Re: Big Ambulances

October 27, 2010

Things seem to go in circles. In the late 80's/ early 90's many people

thought that this would be the answer. Our department had one for over

10 years. It had a very rough ride. Has anyone proven that these units

last longer, or are more cost effective or is it an opinion?

Will the larger unit double as a rescue unit with some type of rescue

equipment or will it be just a larger transport unit?

As with everything, the added cost would have to be justified to approve

the change.

Steve

My opinions are my own...

From: texasems-l [mailto:texasems-l ] On

Behalf Of Shaw, Kenny

Sent: Wednesday, October 27, 2010 3:11 PM

To: texasems-l

Subject: Big Ambulances

EMS Officials in Texas City Say Bigger Ambulances Will Help Drive Costs

Down

BY ROBIN PYLE

Lubbock Avalanche-Journal, Texas

In the case of ambulances, Lubbock EMS officials say bigger is better.

They believe new bigger ambulances will help increase efficiency, lower

maintenance costs and possibly provide more lifesaving opportunities,

though it comes with a bigger price tag too.

The new ambulances started rolling out on Lubbock streets late last

week, said Teague, director of Lubbock's Emergency Medical

Services.

Within the next two weeks, eight of the nine units in the local fleet

will be replaced by the much larger International Wheeled Coach

ambulances, which span a little more than half a foot taller and a foot

wider.

While the cost is roughly $250,000 more to switch to the eight larger

units, officials say the long-run cost savings derived from a longer

life span make them a better financial decision.

The total price tag is about $1.37 million.

The first thing drivers might notice about the new ambulances is the

driver's cab, which looks like those seen on a tractor-trailer rig.

But the most significant improvements won't be seen from a driver's view

in traffic, officials say.

" It will benefit the public, " Teague said, noting improved conditions

for medics and enhanced features will ultimately benefit patients.

Others agree this particular ambulance is among the best on the market.

Buzz Tallant, regional salesman for San Ambulance Sales, said

the type of ambulance has become a popular option for bigger cities in

the past eight to 10 years.

For example, Austin has been using the same kind for more than 11 years.

Lindsley, operations supervisor for the Austin- County EMS,

said they've been well worth it.

The bigger ambulances are designed to handle more and last longer, which

is something larger cities need because of higher usage and demand.

But while smaller towns generally have smaller ambulances, Tallant said,

that doesn't mean those communities have inferior vehicles because they

have what they need.

Lubbock's needs are bigger now as the city continues to grow, Teague

said, noting EMS call volume has more than doubled in the past 10 years,

from 15,000 calls annually to 35,000.

" We run more calls today, and (the old ambulances are) not able to keep

up (as well), " Teague said.

Better features

The bigger size means more working and storage space for emergency

personnel. Increased weight capacities also allow more equipment and

personnel on board.

The ambulances come equipped with mini-refrigerators, meaning medics

will no longer have to rely on a cooler.

But the fridges could have a more meaningful impact and actually could

help emergency personnel save more lives.

Teague said they will be able to store more medications and fluids

inside because of the controlled temperatures, which opens up more

possibilities for conducting more lifesaving procedures en route to the

hospital.

For example, local officials are looking into the possibility that

medics can conduct hypothermia treatment aboard the ambulances for

cardiac arrest patients, a proven therapy that increases the chances of

surviving by lowering the core body temperature.

Being able to do the procedure sooner might help save more lives.

They'll be studying the idea and possibly be ready to offer it as early

as January 2011, Teague said.

Another bonus is the new ambulances also have hydraulic suspensions,

which means the ambulances can automatically lower so crews can get

patients in more easily.

Teague hopes the new ambulances also will be more visible in traffic so

residents are more aware of them.

He didn't think there would be any problems with maneuvering them

despite their size, noting that they actually do pretty well on the

roadway.

Lindsley said the vehicles in Austin have proven to be safer for

emergency personnel because of their bigger size, though the same might

not be true for another vehicle involved in a crash with the large

ambulance for the same reason.

Crashes involving ambulances are not common in Lubbock, and most are

minor accidents involving residents rear-ending ambulances, officials

say.

Cost and savings

The cost of each new ambulance was $172,000 compared to about $140,000

each for the old ones, Teague said. However, that was a reduced priced

after trading in the old ones.

That adds up to a difference of about $256,000 for the total purchase

compared to if officials had bought the smaller ones.

But Teague said that money will be saved in the long run because

maintenance costs are expected to be lower since the bigger ambulances

generally last longer and can handle more.

They're known for running at least 200,000 miles without major problems

-- about 70,000 miles more than the old ones.

And because they have a nearly doubled weight capacity, they should

experience less wear and tear on parts such as brakes and suspension.

Previously those parts saw a lot of wear and tear because they were

" constantly maxing out " on weight capacity, causing more strain to the

vehicle, Teague said.

" It's really going to save us a lot more money on maintenance costs, " he

added.

However, officials didn't yet know exactly how much maintenance would

cost in comparison.

The initial cost was already calculated into the hospital's general

budget so the new ambulances aren't going to cause tax increases or take

money away from other areas, said Greg Bruce, vice president with

University Medical Center, which operates Lubbock EMS.

The timing is right, he said, since most of the fleet needed to be

replaced this year

November 4, 2010

On Wednesday, October 27, 2010 23:15, " Lemming, Steve " slemming@...>

said:

> Things seem to go in circles. In the late 80's/ early 90's many people

> thought that this would be the answer. Our department had one for over

> 10 years. It had a very rough ride. Has anyone proven that these units

> last longer, or are more cost effective or is it an opinion?

It seems that another factor to consider would be the deployment strategy of the

agency. Those who utilise SSM dynamic deployment tend to rack up a lot more

numbers on their Hobbs than their odometer. Consequently, engine life cannot be

simply evaluated by mileage life only.

Rob

November 5, 2010

" a lot depends on the motor " ... I hope you meant to say " engine " ... Sorry.

Could not resist....

Jim davis

Paramedic

November 8, 2010

Well -

I agree with Dudley. You have to know how to use the GVW on the vehicle, and

you absolutely must talk you your builder or dealer and figure out how they

utilize the GVW, otherwise it can turn into a miserable situation. Dallas had

bigger units at one point, but figured out, that as hard as they run, and the

tight spaces that they have to get into (narrow streets, etc.) that the most

common used apparatus, the ambulance, could go smaller. Austin is doing the

same thing, going a bit smaller with an F-450, instead of a Medium Duty Chassis,

if I am not mistaken. Like Dudley said, and he is the safety guru, in the

bigger ambulances, in a collision situation, most often, you win. But, if you

remember, Austin had an accident at a toll booth where that truck was peeled

like a can of sardines. Miami - Dade uses big Medium Duty ambulances built by

Braun, obviously a busy system, but the bigger trucks work well for them.

Chicago uses Type 1 F-450's. You also have to consider the training involved to

operate a big ambulance. Make sure that all people driving complete an EVOC

course on any ambulance type that you use or are looking at going to. Just

always make certain that you have the proper training in place for those that

drive the bigger units, and document that training, and re-train them as often

as neccessary because I may have a pickup, doesn't mean I can drive a school

bus!

Feemster

Re: Big Ambulances

On Thursday, November 4, 2010 20:05, danielfeemster@... said:

> Medium Duty ambulances have

their place in the EMS world, you just have do a complete evaluation of your

system to make sure they are suitable. Dudley has a perfect system for them.

Great input, ! Thank you! I figured it had to be a choice tailored to

he needs of a given system, and certainly not a universal thing. That's why I

peculated on the deployment issues. If you or Dudley could give us more info

egarding the types of systems in which their benefits are maximised, I would

ove to hear it.

Rob

------------------------------------

November 9, 2010

,

Let me interject a couple more points from your reply.

First, many systems had medium duty chassis and are now moving away from them.

This may be related to a couple of issues. First of all is fleet life

expectancy. With a standard passenger truck or van frame, that may very well be

loaded close to it's maximum GVW, if the agency plans on only using these

vehicle for 3 or 4 years and then moving them into reserves or replacing them

altogether...then the cost savings of using a smaller chassis is probably a wise

decision. If an agency is moving into Medium Duty chassis, it should come with

an expectation of being able to use that chassis (which doesn't work as hard due

to spread between actual weight and GVW) for more years. For example, our

system still plans on keeping our Medium Duty trucks as front line vehicles for

between 8-10 years. Our oldest (almost 7 years old) is over 250K miles and

still running well.

As I stated earlier, compare that to our 2001 E350 Type III that has been in

reserve for 3 years, has 170K on it and is on it third transmission.

The next piece is our current economic picture. With the increased emissions

requirements, the cost of ALL chassis has gone up considerably. Even so, you

can save between 20-30K by going to a standard Type I or Type III chassis

compared to say an International chassis. This alone has driven some decisions

around the state and region for agencies moving away from the medium duty truck.

Next is the " myth " about medium duty trucks not fitting in " tighter spaces " or

urban, narrow streets. The box on our Type III from 2001 is the same width and

length as the box on our Medium Duty international. Our height clearance is

about 9 " more on the international because of the height of the chassis frame.

That being said, my International can out turn and out maneuver almost any Type

I ambulance you put me up against.

Miami Dade currently does purchase their ambulances from Braun. They are

currently building their ambulances on a Furion Chassis built by Spartan (a

custom chassis manufacturer). These are VERY sweet and VERY expensive trucks

(almost twice as much as an International chassis) but they are designed by a

custom chassis manufacturer to do one thing....carry an ambulance body. The

ride is almost Cadillac quality and the entire vehicle is warranted and built to

last for EMS. Miami's trade off for going to this super-expensive chassis was

extending their service life per chassis for several more years (like from 4

years to 7 or something like that...don't quote me, I don't have my notes).

On the safety side, my comments were in relation to the chassis ONLY. An

International chassis versus a full-size pickup will fare better than another

pickup or van chassis...mainly due to weight and mass. I was NOT talking about

the patient compartment in any shape or form. You referenced an Austin/

County accident with a toll booth. When you look the pictures, notice despite a

significant impact (removal of the front wheel) the chassis stayed together very

well and protected its occupants. It is the modular body that came apart. This

is the curse of our existence. The chassis held together because it is covered

by the Federal Motor Vehicle Safety Standards (FMVSS) and has been designed and

crash tested to protect its occupants if they are seat belted into their seats.

The modular box (ANY manufacturer) is not dynamically crash tested to a standard

crash test protocol nor is it designed according to any Federal Safety Standard.

There are a lot of strength tests prescribed by the old GSA purchasing

specifications (KKK ambulance specs) but those prove nothing unless it is common

in your service area for someone to gently set 25,000 pounds of water on the top

of you box while you are sitting still. Ambulances are specifically exempt from

FMVSS and that is what is killing our EMS brothers and sisters at a higher rate

than any of our other public safety comrades.

http://www.statesman.com/blogs/content/shared-gen/blogs/austin/cityhall/entries/\

2009/05/20/ems_officials_looking_into_amb.html

Lastly, , I do agree that training is MANDATORY for EVERYONE who drives an

ambulance. We have to know who we are allowing behind our wheels. And I don't

care if you drive a dually pickup everyday...you MUST be trained in driving the

ambulance even if it is smaller. It is not your truck, you cannot assume people

know how to drive and handle your ambulance and frequent driver training and

re-training is a huge necessity. Some other pointers: policies on driving

emergency and non-emergency that are consistently enforced; semi-annual driver

license checks; a standard of what you will or will not allow to drive your

trucks; a determination of what is an appropriate driving record and what is not

(not from your perspective but how it will look on the front page of the local

newspaper) and a conversation with your insurer as to what is appropriate based

upon their comfort levels of your risk (i.e. I learned that our insurance

company will not tell us they won't insure someone, no matter how bad their

record is, because they expect by the time we place them in a driver role, we

have vetted them...in other words, that monkey is on our agency's back).

Anyway, good conversation. Thoughts from others?

Dudley

Re: Big Ambulances

On Thursday, November 4, 2010 20:05, danielfeemster@... said:

> Medium Duty ambulances have

their place in the EMS world, you just have do a complete evaluation of your

system to make sure they are suitable. Dudley has a perfect system for them.

Great input, ! Thank you! I figured it had to be a choice tailored to

he needs of a given system, and certainly not a universal thing. That's why I

peculated on the deployment issues. If you or Dudley could give us more info

egarding the types of systems in which their benefits are maximised, I would

ove to hear it.

Rob

------------------------------------

November 10, 2010

Dudley,

Excellent points. Whoever writes the specs must research the vehicle and not

just listen to the sales rep. When I was writing specs and a sales rep said

â€œWe donâ€™t do it that way on our vehiclesâ€, my response was â€œOK, then you

wonâ€™t get the bid.â€ It is cheaper for the manufacturer to do stock

vehicles. Custom vehicles cost more to manufacture and cut into profits. Even

if you use the specs from the sales rep donâ€™t be afraid to vary from them if

it is something you want. The sales rep wonâ€™t be responding in the vehicle.

The department has to live with the vehicle for many years.

When you spec the medium duty you spec what GVWR you want for the chassis by

specifying the axle ratings. Our Freightliner FL70 with airbags rated for

28,000 GVWR was the roughest ride as it weighed about 14,000 pounds loaded with

equipment and people. The airbags never moved. Spec it with lower weight axles

and it will ride much better. The new M2 can be ordered with front axles from

6,000 to 20,000 pound ratings and rear axles from 10,000 to 52,000 pound

ratings. Same chassis, just different axles and suspension parts. The turning

radius is much better on the medium duty, even with a bigger box, as the front

wheels turn sharper than a Type 1.

Randy E. , R.N., L.P.

From: texasems-l [mailto:texasems-l ] On Behalf

Of THEDUDMAN@...

Sent: Wednesday, November 10, 2010 12:13 AM

To: texasems-l

Subject: Re: Big Ambulances