with a safer environment for  the medics that have to ride in them, well, people are going to complain. And with good reason. Maybe if the designers understood what was happening.....

I have seen all manner of crap (yes, crap) that has been inflicted on patients and medics in the name of efficiency and "better patient care" for a large part of my EMS career. I have seen one former employer spend thousands of dollars trying to get a medium duty ambulance to not qualify as "cruel and unusual punishment" because of the ride they dish out. I remember air suspensions, hydraulic suspensions, Velvet Ride, Comfort Crew, and techniques of tinkering with the air in the air bags, tinkering with the air bag and spring capacity, and even messing with tire size and pressure.

Guess what? They still rode like.....crap. And in some cases, the handling characteristics got......interesting.

I have a couple of observations.

First, we carry too much stuff. I know, we like to think we need all of it to save a life, but there is a lot of stuff that we could probably do without. I mean, how much sterile water and oxygen tanks do you need? Wouldn't 500ml bags of fluid suffice? I mean, seems like I read somewhere that all that fluid we use to give trauma patients was detrimental. And I know 250ml bags are kind of expensive, so how about 500ml bags? With a couple of 250mls for drips, of course.

I know, IV bags are but just a part of what we carry, but I really think we could cut out a lot of what we carry on our ambulances and in our bags. Which would cut down on the weight of the gear, which would cut down on the GVWR, which would, maybe translate into something smaller, lighter, better riding, and, maybe, fuel efficient. Because after all, if they have to spend $4.00 per gallon for diesel fuel, and these ambulances are NOT known for their fuel efficiency, what do you think that does for money that might be available for...salaries?

Second, I think our ambulances are too big. A while back, well-known EMS author Thom Dick wrote an article for JEMS about a smaller, safer ambulance. You can go here to read it. I think he is on to something. Of course, judging by the comments he got recently on Facebook, there may be a lot of people that don't want to let go of their big, rough riding trucks.

Do we really need all of that room? There is tons of evidence out there (real, scientific evidence) that we should not be transporting full arrests- ever- since all of the evidence shows that this is a futile gesture. A futile gesture that needlessly endangers our crews and the public. Do you really need to be up and walking all around the patient on the way to the hospital? Do we really need to be carrying more than one patient in an ambulance? Can you really manage two patients? Really?

Does your dentist, doctor, barber, hair stylist or banker try to take care of two patients/customers at once, in the same office? Of course not. So why do you think you can?

It all boils down to these trucks are too big. To me, the current crop of large type I, type III, and medium duty ambulances are reminiscent of the Big American cars of the 50's, 60s, and early 70's- big muscle, big steel, and big tail fins..... If only they rode that good.

We deserve better and our patients deserve much better.

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