1. Introduction
Ambulance Vehicle Manufacturers; According to the traffic data of the Ministry of Security and Public Administration, there were approximately 700 vehicle accidents every day among 26.8 million vehicles in Korea in 2017. In an accident, serious injuries occur at an average rate of 31.1 people per day, and an average of 3.5 people die in an accident. The number of injured patients transported by an ambulance is about 120,000 per year, and a large number of patients visit emergency medical centers. These patients need to move rapidly while receiving care. Emergency medical services (EMS) is a system that provides emergency medical services. The patient has a right to receive an emergency medical service and is legally obligated to provide the necessary emergency measures and stability until the patient receives necessary medical treatment at the hospital. Among the many conditions affecting the patient’s condition, it is possible to reduce the disability and death of the patient in advance by moving the patient to a hospital that can provide appropriate emergency medical care as soon as possible.
Ambulance vehicle manufacturers caused changes in the emergency medical services (EMS) environment and thus changed the paradigm of emergency medicine. Until the 1970s, ambulance services were not used and privately owned automobiles were used as response vehicles. In 1970, the Emergency Medical Services System Act was enacted in the United States to form a system for transporting a patient to receive emergency medical care. From that time on, special vehicles for transporting patients to receive medical treatment were built according to the prescribed specifications and applied to emergency medical services in each country. In 1973, the first ambulance appeared in Korea, and some vehicles were transported to the hospital with siren sounds. Over the past 50 years, companies that produce and supply ambulances have developed an emergency medical environment by developing technologies that can stabilize the patient. They continue to lead the market while responding to industry and customer demands in a rapidly changing emergency medical services environment. However, manufacturers that have shaped the emergency medical services landscape have not drawn much academic attention to their management strategies.
1.1. Background and Rationale
A comprehensive and effective healthcare system is an essential component of most modern and advanced welfare states. This system includes both preventive and curative healthcare services. As the population increases and urbanization deepens, so do various types of accidents, acute illnesses, and emergencies. Exposure and access to quality emergency medical services (EMS) would lead to a decrease in the economic and social costs of these accidents and emergencies. Decreasing morbidity and mortality and lowering the treatment costs induce governments to invest more money in order to provide faster and more effective EMS.
Providing superior service to patients has become more important in EMS over time. Patient transportation is one of the most crucial processes of all of these services. All patient transportations should be fast, safe, reliable, equipped with all or most advanced medical devices, and completed in comfort to hospitals. Rapid progress in both medicine and production technology has brought about significant developments in medical devices and floating systems used in ambulances on the requirements of these services. These, at the same time, increased the required amount of investment. Nonetheless, even the best-equipped ambulances cannot provide the required medical response when the hospital lacks the equipment. The human factor of EMS also tends to quickly adapt to these developments, which are in the scope of both on-the-job training and the use of medical devices in practice.
1.2. Research Aim and Objectives
This research aims to explore the impact of ambulance vehicle manufacturers on emergency medical services, focusing on a case example and their role in the medical equipment within the vehicle. Therefore, the objectives of the research are as follows:
1) To explore the history of ambulance vehicle manufacturers to date, listing the development and range that manufacturers of ambulances have performed in recent years.
2) To analyze ambulance vehicle regulations and legal issues in the manufacturing process, understanding the characteristics which surgeons consider for the purchase of such vehicles.
3) Identify the range and manufacturers of medical equipment such as stretchers or resuscitation equipment currently equipped in the ambulances and the re-equipment exposed by the surgeons focusing on the ICV company created in 1996.
4) Explore the current status of publicly recognized ambulance vehicle manufacturers assigned for the type of ambulance vehicle in Europe and the rest of the world by the European Standard.
5) Obtain the required approvals (CE-Medical Directive and 93/42) to market the self-manufactured medical equipment for the rest of the world.
6) Disposition of re-specialized personnel for the manufacture and maintenance of equipment.
7) Broaden the IC company with the creation of new medical devices to ventilate the AP-device through a tube through the endotracheal (intubation) called B-vent through and for the exclusive use of the premature called I-B-vent through.
8) Develop a new ambulance vehicle.
2. Emergency Medical Services (EMS) and Ambulance Vehicles
Emergency Medical Services (EMS) is the system responsible for the provision of immediate care to victims of sudden illness or injury. It includes evaluation, testing, care, and transportation. Ambulance services play a key role in the emergency medical services system, which responds to emergencies and provides medical transport to the required treatment centers. Quality vehicles guarantee the delivery of reliable and timely service, which is essential for the safe transportation of patients from their location to appropriate healthcare facilities. Being the first gateway of healthcare facilities, ambulance vehicles have become the most important factor of emergency medical services around the world. Most of the developed countries have very good infrastructure and facilities for emergency medical service’s ambulances. Some ambulances are operated by the emergency medical service, which they also send two or three costly rescue staff. After the patient arrives at the hospital, the hospital sends civil doctors or nurses to take care of the patients in many hospitals in developed countries. However, in the less-developed countries, if an individual wants ambulance facilities, they need to call private ambulance companies. They may not be operated by an emergency medical service.
The design of ambulances is heavily reliant on the medical care system, licensing requirements, reimbursement rates, and the availability of vehicle manufacturers. Ambulances must be built with the best performance, flexibility, and function to comply with national safety standards; they should also incorporate medical equipment. Remarkably, the demand for emergency medical services throughout the world has revitalized the development. The design of the ambulance becomes more complex, incorporating more sophisticated medical equipment to save lives and curb disabilities. Due to the increasing demand in the global market, ambulance vehicle manufacturing companies have put their focus on it and are introducing the most novel healthcare and life support lifesaving equipment with adequate interface design into the vehicles, which can provide incessant care, of course. Therefore, there is much interest among vehicle design and manufacturing companies in delivering the best of wellness. There have been several steps taken in the ambulance vehicle to develop it in a competent way, and it will draw the attention of many industries who are inclined to the EMT field.
2.1. Overview of EMS Ambulance Vehicle Manufacturers
It can be said that in every second of the world, someone’s life is in danger. But when this is said, the fastest possible help is also anticipated. Although many kinds of vehicles and facilities are used for individuals to reach the healthcare institutions providing help for the cure of the existing health problem, vehicle usability is most pronounced especially where the existing health problem has reached its severe level, i.e., at the end of the treatment line.
It cannot be denied that individuals can reach healthcare services without any problems from predetermined places in society, but they may not be provided with the chance to reach the treatment experience for which emergency medical services (EMS) are used, in the fastest possible way with some vehicles available in transplantation circumstances. Since the vehicles used in cases of need can access different serviceability with different technicians in a nation’s defined area, in order to ensure fast response in health issues in emergency states, the expected service quality is expected to be higher than the average level in day-to-day life conditions.
The transportation of all kinds of injured and acutely sick people, and at the same time, specialty and patient transportation vehicles which need to be hospital-based services, depending on the presentation of the necessary experience and abilities, is called an ambulance.
2.2. Role of Ambulance Vehicles in EMS Ambulance Vehicle Manufacturers
Ambulance vehicles are a significant part of EMS and often support the main characteristics of EMS services. According to the types of transportation, three different equipment groups might be used for the transportation of emergency patients. These could be determined as ground EMS (ambulance vehicles), air EMS, and water EMS. In accordance with related research and literature, the most doubtful and known impacts of vehicles are within ground EMS. Other than these, air EMS vehicles, which are often determined as air ambulances, have significant impacts on patient survival rates and outcomes too. Because they have limited time for delivering the first patient interventions among hospital facilities and EMS service locations. However, within their speed factor, ground EMS vehicles can also have impacts on patient survival in terms of the time needed for delivering the first intervention to the patient. More transportation and vehicle interventions related research continues in EMS to be able to understand the real benefit of these ambulances in EMS. There are some specific key factors that can affect vehicle-related and transportation-related discussions and furthermore, research topics in EMS.
In general, the development of physical vehicle characteristics is received within the construction of vehicles. Factors like construction materials, body type, body size, overall vehicle shape, body structure, weight, in-vehicle technologies related to electronic devices and information systems are supported throughout the development in vehicle design. On the other hand, there are several other additional parts of an ambulance vehicle that are determined as general standards and service requirements. For example, stretcher systems are used for patient handling and these systems always have key characteristics such as easy and safe handling, secure carry without injuries, ability to rotate, easy fitting within the vehicle space, position with restraint principles, design to meet different measures. The management of emergency medical services will fulfill the compensation of current deficiencies via efficient vehicle design. Heights, features, and ergonomic principles within ambulance vehicles aim to reduce long-term physical complaints and occupational health hazards of paramedics while also spending effort on patient comfort and provision of additional danger of accidents. In the end, the creation of simple and similar products should be provided in the supply process of various countries in accordance with the characteristics stated in international standards.
3. Ambulance Vehicle Manufacturers
The production of vehicles for medical purposes, and particularly for medical emergencies, began in ancient Rome, where chariots were provided to transport the casualties of battle. The production of specialized vehicles for the evacuation and transportation of the sick and wounded was then developed mainly within the army. Notable among these is the construction of the first vehicle for the exclusive provision of medical services by the Paris Hospital, in 1897. Due to the absence of the right to make proposals and the passage of many years before a factory owner designed and produced the first ambulance vehicles in Brazil, an importation process was initiated from American International Motors, and, in a partnership, Brazil and emergency ambulance vehicles were nationalized at International Motors, originating the first company ambulance in Brazil.
Due to their nature and the distinct objectives that guide them to attend distinct segments of emergency services (public services, private services and outsourced services), today, a market of ambulance vehicle manufacturers is formed, which carries out volumes and competes regularly for the perspective of conquering clients with the most diverse needs. Over the 19 years of the questionnaire survey, some specialized companies have been identified, which sell, produce, distribute, rent, import and take care of the vehicles in the market, called here a group of UNIGEL companies and another ICU Company. These participating companies then correspond to a representative portion of the entire market for ambulance vehicles, taking care of the fleets of patients that they themselves, their original manufacturers, are aiming for.
3.1. Key Players in the Industry
Ambulances routinely transport patients between hospitals, nursing homes, and medical facilities, effectively bridging the medical profession with these and other health-related activities. Ambulance services are vital for maintaining a system of organized emergency care. Nowadays, there are ambulance vehicle manufacturers in the world who have developed self-developing standards, technology, ongoing innovations for different emergencies, and patient transportation needs. Ambulance Vehicle Manufacturers; ICU Company has been involved in the safety and innovation of ambulance vehicles since the day it started its business life. Ambulance and emergency services play a crucial role in maintaining the public health system, primarily concerning road and public area accidents. Also, emergencies and medical needs requiring emergency departments increase to many levels. Along with the increase in emergency behaviors, the need for emergency ambulances has risen.
Ambulance vehicle production and preparation are an important topic. The company stands out for its ability to perform a variety of special conversions. A classic example is the growth of ambulances and other vehicles vital for the public health system, which ICU has manufactured for decades. The development of technology and the advancement of equipment used by hospital emergency departments regularly compel professionals who take responsibility for this type of transport to regularly analyze and redefine their mobility to allow them to always be in step with any changes. A great example of an ambulance vehicle manufacturer that provides a wide spectrum of services for the development of the emergency medical services sector with all its integrated approach is ISU Company. The company performs its operations concerning the standards that the companies are requested, and they have years of experience in forming different vehicles that meet international safety protocols. These vehicles, which include ambulance vehicles, are manufactured to provide the best-quality vehicles to the relevant fields.
3.2. Technological Innovations Ambulance Vehicle Manufacturers
Emergency Medical Services (EMS) tends to be a capital-intensive operation with an overriding, though not exclusive, reliance on ambulances. The ambulance vehicle sector is one of the niches that can facilitate and update the motivation to increase pressure on EMS. There is great opportunity to make a significant impact, yet transport parameters for actively ill victims remain stable because the majority of vehicles mainly provide transportation. This stability was translated as subject to competitive pressures and was not in line with supplying subject quality under a fixed remuneration system. There is certainly potential for financial benefits among vehicle suppliers, however, not only if this impact comes. First of all, the goods provided will define the service delivery characteristics and the authority of the supplier or driver body making up the opportunities. Also, the vehicle will reflect the state in medical efficacy and efficiency based on the technical field. By differentiating with the car manufacturers in both areas to question this issue, the researchers briefly dealt with the legal regulations for the vehicle. The insurance factor is another financial aspect to encourage the development of quality goods in line with the desired benefits of the system. It is essential to define and qualify the vehicle and what is provided as part of its market and compliance for agencies that determine service levels and minimum performance characteristics. The driver-related policy of the vehicle provider will be the technical stages of the breaching process such as destination, staying, transporting, and unloading routes. This process also intervenes by encouraging use to ensure a reasonable availability of equipment.
Technical innovations in vehicle structure, equipment, and performance are the consequence of persistent environmental changes in the policy-making progress. Most countries have increased their priorities and ecological performance toward providing cleaner transport modes. This policy is generally related to cars, and the tax regulations provide higher incentives than single-purpose sales. The scientific data generally violated this trend, setting out the best compromise solution by defining the characteristics of the vehicle or by imposing high costs or operational restrictions. The balance between the vehicle parameters is also an issue and does not relate solely to the ability to reduce pollution with fuel consumption. The vehicle’s communication and control functions are supported by the development of new technology to improve both the management of field operations and emergency delivery cares. The new technology of vehicles also continues addressing some very important health issues that come close to the transport mission and concern the environment.
4. Case Study: ICU Company
The basic goal of ambulance vehicle manufacturers is to produce better-qualified products than others and to reach the final consumer with a certain quality. The first goal that comes to mind for emergency ambulances is to produce a better, more reliable, and more comfortable product. ICU Company is a South Korean company that operates under the umbrella of Hyundai Motor Group. Although the aim is generally said to be the production of electromechanical devices and the manufacture of parts, in the same way, the production of ambulances is also a part of this activity. South Korea maintains a high-quality standard in every product that it has brought to the present since the knitting needle. The fact that one of the largest companies is working in this field increases its importance.
In general, the company’s production is organized not only to meet the needs of its own field but also of the general market and to use the production capacity at the maximum level in times of economic contraction. In order to realize this situation, it is not a company that leaves the market or changes the commercial strategy, on the contrary, it produces a qualified and reliable product umbrella that can supply all the products with a continuous and qualitatively continuous supply. When the ambulances used by various organizations for pre-hospital medical services in the world are examined, their external properties can be similar. The design of vehicles is generally standardized and is integrated with the services provided. When considering this uniqueness, structural standards are considered. These features address the needs of the staff. For example, both the exterior body armor used in counterterrorism operations and the armored ambulance cases with different protection standards directly address the safety standards of the staff.
4.1. Company Overview
ICU (Intensive Care Unit) elevating first-class ambulances are used globally with their experience in the ambulance sector, along with the innovations of approximately 45 years. Providing services with its specialized and experienced team in its organized structure in the directives of “patient-first and 100% quality and satisfaction,” ICU ambulances are manufactured by being intertwined with the changing and developing technology and combining the team spirit, know-how, skills, and experience.
Safety is the predominant principle within the manufacturing of ambulances. The life-saving features are the key indicators forming engineering that is able to measure the priority and trust in the ICU vehicles. Besides, the presentation items are evaluated as being additional in terms of the message which is given to the patient who is on the way to recovery and the healthcare professional.
The structure of the interior space all shows that health insurance is evaluated in terms of providing a working atmosphere in safe and hygienic conditions. The modern design lines, accurate ergonomics ensuring safety with the best and highest quality elevating systems, the most advanced electrical system, and medical infrastructure units tailored to any specific need are features with vast professionalism in ICU Explore. It considers the satisfaction of the requirements of the occupants and offers in short language as “the ideal emergency healthcare specialist for ICU”.
4.2. Product Portfolio
Users’ keywords: Ambulance vehicles; ambulance equipment; medical equipment; ICU Medical A.S.; deliver types; ambulances as big and small series vehicles; vehicle chassis; after-sale service support; spare part assurance; technical training support: ventilator devices; automated CPR (LLSR) devices; software designs for our devices.
It is essential for a manufacturer to develop different types of vehicles before offering its products. Regardless of whether the ambulances are big or small series vehicles, it is seen that they are produced as A1, A2, and B2 types for different uses of hospitals, both in the city and in the country, and facilitate the needs of their use through these vehicles. Looking at the results of the 2018 data, it is seen that the ambulance vehicle manufacturers with expertise in the field and a product portfolio of their own like ICU, which specializes in ventilation and mechanical resuscitation (LLSR), have gained an advantage. ICU vehicle chassis that meet the common use of “Promaster,” “Ducato,” and “Sprinter” in the world, knowing the importance of spare part assurance and after-sale service support, offer both vehicle and equipment support to the end customer together. In addition to this, we continue our work on the Mercedes Vito, VW Crafter, Ford Custom, and vehicle chassis that do not have a place in different provinces of our country. Our efforts for the “Fiat Fiorino” type will soon exist on the Chassis. Our services offered, B2, A1 class vehicles, C1 class station wagon closed box vehicles, and 20 or 25 unit cage cramspurative vehicles.
4.3. Partnerships and Collaborations
Emergency Medical Services agencies often partner with ambulance vehicle manufacturers to help promote new technologies, share feedback on equipment, and to help design equipment that best meets customer needs. A survey of Emergency Medical Services agencies was conducted to explore the cumulative impact of the largest manufacturers on emergency medical services with a focus on the Interstate Commerce Commission, Hustilit, Marion Body Works, McCoy Miller, Medtec, Miller, Wheeled Coach, and Road Rescue. These conclusions will also highlight ICU and how this company developed from the acquisition of Medtec, and how this acquisition has also influenced the features of new Mobile Intensive Care Units available.
Many emergency medical services agencies have also collaborated with the eight companies listed directly for some type of research, product improvement, or to help with testing vehicle features. The behaviors and number of these collaborations are described. Furthermore, the possession and features of ambulances delivered by ICU were compared to the features of newer mobile intensive care units. Currently, the most recent type II van configuration produces a high cost of ownership and is not a contributing factor in the collapse of many emergency medical services units. Providing product information on these fleets can be useful for ambulance service managers, hospital administrators, manufacturers, insurance companies, and Federal Agencies.
5. Impacts and Future Directions
Ambulance today plays a significant role in achieving, sustaining, or improving a victim’s quality of life and status through pre-hospital emergency care practices. Characteristic growth in demand and the substantial increase in expenses for commercially marketable and technically advanced modern special vehicles powered by firmware, which are intended for high specialization tasks (emergency medical, fire and rescue, counseling) is an important factor underpinning their success features. The technical components of these automotive engineering, their use in medical emergencies, and the vehicles’ construction features are determining factors in the effectiveness of the emergency care system employed.
The current chapter has presented business aspects of a company that genuinely cares about stakeholder expectations in terms of manufacturing ambulances. The mentioned company is ICU, a private company, officially responsible for a sizeable share of the global market. The data from ICU’s business report have been used to define the company’s strategic prospective. In particular, it is a clear indication of the benefits that a company experiences in terms of its economic growth, the significant development observed for this particular type of emergency medical service, as a result of the close relations with target audiences, as well as a participation in emergency medical service and supply investments for Republic of Armenia and the entire global system. Note that only the most crucial, but continuously developing, aspects are addressed in this book. The conceptually crucial nature of these interactions was determined as the vital feature – a successful, innovative organization. We have approached, in an overwhelmingly simple, but with proven effectiveness and unimpeachable logic, which enables abundant mutual educational benefits.
5.1. Current Impact of Ambulance Vehicle Manufacturers
Critical discussions about the loss of ambulance vehicle manufacturers in these discussions are still very limited. The importance of distribution in economic development and importance for national defense have led many countries to enact policies that support and encourage domestic vehicle manufacturing companies to be suppliers of their ambulance needs. In almost every region in the U.S., wiring harness assembly continues. Internationally, the vehicle parts supplier community is shrinking much more quickly. Ultimately, some consultants propose that internalizing ambulance vehicle manufacturing will make EMS systems more resilient, sustainable, and adaptable, while decreasing both EMS costs and EMS risks. In the world’s largest mass-casualty incidents, the use of military personnel carriers as ambulances should be acknowledged as an ‘expert-tested’ emergency resource option and not, as is the case now, as a ‘there-are-no-alternatives’ way of remaining in charge of non-standard tools of value. No other required, such as communications, logistics, IT, and insurance. Manufacturers continue to shape the future of EMS ambulance maturity.
However, no matter how magic and brilliant a vehicle is, it is the people who actually get involved and transform it. This study began with the question of how to improve the performance of an ambulance and preserve the lives of urban patients time by its ability to adapt to the chaos of inner cities. Van and light truck specialists joined the team, not the practical, effective goods carrier, which also transports boxes or bags from point A to point B. Initially, with the conversion of low-roof ambulances, the chosen production value was luxury, a CEO who had again lost the bottom line of his industry. Since then, times have changed. Although no transport authority in the densely populated screening germs of bioterrorists and chemical agents was trading cargo space for patient transporters, a provincial company in New York chose the S-bar. In the War of Global Terror, however, the Department of Homeland Security hesitated and the singer of Searth Fleet sought funds two billion dollars after the release of the first concept cars, but units after Ford were designed. A parallel growth of market engines supports the most liberal designs of European ambulances. Every year, the glass lining of the shop window would kill the production and pension funds of the ambulance companies and ambulances that made fictitious ‘debts’ a non-stop speculating house mainstream.
5.2. Future Trends and Developments
According to the spending in the road sector as the most available global transport, and the information technology capacity, it is expected that the worldwide ambulance vehicles market will increase over the next decade, especially for emergency department ambulances and in non-U.S. markets. China market also will inflate for both small hospital and emergency department vehicles, and revenue growth is expected primarily from higher value equipped vehicles to transport more EMTs and patients. In the existing vehicle and chassis aspect, the trend is more complex, which include:
Demand for patient reduction services increased and profitability declined as non-public providers made a huge investment to carry out unwanted costs, which make non-public operators further increase the number of chassis engines, sold the old unneeded equipment to add to the market excess cabinets (medium role chassis) or even unloaded the excess plane. SIGNAL THE AUTOHON-installed emergency health services on behalf of the city may be too high or too low, and are calculated as the number of tasks performed by the personnel and the productivity of the EMTICU, regardless of the budget impact. It is difficult to view the revenue attribution of the insured in terms of the volume cost of the service provided to the health response area.
There is no next year to repay foreign debt, establish the required cash, short-term financing is insufficient or stop the project, to the end of the new ambulance, into negligible net values, parties interested in the community or installed public service of the route should: communicate with taxpayers regarding needed improvements and expansion of public services, try to solve “white issues,” and to give priority to unpaid commissions. In summary, all provides exploration and conversion are provided that the ins to institutions 39 after completion of the transaction will result in a decrease in profitability and an increase in the payment or total shortage of the costs related to the provision of the service. Provide users with such notification headers and pay concert 39 40 1 According to section 5.1 In section 5.3, this research will assist emergency service personnel to measure the user’s willingness to pay for the provision of these commercial or public transport services through accreditations, arrears, reserves or completion notes executed. For foreign health institutions and institutions, this study will provide them with additional information on the cost, transfer and operational performance of the PBAC and CAAs for the application of a credibility rating.