1. Introduction Ford Transit Custom Ambulance
Ford Transit Custom Ambulance; The ambulance holds prime importance in any emergency medical system by providing appropriate care and transferring the patient to major healthcare facilities. The large fleet of ambulances is designed to cater to the varied requirements of municipal corporations, private hospitals, government hospitals, healthcare startups, clinics, and others. The operational area and requirements of different healthcare providers differ significantly. Modern-day ambulances are designed for various services such as basic life support ambulance, advanced life support ambulance, critical care ambulance, neonatal ambulance, mobile diagnostic center, and so on. With the rapid technological development towards patient care facilities, the conventional ambulance used in the past may not compete in terms of facilities provided to the patient and physician. There are very few ambulance manufacturers in the world providing critical features that help physicians exercise procedural intervention on the patient during transfer, resulting in considerable improvement in patient outcomes. The paper aims to describe in-depth design and manufacturing of a low-cost ambulance that complements the advanced capabilities of a major healthcare facility.
The design of the cost-effective ambulance is discussed, and scientific design that enhances patient management and ambulance operational attributes is elaborated. Over the years, ambulance services have been evolving more driven by technology than by automobile design, which in turn has improved physician convergence and patient outcomes. The various important successful features or trends form the basis of a complete and apt requirement to be incorporated while designing a modern-day ambulance. The present-day ambulances available are custom designed. The designs are being quickly modified or changed completely for realization, depending upon the target price set by the end-user. The patient care industry is cognizant of the fact that, in a country with a population of more than a billion living across the nation, there is a requirement for low-cost medical services. For ambulances, the market trends show a slow but gradual rise in the spectrum of different models of ambulance vehicles that need to be made. For a few years, the focus has been on the design and manufacture of Basic Life Support Ambulance, Advanced Life Support Ambulance, Neonatal and Critical Care Ambulance due to the increasing use of modern-day medical equipment and facilities. Modern-day ambulances need an effective design and facilities necessary for patient management by going a step ahead of the prevalent designs. The introduction of such a trauma care system today is necessary to bring about an essential life support skill set to be incorporated into an ambulance, which includes proper oxygen delivery piping with flow meter and oxygen regulator, a syringe or aspirator required to draw solution from a glass bottle and check for blood in the pleural fluid to detect pneumothorax or pneumomediastinum, which is otherwise not apparent, a properly designed patient handle as well as patient transportation with systemic approach monitoring by paramedics. The manufactured custom design ambulance completes and fulfills the basic life criteria and is used as a basic life support ambulance. The patient care industry encompasses the modern age of intrahospital as well as extrahospital healthcare delivery, which includes a spectrum of services beyond just transportation. It recognizes that an ambulance is an extension of the emergency department of a teaching hospital and that the paramedical staff working in such ambulances are the eyes and ears of the emergency department or hospital when the physician is not around.
1.1. Background of Ford Transit Custom Ambulance Design
Ford Transit Custom Ambulance ; Ambulances have evolved from a way to transport someone to the hospital to sophisticated vehicles now carrying medical supplies and technology to stabilize a patient’s condition at the site or on the way to a hospital. The earliest ambulances were horse-drawn, and just like ambulances today, they were used to transport patients to the hospital. While some initiatives were made to use covered wagons with dividers so that patients were isolated at the rear portion of the wagon, early motorcars were also used, including converted vans or motorcars with a tail cockpit to accommodate more patients. In the 1960s, the requirement for efficient transport of wounded soldiers in the battlefield during World War II led to the use of dedicated vehicles according to the needs of the patient and their condition. In these critical situations, patients are transported in vehicles designed to be “mini Intensive Care Units.”
Since 1973, the recommendations for ambulances were first developed by relevant organizations. There are also well-established counterparts to this association in the rest of the world, such as Australia and other countries. The United Kingdom has improved upon the designs several times since 1976 and has also recommended the appropriate size and design of ambulances used in the service. In most societies with mixed domestic scenes, significant differences exist within small transport vehicles with a local area of coverage, varying from primary, secondary, and tertiary standards toward healthcare services. Such differentiation leads to differences in designs, sizes, and areas of coverage and transport facilities. The design of the layout and the equipment present poses ergonomic challenges as part of its layout to make it functional. It must ensure patient and medic safety while providing enough space and mobility for moving around and enough medical equipment to manage critical or highly critical conditions until the final destination is reached. The design of ambulances in a developed society reflects these challenges, where mobility, speed, and on-board critical facilities coexist in a single vehicle. A narrow line of balance is struck between ambulance design and the specificity of care.
1.2. Importance of Customization Ford Transit Custom Ambulance
Customization is one of the main requirements in ambulance designs as the customer’s healthcare systems and patient categories are different. There is no standard patient and no standard mission; therefore, the interior of the ambulance should be as flexible and comfortable as possible. Our rooms-on-wheels can be adjusted to the requirements of the people – the patient and medical crew. It depends on the mission profile for the optimum solution. Therefore, a wide range of smaller medical equipment, suction and infusion devices, defibrillators, patient monitoring, and diagnostic systems can be stored on shelves, in cupboards, or in dedicated pull-out modules. When required, the treatment area can be expanded in seconds to accommodate various pieces of medical equipment, beds, or other systems up to the height and dimensions available. Access to the patient is a critical element of any design.
Of all the five factors needed for successful ambulance design, this is one of the most important. The design of a modern-day ambulance must be informed by a close working relationship between itself and the future patient that it will be called upon to care for, through the medical officers, to the doctors and nurses who will be using the mobile intensive care ward. Feedback and the ability to act upon it immediately must be an inbuilt system into the whole vehicle design program. This free exchange of ideas and mutual trust between ambulance designer and emergency care professional must continue throughout manufacturing, delivery, in-service life, and follow-on servicing. The final ‘report card’ of the design is played out weekly across the world in the patient outcomes from the back of thousands of ambulances. Regulatory requirements are constantly impacting vehicle designs for a successful manufacturer. This provides the consumer with a safe environment where all the necessary medical treatment and patient management systems are on hand and can be rapidly deployed in a very confined area. R&D dividends are patient outcomes and a faster journey to better care and aid.
2. Ford Transit Custom Ambulance Overview
The Ford Transit Custom was launched by Ford in 2012 as the mid-size model of the Ford Transit range. The Transit was first introduced in Europe, but soon arrived in other markets around the world. The Ford Transit Custom is built in Ford’s Köln Niehl plant in Germany for worldwide supply. The vehicle is available in a large number of markets, where it competes with other mid-size vehicles.
The Ford Transit Custom can transport up to 3.3 tons and offers different length and height configurations for the van versions. The Kombi configuration is available for the TC in some markets. The Transit Custom is the professional’s favorite choice for carrying a crew and sizable amounts of cargo, as well as for those who use it exclusively as a private vehicle. A lot of outdoors-oriented customers make use of the Kombi or the specific van, creating campers and other customized projects.
2.1. Features and Specifications Ford Transit Custom Ambulance
Ford Transit Custom Ambulance; The production-standard Transit Custom is converted into an ambulance by the addition of a bespoke Type B high-roof exterior profile and a multi-chamber air distribution system through the use of a composite inner skin with a thermo-formed individual front and rear headliner. An HVAC system is accommodated within the exterior profile roof, and ambient, heating, and cooling functions are integrated into a single housing panel molded into the roof with diffuser outlets. The air distribution technology panel with an HVAC cassette integrated air terminal device is designed with a perforated surface that matches the diffuser of the air supply.
Emergency care to the patient is provided by offering access to sockets and a cargo loading socket, and the ambulatory suction unit, including standard fittings for Type B Category A and Category B medical devices. In the exterior, Type B ambulance existence signals are fitted in link bars that are supplied by the customer. The efficient design of an ambulance interior is to keep the patient medical support equipment and crew within the original interior layout of the vehicle. When a vehicle is fully loaded, the center of gravity has to be minimized, creating a safe working environment. The original seating and interior layout of the production vehicle are retained as much as possible and filled with high-quality durable materials to maintain a safe, hygienically clean, comfortable, and supportive environment for patients and paramedics working in a compact space.
2.2. Adaptations for Ambulance Use
In recent times, new products and concepts have been developed that require the development of vehicle versions, enabling the transport of people, animals, or special equipment to complete the tasks. One of these concepts of vehicles that give a new utility to vans is the ambulance. In Europe, the standard or minimum requirements for ambulances are defined by the EN 1789 standard. This text presents the adaptations developed to fulfill the EN 1789 standard requirements. The entire process of design and manufacturing was made in-house, starting from a regular Ford Transit Custom van.
For a vehicle to be defined as an ambulance, it must meet several requirements to enable it to provide assistance transport in the best conditions for medical conditions. For that to become possible, there are several standard requirements according to which the vehicle must comply. In Europe, the entities highlighted are the UNECE and the CEN, which define the EN 1789 standard. This standard defines several areas such as size, access, interior disposition of elements, mechanical properties, and finishes. The vehicle used as an example to demonstrate the process is the Ford Transit Custom, one of the most used vans in Europe. The entire process of design, development, and manufacturing was made by the team, using the available technology, such as laser cutting, metal bending, and welding. Each piece was carefully designed to guarantee that it fits in the specific position, according to 3D drawings of the interior developed by the team. Each part was tested for ease of assembly, and the entire adaptation process was divided into sections. With six different product codes, it offers ambulance kits with a high degree of standardization and easy installation.
3. ICU Automotive – Ford Transit Custom Ambulance
ICU Automotive is a recognized leader in the industry in the manufacture of ambulance conversions. Based in Upile, Stoke on Trent, Staffordshire, we stand within our purpose to design and convert the New Transit Custom into ambulance excellence for UK and overseas markets. We are a business built on reliability and encompass that into the heart of our design and manufacturing process. ICU Automotive formed following the merger of two well-established companies in October 2017. Dependent on our unit refurbishments and capacity, which does vary subject to the choice of new or approved used vehicles, we have the production capabilities to convert 45-60 Ford Transit Custom ambulances per month on a single shift pattern. If demand went beyond this level, we would look at reviewing the manufacturing strategy. We can also cater for those looking to take supply in batches similar to the West Midlands DES programme, our facility being well-resourced to accommodate both business models.
The company prides itself on providing high-performing and professional service to healthcare providers across the UK. We design and build bespoke conversions with the patient in mind. Our ethos is built around making the patient’s journey through the entire clinical corridor as comfortable and safe as possible. From concept to vehicle handover, our internal user groups work closely with our design team and advisory councils to incorporate the latest technologies and changes in clinical practice to ensure our ambulance explores ambulance design capabilities. The company employs a total of 116 highly skilled staff currently, who work collaboratively to deliver a transformational product to the pre-hospital setting. The Trust was nominated for the Value Award under the “Commercial Procurement Project of the Year” category for our ICU Ambulance. Designed alongside specialists, packaging engineers, Safety and Clinical Advisory Boards, vehicle manufacturers Ford, and specialist coachbuilder ICU, we believe it to be one of the best vehicles offering unrivaled levels of safety when looking at the vehicle as a whole, including the patient compartment and overcab clinical area.
3.1. Company Profile
The industrial and engineering business made a basic start with a team of three engineers in 2012. At that time, we started the work to build the perception and the reason for existence in the business. Upon receiving all necessary inputs, we articulated the above two by holding extensive interactions in the market with customers and stakeholders. Working on what has the potential to be successfully carried out, we developed the same, and the result is where the outcome stands today.
We are making consistent progress in the ambulance industry and registering growth at a rate of nearly 30% year over year, increasing the customer base across the geography of the country. We aspire to become one of the most reliable and acknowledged companies in the national and international market, i.e., the first choice of customers worldwide in the segment of buses, ambulances, and special utility vehicles with the latest technology of hybrid, electric, and fuel cell options. A highly energetic and innovative management team is leading the organization, which is always striving to develop, innovate, and explore the latest technologies to provide our customers with the best in terms of products and services. Our state-of-the-art, technology-driven manufacturing infrastructure is the pride of our organization. We have never left a stone unturned in developing our infrastructure, and we have the best-in-class infrastructure for R&D, design, virtual simulations, validation labs, proto shops, and mainstream manufacturing.
A dedicated team in the field of mechanical and electrical engineering works day in and day out to develop new designs of ambulances, special utility vehicles, and buses, and to strengthen the components used in developing the chassis as per the requirements in line with the guidelines. The continuity and skill set required are developed through the HR strategy, and we always ensure that the skill set of our team is updated with the latest technology through in-house and out-station training programs, seminars, guest lectures, workshops, etc. Our company has been certified in QMS, EMS, OHSAS, and has installed an integrated management system and received certifications for IATF, ISO 9001:2015 QMS, ISO 14001:2015 EMS, and ISO 45001:2018 OHSAS.
3.2. Expertise in Ambulance Conversions
ICU Automotive in England has been one of the leaders in next-generation ambulance development companies in the world, driven by key individuals. ICU Automotive bases their conversion specifically on the geography of the ambulance. They found that since 60% of the world’s population is spread out in rural areas, the vast majority of ambulance callouts will be to individual medical needs. The company bases their ambulance systems on a simple six-step methodology, which has grown from military exercises of arresting, containing, controlling, securing, and stabilizing a person, and then extracting them for specialist treatment. They will say they design ambulances specifically for the expertise and skills of the local paramedic, and the specific requirements of their local healthcare delivery system. ICU will study the requirements to develop and design an effective way of doing so, hand-build a bespoke ISU just for the Recovery, test the ISU and paradigms, install the components, prove the training, and test that the training and equipment will work and are fit for all of the rescue. Both ambulances have been designed with input from healthcare professionals to provide a wide range of facilities and internal vehicle designs to accommodate the healthcare operators, providing mobile healthcare and onboard treatment rooms, as well as solid body designs to provide accessible non-medical welfare facilities for the staff. Following a survey of staff from a local ambulance service, they helped design a new van ambulance with the healthcare staff and the audience it was intended to serve.
4. Design Process Ford Transit Custom Ambulance
A complete research on potential customers and their needs will be required to design an emergency vehicle in a proper way. The project and prototypes made should always go along with the opinions and needs of all paramedics and medics. A Ford Transit Custom ambulance produced in Great Britain and certified by the European Union holds all requirements set in the regulation. To meet these requires a comfortable design in four elements: – Interiors for the care of the patient without risk and sufficient access due to the injuries. – Use of software to allow customers to make different designs based on their needs. – Exterior to be able to park in a garage with a top emergency light. – Lengths of 4972 and 4561 mm. Euroramp can also be added to avoid hydraulic systems. This section will focus on the development of the van in two parts. First, the emergency vehicle has been made with a visual design that does exist. In the second phase, we focus on the inside of the ambulance since one of the main specialties is comfort vehicles.
Designing a new van required having the input of the final user in the initial step and a long process driven by regulation. In the studio, for example, around thirty people had the requirements for three weeks. Making a comfortable ambulance can have a big impact on the relationship between the crew and the patient; the time can get longer if they stop talking and start working on the patient. This can cause delays in the emergency care that can affect the patient in a bad way. All the people in charge of certifying are allowed to give us their ideas of design and what they are going to like in an emergency vehicle. Concerning the exterior part, from the front up to the passenger door is not free to design; currently, in the transit lineup, we have developed two visuals. The interior could be done in two versions for each van: the standard wellness and the “type.” During the phase of concept, there has been a documentation process where all designed vans were modeled in software. Until that moment, it was mainly used in the construction industry. The full organic shape of the van was made with ergonomics in mind, allowing more room inside and enabling the liquid marks to fall faster with cleaning the inside surfaces. All the vans have an open interior design up to three sectors.
4.1. Needs Assessment
The most important step in the design of an ambulance is to assess the needs that the vehicle must fulfill in order to best serve its operators and passengers, and deliver valuable and viable emergency services that can be sustained over time. The objective of the needs assessment is to gain insight based on the specific input from the end users at the ambulance service company, as well as those at the hospital, providing a detailed insight describing which features of the vehicle are deemed most urgent and important to facilitate daily service fitting the current needs and operational landscape. The exchange of detailed information at such an early stage allows the design team to distinguish critical features from customizable ones. Such features will be the basis around which the design will be rebuilt to ensure that the end vehicle has a high level of usability. The needs assessment enables the design team to gain a deep understanding of the regional ambulance operational landscape in order to assess the current emergency healthcare situation and have a clear view of the vehicle features needed to fill the operational gaps that emerge from ongoing activity or that anticipate future operational needs. Furthermore, all regional hospital and company peculiarities are investigated and taken into account to shape the emergency services. Finally, the needs assessment is carried out using only or a combination of qualitative and quantitative techniques in order to gather data that can provide a full image of the operational environment and healthcare regulation covering the geographical region. The quantitative analysis can be supported by the gathering and coherent presentation of previously provided data by the EU Member states that covers the percentage of total revenues spent on healthcare commitments. A solid and debatable analysis is the foundation for the creation of an emergency transport needs assessment, which provides the knowledge base necessary to proceed to the subsequent design decisions. All of the preceding content justifies greater design and product complexity due to customization designed and built to deliver more value and satisfy the customers by allowing the VW Response to expand into a number of different niche markets.
4.2. Conceptualization
4.2.1. Introduction Conceptualization is the next phase after conducting needs assessment, as discussed in Section 4.1. It follows a phased approach from function to form. This ensures a systematic transformation of the identified needs into viable conceptual designs. The designing phase usually begins with conceptualization, as preliminary designs are developed. In this stage, the project team members conduct several brainstorming sessions, workshops, and discussions. Members explore several design alternatives independently and then collaborate to create newer ideas. The project team worked collaboratively with the client and stakeholders since the first stages of the project, through the conduct of workshops and review sessions.
4.2.2. Needs Assessment Transform to Conceptualization Since customers were presented with user journey scenarios where an ambulance vehicle would be used, stakeholders and clients identified needs and their specific requirements based on those scenarios. Focusing on the transfer of the patient from one medical facility to another, four user journey scenarios were used to pinpoint and give life to individual situations for developing innovative design solutions. All scenarios led thus to an ambulance front configuration with a patient compartment in the rear, as the method recommends. The first scenario continued with the patients boarding through the ambulance rear by stepping up from a pallet plus several turntable ladders. The requirements arising from this scenario led to innovative design solutions, and the configuration with the pallet and ladder access was seen as a viable initial concept. Subsequent patient transfer user journey scenarios were developed to further explore designs offering wheelchair and stretcher functionality. Each stage developed the concept design analysis further towards the final proposed design.
5. Manufacturing Process Ford Transit Custom Ambulance
5.1. Material selection and preparation Ambulance conversions begin by selecting and preparing a wide range of materials and components. Quality and durability are vital when choosing materials suitable for ambulance manufacturing, including MIG weld wire, adhesives, and drawer runners for windows, wood, and trays.
5.2. Equipment used ICU Automotive uses the following machinery and tools to complete the manufacturing processes: • fiber laser machines: 2.5 kW fiber laser power, 10,000 x 2,000 cutting area, and resulting high-quality finishes. • press brakes: 30-100 ton capacities, 10,000 mm bending length, and the “answer to longer workpieces.” • easy-form laser angle: real-time angle measurement with complete bending beam parallelism when press brakes bend. • in-house powder coating ovens: hyper-modern powder coating technology where identical powder is baked using two ovens producing 15-minute turnaround times. • roof lifting jigs and bespoke workbenches designed by the in-house design department. • a new 7,000 mm vehicle jig developed by an experienced team member.
5.3. ICU Automotive manufacturing process 9. Cutting: Unique designs are prepared and loaded onto our in-house developed cutting solution before panels are cut and prepared. 10. Assembly (1): Air suspension is fitted. 11. Assembly (2): Doors are fixed into place and the roof is prepared. 12. Installation: The rear pod is lifted into place alongside the window apertures. 13. Assembly (3): Frames are installed. 14. Manufacturing integrated medical systems such as power inverters, charging systems, heaters, and extraction are installed prior to interfacing with the interior electrical systems. 15. Paneling: The walls and roof are upholstered before the preparation of the floor. 16. Final interior installation: Once the floor is in place, all of the interior components are installed into the vehicle. This includes reclining chair systems, crew seating together with the stretcher system and the front cab divider. 17. Final fit: The front cab and control systems are finally connected to the rear ambulance during the final fit stages. Vehicles are then electrically tested before moving to quality check. Compliance with current regulations is maintained through the manufacturing process.
5.4. Procedures for quality inspection The design of the vehicle includes regular and constant quality checks. These range from electrical tests to leakage tests before handover to the customer and its specialist equipment is completed.
5.5. Continuous improvement The design and build of the vehicle at ICU is subject to a robust and continuous improvement change process. Adaptations to the vehicle take place based on customer feedback and, at times, external information.
5.1. Materials and Equipment
The volume production of ambulances and the manufacturing of their main parts require the use of materials and the utilization of equipment such that the goal of the project is reached or even exceeded. State-of-the-art materials with superior performance are being constantly developed for lightweight construction, adapting the…
Overview of materials used for the manufacturing of transit vehicles
Ambulances need to be produced from a robust material because the personnel working with them usually do not need to do time-consuming maintenance work. The materials can be mainly divided into metals, composites, and plastics. Determining the most qualified options can depend on factors including the service life and maintenance works alternative to purchase cost; usability; the risk of user injuries; and the national legal basis. In the case of vehicles made of steel, the maintenance of the vehicle can be ensured for a long time, but some risks are increased mainly due to the operated parts. For years, in category A, the vehicles have usually been produced from mild steel, and galvanized construction parts were galvanized together with the car body parts.
Dissimilar material development is a commonly used solution in various branches. For planar body parts, the creation of combined materials referred to as sandwich elements has become common. Dissimilar single parts used in combination lead to an optimal solution with the use of different materials on the outer and inner sides of the femur. In the case of the femur, a new aluminum product would once again be used in trade, not to mention the high cost. The plate for occultation only has to be as strong and durable as necessary. Therefore, soft iron is hung on the B-pillar, which “melts” in the event of a collision.
5.2. Quality Control
Every ambulance that we manufacture has its own set of check sheets and inspection and test plans used to ensure that every component of the vehicle meets the quality requirements specified in the product manuals. These are agreed with the customer and they underpin our commitment to build the ambulance to the relevant European Whole Vehicle Type Approval. Every component is checked and inspected using either SPC techniques like capability studies and attribute data or using the more traditional go/no-go methods. All of these methods are used to verify that all components conform to that part of the product manual that applies. In the case of the vehicle conversion, we also have to verify that the final vehicle meets the current regulations, so throughout the process, physical tests and measurements are used to further back up the results obtained using capability studies; these confirm that the relevant regulations are met.
Every employee is dedicated to quality and to maintaining our strong reputation, where quality is seen as everyone’s business. Everyone must follow procedures, and any feedback from the end user is fed through a corrective action process to further improve the final product. The system we use is based on the proven principles of vehicle manufacturing and is laid out in our Integrated Management System. This system is assessed annually in order to verify our continuing compliance. We have three quality assurance and six quality control auditors to ensure we are following our own procedures and to help provide products manufactured to a high level at all times. In addition to this, we have at least three batch scrutinizers to ensure the components are of high quality before they are put on the kit for build. We have several management system assessors working with us to make sure we are following our own procedures and also legal safety-oriented procedures. Finally, we have six auditors to further ensure that quality is maintained throughout the vehicle’s lifespan. In total, we have sold over 50,000 ambulances this way.
