1. Introduction to Type 1 Ambulances
Type 1 ambulances are distinguished by the SAE/NFPA designation of a Type 1 ambulance, a classification system used to denote the safety specifications of modern ambulances. Unlike Type III and Type II vans, Type 1 ambulances are built using a truck chassis. Because of the specific chassis needs, SUVs, crossovers, and smaller pickup trucks do not meet the design constraints of a Type 1 ambulance. Type 1 ambulances are mounted to the frame of a truck with the patient compartment of the ambulance being entirely separate from the driver and patient compartments. Furthermore, unlike Type III and Type II ambulances, Type 1 ambulances have pass-through capabilities which allow medical personnel to enter the patient compartment of the ambulance without entering the driver’s cabin. Type 1 ambulances are critical in emergency medical services operations across the United States and worldwide. These robust ambulances are widely used by commercial operators to reduce patient transport costs without the patient comfort compromises inherent with Type III and Type II ambulance van conversions. Beyond moving patients, Type 1 ambulances are critical in reducing overall patient transport time between emergency departments, particularly for critically ill or seriously injured patients. At a majority of ambulance to hospital patient hand-offs, the use of a Type 1 ambulance, capable of providing continuous patient care with a passenger-carrying crew, significantly reduces the time until all personnel are ready to transfer the patient from the ambulance to the emergency department. It is no surprise that more than 60% of all ambulances purchased have the advanced features of a Type 1 ambulance.
1.1. Definition and Classification
Type 1 Ambulances Manufactured by ICU Automotive; The EN 1789 defines the design criteria for types 1, 2, and 3 vehicles: – ambulance, intended for the transport of at least one patient on a stretcher; – medicalized ambulance, intended for the transport of at least one patient on a stretcher in a re-equipable area and with independent entities, designed for emergency medical care during transport. In further detail, a Type 1 ambulance has an O.C. (Omologazione Comunitaria – Community Approval) by the respective Ministry of the Interior for the transport of critically ill patients and for emergency care during transport. They can be used in non-urgent mode, replacing vans, to transport self-sufficient patients, including chair stairs on board (stretchers), as long as the vehicle is equipped with all the supplies and equipment required by observation sites, ambulatory surgery, or day hospitals, including disability correction.
There are Italian regions where a less stringent vehicle approval is requested for hospital-type ambulances used for school or inter-hospital transportation of these patients: these vehicles do not meet the Type 1 standards; they should therefore be classified as Type 2, specifically designed as bodywork with alternative devices. The EN 1789 standard defines a classification: – Type 1 / Class C according to European standards.
1.2. Importance of Type 1 Ambulances
Type 1 ambulances, also commonly referred to as ‘working truck’ ambulances, are specialized units designed for emergency medical services that respond to situations where the patient may not have much time and needs to be provided with a life-support system. They are also supposed to carry both the doctor and the patient to the hospital.
The design of the Type 1 ambulance features a self-supporting patient compartment, ease of loading and unloading the stretcher without excessive manual handling, and sufficient space for doctors and paramedical staff to continue cardiopulmonary resuscitation as required. As the vehicles are coach-built from the chassis, this eases maintenance. This ambulance carries equipment needed for airway management, suturing, administering IV fluids, drugs, or even blood at the site of a disaster; a cardiac monitor and defibrillator are also included. Since all these facilities are available in the vehicle itself, the doctor can treat the patient in the moving vehicle to enhance effectiveness and outcomes. External oxygen, a resuscitation kit, a spine board, a spine collar, and an ambu bag are also present. This vehicle is undoubtedly a great asset for emergency medical care services to reach those in need as quickly as possible and save lives. It is important to focus on the creation of excellence in healthcare delivery in the emergency environment. Many platforms have extended research and development efforts to build excellence today, thereby enhancing the efficiency and effectiveness of healthcare delivery.
2. ICU Automotive: Manufacturer Profile
ICU Automotive As a company with 39 years of motor vehicle production experience, it was established on January 12th, 1983, and started to operate. Starting with the production of commercial vehicles, the company has continued its experience in this field. The mission and vision identified at the beginning of the foundation date were maintained. The company produces vehicles intended for special purposes according to the needs of its customers. In addition to these vehicles, the design and production of bodies from scratch are among the fields of activity. Its team consists of qualified engineers and employees in their field. Accordingly, it is listed as a manufacturer with a minimum of 65% local and foreign product percentage.
The design of ambulances, one of the first vehicles produced, has kept pace with the preferences of the age. Modern medical devices, equipment, and software that allow all kinds of interventions can be added to the ambulances designed by the company according to the institution to which they will serve. 3-D images and complete designs of all the equipment in the ambulance body are available. Development of driver behavior and organizational culture, awareness and culture of following technologies, a human-oriented design that fully adheres to the required standards and regulations, serving with the most developed technical equipment with the latest tools and equipment, development and renewal. Thanks to investments, employees with a sense of quality in production continue their activities. With innovation, R&D activities, monitoring trends, and developing strategies. These are concepts that are frequently encountered, especially in recent years. However, for ICU Automotive, these are not concepts that are mentioned with the flow of the day. These are timeless vision and mission for us. We are at the point we are proud of because we effectively implement it for decades and continue to implement it effectively today. Technological innovation is the main building block of all our activities and certainly our products. For this reason, while planning all of our factories, we first planned R&D units as a separate section. By creating an R&D culture, we set out on the road with a strategy that can compete even with global competitors. We have taken firm steps with our long- and short-term research and development activities, added new products to our portfolio, and continue to offer safe, economical, and high-quality products that respond to different needs. It is critically important to put. Our designs that prioritize safety, comfort, low maintenance, high speed, and durability according to the long-term use of ambulances designed according to the operation conditions of our country are prioritized in compliance with international vehicle standards.
2.1. Company Background
BACKGROUND
Based in the city of Indaiatuba in the state of São Paulo, ICU was founded by entrepreneur Estigarribia and his wife Aparecida in 2010 to professionalize the ambulance conversion market, as this environment started to stand out with customers increasingly demanding safety, quality, and modern design in such vehicles.
Estigarribia Emerson, the company’s founder, is a mechanical engineer and master in computer-aided engineering and developed his career in the automotive industry through several vehicle conversion projects. With a family connection to the Brazilian Red Cross, he is very involved in emergency medical care and the conversion of ambulances. The inspiration goes beyond his father, Aparecido, and many of his brothers; his children Estigarribia and Aparecida are also involved in the business. In particular, Aparecida graduated and started working in the conversion area. This is why all ICU decisions value the human side and the various specific care of the company.
Since 2010, the company has been growing steadily from renting a small shed to an average of 80 vehicles per month in 2017, a result that makes ICU the largest manufacturer of type 1 ambulances in Brazil. Founded by entrepreneurs, ICU also prioritizes teamwork to innovate processes, such as using kit ambulance manufacturing lines to make them faster, more economical, and safer in the queue. With a portfolio of over 50 customers, ICU manufacturing locations are situated in Brazil and abroad today, enabling the operation of the product in several countries. Playing a relevant role in the Brazilian industry, the company has been featured in many events in the area, as well as in media called to serve as a source of opinion and information, since ICU is always creating industry references.
2.2. Innovations and Technologies Type 1 Ambulances
In recent years, the field of emergency medical services has seen significant advancements in technology and innovation, particularly in the design and functionality of type 1 ambulances. These innovations aim to enhance operational efficiency and improve medical functionalities, ensuring that emergency responders can deliver timely and effective care. One notable development is the integration of state-of-the-art technological solutions that facilitate communication and navigation for medical personnel. This includes advanced heads-up displays (HUD) that provide real-time monitoring of medical transport, allowing for better situational awareness and decision-making during emergencies.
Another critical innovation is the introduction of an adjustable door access system, which enhances the ease of entry and exit for medical staff and patients alike. This ergonomic design not only improves the workflow within the ambulance but also fosters better collaboration among medical personnel. The focus on human-computer interaction (HCI) and operational usability is paramount, as these factors directly impact the efficiency of emergency responses. The incorporation of information and communication technology (ICT) tools further supports medical personnel by streamlining communication and ensuring that vital information is readily accessible.
The competitive landscape for emergency medical services is evolving, with organizations like ICU Automotive leveraging market insights and technological advancements to maintain a leading position. The integration of standard emergency radios with professional mobile phones and GPS systems creates a comprehensive navigation and positioning framework. This system enables intuitive emergency assistance through various communication channels, ensuring that responders can quickly access the necessary resources. As the industry moves forward, the potential for new technologies, such as “steer by wire” solutions and enhanced interior designs, promises to redefine the standards for emergency vehicles. With increased interior space and optimized equipment layouts, the future of medical operational interventions looks to be more efficient and effective, ultimately benefiting both responders and patients.
3. Key Features of Type 1 Ambulances by ICU Automotive
These finalization Type 1 ambulances are characterized by cutting-edge materials that highlight quality and durability, as well as structural and optical values and safety criteria. The basis of the carboxylic reinforced sandwich type cellulose with fiber mesh is a continuous monocoque or full construction made of stainless steel that guarantees the ambulance vehicle’s structural integrity and lifelong functionality, both interior and exterior. The available basic design includes the top front and carboxylic reinforced license plate with the standard logo and the possibility of designing it with the logo of the call sign and operation number of the ambulance service on the side. They are light containers with a handlebar and/or a tip that can be individually opened, and one of their practical lamps provides optimal day and night-time lighting in the wake of patient care. If necessary, the structure of the boxes can be set up for the extra fastening of the permanent row and the flotation basket. High design and execution of comfort and security are characterized by a high proportion of the space. The vehicle is the most recyclable type, offering simultaneous and uninterrupted diagnostic and health data recording. A highly configurable medical device is built in to make it possible to fully comply with the required exigencies at any moment, and the technical and service equipment ensures safe and enjoyable traffic operation. The combination of only the most reliable, superior functioning, and minimal operating costs medical equipment is our strength preference. Any vehicles designed and produced by our customers will be provided with the most advanced medical equipment.
3.1. Design and Construction Type 1 Ambulances
The philosophy behind the design of the Type 1 is to create a vehicle for ambulance care designed for work efficiency and maximum use only. Therefore, there are many more considerations regarding the design principles for what has often been called “yellow taxis” previously, medical devices. Our priority in designing this vehicle is focused on ensuring that the medical staff and patients can move around the treatment box without obstacles and to ensure side impact and rollover protection. There is a clear and transparent opening for the stretcher patient when entering or exiting the ambulance. For both patients and other individuals sitting on the team seat, they can see the outside world. The stretcher load table is adjusted to face patients, and the shock absorber under the stretcher provides patient comfort. The vehicle is manufactured using the most suitable techniques; square and processed metal are used and covered with attractive glass-reinforced polyester composite on the outside. The sides, doors, and tailgate are filled with rigid polyurethane foam to withstand side impacts while reducing weight. The bottom of the vehicle is in a stepwise form to minimize aerodynamic resistance and allow the vehicle to be accessed by lowering the wheelchair. The weight distribution is given more consideration in its technical design to ensure that optimal performance is achieved. At the front, the ambulance is equipped with a separate zone that can accommodate technical and medical equipment. It has access to four doors for processing and withdrawal. Considering the ownership of the product in terms of its economic value, the technology was designed in a very modular way, enabling upgrades to current and future medical equipment at the lowest price in action.
Based on the physiological consideration of the best value per unit of interior space, the “unconventional” driver compartment shape has several technical constraints. Both the upright position of the worker and the narrowest access to the back make it difficult for the driver to accidentally collide with the back compartment. However, the rear of the cab is designed to absorb the strongest collision energy. This uncompromising safety concept has received appreciation and has performed well in crash tests. Traffickers also appreciated the design that the stiff frame could be replaced quickly with one screw if needed. This selection of the driver’s location is not the result of a marketing study to avoid increased device size. An ambulance program for ten years is everyone’s vision full of challenges and creativity as a result of intense competition. Every year, many already have medical equipment, whether they are going to treatment destinations or mobilized on the scene itself. Other ambulances are equipped with two types of stretchers, one entirely manual and the other automatic, as found in advanced urban hospitals. A free septic tank will be offered in the beam assembly. The whole set can be fixed in the position depicted, which actually occupies almost the entire pallet assembly floor. Dynamic and static unload tests confirmed the reliability of this solution, which did not limit the maximum of a wheelchair located at the rear of the floor. Dynamic and static tests also confirm the strength and reliability of this stretcher molded and developed. Thus, pumps and water tanks should be able to maneuver from the stretcher operator if necessary. This position is designed with the rear side of the patient’s body in mind. With the feet support completely lowered, the patient’s feet can be moved under the bed when in a row.
3.2. Medical Equipment and Technology Type 1 Ambulances
While the speed of response is an important determinant of emergency patient outcomes, timely care is also critical. Regardless of the remoteness of geographical location, a quality patient care team can be provided within seconds to minutes if that area is critical and significant from the perspective of prehospital care. Devices used in health care, facilities offered, and individual capabilities make it possible to work efficiently in situations in which emergency medical responders find themselves. Type 1 Patient Compartment ambulances are part of the advanced care model, a critical care environment that is presented during transportation.
The vehicles are equipped with all the necessary equipment to diagnose and provide treatment in compliance with hospital protocols. Technical devices are integrated into the structure of the vehicles to achieve full functionality—anticipating their place, nature, and ease of use. The ambulance compartment is equipped with modern medical technology to optimize the handling capacities of emergency medical services staff in a wide variety of situations routinely faced in emergency care. These include adaptive litters that allow the establishment of mobile hospitals where the need for patient care arises. In addition to these vehicles and their medical features, specific systems for real-time diagnostics, such as patient status control and EKG, life-support equipment, such as cardiac analysis/defibrillation and infusion pumps, and technical facilities, such as cutting tools, chest tubes, and ENT intubation, are also available. To facilitate in-route communication and coordination channels with the hospital’s emergency department, these vehicles are equipped with the most up-to-date technology. For each ambulance, the equipment to be installed is subject to precisely defined uniform criteria. All energy-related devices used in the ambulance sector are subject to medical-technical tests. Each device also complies with relevant standards and statutes. The conformity tests specified for all devices used are subject to independent certification. Emergency testing certifications are also required.
4. Safety and Regulatory Standards Type 1 Ambulances
The safety and regulation standards applicable to the design and manufacture of Type 1 First Aid Units are defined by Resolution number 348, dated August 2, 2010, issued by the National Traffic Council. This resolution recently underwent an update through number 815, effective as of May 17, 2021. Law 9053, dated January 25, 1995, and State Decree 37.380, dated July 16, 1997, govern the national and state regulations for the construction of units of health services engaged in emergency transportation. The main objective of these standards is operational safety and the protection of all occupants of the ambulance, as well as the health of the patients being transported.
The National Certification Program for the Standard First Aid Unit was created to ensure national standardization, complementing the resolution established by the National Traffic Council. The program includes the National Crash Test, in full compliance with specifications. Following the most rigorous market requirements, each system in our vehicles is monitored and certified for quality, ensuring the safety of occupants and patients. In addition to the crash safety rating, the standard also specifies the ideal location for each safety feature, the minimum amount of medical equipment, the strength of the structures, color of the stabilizers and doors, the minimum internal height, and many other important items. In response to these demands of law and the market, ICU has undergone a process of constant improvement in order to provide advanced equipment, services, and systems, fully in compliance. During manufacture, and proactively, solutions are adopted to meet the safety and legal requirements, such as the highly reinforced structure, designed to offer the best in technologically advanced safety in compliance with Resolution 815.
The vehicles are equipped with three-point safety restraint system seat belts fitted at each seat and to the patient safety bench, and at the two attendance posts at the patient ROI. The front wall of the assembly in its most advanced design and production version, made of 18mm phenolic wood sandwich up to the Polyal structure, meets the requirements of maximum deformation capacity and impact test in compliance with resolution 815. A more resistant, lighter material than steel, insulated from climatic agents, and bacteriostatic complements the front wall. This material is widely used in the nautical and aerospace industries. The design prioritizes minimal impact, increasing vehicle performance in the event of a vehicle collision. These and other state-of-the-art safety and patient comfort features are designed and implemented to ensure the safety of patients and clinical teams, as well as in compliance with current legislation, and ensure public confidence in the units in operation on emergency calls.
4.1. Occupant Safety Features
This subsection discusses the safety features that are included in our Type 1 ambulances. It ensures the on-road safety of the paramedics sitting in the front, the patients in the compartment, and other occupants in the patient care compartment. We have included advanced safety features in the Type 1 ambulances that are available for the protection of paramedics since it is compulsory for them to be restrained to ensure their maximal protection.
The restraint system of the paramedic includes seat belts of the latest design, seats with integrated 3-point harnesses, custom-designed crewmember safety seats, and airbags of the latest design that are mounted at the front of the cabin. They also come with impact protective construction built into the design of the entire cabin. They not only come with these advanced safety features to protect the lives of the occupants, but also the seats allocated for the patient caregivers have been placed and designed ergonomically to ensure better safety in cases of emergency or during dynamic driving behaviors. Seating orientation, interior design, and total possible cabin design methods are selected by consulting with many industry consultants, patient caregivers, paramedics, and EMTs to compile a design that provides the highest relative road and patient care safety for its occupants.
The design of both the patient care compartment and the cabins is made out of aluminum as well as fiberglass. These materials are also used in the other compartments as required and in the broader application straight to provide better protection and a long service life. These materials are fire-resistant and also resistant to viruses. These designs can properly function in a given situation. Safety is also a high priority while designing patient transport vehicles. This focus on safety is not only to promote the highest quality products but is also a goal of patient safety and patient care. This is made safe, which then turns this vehicle into a unique product in the transport vehicle field.
To make sure of the safety and efficacy of our design, as per the specified regulations, the vehicle is going to be tested for official crash verification by conducting the same crash test in a physical form. The same goes for safety norms for the vehicle and ambulance. This is also done in paper form by the use of simulation. To make this time far more secure, ICU ambulances need to be examined for their ability to meet the criteria for required national safety.
4.2. Compliance with Industry Regulations Type 1 Ambulances
The ICU Automotive Group: our brand and our company strive to provide the highest quality Type 1 ambulances possible. The United States industry has regulations and guidelines from several groups that we are required to comply with during the manufacture of an ambulance. At the state level, many states have adopted additional regulations that a manufacturer must comply with when building a new ambulance. This section details how ICU Automotive works toward achieving the industry regulations and that vehicles are designed to meet these numerous federal and state safety requirements. It discusses the quality control process to adhere to these design standards and the internal processes used to confirm that a vehicle meets these standards. The section also contains relevant properties of the ICU manufactured Type 1 ambulances and specific approvals or certifications that the vehicles and company have received.
In addition to the specific standards listed below, there are many standards and specifications by various manufacturers that need to be adhered to. While inventory needs and custom designs mean that no ICU-built Type 1 ambulance is in constant production, some parts, such as the base structural components and Type 1 body builder parts, often are. With that said, our design, construction process, and components – many of which we manufacture ourselves rather than purchase – have been extensively tested and are compliant with the standards for which certifying encapsulates ambulance safety. Industry organizations and representatives work together to create the regulations that the industry must meet. Compliance with these regulations not only ensures the safety of the product but helps determine the marketability of a vehicle. Failure to comply with the federal automotive safety regulations could lead to significant legal and reputational issues for a company.
5. Future Trends and Innovations Type 1 Ambulances
Type 1 ambulances are highly regulated and slow to change due to government standards and an aging workforce. However, there are technologies and trends that are likely to influence Type 1 ambulance design and application in the future. In no particular order, these are:
1. Electric Vehicles (EV) – The desire to move from oil products to renewable energy as a transportation source is driven not only by environmental reasons but by market certainty. There are also significant maintenance advantages to EVs over fuel-burning vehicles. A primary reason for the addition of advanced technology to fleet vehicles is to mitigate downtime, or at least help plan scheduled downtime.
2. SAE Level 1 Automation – This trend aligns with the move toward EVs. SAE Level 1 automation has moved from being an option on high-end luxury cars into the default setting on most newer vehicles. One operational advantage of this technology is predictive analysis of driver behavior. Many law enforcement agencies are using data gathered from fellow motorists’ phones to help predict where accidents might occur.
3. Telemedicine – The age of telemedicine is upon us, and emergency medicine is no exception. This technology would only be useful to a dedicated secondary transport unit, most likely a critical care service. This is a service that is in your customer’s backyard and likely to return the patient.
4. Type 1 Becomes Less Relevant – Industry suggestions are made out of bias, and ambulances are an extremely regulated industry, but it is plausible to believe that today’s trends in the courier industry and last-mile transport will move over to the secondary transport industry. Many refuse to use Amazon as a suggestion for where healthcare is going, but if the most efficient and comfortable way to get from hospital to home is in a Kia Soul box van, that will probably be the choice made for a customer after all other treatment decisions have cemented. The ability of first responders to start treatment when others would need to wait for transport will reduce the need for advanced EMTs to always accompany the patient. Nursing homes and other care facilities may just have paramedics assigned to specialty cases such as dialysis patients. ICU interacts with its various users to tailor an ambulance to their specific use; this is not user innovation, but it demonstrates the pace at which a 12-year-old ambulance might be “life cycled.”
5.1. Emerging Technologies Type 1 Ambulances
Every day, there are new technological ways to make the lives of the medical and clinical staff working with patients easier and to ensure more efficient treatment. The technological trends in mobile medical and clinical units (ambulances) are similar to the technologies in healthcare that contribute to increased efficiency, expensive medical equipment development, automation of the entire process, vitality monitoring systems, and the first telemedicine units that have been announced. With the help of the mobile and clinical units described above, the latest in information and communication technology has been successfully adapted, maximizing its performance and competitive advantage. In terms of the development and deployment of these units, there is a competitive edge. The application and usage below that would gain the target segment’s attention is precisely these healthcare emergency units incorporating the latest technologies.
Currently, an emergency service falls through the cracks, with the doctor or specialist only being able to make a reliable diagnosis when the basic first-aid diagnosis completes the examination, since the patient is being transferred to the emergency department by the ambulance for reasons beyond their control. The time it takes for the patient to be diagnosed by a specialist can significantly affect the patient’s health, employment, and family welfare rates. The above-mentioned mobile medical and clinical unit will allow doctors or specialists to observe and intervene in the process of diagnosing and repairing the patient’s circulatory problems from the network in real time. Optimization is also made based on algorithms that are based on artificial intelligence and big data, combined with the ability to predict and make appropriate decisions for transporting the patient with maximum safety for intensive care, more burden of urgency of the assistant medical team as well. Furthermore, emerging technologies such as 3D-printed steel, 3D-printed concrete, and aluminum foam show promise for use in future ambulance implementations. Although not yet ready for applications in the engineering conversion project, they are expected to soon provide lighter materials. New composite materials with no metal have also been discovered, offering both safety and insensitivity to corrosion in northeast Brazil’s semiarid climate. Maintenance will no longer be a problem owing to these properties, improving the material for future use. This will offer the market and the perception of innovation the opportunity to stand out. By providing a greater amount of diagnostic and patient information to healthcare workers at the receiving institution, these modern pre-hospital emergency medical services offer the unique ability to identify, test, and ensure the best treatment for the patient. The patient from the outside can receive a faster, more proficient, and compassionate service. Through data analysis, it is confirmed that the necessary infrastructure and plenty of vehicles were built and implemented. Additionally, in programs with an annual emergency department patient census of at least 70,000, few new labor rates and altered spatial solutions for rural care providers have been developed. Over staffing periods were carried out, covering ambulatory staff, community emergency services, past intelligence pathways, and paths to work upon which collaboration was used in detail. Each scenario provided a rich briefing on ambulance clinical training uptake regarding innovation, including the assessment of each scenario and feedback on the participant dynamics over the previous period and positive outcomes at the end.
5.2. Potential Improvements in Design Type 1 Ambulances
The layout of a Type 1 ambulance, to some extent, is driven by user feedback. Design improvements strive to address both practical utilitarian capability and aesthetics. Ultimately, the design goals are to create inviting, efficient, and functional vehicles that respond well to the rapid pace of emergency medical treatment while attending to the requirements of life safety of the patient. In the course of any such feedback, changes to the boundaries of distinct compartments are raised. Development towards modern design and without compartmentalization provides an open interior that can easily be cleaned, the interior can be reconfigured to suit new medical technologies, and creates an inviting working environment. Spatial design improvements can be made to allow quicker access to ACLS drugs, airway equipment, defibrillators, airway suction, and intubation devices, or niche block organization for the introduction of:
1) Major changes to the appearance of the interior and exterior and an improvement to the standard non-modern design and the introduction of sustainable materials for use in fabrication and a quiet interior for patient transport. 2) Proactive offerings to improve space utilization including enhancements that secure medical equipment to reduce accidental falls, and rolling out innovation in sustainable interior surfaces that eliminate cheaply made linoleum.
UX testing suggests important design changes can be made that improve the well-being of the EMS attendant during the rush of night and day shift pressures responding to or training for a spectrum of emergencies. The manufacture and installation of medical equipment is critical to the design of the specialized interior of ambulances and can be adapted to meet multiple standards. Further, a brief discussion of advancements in sustainable equipment mounting and more ergonomic design could form a component of this paper. Incorporating sustainability into the utilization of the surface flooring in the dosing compartment and the operational footprint is pivotal to the change in design and advanced technology. Any improvements that derive from this embedded study should be seen as those proposed by the manufacturer of the final product.
