Q&A with Peter Adsten

Crestline: Building World Class Ambulances is a one-of-a-kind photographic journey through the history of ambulances from 1967 until 2004.

Author Peter Adsten effectively combines words and photos to tell the story of his working career, first as an EMT and then as an ambulance manufacturer in the province of Saskatchewan.

Following his retirement in 2004, Adsten began the long process of researching photo archives and scanning 17,000 Crestline and Ambucraft photos, the best of which are included in his book. The final product contains 336 pages and 560 photos, most of them in color. Adsten has also collected 10,000 old ambulance photos from private collectors and from archives throughout Canada, and encourages readers with old photos to send them to him for his website EMSclassics.com. All proceeds from sales of the book are donated to the Paramedic Association of Canada Benevolent Society.

Why did you write this book?

It was important to me to make a record of who we are, what we did and why we did it. I thought that other than my own family and friends, perhaps others in the EMS industry might be interested in our history, and this is what developed.

You obviously had a good store of photos and information.

Yes, I was fortunate that way. We took a photo almost every time a customer came in to pick up a vehicle we had manufactured, and most of those pictures are still available. I could have written the story without pictures, but I personally like to have pictures as well as the description. The first chapter is the history of when I worked as an EMT for private ambulance services, where we were using Cadillac-type ambulances that kids today call "ghostbusters." The rest of the book chronicles how the ambulances started out as vans with just a few modifications, then vans with a raised roof, and finally the modular ambulances that became dominant and remain so today. So, it traces the transition period when North American-made ambulances went from car-based to van- or truck-based vehicles.

You began work as an EMT. Why did you move from that into manufacturing?

When we had our own ambulance service, we felt a need for a larger vehicle than the car ambulances we were using. We needed more storage space for all the new medical equipment that was being invented, and we needed more room inside the vehicle. During those years, Ford, Dodge and GM all made van ambulances, but they were tiny and didn't have many creature comforts. Then during the late 1970s they suddenly started producing vans that were larger and included air-conditioning, cruise control, comfortable captain chairs and a large fuel tank--all the things that made the van more acceptable. At first, we built two vehicles for our own use. In Canada, by the time you added the duty, currency conversion, federal sales tax and transportation, the Cadillac ambulances that we imported from the United States were very expensive, and we could see we could save a lot of money by building them ourselves. I was a carpenter and my business partner, Ken Sawatsky, was an electrician and was mechanical, and we did our best. They weren't all that great, but they served a purpose and saved us a lot of money.

Were there certain standards that you had to follow?

No. In both Canada and the United States there were absolutely no requirements for performance testing or engineering, so there was an explosion of ambulance manufacturers throughout North America and Canada. Anybody could go to the local dealer and purchase a van that was very well-suited to conversion. Some built good quality and some were in terrible condition. Soon after that happened, many of the traditional car ambulance manufacturers like Superior and Miller Meteor went bankrupt and lost their business or closed.

You published the book yourself. What kind of promotion do you do, and what response have you had?

I've had a good response from previous employees of Crestline and EMS services in Canada. I promote the book on my website, and also through a column that I write for Canadian Emergency News. One important note is that this is the only book of its kind. A dozen books have been written about the old car-based classic ambulances, but beyond the late 1970s there's been no other book in North America written about the old ambulances.

Excerpts from Crestline: Building World Class Ambulances

CHAPTER TWO - CRESTLINE THE EARLY YEARS, 1975 to 1980

  01. Crestline Coach Ltd. Incorporation

Ken and I believed there would be a complete transition from car-based ambulances to van ambulances. For many years professional ambulances had been manufactured by Superior Coach, Miller-Meteor and Hess & Eisenhardt (S&S), who were all based in Ohio, as well as a handful of other smaller companies located throughout the US. These ambulances were all based on car chassis, (primarily Cadillac, Pontiac and Oldsmobile), and provided a comfortable ride for the patient due to their heavy weight and long wheelbase. And depending how they were outfitted with lights, siren, paint and lettering, often looked spectacular! But there were dark clouds on the horizon for these beautiful ambulances. It was becoming difficult to find enough storage space in the car-based ambulances for all the new equipment required by the newly trained EMTs. And at the same time, Ford, Dodge and GM came out with a new generation of vans that were well suited for the manufacture of ambulances. And as we had proven, it was not necessary to have a huge factory to build these van-style ambulances. As well, the new van ambulances were much less expensive than the professional car ambulances imported from the States.

And, we could see there was a glimmer of hope that ambulance service would be "coming into its own." We thought ambulance service might eventually become an integral part of the healthcare system, together with stable funding, and that this would generate business opportunities for the providers of ambulances and related medical equipment.

Taking all of these factors into consideration, we decided to set up a separate company for the manufacture of ambulances and the sale of medical equipment. But what name should we give the new company? We had always liked the name of our ambulance service, Crescent, and we wanted a name that was similar because our two companies were going to be operating in parallel. We selected the name Crestline Coach. The "Crest" part of Crestline gave the impression of being at the forefront (as in the crest of a wave) and the "line" part of Crestline gave the impression of an entire lineup of products. The Coach portion of the name was a carryover from a previous era when most ambulance and funeral vehicle manufacturers had Coach as a part of their name. (After several years we stopped using Coach in our advertising, as our customers preferred to just call us Crestline.)

On April 28, 1975, Crestline Coach Ltd. was incorporated. Ken Sawatsky and I each paid $45 for our 45 shares and Eldon Heppner paid $10 for his 10 shares. Eldon was Ken's friend from their school days in Hepburn. We thought we should take Eldon on as a silent partner because he was a chartered accountant and we realized that we would need on-going financial advice if we were to develop the manufacturing business properly. We had operated Crescent Ambulance Service on an operational style, without much consideration for financial matters. But we thought our new Crestline manufacturing business would require expertise in finances.

CHAPTER FIVE - CRESTLINE, New Products, New Markets 1984 to 1989

  06 Qualified Vehicle Modifier (QVM)

In 1988, Ford Motor Company developed the Qualified Vehicle Modifier (QVM) program to ensure design standards were being met by American and Canadian ambulance manufacturers. Ford representatives made in-plant inspections of ambulance manufacturers and rated their engineering processes, commitment to product improvement and quality of finished product.

In their evaluation, Ford representatives stated that Crestline had:

• Excellent employee training manual.
• Excellent vehicle owners' manual.
• Outstanding R&D, Engineering & Process Control.
• Outstanding attitude, very progressive."

Of the thirty-some ambulance manufacturers in Canada and the U.S., only twelve ambulance manufacturers qualified for charter membership in Ford Motor Company's QVM program. And only one Canadian ambulance manufacturer--Crestline--received the award!

This was one of our finest moments! We had long thought our ambulances were among the best there were--now we had a reputable outside authority like the Ford Motor Company stating it was fact! We all felt immense satisfaction.

We were not about to let this marketing opportunity go unnoticed. We sent news releases to every emergency services publication, we advertised widely and we added the QVM logo everywhere. We wanted everyone to know that Ford had rated us among the best.

But the benefits of being awarded QVM status were not just for marketing purposes. Our Engineering staff could now pick up the phone and talk directly with Ford engineers, allowing us to quickly clear up any question that arose during vehicle design or production. The net result of the QVM program was continual improvements in the quality of our ambulances.

CHAPTER EIGHT - CRESTLINE 1990 to 1994

  07 CrestRide Patient Air Ride System

Prior to the mid 1970s most ambulances were based on a car chassis and were designed to give the patient a smooth ride. But when car ambulances were replaced with ambulances built on truck chassis, the ride for the patient was much rougher. We had experienced this ride problem ourselves at Crescent Ambulance when we switched from Cadillac and Pontiac ambulances to Dodge and GM van ambulances.

The universal complaint of patients riding on an ambulance cot became "this ambulance ride is so rough--why don't you do something about it?" And everyone thought they had an easy solution: lower the air pressure in the tires, buy softer tires, remove some of the vehicle's springs, install softer springs, put springs under the wheels of the cot, and so forth. Unfortunately none of these work without compromising vehicle and patient safety. In fact, Ford QVM guidelines prohibit any tampering with tires or suspension.

Interestingly, research shows that the ride on an ambulance cot actually isn't that rough. The human body has evolved to absorb shock when we walk, run or jump, however when we lay in a horizontal position the body does not absorb shock nearly as well. Thus, the patient lying on the cot feels the shock and vibration of the moving ambulance as though it is magnified. An easy solution to the problem would be to have all patients stand upright in the ambulance!

In 1989 our engineering team, led by Roy Eichendorf, began working on a solution for the rough ride felt by the patient. We named it the CrestRide Patient Air Ride System.

Independent testing at the PAMI Institute confirmed significant reduction of shock and vertical cot vibration to the cot, whenever the CrestRide was activated.

But the real proof as to its effectiveness came after we began installing the CrestRide in ambulances, and patients were given a choice between having the CrestRide down or up (activated). They would always respond "Oh please leave it up, it feels so much better." Patients had the sensation of floating on a cushion of air.

Our advertising at the time stated: "The CrestRide Patient Air Ride System--a totally new concept in patient comfort. Independent of chassis suspension, CrestRide rides on its own cushion of air. Whereas air bag chassis suspension kits are confined to the needs of the chassis, CrestRide has been designed with a free hand to look after the needs of the patient."

The CrestRide did however have one major problem and several minor ones. The major problem was the price. The device was labor intensive to manufacture and some of the component parts were expensive, forcing us to sell the CrestRide for $8,000 (at a time when an ambulance cost between $70,000 and $80,000 depending on model).

In spite of the price, some ambulance services located several hours drive from big city hospitals, began to buy them with their new ambulances. All of the patients loved the CrestRide, but not all of the paramedics (due to a variety of issues, some of which were resolved on later models). In total, we sold between 30 and 40 CrestRides all to long-distance rural ambulance services.

Gradually the interest in the CrestRide waned. We even drove an ambulance equipped with a CrestRide to Ferno in Wilmington, OH, in an attempt to convince them to sell it, but were unsuccessful. Perhaps if we had put more effort into convincing the medical community or provincial regulators of its benefits, it would now be compulsory in ambulances. Certainly, if patients were purchasing the ambulances, every ambulance would be equipped with a CrestRide. The ultimate failure of the CrestRide was one of the biggest disappointments Ken, Ronn and I had in our years with Crestline. We had a solution that worked, for the most common problem in the ambulance service, but we failed in having it become a universal benefit to patients.