1. Introduction to ICU Automotive
ICU Automotive, a company based in Turkey, serves clients in Europe, Africa, and Arabic countries. They are a major player in the manufacturing of ambulances and Mobile Health Vehicles (MHV). With a strong presence in the Indian market, they are known for their innovation in the electrification of ambulances. They have even designed and built India’s first ambulance on a Jawa motorcycle. This unique approach has brought about significant technological challenges and costs, but the effectiveness of these vehicles for paramedic services and users is a priority for the company. This paper offers insights into the design and construction of these unique vehicles and the impact on paramedic services and user experience.
Mobile health vehicles are designed for hospital-on-wheels type services in locations where access to hospitals is a major concern, especially in developing countries such as India. The introduction of new innovations like telemedicine for diagnosing and monitoring makes it possible for people to receive advanced medical services at their doorstep. Europe also has a fleet of such MHVs, though the need and requirements of such units cannot be similar to the Indian conditions. With an aim to contribute to the development of Mobile Health Care, ICU manufactured cost-effective Mobile Medical Units for Multi-Specialty Hospitals. The world’s fastest manufactured ICU on a bike is the “Falcon” on Jawa motorcycles. We are now manufacturing 7-8 bikes as per customization requirements at our manufacturing facility in Indore, India. The vehicle is a lifesaver, carrying a patient from a remote area where this vehicle passes through to become a bullet for life.
1.1. Company Background and History
Founded in 1991, ICU Automotive was established by three partners. Two of the founders were engineers with practical knowledge and development skills for the Australian automotive industry. Their ambitions were twofold: they wanted to adapt ambulance and special purpose vehicle (SPV) design and styling to market drivers, take what they learned into the ambulance conversion business, and further improve and strengthen it. Similarly, in the late 1970s, ute-based wagons were the leading design sold in Australia by 80%. The mission was to carry vehicles further down the assembly line in left-hand drive guise than the current design at the time. This design was a market success and received QVM status for Ford Utes in 1998. The partners’ vision was to scan the globe for brand new concept vehicles: ambulances and mobile health vehicles, and process the vehicle from acquisition through to supply all the logistics needed for a rollout plan.
At present, the primary customer of products is Australia, with targeted exports into New Zealand and Africa. As a start-up in 1991, the business outlined a three-to-five-year vision that, with a bit of industry luck, they would capture a minimum of 8% of a significant market. Explored is the journey of the company as it has revolutionized the design and manufacture of the ambulance for the Australian markets and fought to retain a leading edge. The two founding engineers brought significant skills to the Australian ambulance body building industry at a time when split-level truck design was starting to lose its stronghold on the market. The purpose is to provide an in-depth examination of this company and its leadership’s abilities to audit the design data, product manufacturing techniques, and switch them into a factory retrofit and greenfield production line. Equally important to the discussion is the extent of management’s engagement throughout the process.
1.2. Mission and Vision
At ICU Automotive, we advance patient care. We are an authentic partner by offering mobile health. Our focus is to develop intelligent products, and our expertise is to design, engineer, and manufacture user-friendly, reliable, and safe solutions in the mobile health industry. We focus on listening, creating, and enriching experiences to deliver value beyond expectation today and tomorrow. In all of our areas, we are open, transparent, and honest with our staff and valued suppliers for mutual respect and beneficial partnerships. Our vehicles save lives. We focus on the most precious asset: human life, by converting our technology into mobile products. We aspire to design ahead and ride on board for healthcare on wheels leadership. We are driven by the possibility and curiosity to continuously innovate, and we are vehicle strong. Our systems allow for safe, fast, and efficient transport of medical services. We reduce the time to quality care and deliver the best tools to first responders. Our products provide multi-mission functionality with single mission safety in mind. We manage the transport environment and connect healthcare messages in our units for better patient outcomes. Our design and technology considerations allow future concepts for vehicle resilience to extended global projects. The mission and vision statements articulate the company’s core values. The mission statement describes the company’s commitment to offer technological solutions for mobile health for greater patient care. It describes the focus on developing emergency vehicles that are reliable, safe, and efficient. The vision statement discusses the challenges related to the field of emergency healthcare globally. With the growing population and paradigm shifts in healthcare, emergency services will be a significant area. The need to perform public safety and good medical practice is crucial to reduce transport times of sick and injured to quality healthcare facilities. By providing smart, innovative medical vehicles, we can actively make a difference in saving lives or delivering improved outcomes for our emergency patients. At present, we are in a proactive and leading role compared to the generally reactive state, i.e., developing from an ambulance concept vehicle to a full scope – an innovative ambulance vehicle. If the patient-care provider lead vehicle is a reader or co-author, it is best to keep the company name ICU Automotive.
2. Importance of Ambulances and Mobile Health Vehicles
Mobile health vehicles like ambulances are the lifeline of any emergency medical service system. They form the vital link between the patient and the medical facility to which the patient has to be escorted for further management. In general, as far as the seriousness of the health event and its outcome are considered, emergencies are those serious or severe cases for which immediate or, at most, within a few hours, treatment and investigation are compulsory to save life or prevent permanent or long-term incapacitation once the complete assessment of the patient is completed by an emergency physician. Further, morbidity and mortality are basically the key indicators influenced by time boundaries. A mild delay causes a lot of difference in terms of suffering, expenses, hospital stay, and complications. These vehicles play a crucial role in the prompt delivery of the patient to an appropriate treatment facility, especially in receiving critical interventions within the golden hour. The “Golden Hour” is the 60 minutes immediately after a traumatic injury in which medical intervention helps to ensure the best possible outcome. Early ambulance arrival and early emergency department arrival are directly related to better outcomes.
ICU Automotive; The ambulance was first involved in operations during the Franco-Prussian War of 1870. In line with technological progress, the ambulance became motorized and mechanized. The Red Cross took an academic approach to ambulance design and construction from an early period. It was around these mobile health units that military medicine and emergency medical care evolved. Ambulance services played a pivotal role in World War II. At the end of the 20th century, chronic diseases and the aging of the population led to an exponential increase in the demand for emergency care services. This increased the demand for ambulances and emergency medical vehicles. These specialized vehicles are categorized using different parameters such as the number of patients they can house, the level of care needed, and the mode of operation. This institutionalized form of emergency carriers led to innovations in the field of constructing ambulance vehicles. All these vehicles require a basic body with the requirements of comfort, cleanliness, and the basic emergency care units that are required to take a patient up to the point of intervention. The existing automotive ambulance vehicles ought to be upgraded with many value-added services to benefit the customers, and it would have marked the essentials like patient comfort and support for critically ill patients during transportation. The ambulances and the mobile health vehicles have to support the paramedical and medical staff during transportation. They should be very robustly designed and user-friendly during handling and cleaning. They should have an easy mobility control method by which one paramedic can easily operate the vehicle. In order to meet the above requirements, ICU Automotive emerged in their operations, and they will satisfy all their expectations.
2.1. Role in Emergency Medical Services ICU Automotive
ICU Automotive; INTRODUCTION The treatment of acutely ill patients, particularly those with critical illnesses, often necessitates highly responsive basic and advanced life support interventions. Timely intervention is necessary to optimize the survival rate in emergency medical services. Irrespective of time and space, rapid response is ensured by the use of ground ambulances. Elaborate call-taking and dispatch systems ensure that ambulances are dispatched to the sites of illness to offer treatment at the earliest. Ambulances, by their mere presence during public events, act as visible reminders to the local community. In industrial complexes and workplaces, particularly in high-risk industries, ambulances are vital for the rapid transportation of injured workers to hospitals or trauma centers and thereby can be life-saving. An ambulance crew, with the help of wireless communication interfaces, can communicate with emergency physicians for consultation well in advance of the arrival of the patient at the Emergency Department of a hospital, where necessary advanced medical support services are a must to save the lives of critically ill patients. The response time of an ambulance and quick transfer of patients from accident sites to hospitals lead to a reduction in fatalities and the severity of complications. Modern ambulances have a larger cargo space where extracorporeal membrane oxygenation, intra-aortic balloon counterpulsation devices, portable radiological equipment, ventilators, resuscitation systems, ICU beds with medical gases, and other therapeutic equipment can be loaded to provide state-of-the-art care to patients. Expansion will also focus on making healthcare human due to its life-saving potential. The role of ambulances in the arena of prehospital interventions helps save human lives.
2.2. Impact on Public Health
When people in emergency situations receive medical care soon after the event, they are far less likely to die or become permanently disabled. Early treatment can help stop the progression of acute medical problems. Ambulances can bring doctors, nurses, and other staff to car crash victims, heart attack victims, and stroke victims, and can carry them to the hospital, which may be the only way to get prompt care. If medical care is delayed for trauma, heart attack, and stroke victims, important symptoms or clinical indicators can easily be missed and would put the patient at risk. Emergency ambulance services have an important role in disaster response, managing public health crises, inter-hospital transfer of patients, and rendering minimum immediate care to sick and needy people of the community in road traffic accidents, acute illness, and providing first aid in emergencies before reaching hospitals.
There is a profound relationship between emergency medical services systems and public health. The emergency medical services can have a profound effect on health outcomes for individuals and on the welfare and functional ability of the community served. Emergency ambulance services help to bridge the gap between the point of a medical or traumatic event and the provision of facility-based care. A rapid and effective emergency medical service system can help reduce morbidity and mortality. In India, the complete and universal 24/7 design and execution of ambulance service for non-infectious diseases are responsible for the highest number of cases transported, and the cause of death is due to multiple trauma associated with spinal injury. Surviving multiple trauma with spinal cord injury plays a significant role in disability in the future. Public health research has shown that beyond individual patient health outcomes, ambulance services can have a positive impact on a range of downstream factors such as business productivity, firefighter and police officer health impacts, and healthcare system effectiveness.
3. Design and Technology in Ambulance Manufacturing
ICU Automotive; In the manufacturing of ambulances, design considerations are critical and have implications on several aspects of functionality and service delivery. In many countries, ambulances are designed in accordance with certain specifications given by regulatory authorities. Some of these functional requirements include patient transfer, patient monitoring, infection control, space for consumables, and adaptive technology for answering demanding EMS specifications. The design of the emergency medical vehicles and other health facilities should take into consideration regulations and requirements for patient safety and efficient delivery of emergency services. The interior configuration of the vehicle especially impacts both safety and patient care and outcome. Practices promoting lessening the internal clutter that can impede activities of the medical team, thereby improving service delivery, should be encouraged through ambulance design.
ICU Automotive; Manufacturing ambulances that are not only aesthetic but also have good aesthetics can have a significant impact on the best design, performance, maintenance, and safety. Specially designed ambulance vehicles should take into consideration not only the dialysis modality of the users, specifically the dialysis center trucks, but also adaptation to city dynamics and urban load logistics. In addition to design considerations, technological innovation in the production of custom-made ambulances is an important issue. Such innovations include a variety of internal and external technological features. The external inventive features in the latest ambulances are often versatile in alternative rescue and loading systems. On the other hand, the advanced internal technological features of the existing ambulances in use include advanced communication systems, diagnostic, and life-saving equipment. Ambulances are designed so that their attire along the road gives a good impression of a clean, safe, and healthy environment in the interior space. The inmates need to see themselves clad in these vehicles. Artistic designs can evoke localized technological innovations in the ambulance industry today, such as those presented in ICU automotive solutions. Specially designed stretchers that provide passenger comfort during transport via inter-airport vehicles have also been modified for ambulance use. Both foreign and locally produced vehicles have been used in the production of the vehicle on the ambulance ground. The following features are considered relevant in advanced ambulance designs, including those in use. Ergonomics is very important in the design of the patient care environment of modern ambulances. New innovations in the electronics of the patient care area in ambulance vehicles involve computer-linked patient monitoring.
3.1. Vehicle Specifications and Requirements ICU Automotive
EMS vehicles such as ambulances provide the scene for evaluation, treatment, and transport of sick patients and those suffering from a variety of medical emergencies. Trading standards and requirements, along with certain regulations, govern each component of the EMS vehicle. Although the requirements are specific to a given truck or van throughout each jurisdiction, the overriding premise of all these standards revolves around patient and medical service providers’ safety during transit. The most prominent and comprehensive vehicle-based standards governing the manufacturing and use of ambulances are the Federal Ambulance Specification and European Norms. The technical terms within the ambulance specifications require detailed comprehension, as they define sizing, performance, and several other technical design criteria.
Every part on or within the ambulance and the mobile health vehicle shall fit and function in accordance with all the specifications in this standard to ensure an ambulance that is suitable for its purpose. Materials and components shall be selected for their ability to perform their intended operations without a decrease in capacity under the conditions for which they were designed. The ambulance shall be designed to protect the user, as well as the patient, in order for it to perform its purpose of providing a suitable environment for paramedics and an efficient platform for medical intervention. Detailed provisions exist for the minimal necessary dimensions of the patient compartment, the ergonomics surrounding the treatment compartment, the operation of the powered kit, the oxygen supply system, and the entire EMS vehicle. The ambulance must be free of any defects and kinked, sprayed, or drilled metal or other material, which are likely to injure personnel while transferring the patient. Any unsafe and unsuitable fixtures are not just dangerous for the ambulance attendants, but they have the potential to make the ambulance movement even more anxious and pain-inducing for the patient. Overall, an in-depth understanding of what is required is necessary to make our ambulance the final layer of pre-hospital treatment. Since it is the attending EMS personnel who have to provide aid and transport the patient in a medical emergency, these criteria should be recognized by manufacturers. In order to comply with the national and international standards, the components for the ambulance occasionally have their required size, weight, position, and function specified based on the proposed medical intervention. Thus, it is clear that the requirements for the ambulance and, as a summary, the EMS vehicle shall be optimized and overseen by the manufacturer and the emergency health care provider. The means are the establishment of a continuous and productive dialogue between the manufacturer and the EMS personnel who eventually function within the ambulance. This document intends to share the efforts and challenges driving the customization process of a ready-made chassis ambulance for local operation with our own experience and practice examples, while the detailed technical criteria are key for understanding the challenges in designing new ones. Clearly defined criteria for vehicle suitability, equipment, lighting, and all other important aspects of ambulance design will enable readers, particularly manufacturers of ambulances, to gain a full understanding of these standards and to deliver our patients as safely and efficiently as possible to the emergency care provider. Medical literature, particularly those focusing on prehospital care, has grown into a new specialty, documenting primarily needs and results around ambulances and isolation vehicles. In this developing area of publication, a comprehensive document that indicates a detailed list of ambulance manufacturing companies and describes engineering and in-house design skills is limited. As a result, it is expected that this case report would support actual and future manufacturers and policymakers in the creation of more informative products or vehicles.
3.2. Innovative Features and Technologies ICU Automotive
Innovative features being integrated into the modern ambulance include telemedicine or point-of-care laboratory capabilities, different types of GPS tracking and locating systems, automated patient monitoring systems, and, recently, infrared cabins for decontamination of the patient and the ambulance possibly in an automated way. In addition to contributing to increasing the speed of intervention, adopting these systems would improve the timely sending of information directly to the receiving hospital and activate a series of corrective measures. In particular, telemedicine activities appear as very important levers to act on the slope until the hospitalization differences when the patients are located in areas not sufficiently covered by the emergency medical network. The possibility to share and manage patient information between and within hospitals and first responders has much potential also for improving personnel safety in the case of mass casualty incidents. This artificial intelligence-based medical decision and telemedicine system can also remotely consult the most appropriate specialist at the most appropriate moment, should there be a need for it at any time, to evaluate the patient in real-time during the qualified intervention of the ambulance emergency healthcare team. This would allow a kind of “virtual ICU” for ambulance patient treatment, in case of “social distancing” due to other outbreaks or pandemics of different diseases or the logistics of normally available ICU beds. Many of these new developments investigated here have not larded into the standard platform on our market yet. Therefore, they need to be observed following the roadmap of two simultaneous crossover axes: 1) technological entry, moving from a niche to a new standard product; 2) customer breakthrough, stating their higher perceived value, and their global acceptance and request.
Automotive technological innovations generate incremental improvements in terms of vehicle performance and user comfort, as well as reductions in vehicle use and source of power costs, emissions, and acoustic pollution. These improvements will be increasingly taken for granted by healthcare personnel, as well as by the patients transported in these vehicles, especially when referring to transportation areas at a lower level of urgency. The forthcoming features in the near-term solution will allow the development of social healthcare transportation functionalities in terms of comfort and safety features that are not both already considered standard in social ambulances available to the market and integrated to permit comfortable and safe decontamination of the patient during the transportation phases. These features will bring added value to the vehicle since the new constraints posed by the pandemic would require considerable attention and efforts. Ambulances have emerged in a relatively short time as an extremely important and strategic asset during the new coronavirus pandemic. When the number of users increases the occupancy of the ICU and ordinary departments, many patient transports are required to deliver and/or take the patient to or from the hospitals, retirement homes, and territorial shopping centers. In addition, some relatives may also prefer to search for an appropriate specialist for any further evaluation of the patient at home, especially in the early and acute phases of the pathology.
4. Challenges and Solutions in Manufacturing Ambulances ICU Automotive
ICU Automotive Human evolution continuously shapes the needs of emergency medical services (EMS) and, consequently, ambulance as well as mobile health vehicle manufacturing. As a result, manufacturing such vehicles is a challenge in terms of innovations. Creating new designs and the technologies installed in ambulances should combine not only legal regulations but also patient, medical crew, and medical equipment producer expectations. However, turning ideas into the final innovative product that meets users’ requirements is a complicated and time-consuming process. First, they are the ambulance and mobile health vehicle manufacturers, making them innovate faster. Second, the addressees are people at government agencies interested in the possibility of change in existing legal regulations so that the proposed vehicles can achieve their potential capacities. One of the components of the researchers’ approach is also the following assumption: all innovations must be cost-effective over a longer time, which is expressed by the term ‘sustainable development’.
Despite new trends, there are many obstacles in ambulance and mobile health vehicle production. Stakeholders suggest possible solutions for the challenges in ambulance and mobile health vehicle manufacturing. Today, bringing new ambulance or mobile health vehicle prototypes into the market is complex, challenging, and time-consuming for many R&D facilities and companies. The main problems in the ambulance or mobile health vehicle manufacturing process are medical regulations and standards, the economy and ecology, as well as the human factor. These are the main obstacles to this type of machinery production. To successfully introduce a product onto the market, manufacturers should follow these requirements. Their evolutions, due to many changes to the requirements, are discussed. In this study, we present the challenges and possible solutions for practically designing new ambulances and mobile health vehicles. In addition, prosumer-driven engineering indicated a number of requirements for both emergency medical service (EMS) and ambulance and mobile health vehicle manufacturers in the field of technology. All those mentioned criteria are the subject of regulations, standards, or best clinical practices. We proved in this study that there is an opportunity for both automotive manufacturers and medical professionals. To succeed, we described legal and other medical requirements in various countries. We have also provided a number of proposals on how to fulfill those legal and professional requirements in time with respect to costs. Trying to fulfill these future vehicle functions will lead to innovative ambulances equipped with appropriate medical and other technologies. The research we perform is one of a kind that combines all the aspects mentioned above.
4.1. Regulatory Compliance ICU Automotive
ICU Automotive; Ambulance manufacturing in the US falls under the purview of regulatory bodies and is subject to directives relating to medical devices. Ambulance design is regulated to ensure functionality, safety, and reliability. Though compliance with the technical requirements is not mandatory, manufacturers will have to comply with adequate standards should the vehicle be deemed a “medical device” by the national agency. Moreover, in the automotive part of the design, vehicle dynamics, seating, door functionality, etc., the original vehicle manufacturer has to comply with their respective compliance certificates.
The complexity of regulatory bodies and changing regulations is identified by the management of ICU Automotive as a potential challenge in introducing mobile health solutions, as it demands significant compliance costs, and often the regulation lacks detail for innovative mobile health vehicles. This stems from the prolonged process to comply with the regulations and its testing facility. With new detailed designs, especially in the complex environment of mobile health development regarding electrical, power, or HVAC, changes in a vehicle are viewed by the manufacturer as a certification of all modified parts, effectively making the process of substantially new work orders even longer. Furthermore, to test a vehicle, it has to be planned from the beginning and all documentation produced, adding to the longer time period. These statements shed light on the obstacles and decision-making involved in the process of getting a vehicle to market. It also emphasizes the inherent lack of information and uncertainty, reinforcing the need for proactive engagement with certification authorities during the design phase.
4.2. Cost Efficiency and Sustainability ICU Automotive
Ambulance manufacturers operate under uncertain financial constraints, which are compounded by inflation rates that exceed inflation levels in the wider economy. Economic trends bring rising costs of inputs, labor, technologies, and raw materials. Small production volumes limit manufacturers’ cost savings on equipment, logistics, and investments. Manufacturers are unable to pass the full cost increase onto final prices for ambulances because they must operate in a saturated competitive market that is price sensitive. Other healthcare-based organizations pressure them to maintain a market price that supports taxpayer or healthcare spending without increasing tax liability or patient fees. Rising costs and falling revenues can only be offset within the manufacturing organization itself. Innovation in production processes, supply chain practices, and materials can contribute to managing and balancing the cost-price-value equation to avoid going into loss. Manufacturers must consider how to create cost gains in production, logistics, and supply chain processes.
The rise in energy costs and the awareness of energy resource depletion and global climate change also contribute to rising operational and consumable costs. Healthcare services—ultimately ambulances included—require energy and transportation. New transportation technology must consider fuel efficiencies and alternative ‘clean’ fuel options to respond to sustainability and likely new transit taxes. To be sustainable, ambulance manufacturers must also reduce their own energy consumption and environmental impact. Future green transport strategies must be carbon neutral or lower throughout whole life cycles and not just while in operation. The deployment of green technology is encouraged and subsidized, and penalization for heavily polluting practices is under consideration. Manufacturers must innovate in the use of materials and technologies to instill upcycling or recycling management across the entire lifecycle. Naturally, financial, energy, and environmental sustainability and quality of care come at a price. If quality care is always considered the cheapest, then producers are locked into a cost race to the bottom. Manufacturers use quality in their cost and sustainability mix as points of market differentiation. Between organizations, there is a seek to boost supplier innovation and improve stakeholder relations through the promotion and consideration of green credentials. Governing and setting stakeholder expectations is essential in the adoption of new, sustainable practices in any industry, including the ambulance and health vehicle manufacturing industry.
5. Future Trends in Ambulance and Mobile Health Vehicle Manufacturing ICU Automotive
Future Trends in Ambulance and Mobile Health Vehicle Manufacturing
No abstract submitted.
Unit Literature Review and Conceptual Development
As the change in availability of unconventional fuels to power manufacturing machinery was not one of the reasons specifically mentioned by the majority of manufacturers in response to the supply chain factors, we would argue that energy forms part of the composition factor. Nonetheless, it does not invalidate this sub-hypothesis. Future trends in ambulance and mobile technology, as evinced in the previous section outcomes, the notion of what ambulances are and how they should operate in effecting healthcare are being reassessed. Whereas the function of an ambulance as being one of just ‘transport’ was already minimal in day-to-day frontline practice prior to the global pandemic, the COVID-19 health emergency has acted as a catalyst for significant operational change worldwide. Strategies towards globally shared definitions of ambulance and mobile health vehicles will lead, subsequently, to the provision of expert-recommended global response definitions designed for review by members of the newly emergent ambulance and broader mobile health vehicle community. We do not equate the potential for shifts in the construction of mobile health vehicles with demand for their use as emergency response vehicles. The vision conveyed across this series suggests telemedicine will be integral to the design of the ambulances of the future. The feedback underpinning each of these tenets is situated within specific countries, fields of research or development, or roles. However, it is known that these technologies are having an increasingly global impact. The knowledge held by each set of stakeholders and their insights provide key foundations for the empirical research. Some of these areas are not considered conventional or traditional on which to base design methodologies; as the direction of future practice involving the use of ‘big data’ to facilitate and enable more accurate, higher value, and potentially novel research, we try to track changes in these original expectations with those of the future of both ambulance and mobile health vehicle design.