1. Introduction
Ford Transit Ambulance; The demand for emergency medical services and a variety of medical equipment in low- and medium-acuity transports is increasing day by day. Designed properly, the ambulance can help provide better medical care in less time. It has been seen that paramedics often waste a considerable amount of time finding medical equipment for patient care, which can be crucial in handing over the patient within the “golden hour.” That is why it is important not only to have a sufficient amount of medical equipment in the ambulance, but also that the medical equipment is ergonomically set up, as is the storage of this medical equipment. Several attempts to optimize the configuration of medical equipment in an ambulance focusing mainly on medical equipment storage or van body building have been made.
The research question is: “Are there any differences in the configuration of medical equipment in Type 1, Type 2, and Type 3 ambulances?” Ambulance manufacturers and van bodybuilders in the country are trying to design ambulances according to the needs of the respective agencies, not having a common standard. It is therefore expected that the greatest difference will be between Type 1 and Types 2 and 3, as remounting is restricted in Type 1 PD configurations because it is built on truck platforms, while Types 2 and 3 are built on van bodies. The complete configuration data for Types 1, 2, and 3 ambulances were requested from the ambulance builder. From this data, the most complex non-type-specific equipment was extracted.
1.1. Background and Significance Ford Transit Ambulance
Ford Transit Ambulance is emergency medical vehicles intended to move injured or ill patients from the scene of an accident, a public place, or a residence to or between healthcare facilities. Historically, ambulance designs were built from non-modified commercially available vehicles. Today, over 95% of ambulances are custom-made commercial trucks. Many advances in ambulance design, patient care, and outcomes have been a direct result of how ambulances are designed and equipped. As the patient load on emergency medical personnel and equipment has increased, changes have occurred to ensure that the patient receives critical care at the hospital instead of in the ambulance. Using the appropriate medical equipment and medications in an ambulance is essential to patient care, but most research and design enhancements are done based on acute care and not transport. Ambulance configuration has an impact on transport, which will not only affect patient care but also worker safety. Over the years, ambulances have evolved as the treatment people receive has changed. The current market is using a third generation of Type 2 and many different variations and designs of Type 3. Changing regulations, new technology, and differing patient populations prompted this evolution. This change required manufacturers to consider best practices in design and configuration analysis. However, a review of current materials revealed a gap in the analysis of the best approach to the configuration of Type 1, Type 2, and Type 3 ambulances, improvements in safety and comfort for the crew, and availability and accessibility of equipment and medication during transport. In conclusion, an independent and yet unified assessment of medical equipment layout design in Type 1 and newly designed Type 2s and Type 3s is warranted. Political, military, and private ambulance operators have become increasingly interested in creating best practices for their employees and emergency medical response to those who need it the most – the patient in crisis.
1.2. Research Objectives Ford Transit Ambulance
The objective of this work is to propose the location with the highest practical medical equipment layout in three different vans, which are frequently used as ambulances, to speed up medical intervention in the ambulance compartment. The study discusses and compares different types of ambulances’ rear compartment medical equipment layouts and arrangements. It is also aimed to be a guide for ambulance room interior design and configuration. This study contributes to the literature by discussing the differences between Type 1, Type 2, and Type 3 ambulances, both from the outside and inside. It is of great importance for preventing accidents during the vehicle’s motion.
Due to high acceleration and braking values, it could be unsafe in the passenger cabin or the patient compartment. It would be helpful in terms of patient and healthcare staff safety in the ambulance vehicle. The default position in any vehicle should be the ideal position, taking into account the driver’s arm span. As a result, ambulances must be designed on a human scale to reduce the probability of human error. Moreover, after measuring the medical supplies, the ambulance compartment must be evaluated in terms of booth configuration and confidence interval combinations as desired to obtain a good layout. Attention should be paid to the location of the medical equipment, as this may affect the handling and distribution of the patients’ weight. The purpose of this study is to arrange the best practice lane, including the livelihood of the ambulance, to collect information on the current state and standard of furniture and equipment placement to develop useful recommendations for setting the ideal space for suppliers nested in future knowledge. Some ambulance kit setups were identified and compared through response. Overall, our results presented an equipment setting that showed recommendations for each of the ambulances studied to enable utilitarian entrance in the design process.
2. Ford Transit Ambulance Types and Classifications
Type 1 Ford Transit Ambulance, there is no universal design for ambulances. Instead, there are several types of ambulances of various sizes and specifications, designed and deployed around the world according to the specific needs and regulations of the country or region. The Type 1, Type 2, Type 3, and Type 3/N ambulances are recognized by the majority of regulatory bodies. This study is conducted in Turkey, where only Type 1, Type 2, Type 3, and Type 3/N ambulances are used. Although the use of Type 1 and Type 3 ambulances has decreased in the last few years due to difficulties in practice, in previous years they constituted the majority of the ambulance service. The use of Type 3/N ambulances was generally limited to rural areas due to difficulties in transportation and the provision of patient health services. In recent years, it has been decided that the number of vehicles used will be gradually reduced and withdrawn from the inventory.
This type of ambulance is a strong and unique unit consisting of the chassis of the commercial vehicle cabin and loading area, which are in separate locations. The Type 3/N bypass ambulance design contained all of the regulatory provisions other than its difference from the Type 3 ambulance. In the framework of the changing conditions of modern medicine, cargo ambulance designs have included equipment that has proven difficult in the process of providing patient health services. In general, this equipment is positioned in such a way that its use is difficult or cannot be utilized because of space limitations. Therefore, the positioning and design of the aided equipment in the modern Turkish ambulance design is crucial. It is also required to finalize a preliminary design process that highlights the critical properties of the design to facilitate the selection of original and highly successful spatial solution alternatives. Finally, it is essential to improve the user’s mental and physical performance in the superior product. With this administration, the accomplishment of efficient ambulance designs created with the theme of achieving high user performance is essential.
2.1. Type 1 Ford Transit Ambulance
The exterior of Type 1 Ford Transit Ambulance resembles a van. These are also known as emergency vans, walk-in vans, or van conversions. A Type I ambulance has a custom roof profile with an emergency service light and a running board. The emergency service light on a Type I late model always appears as a narrow horizontal line on the windscreen. However, many older models might have a peephole-like device on top of the front interior roof, through which the light is visible. This type of ambulance has a low profile that allows the transportation of patients in an ambulance area located very close to the driver’s and front seat passenger’s cabin, without having to purchase a crew cab chassis. Except for the emergency service light bar affixed to the roof of the transport module, all the other required accessories, such as the oxygen tank, the stretcher, and the medical equipment, are inside the ambulance and can be accessed through the sliding side door. Because the distance from the patient to the medical devices and the medical staff required to operate the devices is short, it is very convenient for medical staff to perform first aid and ambulance care services.
2.2. Type 2 Ford Transit Ambulance
Type 2 Ford Transit Ambulance can be described as a “Specialty Van Modular” ambulance and is a van front cutaway with a fixed ambulance module. The module originally installed on this type of ambulance can present itself in different ways: with a raised roof, called a high roof, which is placed as a sign of the ambulance manufacturer, presenting a frontal asymmetry of the cockpit, ending the front panel in new areas of fixation in the side panels of the module. In another configuration, the manufacturer adapts an internal subframe that forms rails throughout the periphery, performing the anchoring of the module, enabling its adaptation and fitting either in the original version of the vehicle or with a raised roof, which allows greater movement of the medical and nursing team within the conversion. The main manufacturers of freight van conversions only have vans with the original structure retired in this type, due to the low volume, making a special conversion. This conversion begins with the company removing the original roof and sanding, then welding reinforcements for the placement of the ambulance’s raised roof, lining with plasterboard or a similar insulating and waterproofing material, in addition to reinforcing the side walls for the fixation of the rails and completion of internal parts of the module such as a sliding door if the same should opt for an additional longitudinal seat in the module. The side access door receives adjustments in the two rear window openings; the rear platform can be made in different ways according to the need of the requesting institution, which can be fixed or removable. Since the dimensions of the ambulance module unit do not change, it can handle the same volume of equipment as type 1, but offering a more favorable price due to the reduced customization.
A type 2 ambulance, with fixed modules, brings the rear module to the original height, possibly changing the vehicle’s right rear wheel and employing an intermediate sign to rescue the injured through the door. The placement of the medical-hospital equipment can be absorbed by modifying the left door of the trunk to hold a stretcher, lessening the lateral traffic of the healthcare team. The composition of a transparent winglet, a tool needed for advanced life support, a pharmacy kit, and a transport ventilator placed on a shelf can be rebalanced from the ceiling. Placement of an inlet and outlet catheter adjacent to the pulse oximeter monitor, multifunction monitor, defibrillator, and blood pressure monitor, which can be mounted on the retractable shelf that can be used as a small desk, or on the wall with electrical outlet support for a battery charger, would fit well to withstand lengthy shifts without downtime loss, a Promobom oxygen cylinder stand, two Inaway foldable chairs, and two Inaway multiple boards support the team during transport. The cabin has an ergonomic look due to the wide layout desk and the presence of the folding shelf where the oxygen tank used for first aid and the respiratory system materials are kept, supporting accessories with disposable materials and maintenance devices. The front case, built for residential use, was adjusted and designed to accommodate an undercooled chest compressor and the second collapsible chair mounted on the left door. In the ultraportable undervoltage case, a pediatric and an adult intubation kit and Inaway-type portable lighting and portable cylinder stand are located next to suction equipment. The main advantages of the type 2 ambulance can be highlighted for the reduced price and the possibility of using any common car rental company. The inherent drawbacks to the type 1 referral ensure limited options for internal adaptation.
2.3. Type 3 Ford Transit Ambulance
Type 3 Ford Transit Ambulance is van conversions of light cargo vehicles. The establishment of this ambulance type was enabled by the contribution to the effort to standardize the Special Purpose Vehicle Classification, applicable to light-duty truck products. In 1996, the first Ford E350 Type 3 ambulance was for sale, loaded with a selection of emergency response equipment and accessories representing a vehicle upon which professionals may task organize and mobilize to deliver pre-hospital medical care to the sick or injured.
The vehicle offers features such as a rear-area liquid oxygen supply system, rear patient compartment HVAC with air filtration, and an extensively field-proven patient compartment welded shell construction designed to meet and slightly exceed the safety criteria of the Federal Motor Vehicle Safety Standards. The Type 3 ambulance is a popular model that can be safely operated by an Advanced Life Support crew due to its larger size and patient care capabilities. It is highly mobile, easy to drive and maneuver, and is convenient to use for transporting patients on longer trips when ALS is indicated.
3. Medical Equipment in Ford Transit Ambulance
Even though little has been written on the topic, effectively equipping ambulances is crucial for providing timely emergency medical care. The equipment located in ambulances varies, but defibrillators, oxygen therapy devices, supplies for bandaging and splinting, cardiac monitors, and trauma kits are some of the essential items. Furthermore, larger ambulances often accommodate many more tools and devices that can expand the medical interventions that may be possible en route or at the point of patient contact. All of the equipment mentioned is crucial in providing care and is required by some level of regulations or guidelines. Emergency medical equipment governance is of utmost importance for EMS organizations. While ensuring tools are functional comes from regular inventory management and vehicle maintenance compliance, several federal regulations and guidelines can dictate redundancy and frequency of inventory inspections. The equipment carried must be located and installed in the ambulance in a manner that facilitates easy access. This holds true for all types of vehicles but may be particularly important when space limitations would limit the number of types of equipment carried, for example, in the case of a small vehicle like a van. Still, some of the equipment might be limited only to specific types of ambulances, such as the stretcher and the weight it has to sustain. In order to decrease reaction times, personnel have to have also been specifically instructed to work on several pieces of the equipment from different potential locations.
3.1. Essential Medical Equipment in Ford Transit Ambulance
The first responder’s ability to provide the required immediate medical support during the patient’s transport to definitive care has been identified as a critical part of patient outcomes. Medical equipment is essential for emergency medical services to support the treatment regime en route to the hospital, even in the case of road traffic crash scenarios wherein most injuries are trauma-related and require transport to clinical care. This equipment can be divided into several categories: Basic First Aid Supplies: Such as bandages, gauze, and an assortment of band-aids. Advanced Life Support Gear: These are the tools and medications required to intubate, administer IV medications, provide external cardiac pacing, etc. Monitoring Devices: Heart monitors, pulse oximeters, end-tidal CO2 measurement devices, and noninvasive blood pressure measurement devices. Environmental Control: Things such as the ability to warm IV fluid, warm the patient using a blanket, and the ability to provide additional oxygen or suctioning to a patient. Spinal Immobilization: Collars, backboards, etc. Preplanning of this equipment is necessary to prevent any disorder or other problems. Essential equipment for providing medical support is carefully delegated and distributed. In addition, the equipment is tailored to the situation and personnel involved.
It is crucial that any equipment in an ambulance’s inventory is always in good standing as tools are essential in this field to help maintain the vitals and assist the patient. Meeting patient care needs has been incorporated into the following approaches to optimizing medical equipment inventory and layout, enumerating the tools needed to deliver care on a normal basis. To support the diverse environments and patient populations served by the EMS system, redundancy and adaptability have been included as optimization goals. Many prehospital care guidelines require that emergency medical service personnel prepare, transport, and assemble specific pieces of equipment. Developing guidelines and training requirements can ensure that the items included in the inventory are available when needed to resuscitate an unconscious patient and set up the monitoring, drainage, or other equipment necessary for emergency resuscitative care. In order to improve the speed and ease with which specific items of an emergency medical kit can be located, redundancy and commonality of equipment were studied. Withdrawal times were helpful. Sufficient training in equipment use and sight-independent placement are important to ensure that EMS personnel have effective access to the equipment on the inventory. The recommended training requirements and approaches are outlined in the following sections. Inclusion of the following features in all EMS systems and EMS vehicle designs must supplement ergonomics and levels of compartment access:
4. Comparative Analysis of Type 1, Type 2, and Type 3 Ford Transit Ambulance
In reviewing the literature, the authors of the current comparative study identified three different types of ambulances currently in operation in the United States of America. Type 1 ambulances are built using a van chassis and are specifically constructed for life support of the patient during transport to a medical care facility. Moving up in size are Type 2 ambulances, which are built using a van cutaway chassis. Not as commonly utilized is this chassis, but it provides space for additional top-mount patient compartments. Last is Type 3 ambulances, built using a chassis-cab and ambulance module. This modality is constructed using light truck box corridor compartments. The choice of chassis directly influences the size and configuration of medical compartments. Although models determine decisions related to various types of medical equipment and configuration, these decisions need to be updated due to an ever-shifting landscape of medical science. This lack of information suggests that research should be undertaken examining the relationships between vehicle physical design and effective medical equipment unit layout, size, and access in various types of ambulances.
The use of three different ambulances results in differences in equipment. Furthermore, work to reduce operational costs and address response issues has resulted in radiological equipment additions such as portable ultrasound systems. While a model may provide an optimal configuration for the combination of equipment present in its design, such a model does not quantify the differences in accessible equipment or make any note of the placement of equipment. There are many ambulances equipped with the same combination of equipment due to having similar situations and needs shared among them. Furthermore, most facilities will have already purchased their ambulances built to a specific type; changing the design of medical compartments may require a complete overhaul of their emergency medical system. The current study used a focus group of experienced emergency medical services staff to identify three different type configurations of ambulances in use within the United States: ambulance type 1—a single rear-wheel light truck, ambulance type 2—a commercial van on a track chassis, and ambulance type 3—dually light truck chassis.
4.1. Equipment Layout and Accessibility
Some proposals of methodological principles for the configuration of medical supplies in ambulances include their rapid search during emergency activities, ensuring a continuous flow of personnel and medical undertakings. These also display the graphic as a functional map inside the modules and an explorable metric connectivity among those places, where ‘explorability’ is relative to the dimension, shape, and complexity of the corresponding box. The size and quantity of boxes in the new system with strategic locations in the ambulance modules vary because the use is gradual, increasing with the level of pre-hospital care from triage procedures to the clinical steps. Both these and the previous proposals have a basic weakness because they assume a fixed position layout of the medical supplies in the ambulance modules, optimized and permanent, regardless of the specific medical current demands.
The rapid change of the medical conditions inside and beyond the ambulance may occur according to the ‘target patients’ attended, given by the working protocols, resulting in virtual ‘Triage Classes’ or levels of pre-hospital assistance. This kind of response has to necessarily be independent of the urgency level in the pre-hospital assistance. The medical procedures that mostly require mobility inside and outside the ambulance are in alphabetical order: if there are two or more elements, they are expressed with randomized terminal A, B, C… to Z, without decreasing the infinitesimal and random grid search. Other activities may be carried out as mobile, staying seated or standing, i.e., without moving within the ambulance, e.g., using the ECG and other electrical control systems. The flow layout suggests that the cages for the mobile, rapidly available medical supplies be grouped along the cardiopulmonary axis. The emergency procedures that can be carried out as mobile plus conveniently seated and easily reached are in summary: A, A + B; A + B + B; A + B + C; A + C + C. This layout follows the mobile plus seated health care modality trends generally recommended during transport and the starting emergency care, counseling for people with a heart-related problem to attend in general the sitting position for the test.
4.2. Space and Weight Considerations
One of the primary constraints for ambulance design is the limited amount of space and the weight requirements the EAE can tolerate. Types 1 through 3 can carry the same patient load; however, smaller CVEs will have a lower combined equipment and crew weight limit than Type 3. An average paramedic rig can carry 500-600 pounds of equipment and two responders, who could have a total weight of 400 pounds, which leaves about 1,500 pounds for the patient and incident-related medications. Weight can have an impact on the reaction time and handling of the vehicle, which is proportional to the distance from the vehicle center of gravity and the amount of time it takes for an action to move the center of gravity to a point outside the wheel’s footprint. Unsprung weight and crew placement in the back of the vehicle should not be located too far aft. The ability of the vehicle to absorb impacts, such as hitting a pothole or running over debris on the highway, is another area of concern. Designers work with the vehicle chassis manufacturer on weight distribution of the EAE on the cargo floor, and if too much weight is towards one end versus the other, it can affect overall ambulance performance. In Type 1 and Type 3 ambulances, the weight of the equipment that is placed above the E035 can force the vehicle to pull more to one side, causing the vehicle operator to counter-steer during emergency vehicle operations. An EAE must be able to hold all of the required equipment and supplies, configured in a way that is easy to use by emergency workers under stress, while keeping the rest of the vehicle as accessible as possible.
There is no published set of hard molds to which an EAE must comply; instead, there are certain space requirements and a larger set of operational parameters an EAE must meet the previously mentioned space and weight constraints. Storing equipment on the floor and the wall to optimize space must be balanced with the need to work on the patient, retrieve equipment while the patient is on the stretcher inside the patient compartment, and standard of care operation requirements. The needs of the patient and operational aspects of the providers are usually met by the work of the designer in many areas such as vehicle type, number of workstations, lighting, climate control, energy sources, motorized loading systems, interior surfaces, and wall cabinets. Our goal is to locate the necessary equipment, inside a cabinet or out, so that the level of care is not compromised.
5. Conclusion and Recommendations
This study highlights the significance of optimizing the medical equipment configuration within Ford Transit Type 1, Type 2, and Type 3 vehicles. While these vehicles are similar, there are distinct dissimilarities that need to be incorporated into the configuration of each ambulance type for efficient use. When doing so, the entry and egress, narrow corridor, and cab access designs of a Type 1 may be resolved; the accessibility, equipment number and weight, and egress of a Type 2 can be expanded; and the improved side entry design of temporary housing utilized in a Type 3 is advanced further. The findings incorporate the Peek Vision, which has never been addressed in the ambulance configuration, using evidence compiled over the last ten years.
The primary recommendation is for regular stakeholders to collaborate with registrars, team leaders, and ambulance designers to enhance evidence-based vehicle designs to maximize equipment accessibility and operational efficiency of the national emergency ambulance service. Suggested amendments for each type include sufficient space for the provision of patient care and the necessary medications as per the recommended Basic Pack only, capnography for infants and children along with airway adjuncts for children. Either for a more exhaustive vehicle design, efforts to revise the EPLS or intimacy with the Neonatal and Pediatric Resuscitation Program should ensure they are more appropriate to the Australian and Melbourne context. In addition, the provision of colorimetric capnography within the vehicle expands upon existing capabilities, providing more comprehensive options for on-road monitoring. Other future research topics include the evaluation of the Peek Vision adapter to test for amblyopia, the need to greenlight and develop a custodial ambulance that also caters to the mental health of both the caregiver and patient, and last but not least, paramedics need additional evidence to inform the physical configuration of an ambulance in response to changing and emerging medical practices. Current evidence shows that the vehicles reflect the evidence-based approach to optimizing our patient care capabilities.
