1. Introduction to Ambulance Design
Ford Transit Ambulance; Ambulance design is crucial in the context of emergency medical services. A well-designed ambulance based on the nature and complexity of the injury may significantly affect the patient’s mobility and reduce the risk of new injuries caused by moving. Ambulance design has evolved with the changing healthcare requirements; however, the basic function is the same, which is to provide care and transport the patient at the same time. Fast access to medical care can reduce mortality and increase the chances of recovery for seriously ill patients. In recent years, there has been a considerable increase in the interest in providing high-quality and effective high-technology medical services through ambulances, under the unofficial maxim of care in transition, and some vehicles, called mobile intensive care units or heart ambulances, are being used only for the transportation of seriously ill patients.
The ambulance must be carefully designed for all the mentioned functions and the environmental conditions, which occur both inside and outside the vehicle during emergency transportation. The additional medical facilities that are attached in the special medical cell within the ambulance must be carefully housed to carry various medical equipment, keeping in view various emergency situations and situations with different geographic conditions. At the same time, it is necessary to take care of the physical situation of the paramedics of the 1A-based medical team that is going to be replaced so that they can get the necessary comfort during the work. In order to transport and treat seriously ill patients as much as possible and to provide a conducive environment for the paramedic’s location and medical personnel as far as possible, the design and layout of the ambulance must be such that all the mentioned requirements are met.
1.1. Importance of Ambulance Design in Emergency Medical Services
1.1 Importance of Ford Transit Ambulance Design
The ultimate goal of Emergency Medical Services is to save lives by reducing premature deaths due to medical emergencies and fluid stabilizations. In the golden hour of a trauma, the design of an ambulance plays a major part in whether medical treatments will be effective or not. The time that the medical team needs to reach the patient and provide interventions is every bit as crucial as the care delivered at the hospital. Most medical prognoses, as well as the satisfaction of patients and their families, are linked to timely pre-hospital care and successful clinical procedures. Patient care throughout transport is critical, and the most recent vehicle designs will assist in shifting the paradigm from transporter to treatment location. The patient compartment size, simple access to medical devices, and patient proximity are also significant for successful medical procedures, which save lives. Weather conditions play a significant role in the design process of ambulances. The basic layout of the ambulance is based on the variety of handles possible in different weather conditions.
The performance of this complex system is assessed by the provision of patient care, the provision of critical medical intervention, the dispatch of patients to health facilities, and the provision of breathing support at the scene of the accident. The magnitude of the design and layout of the ambulance is discussed in terms of both mechanical and electrical design of the system. Technical satisfaction and patient and user satisfaction are the yardstick for this system. Medical advancements in pre-hospital care are necessary for emergency success. Ambulance design should enable quicker diagnosis, safe patient and professional treatment, and provide proper comfort throughout the trip. Pre-hospital patient transportation to medical institutions has aided in reducing the rate of preventable deaths by speedier patient access to hospitals that meet medical standards for trauma care. Rapid care in trauma decreases morbidity, enhances, and extends the patient’s long-term health.
2. Ford Transit Ambulance as a Base Vehicle
The Ford Transit was chosen as a base vehicle for the ambulance conversion. The choice was based on a number of factors: the base vehicle has a wide variety of options, has a factory warranty of 5 years or 150,000 miles, and is sold and serviced nationally. It also has a variety of configurations, including cutaways, and provides easy access to interior panels for equipment storage and installations. The Ford Transit has two engines it is based on: a 3.7L gasoline and a 3.2L turbo-diesel. Out of the different variations of configuration, two are planned: a 148-inch wheelbase HR-EL dually and a 148-inch wheelbase HR-DRW 4×4. Features of the Ford Transit that make it an ideal base vehicle for the ambulance are a choice of drivetrains and customizable options. The Ford Transit has several options, including the regular cargo van, electric start cargo van, extended length cargo van, 2-passenger seating modification, part-window flooring, and several user preference options available. The Ford Transit’s interior dimensions are also within a range where practical and well-functioning designs can be produced.
Since several OEMs are using the Ford Transit as a base vehicle, the designs shown for the Ford Transit can be used as a limo, patient, combo, or medium-duty ambulance based on customer preference. The Ford Transit started production in the 2015 model year as a full-size van. It is an alternative to the very popular E-Series models. Ford was already upfitting Transits for ambulance use right out of the gate. The standard configurations of the ambulance devices on board are shown. After-market installations of medical devices or customized installations are also possible. Ford already had several hundred on backorder when the production of the Transit started. Ford has shown a mock-up of a 4×4 ambulance. This Transit is on a dually, extended cargo van and uses the passenger-side door for entry.
The 2015 Ford Transit offers three different body lengths within a choice of three roof heights. These vans feature 57 inches of open headroom and 77 inches of lowest emergency lighting mounting height. Ford Transit ambulances are available in either a 2-wheel drive or 4-wheel drive configuration. All Ford Transit commercial cutaway ambulances feature the 3.7L V-6 engine and a six-speed automatic transmission with SelectShift, offering two modes of operation: Progressive Range Select lets you toggle on the shift lever to reduce the range of available gears; Full Manual Mode gives gear selection control to the ambulance driver, allowing the driver full capacity to upshift or downshift as needed. The Ford Transit van is also offered in a deluxe cutaway version with a fiberglass rear shell that houses the emergency equipment.
2.1. Overview of Ford Transit Ambulance Model Range
Ford Transit is a complete family of Ford vehicles, offered in a variety of chassis cabs, minibuses, cargo vans, and unique configurations. As of 2021, Ford Transit Series vehicles are available in several brands, including Ford, Volkswagen Commercial, Titan, and others, as new and used, with model years ranging from current to 2014. Units of the fourth generation entered the world market in 2019, and Ford Transit is currently the top-selling van brand in the USA.
Each of this series of vehicles has a variety of specifications, such as engines, gearboxes, colors, etc.; but for usage in the field of ambulances, minibuses, and carriers, versions with the following technical characteristics are mainly used and correspond to standards in CIS countries and post-Soviet republics: Ford Transit 2019 350 XLT HD 4dr High Roof LWB DRW Extended Cargo Van with Sliding Passenger Side Door and 3rd Row Seat. Ford Transit 250 2021 Cargo Van HD XLT 3dr LWB High Roof DRW Rear Wheel Drive, Cargo dimensions 1503 / 3220 x 1793 x 1848; 9-speed automatic transmission; EcoBoost V6 Engine; modern exterior body kit with LED optics; 3-seat row in the cargo facility; Cargo compartment length: 3910 mm; Cargo volume: 15 m3; Cargo width between wheel arches: 1384 mm. Measurements of the cargo space and carrying capacity are shown above.
Modern models of Ford Transit vehicles are equipped with modern engines and advanced electronic systems to control the performance of internal electronic systems and ensure active and passive safety of passengers. In accordance with constantly updated market research and specific user needs, additional models of Ford vehicles of the Transit family can be offered in the form of customs vehicles. The choice of whether to convert the Ford Transit vehicles into ambulances, carriers, or minibuses heavily depends on the requirements and the environment they are being used in. Ford Transit is a popular vehicle in Europe and the USA in the EMS sector. The competition is very high, so the best models in the market must be used to produce the right Ford ambulance. Ford Transit vehicles were chosen in this research as they have different models with varying capacities and capabilities suitable to be modified and converted into an ambulance. In modern EMS work, it is not just enough to have a vehicle that can travel from one place to another but also to have modern technological features to keep the content and teams secure. These depend on where the ambulance is used and why ambulances are chosen for these cases.
3. Conversion Process by ICU Automotive – Ford Transit Ambulance
In this section of the paper, it is established that the Ford Transit vehicle has been subjected to conceptual design according to the current requirements for the use of specialized ambulances. Each stage of the ambulance conversion process is discussed in the following chapters.
The consequence of the conceptual design is an ambulance that is not only easy to mass produce but is also adapted to patient care, thoroughly integrated with the equipment and solutions used in the vehicles intended for specific functions and ensuring the provision of health services. At the design stage of the ambulance, particular attention was paid to ensuring the required comfort for the transported patients, as well as flexibility in adapting the equipment to the requirements of emergency services. The design concept allows for receiving individual requests from clients, such as universal platforms, an alternative individual ambulance, etc. One of the elements of the implemented concept was professional collaboration and partnership with designers, engineers, and emergency services, and the development and initial testing of the vehicle took place in collaboration with emergency service representatives in the workplace.
The beginning of the conversion is an overall concept, defining the ideas, philosophy, and layout of an ambulance. The designed vehicle used by the company is the Ford Transit van series. Throughout this report, reference will be made to the Ford Transit due to its popularity and the specific conversion details provided. Conversion companies with CAD/CAM capability carry out computer-aided design and use a database of vehicles to build a ‘concept’ vehicle. This enables potential clients to view in virtual reality what the actual ambulance will look like when installed on the given chassis. Proof of concept vehicles/designs helps marketing and customer congruence initiatives. Several potential problems are identified prior to installation and testing. An ideal and common solution is to have a 3D design laboratory so that improvements or amendments can be made at the design stage before commencing with manufacture. This also allows for alteration and customer flexibility, thus fostering a much better customer working relationship. There is also the ability to produce prototype or individual small one-off conversions which, in some cases, may be necessary. The importance of the drawing/technical section liaising with the Emergency Service Representatives cannot be underestimated. These professionals have a wealth of practical and theoretical knowledge which is invaluable and essential to the conversion process. At this stage, all European safety and regulatory restrictions are taken into consideration, and exceeding these standards is of the order of the day for verification in police, fire, and medical testing. A nationwide team of sales personnel and technical staff are available to visit the ambulance industry and Emergency Service Representatives on a day-to-day basis for discussions, demonstrations, and conversion views. The basic principles for a good and practical ambulance are as follows.
3.1. Customization of Interior for Medical Equipment – Ford Transit Ambulance
The interior of the ambulance is very important, especially for medical equipment. The layout should ensure that medical equipment is best arranged, managed, and easily accessible for rescues and patients. The first aim is for ambulance workers to find and use a single item quickly. Because ambulances have many kinds of medical equipment and various items stored separately, the interior of the ambulance must possess as many modules as the capital dimensions. The inner layout must allow all medical equipment to be used and arranged according to the frequency of everyday occurrences. The reason is that many work necessities are carried out in the ambulance. Workers should have quick access to the single worksheet, tools, and non-living patients. For working order, the layout should manage tools in an organized manner.
In the van, dichotomous storage of our medical equipment exists, considering the state of the van and ambulance items according to the nature of the work and by using traceability location. It is aimed to follow SME and TI. In particular, passengers in the rear section of the van should provide maximum benefit so that the safety of the vehicle is not at risk, and the treatment process for the patient is prepared in the face of problems located here. For example, in this part, critical patients who start infusion in the treatment process, drugs used in a halter system, defibrillator, suction, etc., are kept. It is important to use the interior of the vehicle universally and for everyone in all conditions. The interior of the van is designed to be used in the same way without making significant changes in vehicles of different lots. It was authorized by those who know the duties of healthcare professionals best, and after research to determine modules via the opinions of experts, we designed the project. In conclusion, we can say that interior design and industrial models require specialized solutions to improve the efficiency of work and academic study. As a result of the feasibility studies, cooperation in structuring management is also crucial for the success of the developed model. This prevents unnecessary coincidences in the interiors of ambulances. It facilitates quick and effective treatment of patients with critical diseases and creates a comfortable place for non-living patients. Therefore, interior design is a very effective part of the design of an ambulance. The layout, design, and use of the interior of the ambulance are constructed as proposed by the cooperation of the project partners within a total of 35 titles.
4. Safety and Regulatory Compliance – Ford Transit Ambulance
There are existing standards, regulations, bodies, and requirements that are driving the construction of ambulances, both in terms of operation and patient care. For operation, basic requirements include vehicle safety, driver safety, etc.; driver and passenger restraints to protect occupants in the event of crashes; service life and wear and tear; and so forth. Patient care requirements include managing dynamic environments, providing safety for the care of patients, and dealing with specific types of medical equipment, including biological hazards. Currently accepted approaches are discussed in this section, using the variable light-weighting shoulder track as a design feature. ICU Automotive has aimed to push this envelope in a triple redundancy system that currently has four patent applications filed.
One of the most commonly used safety devices in vehicles is the seatbelt. In ambulances, where occupants must be restrained for long periods of time, or possibly lying down, this is critical. Multiple different seatbelt systems with and without retractor pretensioners are used in ambulances. Car manufacturers have been continually pushing the envelope with technology to improve safety and crashworthiness of the vehicle. Many of these features are beginning to appear in ambulances as they become more prevalent in fleet vehicles. Ambulances designed by some manufacturers utilize features like crumple zones, airbags, reverse sensing technology, electronic stability control, rollover stability control, canvas-based paramedic seats, and ultra-high strength steels. The vehicles are also crash tested. Note that there is nothing stopping these features from being used for older, but newer generation ambulances. Leveraging dual sliding doors, combined with low floor designs, creates a loading floor with a near constant height. This can facilitate easier stretcher loading and unloading for ambulance crews, who are tasked with lifting increasingly heavier patients.
It must also be acknowledged that failures of compliance have occurred and are not unheard of. For example, of existing crash tests conducted on ambulances certified to certain standards, manufacturers and regulatory bodies have identified various issues and subsequently improved the design and manufacturing of ambulances. Older variants (i.e., smaller capacity, lighter NSV, etc.) ambulances were judged safety standard compliant, but it is very possible now that as standards improve, and new variants are offered, the ambulances will not be. Respected or mandated safety standards are driven by mineral versus outcome tools and have evolved to incentivize continuous improvement in the manufacture of ambulances. They are enforceable through the Health and Safety at Work Acts, which rarely provide for a reliable, commonly respected safety guideline. Enforcing a single standard can incentivize the major player to perform safely, as they are responsible for identifying and applying the standard. Multiple entity producers may not be knowledgeable enough about what market holders care about, or may be apathetic, to create and adopt a safety standard. In scenarios where there is no clearly mandated standard or safety regulation, entities will make ambulance safety engineering and design choices based on assumptions about market expectations regarding ambulance safety. No entity would knowingly design or manufacture an ambulance with inadequate pedestrian protection, which can kill or maim.
4.1. Crash Testing and Safety Features – Ford Transit Ambulance
Dynamic sled testing was an important and regular part of the design process. This allowed close scrutiny of the occupant response to the varying deceleration profiles each time we modified the vehicle or changed the seat mounting configuration. The testing was set up so that all seat belt mounting combinations and floor fixtures could be easily modified during the test, ensuring a large portion of the design space was covered. Car-to-car testing allows manufacturers to make design decisions away from the fixed points of the typical test dummies: the industry can look at how modularity can be used to safely accommodate a wider variety of potentially vulnerable passengers.
The ambulance is constructed with strengthened side structures and additional energy absorbers in addition to standard driver and passenger side airbags. The Anti-lock Braking System optimizes braking, assisting the driver in maintaining control of the van even during emergency braking or when braking on poor surfaces. The Electronic Stability Control detects the potential for a skid and intervenes by automatically regulating the accelerator or strategically braking on individual wheels to bring the vehicle safely back under control. To ensure both patient and crew safety during transport, all the weight-bearing equipment is mounted securely and subjected to soft impact deceleration by means of deceleration testing using crash test dummies, similar to those used to test airbags. As with all tests, the results of the safety tests must be incorporated to continuously improve the design where necessary and provide feedback to continually evolve and adapt the design. In addition to the usual testing requirements, the most extensive standard to investigate and test the vehicle’s safety on the market comes from the UK in certification at Millbrook.
5. Future Trends in Ford Transit Ambulance Design
Future Trends – Technological Developments
Several major forces will shape future ambulance design, such as technological developments in medicine, pre-hospital care, and especially emergency communication and vehicle control systems. For example, potential future ambulance systems incorporate telemedicine technology, which could allow EMS personnel to use sensors on their vehicles and EMT wearables to gather, send, and receive vital signs, medication administration, and patient condition information. Ambulance communication and connectivity systems make up the backbone of the highly flexible, adaptable, and safe transport and treatment systems of the future. Advanced communication and configuration systems developed in vehicles connect with all associated systems to ensure real-time, seamless connections between the healthcare system components. Future medical communication and connection systems provide diagnostics, communications access, therapies, and self-care strategies. Future delivery and professional care services will also demonstrate greater independence from the vehicle and greater digital linkages between components.
In the future, urban hospitals and healthcare providers may develop advanced AI systems to predict which tracking and on-board vehicle systems should be activated for each ambulance run. We can expect ambulances to maximize efficiency by undergoing upgrades from traditional diesel trucks to electric vehicles for power, considering the development of electromagnetic shielding equipment. As the Emergency Medical Service operational environment is largely affected by technical, socio-political, and infrastructural changes, designs shall respond to trend changes in service delivery and healthcare delivery systems.
The sustainability of such ambulances is largely predicated on power generation, storage, and use, while design criteria are weighed for an ambulance with the top priority of saving lives. In general, ambulance designs are largely influenced by environmental factors, which are largely predicated on HEV drive systems that generate most exhaust fumes, subsequently influencing designs based on the environmental impacts of HEVs, as burning fuel releases greenhouse gases. Innovative ambulances differentiate the emergency department operations of healthcare systems and responders. This ensures that any care provided by the EMS providers results in better outcomes for injuries. Development and design shall focus significantly on patients’ families and the general public, especially vehicular commuters, and healthcare providers to develop improved public-private partnerships for greater response collaborations in hazardous materials incidents.
