1. Introduction to Custom Ambulance Manufacturing
Custom ambulance manufacturing involves the creation and design of ambulances built to the specifications of the purchaser. It depends on an array of materials and accessories to meet the demands and preferences of each buyer. Inside an ambulance, patients may require a highly specialized environment, as monotone white environments have been shown to cause anxiety in patients. Additionally, they need to be eco-friendly, and paneling in resin impregnated with hemp has been demonstrated to be 100% biodegradable. It should bring change from $500,000 to $2,000,000.
This paper highlights innovations and trends in the manufacturing of custom ambulances as a contribution to the industry. Factors affecting this customized manufacturing process are discussed, with specific reference to technology advancements and changing consumer demand. Observations are also made about the drivers and restraints leveraging these trends. This paper gathers useful data to predict opportunities in a rapidly evolving marketplace. A custom vehicle is specially redesigned to fulfill the donor’s personal preferences or standards. Although custom vehicle design was previously primarily for private individuals, businesses now account for the majority of the custom manufacturing market. If you have specific requirements, an increasing number of businesses, ranging from small businesses to niche manufacturers, specialize in developing high-end, customized vehicles.
2. Design Considerations
Design considerations for custom ambulance manufacturing center on the arrangement of systems and features in such a way as to enhance patient care, comfort, and well-being, and protect caregivers and operators from potential harm. Following the patient from point of entry, into the ambulance, to extended care in an institutional setting, and all elements of patient handling, care, and monitoring in between direct many of the design details for the vehicle. Many aspects of the design of the vehicle may be described as ergonomic, which to some extent is a detailed exploration of human factors engineering.
Importantly, if the vehicle is designed in such a way as to facilitate patient care, caregivers and care providers can more quickly administer needed care, and do so more effectively, improving patient outcomes and reducing overall healthcare costs. It is also considered that using a vehicle as a fully integrated part of the patient treatment and care continuum has the potential to be a differentiator for existing protocols and transport technologies in ambulance vehicles and design. Morphing these ideas even further, it can be argued that patient outcome and care may become vehicles for selling vehicles, especially when accompanied by outcomes measurements and patient satisfaction scores not currently obtained by domestic manufacturers of ambulance vehicles. Market reports from industry analysts indicate that efficiency and cost savings are growing consumer demands. As machines designed for human occupants to perform tasks, ambulances are moving ergonomic mobile environments. Design of any type of emergency vehicle can greatly impact the efficiency with which caregivers, paramedics, and EMTs can administer care, work, and communicate, and how technicians and maintenance workers service the vehicle. Features that determine operability of the vehicle and available systems are of particular concern, since design features very greatly can hinder or enhance successful functionality.
2.1. Patient Care and Safety Features
Equipment and design features focused on patient safety and care are important elements in custom ambulance manufacturing considerations. Certainly, high-end custom ambulances may house advanced equipment, such as the hitches and stretchers of Sullivan Ambulance remounts, a company known for its extensive work with ambulances, and the safety equipment of Lifeline, some of which are installed in ambulances providing service at Richard Childress Racing. Numerous custom special features are designed to enhance patient safety in transportation and facilitate complex medical care. Such innovations include Lenco Armored Vehicles’ Ramp Bypass system, Braun’s EZ-Load system, and multiple Stryker and Ferno Special Operations Rescue Unit Models, as well as the customized adjustable rear suspension that has been included on some Horton ambulances. Custom patient care-related design features can range from highly specific innovations such as an Altamont Ambulance Service truck that is completely built for EMTs treating cats and dogs, a Lifeline E Superliner built with a “no adapter, no extension” ramp configuration to accommodate bariatric patients, or a Horton Type III Crossover with a “no lift cot easy clean” design, to a KME mobile microscopy command center for Albany Medical College, designed to provide care en route to the hospital in specific cases.
Integrating specialized design features into the manufacturing process can add developments to patient care and safety in EMS systems. The majority of literature on patient care and safety features focuses on describing innovative appliances or comprehensive patient-caring EMS systems primarily from a hospital perspective with limited reference to ambulance manufacturing. For example, Bledsoe et al. posit that High-Performance EMS has a large focus on using “beyond the van,” “throw-and-go,” “stand-and-deliver,” and minimal lifting concepts to decrease the amount of human intervention needed prior to hospital care, thereby increasing safety for both the EMS worker and the patient. They argue that ideally, “one should never have to lift and carry the patient”; however, our research noted that no matter how many features are made available in the popEMS system or the ambulance, human handling will likely never be completely negated.
2.2. Ergonomics and Accessibility
From an engineering and design point of view, there are two relevant considerations that one could take into account: the ergonomics and the accessibility of a customized ambulance. Ergonomics is the study of people’s efficiency in their working environment, with the aim of producing designs that facilitate the operation, effectiveness, and safety of equipment, systems, and vehicles. In an ambulance, this is relevant for the staff present in the vehicles. For example, research showed that there were concerns among the medical staff regarding the layout of the ambulance, the ease of use, and the capacity of their use under adverse conditions. There is also a substantial impact on the level of services that can be rendered in a timely and cost-effective manner.
Besides that, ease of access is also critical from the patient’s perspective. Patients with disabilities and other mobility challenges, as well as the older generation, are increasing. In the United States alone, approximately 20% of the population, which amounts to over 50 million individuals, have some form of disability. More than 75% of the 46 million people in the United States are older than 65 with some form of health problem requiring the aid of a person related to carrying out specific tasks. For the ease of movement, comfort, and quality of care rendered to sick and old patients, the seamless flow of patients into the ambulance is important. A new concept-level design that adequately caters to the physical requirements of both caregivers and patients inside a healthcare delivery custom ambulance can pave the way for major production improvements. Designing for ease of access involves planning and designing items that are convenient and beneficial to several individuals.
3. Technology Integration
3. Technology Integration
Custom ambulance manufacturers are now able to partner with telematics teams to install vehicle tracking and fleet management systems into every ambulance they produce. This cutting-edge technology allows the ambulance service, hospitals, and EMS departments to see their ambulance’s location at any time, provides scheduled maintenance reminders, records driver and vehicle operational data, and more. As technology continues to evolve, the utilization of various connectivity solutions to enable on-demand and remote medical consultations or other health services is becoming more frequent.
With the continued advancements in handheld medical equipment and tablet computers, the options for equipping ambulances with state-of-the-art connectivity are endless. Furthermore, medical supply hardware can be set up in ambulances, so medics may carry a single handheld “tablet computer” for multiple vital signs assessment requirements and integrate these tools into rugged computing hardware that can clean and touchscreen disinfect as needed. With advances in the availability and affordability of video telemedicine programs, some custom ambulance manufacturers are also exploring vehicles equipped with stabilization mechanisms and all the necessary input jacks and plugs to allow for real-time patient monitoring and video conferencing with a trauma surgeon in case of life-threatening injuries and other life-saving transfer solutions.
These types of systems, when paired with medical care consoles, also provide fleet management oversight, informing ambulance companies and EMS department managers about the location of vehicles and the number of emergency medical personnel working in the district, making it easier to customize and continually adapt training programs based on actual data about the number of patients treated with the services provided. Furthermore, the hardware and data requirements for this technology, which mirrors some fleet management software but is specifically designed for EMS and patient care models, are becoming more and more affordable for smaller departments.
3.1. Telemedicine and Connectivity Solutions
3.1 Telemedicine and Connectivity Solutions in Custom Ambulance Manufacturing
The capabilities of telemedicine and connectivity solutions are considered as the most important items of the custom ambulance manufacturing process. During medical emergency transportation, real-time communication between medical staff who stay in the ambulance and healthcare facilities helps medical staff monitor the patient to take quick medical intervention and helps them make decisions more quickly. The IT solution has become a very important item of clinical decision support for medical staff.
For custom ambulances equipped with telemedicine systems, the telemedicine doctor will be “on board” directly so that further decisions about patient treatment can be made upon arrival at the hospital. The decision will be based on the medic’s information and the result of the patient’s physical condition monitoring by the doctor at the hospital, which is integrated into the telemedicine system by the Biomedical Technology Department. This department has been involved in Accelerating Medical Preparedness for Military Warfighters Using Advanced Simulation and Artificial Intelligence (AMPT), which is part of the U.S. Army Medical Simulation Training Center at the University of Nebraska Medical Center. Recent developments in the architecture of telemedicine and connectivity solutions for custom ambulances in the context of telemedicine are summarized below.
A commercial tablet (iPad) has been integrated into the ambulance via an ambulance mount for ease of use but still maintaining mobility. The iPad can be taken outside the ambulance for the medic to carry it around the patient’s residence and record video of the patient or property damage. The medic tablet sends data to a server (IIS) that the University of Nebraska Medical Center is in control of, and they can then view the video. In addition, the medic tablet sends a text message to the system saying they are “clear” of the incident (or done); this is a command prompt. Everything the medic sends is recorded, time-stamped, and data-based. If the medic types a command like “clear,” that is recorded with time and date in the database for future post-incident review and analysis in the development of standard operating protocols (SOP).
3.2. Vehicle Tracking and Fleet Management Systems
Emergency Medical Services (EMS) systems need accurate and timely information about their operations, especially current ambulance locations, response activity, and vehicle maintenance levels. Custom ambulances are the final critical link in patient treatment and transfer for multiple levels of healthcare and all levels of emergencies. Emergency medical equipment, technology, and design for capacity to hold different size patients continues to evolve. Information is power, and getting the right information to the accretive personnel to dispatch the right-sized ambulance to get to the patient within the golden hour takes multi-functional teams working at peak efficiency. A custom ambulance manufacturer looks for a good return on multiple levels. Including building the safest, easy to clean, itching to the latest Intel Core college local EMS, and fire departments in other words, equipment. In April 2019, the Volume Division of Leader (Custom Ambulance manufacturer) recovered alarm pendants and key findings for such a vital part need to be durable, easy to press and activate, and been repositioned on the side to stay for some. Leader is in it for a forever business relationship.
Real-time integration of the latest global positioning system (GPS) vehicle tracking and navigation systems can help improve multiple aspects of prior vehicle installations. All current manufacturers with electrical and communications upfit to ambulances have incident dispatching and alert capacities with an eye towards improving safety and the efficient deployment of ambulances from the ambulance replacements and accident cleanup/recovery for customers, state and federal authorities. The quickest distance or fastest trip is not always the most efficient or fastest way to reach a destination. Our manufacturer dealers have the ability to configure GPS units for the end users in various ways. Notifications can be sent for normal vehicle maintenance like changing oil or a basic service, mileage or engine hour notification as part of extended ambulance and chassis warranty programs, or recall notifications for any vehicle space. The tracked data and analyses can be backed up and used for accident reporting, tracking, and faster insurance compensation, especially as more states adopt and mandate electronic verification of insurance for driver’s license renewal or suspension hearings. GPS tracking systems can be equipped with drivers for back office oversight to both track and analyze performance as with a standard sedan or to use the vehicle tracking system for the same standard reasons with emergency lights and sirens in operation. GPS and AVL integration can also greatly assist in the routing and diversion of ambulances during heavy traffic conditions on key arterials by selectively routing, on-the-fly, “green light” route information that has been tested during off-peak hours. This can minimize the miles driven and downtime in getting the ambulance back into service while optimizing the congested gridline resource allocation and enabling faster response times to nearby incidents. GPS tracking can even go so far as to assist with the tracks and types of warning lights running or stopped with or without sound.
4. Regulatory Compliance and Standards
When it comes to manufacturing customized ambulances, several standards generally apply to the process. The first of these is meeting and exceeding the federal KKK1 standard for ambulance specifications and ambulance remounts. This KKK1 certification is a key factor in the design, construction, and remounting of custom and stock ambulances. In addition, many manufacturers also carry the coveted ISO 9001 certification. The ISO 9001 certification is all about quality and ensures that a facility maintains a strong quality management system with an added emphasis on a customer focus, a constantly improving process approach, support from top management, and methodologies to ensure patient safety, legal and regulatory compliance, and continual improvement.
In a broader context, custom ambulance manufacturers are impacted by federal regulations. As they engage in the design of chassis to accommodate unique ambulance configurations, custom manufacturers must comply with National Highway Traffic Safety Administration (NHTSA) regulations. The biggest impact of federal standards on custom manufacturers is through the NHTSA’s Federal Motor Vehicle Safety Standards (FMVSS). Ambulances are categorized as Type I, Type II (often a van), Type III (a cab and chassis with a modular patient compartment), or Type III ambulance remounts (a Type III ambulance to which a new patient module is affixed). The NHTSA established ambulance equipment standards to ensure that key components – such as ambulance windows, doors, lights, and their equipment – did not pose an unreasonable risk of death or injury, but these standards do not regulate the design or manufacture of ambulances. The ambulance equipment standards do not regulate the design of patient compartments or impose other mandates that dictate the manufacturing process.
5. Case Studies and Success Stories
The final section should include case studies and success stories identified as critical in the previous section. It presents actual integration solutions or new designs based on the customer needs and the displayed statistics in exceptional circumstances. This can deal with the required technology (all described above), innovative medical process solutions, or modern design of these units. At the same time, explaining how these examples go beyond current standards will allow the readers to understand how these ideas might be implemented in future ambulance production. Examples from different countries would be especially beneficial.
How to prepare a successful manuscript based on this content: Depending on trends and innovations observed in published literature during the literature review process, it might be possible to elaborate more on this section. If obvious examples are not found, however, it may be more prudent to focus on summarizing the conclusions and looking forward to the future. Concentrate on the evolution of ambulances to demonstrate how a relevant and interesting manuscript can be prepared based on this paper. Clearly indicate how to address various elements of the aforementioned issues. Consider whether changing EMS and other concepts as well as other procedures influenced ambulance production. This will provide an excellent basis for creating a manuscript.