A COMPREHENSIVE GUIDE TO TYPE 1 AMBULANCE MEDICAL EQUIPMENTS AND SPECIFICATIONS

A COMPREHENSIVE GUIDE TO TYPE 1 AMBULANCE MEDICAL EQUIPMENTS AND SPECIFICATIONS

1. Introduction to Type 1 Ambulances

Type 1 ambulances are equipped with advanced life support amenities for treating the critically ill and those in need of advanced life support and stabilization before being conveyed to a hospital. They are usually staffed with a paramedic to work as a lead caregiver and work in close partnership with another medic and an emergency medical technician. Unit sizes may include chauffeurs and communicators or dispatchers stationed in communication centers, as well as logistical personnel responsible for managing inventory and maintaining it.

Type I ambulances (otherwise known as Class I ambulances) are advanced life support ambulances which are constructed for those heavy-duty trucks built with full panel truck bodies. Type I ambulances are trucks reinforced with the heaviest frames to be able to support an ambulance body and the gear that is attached to these types of vehicles. They are also strong enough to be able to tow a boat, a trailer, or a vehicle. For example, most communities like the fire department buy a Type I ambulance because the kind of work they are put through is demanding and requires such rigorous construction.

1.1. Definition and Purpose

In the early 2000s, it became apparent that EMTs and paramedics needed the ability to perform more procedures in the field to better serve the community. Manufacturers began to explore different ways to maximize their interior dimensions, which led to extended interior heights and lengths, and rear door configurations that maximize both space and access. These rigs are panel construction ambulances – they have a box-shaped design and sit on a light or heavy-duty chassis. Contrarily, van-style ambulances are designed to meet the needs of EMTs and paramedics who deliver BLS services and provide patient transports. The unique challenges associated with EMTs and paramedics serving both the BLS and ALS patient population mean that a sizable, customized build is necessary to handle the higher demands for ALS. Hence, Type 1 ambulances are the largest of the four models and are primarily focused on ALS care and services. They are meant to handle the management of the kinds of equipment and supplies associated with needing advanced life support (ALS) care.

Type 1 ambulances are large enough to handle pediatric emergencies, mass casualty incidents (MCIs), and hazardous materials (HAZMAT) transports. They have enough storage to manage the equipment and supplies associated with ALS care. It’s crucial that Type 1 ambulances meet all local and regional medical service requirements to serve the community in which they’re stationed. Meeting those needs, however, is only part of the equation. Type 1 ambulance specifications drive the manufacturing process, and this guide will detail the unique foundation Type 1 ambulances are built on, its medical equipment, and what makes them crucial in the provision of emergency medical services (EMS). Furthermore, when you’re responsible for a Type 1 ambulance, it’s crucial to know what to look for when in-service maintenance is performed so your rig stays on the road and out of the shop.

A comprehensive guide to Type 1 ambulance medical equipment and specifications, from the foundation to installation and maintenance.

1.2. Classification of Ambulance Types

The healthcare facility on wheels has high specifications for patient care and has modular divisions in a Type 1 ambulance. The dashboard engine of the Type 1 ambulance is a basic commercial vehicle manufacturer chassis that has been modified to house the patient’s basic life support centers. The specifications of Type 1 are that the compartment is always closed from drivers. The Type 1 ambulance includes facilities that maintain ventilation, air conditioning, and patient oxygenation. According to Ambunet, the specifications of the Type 1 ambulance’s structure are such as the body SL no. 3.7 with a width of 83″ and a height of 72″. The Type 1 ambulance includes a full bumper and emergency light bar on the top.

An ambulance is a crucial part of any urban or rural community healthcare system. It is a pre-hospital care service for transporting patients to definitive healthcare facilities. The ambulances can be classified as Type 1, Type 2, Type 2N, Type 3, and Type 3N. The different types are based on modular components. The demand for an ambulance has been increasing as the percentage of healthcare facilities set up by the government as part of rural healthcare development programs to reduce maternal and infant mortality rates.

2. Medical Equipment in Type 1 Ambulances

Specialized equipment essential for support of medical treatment, for example, methyl alcohol, accruflame kit, equipment for administration and monitoring of anesthesia for intubation, constantly regulated inhalation and oxygen with battery-powered supply in order to move the patient where required, as well as short-term to provide enough for smooth transfer of patient from ambulance to overhead plane. Use of intravenous bottle holders, oxygen bottle holders and the like are allowed, but must be equipped with safety door or straps. Handles, stretchers, and fastening devices must be equipped with safety covers.

The primary purpose of a Type 1 ambulance is to safely transport an individual, without the need for emergency medical care, to a medical facility. It can be used by quick reaction parties as a medical aid station for short-term care and transportation for subsequent evacuation. The size of the unit is large enough to comfortably and effectively take care of three litter patients. The necessary items required to support the mission of the ambulance can be stowed with relative safety to the patient, or within easy carrying distance of those items.

2.1. Basic Medical Equipment List

1. Laryngoscope system: • Blades (adult size, pediatric size) • Handles • Miller blades • Macintosh blades • Bougies/gum elastic bougie (GEB) • Bougie-stylet (optional) • Cricothyrotomy kits 2. Stylet or bougie in appropriate sizes 3. Endotracheal tubes: uncuffed (optional) 4. End-tidal CO2 monitoring device (also known as ETCO2, capnography, or color-change detector (CCD) device) 5. Nasopharyngeal airways 6. Oropharyngeal airways 7. Self-inflating and flow-inflating bag-valve-mask devices and appropriate masks and PEEP valve(s) 8. Positive pressure ventilation devices 9. Laryngeal mask airways • Appropriate sized tubes • Masks • Inflation devices 10. Oxygen delivery equipment • Nasal cannulae • Non-rebreather masks • Oropharyngeal catheter • High-flow O2 delivery systems 11. Thermometer(s): • Disposable oral thermometers • Tympanic thermometers 12. Warming devices: • Warm blankets • Forced-air warming systems • Fluid warmers 13. Endotracheal tube securing devices: • Tape • Adhesives • Tube-holders 14. Pulse oximeter(s). If monitor is utilized, connect to the non-invasive blood pressure (NIBP) function 15. Bag-valve-mask (BVM) and pocket mask devices 16. Micro-tube holder, drill, screwdriver, adapters 17. Simple, airplane, and oropharyngeal suction devices 18. Disposable oral/nasal airways 19. Advanced airway equipment: Intraosseous device placement materials/skeletal guns: • Fluid delivery materials • Non-invasive BP devices • ECG monitoring systems • ECG electrodes and razors 20. Bag: • Stethoscope(s) and extraluminal monitors • Sphygmomanometer(s) • Dongling type (velcro or fabric) restraints 21. Specialty pediatric drug delivery supplies: • IO butterfly or needle • Scalpel • Heimlich (or other) chest decompression needle • Tourniquet 22. Pressure monitoring devices 23. Catheter-over-needle and open-tapered needles 24. Miscellaneous equipment: • Umbilical venous catheter insertion materials • Specialty IV catheters and needles • Cutdown tray (optional) with its tubing, introducers, adapters and sterilization kit 25. Drug delivery and intubation guides and equipment.

2.2. Advanced Life Support (ALS) Equipment

1. Multi-functional defibrillator with 3 or 5-lead ECG, pulse oximetry, and noninvasive blood pressure (NIBP) monitor 2. Color screen 3. Telemetry capability (optional) 4. Transparent three (3) or five (5) lead bridge with cables for monitor/defibrillator 5. Any additional connections and internal shielding required by the monitor/defibrillator manufacturer

1. Two adult aluminum oxygen ‘D’ cylinders – side shelf mounted 2. One pediatric aluminum oxygen “C” cylinder – back wall mounted 3. Inverter electrical system with four (4) 110-VAC outlets – left wall mounted 4. Defibrillator – monitor shelf mounted 5. Infant ventilator – monitor shelf mounted 6. Adult ventilator – monitor shelf mounted 7. Carbon Dioxide (CO2) monitoring equipment – monitor shelf mounted 8. Intravenous (IV) Pump – monitor shelf mounted 9. Solid state refrigerator – right wall mounted 10. IV Pole – ceiling mounted 11. Overhead lighting and IV Bar – ceiling mounted 12. Map light – right side wall mounted 13. IV Fluid warmer mounted – monitor shelf mounted The cardiac monitor location shall be factory installed in the overhead patient compartment shelf cabinet with the following features:

2. Ambulance Equipment Floormap 2.1. Overview and Standard Equipment Locations 2.2. Advanced Life Support (ALS) Equipment 2.3. Cardiac Monitor Equipment 2.4. Optional Life Support Equipment 2.5. Basic Life Support (BOS) Equipment 2.6. Climate Control System 2.7. Bulkhead and Squad Bench Seat 2.8. Custom Ambulance Cabinetry Following are the manufacturer’s features and standard locations for the advanced life support (ALS) medical equipment:

3. Specifications of Type 1 Ambulances

Type I ambulances are constructed according to the Type II reference ambulance’s basic dimensions, while having a bigger size and carrying capacity, and are built mainly for patient transport and intelligent patient transport, especially for the transfer of bariatric-sized and dangerous patients.

It is seen that Type II ambulances are built both with flat-floor and end-molding superstructures, but Type I ambulances are only built on a flat-floor superstructure, and hence it becomes necessary to build a special version of a MCV or a MCC without a low floor specifically for Type I ambulances. Older Eurocargo models may be considered suitable for this specification, if they also possess a side structure. In all other respects, the reference ambulance that will be built on a human transporter vehicle is quite similar to the boxed type II ambulance.

It seems rather logical that a mid-term chassis with a MID or a RWD, and a diesel engine with a power exceeding 120 PS, be preferable, but of course will change according to the relief and weight requirements of the country. Especially for long operation durations, higher passenger capacity and more medical apparatus capacity must be provided. It is quite interesting that roof heights for ambulances are approximately the same, approximately 5 m, whether they are built on a flat-floor, RWD 3.5 or 5.5-t class vehicle.

The “designer” and “operation” responsibilities of an ambulance are regulated by NFPA 1917 standards published by the United States National Fire Protection Association (NFPA), while interior material choices and ventilation design are regulated by other NFPA standards. Material aspects other than fire-fighting are all listed in the European Directive 2001/85/EC, together with the pertinent tests.

The reference standards issued by the United States National Fire Protection Association (NFPA) are recognized and used to different extents by almost every country, and especially in the United States. NFPA 1917 is the reference standard for “Automotive Ambulances” and includes detailed information regarding the build-up of Type I, II, III and IV ambulances. Type I ambulances share material properties such as the use of non-combustible materials, and fire-ease of access nozzles with Type III and Type IV ambulances. In contrast to the others, Type I ambulances are totally separate from truck cabins both in terms of the manufacturing and strength aspects. If a Type 1 ambulance is built on a truck chassis instead of a van, it is called a “medium-duty ambulance”.

Type I ambulances are considered to provide the maximum working space and equipment when compared to the other types of ambulances. They are usually built using a cut-away van or truck chassis that are manufactured by vehicle distributors. Similarly to other ambulances with a box superstructure (Type II), they can be equipped according to the needs and relief of the countries within the boundaries of the standards.

3.1. Chassis and Vehicle Features

To meet the requirements of patrons with good faith, earners must provide the FAV with appropriate test documentation for vehicle safety performance tests, such as the civilian new car evaluation program conducted by the National Road Transport Safety Administration. Describe additional details and features, such as structure supporting stretcher locks tested for compliance with federal regulations, rear-facing and adult seat belts, and seats. If a third-party crash test is performed to FMVSS 206, 214, 222, 301, and 403, please clarify this point. A known ambulance manufacturer is highly recommended for performance. Also, the FAV may visit a requested vehicle for the survey to verify the claims and capabilities.

3.1.3 Minimum vehicle weight capacity should be provided.

3.1.2 On/off-road capabilities are vital for military-specific missions, and an AWD/4WD system is preferred, especially for off-road combat zone use. Special suspension and tire upgrades or similar features for additional off-road and off-terrain capabilities provided and additional forces apply.

3.1.1 The ambulance will be built on a 4×4, FWD, 2WD, or AWD make and model of an ambulance that is suitable for off-road use. Manufacturer and model year must be specified. Notes and additional details should be provided. The vehicle must currently be in production, and service-only units will not be considered. Single engine versus diesel/electric engines for medical devices, which will be discussed in detail, are not acceptable. Special notes, such as specialized brackets or grinder systems to handle security threat situations, may be mentioned.

3.2. Interior Layout and Design

The depth of the bench and the volume between the patient seat and the Squad Bench (the area often occupied by medical equipment) is variable. It would appear that the bench should be as shallow as possible, for maximum patient space at the rear and optimum weight balance. All equipment should adhere to automotive standards of “crashworthiness” and be able to withstand the prescribed maximum deceleration without becoming dislodged. Additionally, a pull test of 30G (corrected to automotive standards) should not damage the patient, the operator, or the stored equipment. The medical cabinet must be made from a rugged but impact-resistant material, analogously tested for crashworthiness up to a deceleration of 30G. In order to ensure operator and patient safety in the event of a collision, doors and drawers should latch independently. Standard automotive latching devices will be tested for crashworthiness.

In terms of interior layout and design, it is critical to ensure that as many features as possible are adjustable. This allows the configuration to be adapted over time as operational needs change and guarantees that in the shorter term, each piece of equipment is properly stored for stability and safety. Clutter – found commonly in emergency situations where it is essential to be able to locate and gain access to everything quickly – is an operational necessity that requires a suitably designed and crafted storage system.

4. Regulatory Standards and Guidelines

B. Regulatory Structure In Victoria, state government regulations define the scope of services that can be provided by each accredited statewide provider. Compliance with these regulations must be achieved by providers whenever they are certified to operate within the ambulance services industry – that is, the Victorian Health Department’s Office of the Chief Health Officer (CHO) with services designed and/or intended to be provided for the public or for private commercial agencies. Additionally, there are our own internal standards that are defined and supervised by the management of each individual provider. These include guidelines for clinical practice, staff training, occupational hazards, clinical and other logistics, infection control, clinical research, patient and other clinical records, equipment and breakdown procedures, billing, audit requirements, etc. These guidelines on staff training, etc. are generally developed by the OM/ED and FTO/PM teams in conjunction with qualified external sources.

A. Introduction As mentioned previously, ambulance specifications should meet minimum standards for safety, durability, ergonomics, and clinical environments. There are a number of standards and guidelines published by the Australian Council of Ambulance Authorities (ACAA), the National Ambulance Equipment Group (NAEG), the British Ambulance Association (BAA), the Society of Automotive Engineers (SAE), and the United States General Administration (GSA) that set out minimum standards for various aspects of design and equipment. These are set out in Appendices 5 and 6. This thesis aims to develop a set of minimum features that should appear in a next-generation ambulance with a focus on the clinical area: the patient and equipment spaces. The following points have been considered: clinical care trends, client needs, technology trends, vehicle design trends, architectural design trends, ergonomics and design parameters, and other aspects that can increase safety, decrease costs, and increase operational efficiency.

4.1. National Standards and Requirements

To meet the requirements of the state noting the Ambulance Architectural Manual or the guidelines set down by the American National Standard publication, professional vendors such as General Vehicle, Horton, and Marque would build ambulances. The interior cabinets and racks are to be built up to the top surface of the spineboard and be equipped with all the necessary first responders (EMT or EMT-P) equipment to provide basic life support. These cabinets are specified to accommodate a certain size and quantity of equipment such as oxygen tanks, suction clean up equipment, intravenous support equipment, intravenous solutions, dressings, splint kits, and any other first responder equipment. There are trays for vials and drug kits, and a large compartment for an AED, a defibrillator, and a suction pump. These cabinets are to be built with the necessary dividers to keep the equipment secured during both normal vehicular and off-road movements.

The standards set down by the American National Standards program for the construction of an ambulance and the ambulance components are found in publications KKK-A-1822 and KKK-A-1822E. Some states, however, have their own architectural manuals governing the construction and equipping of an ambulance. States like California have an Architectural Manual for Ambulances, and New York has its State Department of Health guidelines for Ambulance Design. Most of the equipment specified in the manuals is common to most ambulances, while a few items are specific to the state the ambulance is to serve.

4.2. Industry Best Practices

First responders can ensure their fleet is well-built by considering all aspects of industry best practice research outside the center metal walls of type 1 ambulances.

First, consider the daily maintenance for the safety and optimization of your crew. For instance, customizing your ambulance interior layout and materials according to the number of responding crew members (1, 2, or 3 EMTs) ensures efficient patient care and optimal positioning for quick life-saving usage of the medical equipment. The advanced knowledge regarding NEMA and GFCI breaker systems could save and improve your crew’s safety profile when they use your life-saving equipment. Information about various levels of sound reduction will protect the crew’s hearing and health. Take numerous steps to understand and prevent long-term issues with the cooling system and maintenance obstacles.

Industry best practices pertain to methods and expertise about delivering durable, feature-rich, and comprehensive ambulances. Type 1 ambulance manufacturers have much experience in the field and expert insight for translating their metal boxes into modern-day life-saving units. Please take note of what type of chassis your Type 1 ambulance is built on. This could affect the ambulance operations and the quality of first-time build. Make sure to ask state local dealers and local end-customers for feedback on the ease of finding matching service and parts.

5. Conclusion

Type I ambulances are the leading choice for the transportation of critical care patients and paramedics, including EMT-Paramedics, Paramedics, Licensed Vocational Nurses and Registered Nurses. The Type I ambulances possess a Unicell ambulance body that is a fully integrated unit that is installed on a 4 x 2 or 4 x 4 standard truck or cutaway chassis. They range in size from the mid-size F-450 to the full-size F-550, and can range in construction material from the standard aluminum to a special order stainless steel. Type I ambulances have the ability to carry multiple EMS personnel, and have a longer wheelbase which provides a wider patient compartment. They are often used for long distance transport since it has a long wheelbase for good ride quality at high speeds. A four-wheel drive chassis is chosen if the patient location will be over uneven or unpaved terrain areas.

The Type I ambulance is the top of the line for road use. It is a heavy-duty truck chassis carrying a module constructed in one piece. Type I’s are designed with the critical care patient in mind, examining the full continuum of care provided by paramedics and other emergency responders. They typically have the most extensive lighting and highest amount of specialized equipment to simulate an ER environment. The large interior of Type I ambulances can be configured in several ways. Dual Squad Bench, Single Squad Bench, or Long Squad Bench configurations can be laid out to provide paramedic seating and/or equipment storage, as well as stowage cubicles above the squad benches.

5.1. Summary of Key Points

The guide consists of Table 1 on Section 3 of the aforementioned Title 13 CCR regulation, which lists the specifications for the key medical equipment that must be included in a Type 1 ambulance. This list includes specifications for 49 basic pieces of medical equipment, of which only five are unnecessary relative to the equipment configuration of a Bimodal Into Van ambulance. As a useful guideline for interested beneficiaries of federal assistance, a detailed itemization of each of the 49 basic pieces of medical equipment specified by the state is provided. Also provided is a checklist that achieves two important objectives. On the one hand, it permits monitored jurisdictions and states to confirm that their ambulances are adequately equipped with the medical equipment that they have obtained or are in the process of acquiring. On the other hand, it serves as a guide for ambulance vendors to develop and supply ambulances that meet the specifications of the Type 1 ambulance standard.

This report provides detailed technical specifications of Type 1 ambulances which serve as a “formulary” delineating the key elements of a Type 1 ambulance used as a benchmark for design, quality control, and budgeting for states and localities which receive federal assistance on ambulance acquisition. This appendix provides a comprehensive description of the set of medical equipment that should be included in a Type 1 ambulance according to the standards prescribed by the State of California in its Title 13 CCR guidelines. This description provides a guide for local governments about the basic set of medical equipment that must be included in an ambulance, as well as a checklist for prospective vendors of such equipment that will be used by local governments and states in competitive bidding and post-procurement inspections to assure that the ambulances purchased for their jurisdictions meet the Type 1 ambulance standard.

5.2. Future Trends and Innovations

Prehospital and hospital communication systems are undergoing tremendous changes and improvements. Today, the number 112 is operational for police, firefighters, and ambulance institutions. However, it is still very difficult to reach a medical professional. It is challenging for people calling to determine whether they are inquiring or asking for medical help, as the same title, “Dr.,” is used for both doctors and professors in Turkish. An efficient communication system is needed to avoid this problem. Therefore, regardless of whether they are a professor or not, people from health organizations should be able to call 112 with “112/112+++Dr.” markers. This would indicate that it is a medical call. Moreover, calls from different stations should be transmitted to dedicated telephone or email addresses. When nobody is present, the calls should be redirected to the relevant person. Such an arrangement could even facilitate communication between stations and hospitals. In this way, potential emergencies who come to the station can reach the hospital first.