Safer Spaces, Smarter Design

Mecklenburg EMS Agency (Medic), which operates the busiest agency in North Carolina out of its Charlotte headquarters, recently engaged in an innovative project to redesign the agency’s ALS ambulance, including moving to a new chassis. The results it achieved were worth the effort, and getting there was all about the process.

Background: Ambulance Redesign 

In 2016 Medic began an extensive project to completely redesign the agency’s ALS ambulance. Leadership wanted to move away from the International TerraStar chassis its current build was tethered to in addition to improving safety for caregivers and patients in the module. The project team was asked to produce a design that met or exceeded the Commission on Accreditation of Ambulance Services’ Ground Vehicle Standard (GVS), improved vehicle reliability, increased employee satisfaction with their work environment, lowered overall cost of ownership, and improved comfort for the patient. 

The project was executed following methodologies established by the Institute for Healthcare Improvement (IHI), which employs various tools and processes to help drive successful improvement initiatives in healthcare organizations. 

The redesign team consisted of employees from various departments, including field operations, quality improvement, logistics, and fleet. The project was structured to include frontline providers each step of the way, making the process transparent and giving employees a clear voice in the final product.  

The team first brought in multiple Type I, II, and III vehicle chassis for field crews to test drive. The Dodge 5500 chassis was chosen after various models were evaluated and scored based on features such as ergonomics, comfort, drivability, ease of maintenance, acceleration, and braking.

With the chassis choice made, the team transitioned to gathering input into the design of the patient care module. Focus groups were held with field employees to gather feedback on their work environment. The team collected data to gain clarity on the patient conditions most often treated in the back of the ambulance, which led to the development of a list of the most frequently accessed supplies in transit.  

The team wanted to use the gathered input to create an initial design for testing and feedback. To avoid the substantial cost of fabricating a sample module for testing, they built a scale model in house using heavy-duty corrugated cardboard. Field operations employees were asked to simulate calls while being videotaped to collect their reactions and thoughts on the placement of equipment and supplies throughout the module. This resulted in numerous employee-focused improvements to the location and organization of equipment that will help them stay safely strapped in the attendant’s seat while still able to care for their patient.  

Outside the caregiver-driven changes in the module, the project team identified a number of other operational improvements. These included installation of a LiquidSpring suspension, which dramatically improves ride comfort for patients; an improved A/C system design for better temperature modulation during the hot North Carolina summer; a touchscreen multiplexing system at eye level for safer manipulation of controls; and upgraded wall insulation for a quieter ride for both patient and caregiver.

From a safety perspective, Medic’s design included a number of changes aimed at earning CAAS safety certification. These included the repositioning of all cabinets and equipment to reduce the risk of head strike by providers; an improved mounting solution for securing the stretcher to the floor; a six-point retractable safety harness to secure the caregiver in the attendant’s chair; LED lighting throughout the vehicle to improve visibility; and an upgraded cardiac monitor bracket to meet crash standards.

With a well-tested plan in place, Medic purchased two Dodge 5500 chassis and had new patient modules built by American Emergency Vehicles of West Jefferson, N.C. They were placed into the system and tested for 90 days, cycling through as many caregivers as possible. That process yielded excellent feedback that led to revisions before the new design was finalized and additional units ordered. Both test trucks were modified with the revisions and returned to full-time duty.    

Once the gradual replacement process began, leaders evaluated data on per-mile operating costs for four TerraStars that went into service at nearly the same time as the first four Dodge 5500s.  After an average of 130,000 miles traveled, the Dodges’ cost per mile was $0.86, and the TerraStars’ $1.15. At the current run rate, the Dodges are predicted to cost $82,650 less per vehicle to operate over their predicted seven-year lifespan. When factored for all 72 ambulances, the predicted savings is $5.9 million for one full replacement cycle.  

Going Green

To reduce environmental impact, engine wear, and waste due to fuel costs, Medic developed another project team aimed at reducing idle time. Its research identified the ZeroRPM idle-reduction technology as a proven, viable option to reduce the amount of idle time that occurs among the agency’s fleet when an ambulance is on scene, parked at the ED, or in static standby for its next call. Using high-capacity batteries, ZeroRPM decreases idle time by allowing complete use of the ambulance’s critical functions while the engine is off, including A/C, heat, electric windows, lighting, and vital equipment. The system was installed in one ambulance in September 2018 and was tested for six months.  The data demonstrated a significant reduction in all measurable emission products, a 20% reduction in fuel consumption, and double the average miles traveled per engine hour of operation.  

Sidebar: Time-Savers

In January 2018, Medic moved into a new 181,000-square-foot, state-of-the-art facility. One of its features is an automatic car wash, which is utilized after each shift instead of a manual process. 

Medic provides full-time logistical support to restock ambulances before and after each shift. 

Medic’s fleet department consists of a team of master mechanics dedicated to providing maintenance and repair for the agency’s fleet of 72 ambulances. The team is responsible for extensively tracking reliability and performance. 

Jeff Keith is deputy director of Mecklenburg EMS Agency. He oversees areas that include operations support, fleet services, logistics, information technology, and public relations. 

Grace Nelson is public relations supervisor for Mecklenburg EMS Agency. She is responsible for public information, media relations, community engagement, and internal communications. 

Sidebar: California Service Slashes Costs With Fuel Delivery

Southern California-based Cal-Med Ambulance has partnered a same-day fuel delivery service to improve operational efficiencies through on-demand fuel delivery. 

With a fleet of 20 ambulances needing to be fueled and ready for service 24/7, Cal-Med’s management team sent two EMTs to fill up every vehicle at the end of their shifts. However, this method was leading to unnecessary overtime and lost gas cards. 

As overtime costs skyrocketed and fueling-card expenses became increasingly difficult to track, Cal-Med decided to look for a more efficient and cost-effective fueling method. The company chose San Mateo-based Booster Fuels, which helped streamline Cal-Med’s fuel management with a one-stop-shop gas approach: Booster delivers to their location seven days per week with no middleman, ensuring vehicles are ready to go 24/7.

Since partnering with Booster, Cal-Med has reduced fuel costs by 57%, and crews no longer need to stop to fill up, as the vehicles have full tanks of gas at the start of each shift. 

“Working with Booster has been a game-change for us. Now we can focus on more important tasks and be there when our customers need us,” says Jeff Twycross, director of operations for Cal-Med. “No more worrying about filling up, wasting employee time, or administrative headaches.”

Cal-Med isn’t alone. A Booster survey of fleet professionals across the country found that on average, each fleet fill-up takes an additional 20 minutes, and 60% of drivers add at least two miles to their routes. 

On-demand fuel delivery can also reduce road congestion and CO₂ emissions and protects community land and water from the negative effects of underground storage tanks, according to the company. 

—Source: Cal-Med Ambulance

Sidebar: Mayo Clinic’s Fleet Redesign Prioritizes Safety

The Mayo Clinic Ambulance Service changed the look of the outside of its ambulances in 2019, adding a distinctive black-and-white reflective wrap material and other high-visibility features. Now Mayo’s ambulance interiors are being redesigned to enhance the safety and comfort of patients and care providers.

The Mayo Clinic’s ambulance team convened a group of EMTs, paramedics, and representatives from other work disciplines in September 2018 to consider ways to increase safety. The group brainstormed ideas that included putting equipment and supplies within arm’s reach in the back of the ambulance to minimize times when crews were not restrained with seat belts. They also looked for ways to enhance ergonomics and reduce injuries due to lifting and exertion.

“We determined our current configuration needed to be updated to better protect and restrain our patient care providers when they are in the back of a moving ambulance taking care of patients,” says Matthew Will, director of clinical services for the organization. “We took one of our existing ambulances that had been removed from service, and with the help of our fleet-services vendor, we took all the existing cabinets and compartments out of the back and began with a clean slate.” 

It took the group about four months to draw up what it wanted, says Paul McIntyre, support services specialist. “We had a functional prototype ambulance that was about 95% complete in matching what we wanted to create,” McIntyre says. “We included enhanced safety features to allow our providers to be seated, including better seat belt technology, and still give them access to the things they need to do what is needed for their patient.”

The redesign also added injury-reduction features, such as:

• A lift for large oxygen tanks;
• Security enhancements using fortified antitheft technology;
• Monitoring systems that indicate when the driver is making a turn, braking, or stopping.

The heating and cooling system in the patient care area also was updated for comfort. Not only are the climate control systems more regulated, they keep medications and equipment at optimal temperatures at all times.

The Mayo Clinic team collaborated with Braun Industries on the build. “The team at Mayo Clinic has put a lot of time and study into what can make an ambulance safer for care providers and their patients,” says Fred Pawelk, regional representative for Braun.

Pawelk says this new ambulance interior incorporates data from crash tests, new Society of Automotive Engineers standards, and industry best practices.

“We did some things with the Mayo Clinic ambulance that we had not done before as a manufacturer,” Pawelk says. “We mounted cabinets in new ways. We were able to work with the Mayo team to make major changes to the inside of the ambulance without making significant changes to the exterior or size of the vehicle, which means crews are familiar with operating and maneuvering the vehicle.”

McIntyre attributes the final result to a team effort. “We involved our patient care providers who work in the ambulance, our fleet management area, safety coordinators, and our leadership team—all working with the manufacturer and getting us to the point where we are today,” McIntyre says. “Many different considerations have been made to our ambulances, all with the goal of creating something that provides safety, security, injury reduction, and functionality for our patient care providers to better serve our patients.”

The new ambulances went into service at all Mayo Clinic Ambulance Service locations in December 2019.

—Source: Mayo Clinic