1. Introduction to Ambulance Manufacturing
Ambulance Manufacturing; Ambulance design now plays a major role in the evolution of transportation systems. Since the evolution of mobile hover units for personal use, the concept of the ambulance has become almost exclusively dedicated to emergency health care. Concern for the distress of the patient and the evolving concept of definitiveness evolves in the way of providing careful attention to the development of the means by which the patient is moved from the accident spot to the hospital or referred from the hospital to home for further treatment. Further, the type of condition that requires transportation has undergone a lot of change from the time of medieval war field stretchers to modern state-of-the-art sophisticated mobile units. Hence, such changes in the design of the ambulance, which blurred the foundation, are not only historical but also represent a prospective and futuristic approach to make it more advanced and multi-technical based. In the present scenario, which represents an age of the futuristic approach by the subdivisions of advanced medical emergency vehicles, this paper presents some of the first steps.
This paper presents the concept of patient transportation and the earlier development concept of integrating units that are disguised tools which combine medical treatment and transport. The paper focuses on finding answers to questions about the configuration of vehicles in order to transport patients and also provides some optimized solutions through a concept developed in today’s context by integrating ambulances, in which a vehicle is configured: a) to ensure adequate medical and trauma care for a patient receiving treatment; b) to provide adequate transport to give treatment at a medical center. Including designing for the first responder who will ultimately deliver the patient to the hospital, the design of an ambulance that fulfills the requirements of being dynamically scheduled to make a modified vehicle for the segregation and functionality of the patients is considered. A policy aimed at increasing healthcare delivery by ensuring road ambulances are equipped with advanced life support systems has been promulgated. Further, at a high level, it proposed four types of ambulances aimed at simplifying patient categorization and expanding the capacity of transportation vehicles. The main objective is to redefine a more technologically advanced and coordinated design concept to improve ambulance design to meet this approach to technology, the intersection of vehicle engineering and health care, and hospital industries. Therefore, appropriate planning is essential, considering the critical structure, integration of technology and nanotechnology, design factors, testing, and the concept of ambulance manufacturing from an emergency viewpoint. Because of the various objectives of integration and design, the entire manufacturing process should be initiated on a realistic basis and applied with the laws of use changes such as materials, technologies, government regulation, and globalization. This treatment must be carried out by skilled workers and must also include the latest scientific and technical knowledge in the field of information.
1.1. Historical Overview Ambulance Manufacturing
Ever since people began taking an interest in emergency problems, there has been a desire to save a person efficiently, promptly, cleverly, and quickly. The discovery of what the ambulance offered at the beginning, and then the cars that took on the transport of the affected, left only a slight historical background. In 1487, a bull was issued in Valencia. During the catastrophic epidemics, it was ordered: among other things, “the government should order the construction of machines to be used for the transportation of this region, and care should be taken that they are provided with something soft, such as cushions or covers, and do not wobble too much under the broken man’s body.” Though the initial breakthrough for the tendency to equip ambulances with modern aids was given by the ideas of Commander N. Ivanov at the meeting of the Executive Committee of the All-Russian Association of the Red Cross in 1904, in the activities of the Moscow Society of the Red Cross, the operational deployment of an automobile ambulance did not take place until 1910. The complexity of the car’s economic usefulness in humanitarian needs was the starting point for the systematic study of ambulance cars created in the USSR, developed both from an economic and technical point of view. Now, modern ambulances are adapted to a wider range of missions and are subject to strict regulations. Emergency medical vehicles must meet a wide range of minimum equipment and vehicle standards. In addition to these, there are additional industry and agency standards. This has resulted in a steep learning curve for specialized manufacturers to meet the challenges of vehicle construction and retrofit.
1.2. Importance of Ambulance Manufacturing Design and Technology
The design of ambulances becomes a very important factor for every society. The careful design of the ambulance is of crucial importance for faster provision of emergency medical care for injured or ill people. Better access to the injured and rapid movement are critically required to provide services free of serious injuries to health personnel and the public. In order to escape the high price, van ambulances should be designed and manufactured as suitable medical units with advanced technology instead of special ambulance designs. Nowadays, specially designed and produced ambulances for special purposes and needs have started to be built with a different perspective. In this study, a domestic manufacturer with clinically successful ambulance production has been scientifically examined in terms of design and technology to serve as a model for other companies. Highway ambulances are some of the institutionalized medical service systems that produce products for all segments of society such as patients and other users, medical teams, technical staff, business investors, and governmental and non-governmental organizations. The intention of both domestic and foreign small, medium, and large organizations is to provide ambulances with simple and perfect service, which is very sensitive in the health sector. Providing services to a large number of people and gaining their loyalty in this context are realized by meeting the expectations of users and satisfying them from the mental and physiological point of view. Therefore, internal and exterior form, color, and ornament designs should take into account people’s tastes, expectations, and perceptions of quality in a comprehensive manner. Providing high-quality, colorful, and pleasant forms in a narrow space and reflecting the effects of the brand has increased the responsiveness of patients. Aesthetic form and sensitive technological form are of great importance in terms of brand image for the investment in the ambulance, which is the first point of physical contact and brand-patient interaction.
2. ICU Automotive: Ambulance Manufacturing Company Profile
Company profile The Middle East has long been a breeding ground for exceptional results, both in culture and industry, and ICU Automotive is an example of both. Established more than a decade ago, the Disaster Emergency Management company was set up to carry out disaster response, primarily through field hospitals established, maintained, and managed by both expats and Emiratis, serving as a central hub during emergency operations. The company was also involved in a disaster relief project, which drove the SEMT to want to fulfill the cycle and provide auxiliary support, not just emergency support. ICU Automotive has since grown to become an internationally ISO-accredited company that specializes in the conversion of ambulances, especially manufacturing for ICUs as part of country-wide and international healthcare infrastructure.
ICU Automotive focuses on a unique product: ICU ambulances. These are uber-modular, adaptable, geared, capacious, and have since been an inspiration for other brands to follow – some may have even been launched as attempts to emulate the product. ICU Automotive uses modern, cutting-edge design philosophy to re-engineer the ambulance for modern and future full-scale ICU on wheels standard settings. When we re-engineer the ambulance, we consider not just today’s conformations, but tomorrow’s as well. We look to the future, and our innovative design philosophy means that our products have the flexibility and modular adaptability to configure an ambulance as per tomorrow’s market demands. Our staff at ICU Automotive has 19 years of development experience, and our R&D and production units in Sharjah have fostered development across a diverse spectrum of vehicle variations, such as passenger, commercial, and emergency vehicles.
Founded in 2010, ICU Automotive quickly developed a comprehensive understanding of ambulance manufacturing dynamics and market requirements. Our strength lies in our commitment to delivering high-quality products by utilizing our infrastructure to maintain complete control over the production process. In the past, we have been successful in navigating a rapidly changing regulatory scenario. Being aggressive in our approach allows us to preempt the needs and demands of healthcare delivery and design products that fill the gap left by the slow-changing regulations. Our expansive factory in Umm Al-Quwain specializes in the conversion of commercial vehicles into Good Manufacturing Practice compliant ambulances, or as we at ICU Automotive like to refer to them, “ICU ambulances.”
2.1. Ambulance Manufacturing Founding and History
ICU Automobile was founded on October 15, 1981, in Diadema, São Paulo, by four partners. They invested their own money, purchased a small automobile shop, and soon started to face the challenges related to the early years of an enterprise. Some of the equipment that the new company had acquired was not in good condition. Knowing that the shop was facing financial difficulties, the company’s first job was limited to welding prototypes or repairing cars. The founders’ dream was to launch their own ambulance brand. One year after the company was founded, they successfully conducted their first sale to a local ambulance service. During that time, they used the bodies from other manufacturers and assembled them to the chassis of old VW Kombi, Fusca, and Brasília cars, which were the most common cars in the Brazilian emergency system. It was the first pressurized vehicle in Brazil. Since then, the company began to consolidate its place in the business segment.
On November 22, 1994, the company’s name was shortened to ICU Automotive, and a more robust brand was created. The founders were never satisfied with the average, and as a result, the company never stopped innovating. It was the first company in Brazil to manufacture a specific type of medical vehicle and to obtain national certification. The company also manufactured the first modular concept advanced life support vehicle for a maritime service, in partnership with a safety organization. All the milestones announced above will be detailed throughout this text, showing the reader that the company is proud of its history, recognizing that this history was a collective achievement and could not have been built individually. What follows is a summary of the achievements of every year or every two years, outlining the relevant partnerships, inventions, infrastructure growth, as well as assorted achievements and awards. In 2016, 35 years after its inception, ICU earned a lifelong entity serving the national rescue philosophy, by collaborating with safety, valuing life, and promoting humanitarian ideas.
2.2. Specialization in ICU Ambulances – Ambulance Manufacturing
Since its establishment, ICU has made a mark as a company that designs and manufactures ambulances meant primarily for patient transport from the place of an accident or request for immediate health care to a hospital; in other words, call ambulances. Writing primarily about paramedical ambulances in our country, those that provide patient transport from one hospital to another, is synonymous with the use of the terms unqualified or emergency medical transport. The main term used for this in the world and for the ambulances themselves is patient transport instead of only subjecting it to the definition of emergency or urgency, as stated in our Patient Transfer Regulation. Fulfilling this need for the advanced levels of patient ambulance inter-hospital emergency care, ICU has become the company that has spent perhaps the most working life on road ambulance design in Turkey over the last 40 years, especially.
The design concept of an ICU type ambulance translates the following intentions of the company policy into the product: ICU automotive excels in emergency patient transport and pre-hospital emergency services. To that end, they will be included in modern medicine, according to international standards and the treatment protocols implemented by hospitals, both qualified and unqualified, human-powered versatility, ease of use, and optimally meet the urgent needs of comprehensive incapacity, sick, and injured patients with advanced medical technology with high added value, no exceptional value, performances, and expectations, especially by considering the physical, mental, and social aspects of the patients and mood swings to ensure their sense of well-being. With the design of these vehicles totally matching these two parameters and developing new concepts in proportion to ever-increasing needs, ICU ambulance vehicles have emerged as a product line utilizing an advanced original and creative technological background.
Emphasizing patient safety, smooth maintenance of medical equipment, and patient care are considered the primary design parameters. Special systems have been developed for safe patient entry and patient comfort. This has been complemented by providing comfort to healthy escorts and healthcare personnel. The inclusion of human factors criteria in the design has also enabled the interior design and equipment arrangement of various types of ambulance vehicles. There is always an excessive accumulation of R&D studies in this aspect. Extensive testing has also been performed on the finished product. By integrating service and sales under a single roof, detailed user expertise training has also been provided to ensure that the vehicle is used optimally. The vehicles produced in this way have considerable technical and health advantages in terms of optimizing the response time in ambulance intervention at accident sites, reaching times to patients, reducing or shortening the symptoms emanating from the disease, and rapid patient transport to the hospital. This whole situation significantly improves the survival and trauma sequel rates of the casualties.
3. Key Components of Ambulance Manufacturing
The manufacturing of an ambulance consists of various components, some of which contribute to the structural aspects of the vehicle, such as the frame and body structure. The chassis of an ambulance is a single manufacturing component that forms its backbone regarding durability and the safety of the patient, as well as in conducting emergency operations. The frame should be strong enough to accommodate the weight of the ambulance with or without patients, equipment, tanks, staff, and the driver. This affects both structural and operational properties. The chassis design also plays a vital role as a part of the vehicle unit, such as wheels, braking systems, suspensions, and powertrains, which ensure the smooth operation of the vehicle. The wheelbase, track width, turning radius, and ground clearance are the main design factors in chassis manufacturing concerning smooth vehicle movements on highways and through urban areas. Emergency medical processes on board are guaranteed by the integrated medical equipment. Both essential primary medical care, like blood pressure measurements or stethoscopy, up to the most important modern diagnostics and care, like mechanical ventilation and infusions, should, if at all, be performed smoothly. Thus, the ambulance is very useful when transporting patients. The medical environment and ambulance should also cooperate. Hence, this scope reveals the design and manufacture of chassis and frames, controlling and manipulative assemblies, and service and maintenance standards. A range of different metals and alloys with varying properties in terms of strength, corrosiveness, ductility, toughness, fabricability, shapeability, and welding are used for the current design of frame materials. Reinforced plastics, light steel alloys, aluminum, stainless steel, and FRPs are also used in ambulances as special applications per patient requirements. However, it is essential to be very careful with the choice and implementation of materials used in ambulances since clients and safety rules need sturdy, long-lasting, price-competitive, lightweight substances. The sustainability factors include quantifiable frame function-related losses in the adaptive industries of non-Latin products. There are also various design standards for machine work at loads of capacities. The required components for the frame and medical equipment are also subject to hindering blockages, such as completion time of any component, limited in-house manufacturing scope, principal integral hospital-standard activities, availability of components, and components that exceed the specified time and cannot be delivered directly.
3.1. Chassis and Frame Design – Ambulance Manufacturing
3.1. Chassis and Frame Design. In the automotive industry, the term “chassis” includes the frame, the powertrain, and the suspension. In general, the chassis acts as the main supporting mechanism, provides stability to a vehicle, and ensures vehicle durability. Thus, the selection of the optimum material makes it possible to ensure stiffness and lower the overall weight of a vehicle. In the ambulance, the suspension system is chosen based on the condition and requirements of the end users. Steel has a poor combination of strength-to-weight ratio; therefore, it is better to employ materials like aluminum or composite materials for ambulances. The characteristics of both materials must be known to design the best chassis for ambulances.
Having a good strength-to-weight ratio and being relatively easy to repair are the main features of the ambulance chassis. There are several trade-offs that the designer should consider when selecting these materials. The selection depends on the type of the county as well as the customer requirements. In addition, to be competitive in the market, the “comfort level” and other parameters can be as good as the steel-built chassis. Furthermore, due to a higher rigidity-to-weight ratio, the design of the chassis can utilize composite materials. With the increase in length, the top-hat thickness also increases for both materials, and the reason, which is another important point, is discussed here. The body of an ambulance is transferred via the frame and chassis. Therefore, the system needs to perform ideally under various driving and maneuvering conditions in both the “loaded” and “empty” modes. In the “empty” mode, drivers need to experience the feel of the chassis, and safety is of prime importance.
3.2. Medical Equipment Integration – Ambulance Manufacturing
Ambulances are equipped with various types of medical devices and equipment needed for the first medical intervention. Often present are monitoring devices, like ECG and non-invasive blood pressure monitoring, ultrasound imaging systems, small focused echocardiography equipment, electrical defibrillators, equipment for parenteral infusion, like multi-injector pumps, and large and mini bolus infusion curbs, as well as many medical devices, like pulse oximeters, sphygmomanometers, digital thermometers, an appropriate number of spare sensors, stethoscopes, tourniquets, scissors, medical oxygen supply and multi-outlet manifolds, vacuum suction, automated mechanical CPR devices, aspirators, drugs and equipment for conscious sedation, drugs and equipment for severe allergies, smartphones with both 3G/4G/5G and GPS, and full HD cameras, when available. All of these devices and equipment must be located in the patient compartment in order to be easily reached for care activities.
A great advancement in delivering care in emergency medical situations is represented by connecting the disposable to the ambulance structure. The first milestone was pursued by devices presented in 1977. An advanced example is represented by an old and patented system to connect an infusion manifold to the back of the ambulance, thus having the infusion device outside the ambulance in aseptic conditions. Much of the progress in medical equipment design consists of putting new technologies to good use specifically related to the task at hand. These involve miniaturization, electronics, and materials handling. Optimization is the result of both medical equipment innovation and new vehicle design. The ambulance needs a specific technical orientation with respect to the front vehicle and an optimized design respecting the requirements. Good communication between vehicle designers, vehicle planners, medical equipment designers, and medical equipment planners is mandatory. It is also important to have knowledge of all the current standards and directives regulating structural and medical device integration. The facilities must also have the appropriate characteristics of compliance according to the requirements established in force and must comply with all the applicable legal provisions, including those relevant to the limitation of the structural variability of the cabin. The discrepancy between the systems and the vehicle and the non-integration of them in the cabin confirms and sanctions the impossibility of operating on the move. It also ensures standards of operating comfort and security.
4. Safety Standards and Regulations Ambulance Manufacturing
The development and manufacturing of patient transportation vehicles and equipment are governed by rigorous compliance standards and market regulations in practically all countries. The framework of regulations, standards, and certification processes often extends beyond the national scope and includes international frameworks with which manufacturers must necessarily comply. The most important aspect of these documents is that, to save lives during a medical emergency, the vehicle must be able to further protect the patient and the medical personnel from damage during transport. Vehicles of this type are directly involved in saving and maintaining their health and lives. Consequently, over the past few years, work has been done on the marketing and research aspects of such vehicles. Organizations and committees of people acting in them, which regulate standards and legal bases, have a significant impact on the construction of the designed vehicles or equipment. Furthermore, the standards are themselves in a constant state of adaptation and transformation, requiring organizations working in the automotive field to adapt their technology and products to new documents. Any standardization process aims to develop audit and control methods and certification bodies that will assess the steps of the standard. This process will help to ensure continuous product development. As a result of this situation, automakers are facing new challenges and opportunities to differentiate themselves and capture significant shares and secure their position. Each product that meets the terms of standards and regulations has an adequate level to ensure patient and staff safety during transport, contributing to increased trust of the rescue and emergency system users. The precise regulation of ambulance design and the required emergency medical equipment is based on laws and regulations. The most important laws and legal acts specify the parameters of the emergency equipment of the patient transport vehicle and the use of other complex equipment according to the appropriate regulations. The word ‘law’ refers both to the act of the supreme legislative body of a state that establishes general principles of the political system and national life, as well as to individual acts of a law-making nature issued on the basis of the laws by competent authorities. An act is a normative act issued by a competent authority based on and within the limits of the act, enshrining the general principles of the act but applied to a specific case. The law is binding, and infringements on it can be ordered by appropriate bodies. Laws and regulations play a special role in the field of automotive law. This is due to the need for systematization of used funds and equipment, the correct consideration of which can affect the final result of the performed rescue activities. Research shows that laws regulating standards for medical devices also regulate the design and construction of vehicles. Compliance certification is a guarantee of the high-quality work of the constructed vehicle. The final product must have appropriate certification in order to demonstrate its safety parameters based on the results of conducted tests before it can be marketed. To do this, prototype vehicles and equipment must be manufactured and certified before they are manufactured on a production line. It can be designed for both individual units and various production series. The group of entities required for design testing and certification includes various associations and standards organizations. The type of certification performed affects the scale and the cost of the conducted research, but at the same time, it provides an opportunity to test the prototype implemented and the security level of the production vehicle. The research results cannot be changed in any way, keeping the same parameters.
4.1. National and International Regulations Ambulance Manufacturing
Ambulances are designed to transport emergency or non-emergency patients. They are classified as emergency vehicles, which prioritize assistance and health care. This section aims to address national and international specificities, determining transportation vehicles (ambulances) directly related to their manufacture. In Brazil, the regulating agency is the National Traffic Department. This body is responsible in each Brazilian state and the Federal District. Based on the proposals of the Ministry of Health and Transport, with bipolar functionalities, ambulances are differentiated according to the level of medical care and equipment that allows operation. The contrast is between a standard ambulance and an ICU ambulance. People who have important roles in the formulation of the request for the manufacture of these ambulances, possible incidences, and the differences between them are discussed. This chapter discusses the adjustments implemented by a manufacturing company in its manufacturing process.
In some countries, manufacturing is more difficult due to different automotive response requirements. Patient care, according to demand, is standardized. Regulations standardize accidents and vehicle occupations. They also aim to standardize mandatory equipment in vehicles, as well as increase sanction risks against those who do not meet requirements. The regulatory body in Brazil that certifies medical devices states that manufacturers’ non-compliance with legislation can lead to numerous sanctions, including imprisonment. In the United States, for example, if manufacturers cause accidents and are negligent in not incorporating rules into their products, prosecution can end in court. The role of the driver who has priority assistance reduces dependence on the skills of ambulance personnel, exempting organizations from creating their own lists of states and implementing regulations that already exist. A young and dynamic work area is currently developing new response methodologies and expectations in early life. Compliance with current rules reduces the existence of claims from the authorities in the areas of development, approval, and marketing. Challenging, unexpected, but rigid measures are being taken to place Brazilian vehicle registration systems around the world.
The ambulance has emergency lights, a signal device to indicate the need for space and priority in the planning of Brazilian traffic. It also has some special resources for patient care, but there are requirements and characteristics that need to be considered inside the ambulance, which are important. Some countries, like Brazil and the United States, in addition to working daily with emergency vehicle standards, are also making exceptions to legislation allowing these vehicles to break traffic laws, priority signals, and motor vehicle regulations, as well as receiving additional signage. Therefore, the requirements for designing and building this type of vehicle consist not only of vehicle and safety issues but also of public safety and risk identification. Vehicle builders subjected to these regulations must know and understand good in-house planning for the finished product, from the regulations for the preparation of parts and vehicles before these components are transported to the company and assembled.
5. Innovations in Ambulance Manufacturing
Innovations such as improved communication systems, electronic patient care reporting, and electronic field triage systems are helping disparate emergency responders to interact and coordinate in life-saving ways. Emergency medical personnel also use the vehicle to convey specific and up-to-the-minute clinical impressions and real-time patient vital statistics to the receiving hospital. With the use of big data in the healthcare industry, emergency medical teams are going beyond simply collecting and utilizing additional clinical data. The advancement of technology is allowing emergency medical personnel to share richer medical data and information to help optimize the emergency decision-making process. Increasingly, ambulances and emergency department teams are able to share a patient’s vital status, pictures of accident scenes and wounds, and even modality images.
Some advanced systems in a few pilot projects allow emergency medical service agencies to create real-time video conference calls between first responders and on-call experts to gather trauma teams and give them a chance to see a patient’s wounds or examine a site via phone. Investigations are ongoing to determine if telemedicine can improve communication, speed up arrival or transfer of treatment for emergency medical service patients. Automobile manufacturers now make five types of vehicles to replace older, more polluting vehicles. The redesign of these units requires ambulance manufacturers to work with template vehicle models, such as a minibus, as well as to see what the new unit is by adding some special attributes such as new technology, integration, redesign, and layout. This system has been shown to work with some difficulties, as it has to operate in the existing framework of minimal standards regarding door sizes and accessibility; space allocation; vehicle attributes such as engine capacity, seating, and lighting; and cooling technologies.
5.1. Advanced Communication Systems – Ambulance Manufacturing
Ambulance services these days are relying on a great deal of technology to effectively dispatch, identify, and track their ambulances. Most notably, ambulances are now utilizing global positioning systems to assist in providing accurate routing and up-to-date information. The ability for the medical team to send and receive important information is paramount to the required quality of care for patients in the pre-hospital setting during emergency situations. Advanced communication systems help in clearing the way for the swift transit to the hospital. Emergency patients present with a variety of clinical needs requiring transport to a variety of hospitals capable of providing necessary medical intervention or transfer care for definitive treatment. Many services are now beginning to employ live video feeds from the ambulance and provide remote transmission of vital signs including 12-lead electrocardiograms directly to the cardiologist on call prior to patient arrival. Several studies have shown that significant improvements in “door-to-balloon” time and overall morbidity and mortality of acute coronary syndrome patients are realized when the emergency medical service notifies the receiving hospital of critical ECGs prior to arrival. Improved pre-hospital advancements such as written or computer-based mechanisms and advanced communication systems between paramedics and the cardiovascular care center to activate the catheterization lab have streamlined this process, greatly reducing D2B times as well as overall delay. Real-time 12-lead ECG transmission has yet to be fully implemented in all existing ambulances. Remote monitoring capability has been shown to increase the efficiency and effectiveness of medical response during planned special events and air medical services. In one such case, of the 1,200 ground-based special events, only 120 required transport to the hospital. Only 2% of those transports resulted in patient admission to the hospital. No adverse patient outcomes were noted associated with the usage of a remote ambulance monitoring system. Bundled with this communication technology, however, are challenges in design and implementation. It is critical that training occurs at all levels and with all vendors to assure an effective and safe process. These need to include the pre-hospital providers/recipients including emergency physicians, nursing agencies, and field medics. This technology must be integrated into the existing framework of the emergency medical dispatch centers to assure accurate and full use arrangements. Improper use or lack of essential training in the utilization of transmission capabilities can disrupt dispatch, real-time command, and system entry. Wi-Fi or cellular phone capacity may be limited in certain geographic areas. While cutting-edge technology is on the horizon, the organization will continue to utilize technology with town and country communication as the only two-way EMS communications system in the United States. Verification has occurred from field units throughout the Midwest with zero information loss, difficulty in connectivity, and soundness in reporting. In DuPage County, Sheriff and Fire carry this capability in each vehicle with excellent town and country communication. Fire departments will carry this technology on the emergency medical vehicles for ST elevation myocardial infarction commands. This technology is utilized in other areas equipped with the capability of dispatch, computer-aided dispatch, law enforcement, and fire agencies at 700/800 MHz level communications only.
5.2. Telemedicine Integration – Ambulance Manufacturing
Technologically equipped high-end ambulances can help an ambulance doctor make a pre-diagnosis over the phone in some areas without having to wait until the patient arrives. In many countries, the results of tests for arrhythmias are sent to the hospital via a Bluetooth connection. This must be intensively clinically regulated. Most deaths from heart problems are due to the response time being more than 5-6 hours. If symptoms that may indicate a heart attack or acute pain suddenly occur in the chest, do not chew any medicine until the doctor’s prescription is taken. Telemedicine allows a patient in an ambulance to be advised or examined by a healthcare professional at a hospital, regardless of their medical ethics, breakthroughs, and the passage of time and place. Today, virtually any type of pathology can be remotely monitored by the medical industry not only at the hospital but also in the ambulance. Physicians in many parts of the United States, the United Kingdom, and Germany are trained in telecare. Thanks to telemedicine, a patient with a stroke can receive medical advice from a neurologist in advance who does not need to be transported to the hospital, reducing complications and medical expenses. In short, telemedicine allows a physician, nurse, paramedic, or EMCC operator to consult with patients or physicians via audio, video, photo, text, or other means during transport. Over the phone, the information can be sent to the medical call center or the ambulance dispatch center via a text message or email. Depending on the software installed and the development of telemedicine services, it is possible to talk with the doctor or consultant via video for further assistance and to send photo or video documentation during transportation. At the same time, it is important for the patient to receive an explanation from the doctor. The benefits of telemedicine in the ambulance are that in a few minutes, both the ambulance doctor and the hospital consultant can have enough information about the patient, so they can advise the best possible intervention, drug, and location. It is also possible to send the patient to the nearest and most appropriate hospital, without having to re-route them later. Only about 200 ambulances are currently equipped with such a system.
6. Sustainability and Green Initiatives in Ambulance Manufacturing
Sustainability and Green Initiatives in the Ambulance Manufacturing
There are growing trends towards green or sustainable operational manufacturing plants and processes. Similarly, paramedical services are developing sustainable solutions in vehicle manufacturing. Ambulances have high maintenance and operation costs due to the extensive use of the vehicle. As a vehicle manufacturing company for ambulances, there are many challenges to produce products under a sustainable label.
The fuel consumption of ambulances ranges from 13-17 km/l or 8-10 l/100 km. Fuel consumption is based on the weight of the vehicle, with a correlation that the heavier the vehicle, the higher the fuel consumption. Since an ambulance carries an extra load of fixtures like stretchers and oxygen cylinders, costs are steadily increasing as a viable alternative to secure additional financing to reduce internal and peripheral expenses. Advances and investments in this specialized research and development help accelerate their growth and commercialization for improved use of those commodities. Initially, the capital expenses related to manufacturing any adaptive ambulance vehicles according to the guidelines are through internal combustion engines.
To enhance eco-friendliness, such as reducing air pollution and adapting to sound axis tolerances, an eco-friendly manufacturing process is established to optimize the movement of the vehicle by changing the power distribution volume and direction in a synchronized manner. Emissions from the transportation system have been evaluated, and eco-design parameters for caliber, ethics, environmental impact, social performance, and safety have been analyzed. Furthermore, the automotive industry is always inspired by technologies like eco-friendly systems that reduce pollution. Current trends in ambulance technologies have greatly inclined towards electric vehicles and hybrids. There is a substantial amount of government incentives for waste reduction due to pollution. The government mainly provides subsidies to ambulances that are environmentally friendly. The disaster has been prompted by the avalanche, which has led to a large number of rescued vehicles using green initiatives that have also been indirectly saved. Another important factor is that when the completed product of an ambulance reaches the user, the company realizes that the distance to the destination may not be too far, often just a few kilometers within the city or town. Many times, the vehicle uses electricity rather than alternative fuels. The fact that paramedics do not have to keep standby to drive a diesel vehicle was one of the crucial factors for producing electric vehicles. This also makes vehicle tracking extremely straightforward and easy. To summarize, the healthcare industry is certainly inclined towards an eco-friendly transportation system. The Emergency Multi-Purpose Vehicle Weight (EMVW) is defined as the weight for a given ambulance type used to carry a patient and two crew members; for a given vehicle, it is two-thirds the weight of the payload stated. The EMVW is included in the European Community Whole Vehicle and can be summarized in simple terms as it relates to the “Certificate of Conformity” as one of the release documents.
Section Summary: Sustainability and Green Ambulance Emergencies – Innovation Trend.
6.1. Electric and Hybrid Ambulance Models – Ambulance Manufacturing
Medical and ambulance practitioners increasingly perceive the need to develop and adopt electric and hybrid models of ambulances. The propulsion system of these models brings the lowest levels of pollutant emissions and noise, contributing to the reduction of CO2 levels. Moreover, although they present higher investment, they will enable lower fuel costs and, mainly with electric ambulances, the cost of recharging is significantly lower compared to diesel costs. In addition, they bring technological features in the traction system, such as power management and regenerative braking, that greatly increase the performance and energy efficiency of the vehicle. Not only the ambulance industry, but several car manufacturers are investing or planning to increase their proportion in pure and hybrid electric vehicles. The main challenges and barriers for the increase of ambulances are the higher acquisition costs and the still-limited range of pure electric vehicles. In the case of electric ambulances, there is a limitation to the installation of batteries, which reduces the range and, in many cases, makes recharging in a hospital impossible. Additionally, the recharging infrastructure in mixed regions is not available, with the recharging time being too long for emergencies. In the legislative scope, despite the existence of regulatory standards, the new vehicles and recharging stations for electric and hybrid mobility require new certification processes and the training of professionals, thus increasing their widespread implementation in the healthcare industry. Several case studies of the adoption of electric and hybrid ambulances show increasing use of electric ambulances. These case studies show the benefits of reducing greenhouse gas emissions in the transportation sector and the healthcare industry. They also address trade-offs and growth in the sustainability of ambulance manufacturing in these markets. Some final comments are in order. In conclusion, it is important to innovate the ambulance industry and adopt electric and alternative models of vehicles, combined with green supply chains, minimizing the environmental impacts of the ambulance system and producing higher energy-efficient ambulances. All advantages such as lower pollutant emissions, low self-noise, and high reliability in energy management of the vehicles prompt a positive perception by a large share of practitioners, entrepreneurs, and professionals in developed countries. The power supplied by the electric-motor ambulance without using electricity-generated mobile medical room applications is considered not to have a high health security impact since the energy sources are less dependent on energy, CO2 consumption, and hydrocarbons, leading to a negligible impact for instant adverse effects of CO2 or electric energy. In the case studies, one developed urban electric ambulance performance has a patient transport capacity of 2,559 patients, while the other regional pure electric ambulance has a maximum daily service capacity of 791 geriatric patients. The performance of a hybrid prototype semi-urban and urban ambulance that runs on conventional fuel, while the capability of minimally-dependent and energy-efficient powering non-acute mobile healthcare has full hybrid capabilities with an autonomous electric drivetrain.
7. Case Studies and Success Stories Ambulance Manufacturing
Lare leads to Aintree and other awards Adaptive architecture The frontline medic’s perspective Cushions Splints and reels Consideration of all onboard tasks Affording capabilities. How should we be window shopping? These extracts from our discussions and interviews with successful ambulance service customers give insight into what impressed each about their chosen mobile ICU design. The last comments provide food for thought for every current and potential ambulance manufacturer. By illustrating ‘what works’ in a difficult environment – in other words, innovative advances in at least patient care and operator need satisfaction – we hope to encourage other innovators to step forward and explain how their pioneering architectural and interior engineering designs arose and suit today’s medical, practical, all-situations realities. That is to say – this section doesn’t stand by for tomorrow – much of this new technology has been developed today to answer the needs of the last 100 years of emergency transport, ambulance attendants, and patient care. It works – and we think this is worthy of serious reconsideration by everyone who must consider ambulance design. Whether you are on ‘the rolling chassis or infrastructure production side’ or ‘just’ helping, day in and day out, to transport people in distress.
7.1. Impact of ICU Ambulance Manufacturing in Emergency Response
In-depth case analysis confirms that the deployment of ICU ambulances improves overall critical care during transport. These ambulances have highly specialized equipment and facilities. The analysis shows 38 case studies using ICU ambulances for emergent transportation of severely afflicted patients. It was observed that a good patient condition endpoint was achieved in 22 cases. Of these, 21 led to patient discharge with good general health. In another case, the patient was discharged from the hospital in good condition. Only three patients showed severe complications in three different ICUs. It can be presumed that the cohorts transferred by these customized ambulances carried a more severe condition at the outset. Therefore, they are more likely to present with more critical events while hospitalized and might have needed more specialized ICU care. Various medical devices can be available within ICU ambulances to equip differently compromised patients. An in-hospital case-control study comparing patient outcomes under routine care in the conventional ambulance and ICU ambulance indicated that the employment of the specialized ambulance unit efficiently reduces emergency in-house time in patients by 51.3%. The application of this ICU vehicle scale-up may also enhance emergency care services in terms of in-house potential and disaster response situations.
Specific in-depth case analyses conducted by healthcare professionals who are familiar with the context in real deployment settings reflect that the ICU ambulances used in certain regions demonstrate considerable significance across various perceived facets, such as a tremendous direct impact on the continuity of critical care and the response outcomes, given quicker response time and an increase in patient survival. An emergency and critical care medical center began using a specialized ICU ambulance in an effort to establish an enhanced pre-hospital care system. A review by a healthcare professional revealed some interesting and positive outcomes with the operational ICU ambulance. Specifically, it was found that the new service had expedited the emergency response as well as the initiation of appropriate critical care, improved triage quality, and subsequently the patient outcomes. The mobility is quite commendable compared to what was previously available because of its new vehicles. This allows interventions to be delivered at the scene, thus presenting the significant impact of ICU ambulances on patient outcomes. Furthermore, the quick transfer reduces overstretch and congestion in hospitals. In comparison with the previous in-house ambulance vehicles, this vehicle does induce added value to emergency services, such as quicker patient management at the hospital and the prompt return of healthcare providers from remote clinic locations to the hospital.
8. Future Directions in Ambulance Manufacturing
A number of newer innovations and product offerings are available to ambulance design engineers and the end users of medical and transport services. The integration of artificial intelligence with vision and robotics technologies can provide very precise situational awareness which, combined with a perennially updated electronic prehospital medical record, could well improve the accuracy of dispatch to the benefit of the patient. Unmanned aerial vehicle type equipment could also enable the faster delivery of medications such as those associated with sudden cardiac arrest to the community. This means if a first responder can diagnose cardiac arrest, bystander CPR can start, the unmanned aircraft system can be dispatched and arrive before paramedic ambulances for a faster resuscitation. Currently, many research and implementation questions would have to be answered before this came into effect; however, the technology may be in use in the near future.
In the event of regulatory, social, and ethical approval, reconfiguration of the patient care compartment and ongoing population aging may see the introduction of a positive pressure ventilated patient care canopy area. Robotic steering, parking, and automated connections could see even more time savings and improvements to personnel health and safety in the near future. The major challenge to the ambulance of the future could well be the public’s acceptance of the in-profession and out-of-profession vocation and the ethical strength of the elective treatment and non-inclusion shortfalls it exposes in society. It is likely many of the future developments in vehicle and method design will require changes in legislation, vehicle standards, and other regulations as such open, transparent partnerships between automotive and healthcare engineering need to be encouraged.
8.1. AI and Robotics in Ambulance Manufacturing
AI and robotics are getting integrated into the design and operation of ambulances that are likely to make emergency medical services efficient and less labor-intensive in the near future. AI has already shown potential for use in optimizing the routing of ambulances to reduce patient transportation time, maximize patient coverage, ambulance availability, workload balancing, and more. The filling of missing data and prediction of vital signs for a fleet of ambulances to provide proper treatment to patients has been showcased, whereas predictive analytics has been used to predict the days with high admission rates, integrating it with patients’ conditions to dispatch ambulances proactively to decongest the emergency department and reduce the waiting time for the arrival of ambulances. The proposal is to implement AI technologies such as computational intelligence, IoT, and machine learning to perform heterogeneous patient data acquisition and transmit this data accurately to hospital servers to enable timely rescue measures. Robotic systems are being integrated to assist EMS teams in diagnosis, treatment, and patient management and monitoring during patient transportation. An autonomous, low-cost, low-powered, general-service mobile robot has been designed to perform such tasks. Modern robotic systems are integrated into ambulances to provide timely and safe treatment at patients’ homes. Autonomous robotic arms are integrated to lift and load patients into the ambulance without any manual intervention, reducing human errors and preserving staff safety, offering research and commercial opportunities for vehicle manufacturers. Today’s AI is not a trivial concept, as it is a confluence of several enabling technologies like IoT, edge computing, and cyber-physical systems. A variety of technical, ethical, and operational challenges would be faced by manufacturers and emergency services, such as the need for significant training and education to take advantage of AI’s benefits. Interest has been shown in developing VAT that can be readily integrated with new vehicles and retrofit old ones as well. Such existing systems help position the proposed solution in the ambulance market.
