Broward County's New Engine/Patient Transport Units

[firedude 985]

Broward County Sheriff/Fire Rescue have taken delivery of new engines with a special feature, Patient Transport.

Picture courtesy of Pierce MFG

The extended cab can fit a full size stretcher and EMS equipment. There is a lift on the other side to raise the stretcher. Any thoughts on this? Is this a new cost-saving measure?

[Bnechis 3,961]

Broward County Sheriff/Fire Rescue have taken delivery of new engines with a special feature, Patient Transport.

The extended cab can fit a full size stretcher and EMS equipment. There is a lift on the other side to raise the stretcher. Any thoughts on this? Is this a new cost-saving measure?

Its been done before and in most cases the dept always goes back to a seperate eng and amb.

[ny10570 745]

Even on paper this doesn't make sense. I just don't get what these agencies are thinking.

[FireMedic049 597]

From what I recall regarding this unit on another forum, this unit is going to more remote location in the county along I-95 that doesn't have an ambulance assigned to this station. Supposedly, the engine will not be a primary transport unit, but was given the ability to do so if need be.

[PEMO3 523]

If not considered as a primary transport unit it may make sense but seems to add a lot more size to a vehicle and in essence a very expensive ambulance with added other costs. I question the fact that you now have an engine that is out of service while transporting and at the hospital possible doing bio-med decon of a "patient compartment". Another thought is how far outside the primary response area is the hospital. This engine if I am not mistaken is located on I-75 just east of Andytown, Fl., the closest ER is Memorial Hospital West in Pembroke Pines, FL about 28 miles or 30 minutes away. Justifying a engine doing patient transport and being 30+ min away on a regular basis would be hard on the primary coverage area.

[Mark Z 18]

I don't know that this is such a good idea, I believe it has been tried before and found to be a bad idea! I don't know that I would want to do a transport in one1 OTOH, is it any dumber an idea than a CAFS unit on an ambulance? You end up with a vehicle that doesn't do either job well! Time will tell if it works out the way Broward wants it to! But what do you expect from a sheriffs dept that runs the fire side?

Edited September 17, 2011 by Mark Z

[JohnnyOV 2]

Even on paper this doesn't make sense. I just don't get what these agencies are thinking.

Same thing they were thinking when they merged the Sheriff's office, and the Fire Department.

[FireMedic049 597]

I don't know that this is such a good idea, I believe it has been tried before and found to be a bad idea! I don't know that I would want to do a transport in one........

I can't say how it will work out and don't know much about their operation. As for doing the transport in this unit, I suppose it's probably better than sitting on scene for 20+ minutes with a critical patient waiting for an ambulance to get there.

OTOH, is it any dumber an idea than a CAFS unit on an ambulance? You end up with a vehicle that doesn't do either job well! Time will tell if it works out the way Broward wants it to! But what do you expect from a sheriffs dept that runs the fire side?

Why is CAFS on an ambulance dumb? How does CAFS on an ambulance leave you with "a vehicle that doesn't do either job well"? What are the two jobs that it isn't doing well?

An EMS and Rescue service near me acquired two atypical ambulances a year or so ago. (A little background - The service a large township (with lots of MVAs) operating traditional ambulances and a heavy rescue style vehicle. Back when they started, they provided the rescue services to the township, predominately with home response personnel including people who were also FD members. Over the years, the various VFDs in the township have over-duplicated the rescue services. These days, they are mostly a career department and I don't think they rely on "off-duty" personnel to staff the unit, so there are times in which their rescue may not be able to respond and are reliant on the VFDs. However, the VFDs suffer from the same response issues that most other VFDs do and are thus inconsistent with their responses.)

The two ambulances are on medium duty chassis and have a small CAFS system and a HRT with a small power unit. Aside from having a different layout, the units are fairly identical to units I've operated at other EMS agencies and have performed well as an ambulance. Now if these units were designed to replace a structural pumper and a heavy rescue truck, then sure they'd have a hard time doing those jobs well. However, they weren't designed to replace those units. They were designed to address the response issues of the VFDs.

The CAFS is not for fighting a house fire, it's predominately for patient/crew protection in the event of a MVA/vehicle fire. The rescue tools carried are not intended for them to work a heavy entrapment by themselves (and then clean up before transporting), they are predominately intended for minor extrication situations, like a simple door pop, where the VFDs are slow to respond and their rescue doesn't have staffing. They can quickly pop the door and get on with taking care of the patient instead of "wasting time" waiting for them to arrive and perform a "30 second extrication". Seems to be working so far.

Combination units do typically tend to represent a certain degree of compromise compared to separate units, but that doesn't necessarily automatically translate into not being able to do different jobs well. Sometimes they aren't intended to do everything and can do what a department needs them to do quite well.

[16fire5 693]

That's sooooooome wheelbase. Don't forget to figure in the price of the repairs after sideswiping things.

[Bnechis 3,961]

The CAFS is not for fighting a house fire, it's predominately for patient/crew protection in the event of a MVA/vehicle fire.

CAFS for class B fires? Wouldn't it make more sense to go with a class B system?

Or instead of the money, complication and maintenance, add 2) 20Ibs DC & 2) 2.5 gal AFFF. Very few ambulances carry that simple "fire" power.

The rescue tools carried are not intended for them to work a heavy entrapment by themselves (and then clean up before transporting), they are predominately intended for minor extrication situations, like a simple door pop, where the VFDs are slow to respond and their rescue doesn't have staffing. They can quickly pop the door and get on with taking care of the patient instead of "wasting time" waiting for them to arrive and perform a "30 second extrication". Seems to be working so far.

Combination units do typically tend to represent a certain degree of compromise compared to separate units, but that doesn't necessarily automatically translate into not being able to do different jobs well. Sometimes they aren't intended to do everything and can do what a department needs them to do quite well.

I have worked on ambulances that had some basic tools and its great to be able to pop a door, but most units with minimal equipment (even engine companies) NEVER CARRY ENOUGH CRIBBING to stabilize even the simplist 1 car accident. Having the tool without the cribbing is like doing ALS without BLS.

And it encourages cutting corners, as we saw in the NYPD ESU drop the car on the motorcyclist. I got the tool to pop the door, but I can beat the FD to do anything with it......

[ny10570 745]

A little foam to control the fire and a tool for the door pop both sound like good ideas, but neither are good enough to do the job when it matters most. A little door pop, absolutely makes things easier at times, but isn't necessary. I've taken patients out the other side of the car and out the rear window. How much fire are you candling with the on board CAFS system?? I've seen a lot of fire knocked back very fast with a couple dry chem extinguishers. If you're not going to extinguish the fire, that seems like the better option for quickly snatching the patient.

Isolated company with occasional 20 minute waits and 30 mile transports seems like all the more reason for a dedicated EMS vehicle. I'd like to see how many structure fires vs how many hospital admissions that area generates. If we're talking about saving lives then an ambulance with added firefighting capacity would make more sense than an engine with added EMS capacity. I'm not saying there shouldn't be an engine there, more questioning why its acceptable to cut corners with EMS.

[Danger 160]

That thing is a disaster, however...while the wheelbase is awful, it only covers an 80 mile stretch of highway with little to no chance of second due activity. And, while the transport engine is a terrible concept regardless, this is not the primary transport unit, there is an ambulance stationed with it and this is supposed to only be for secondary use.

[67R93 5]

I think it's a cool idea, though as cool as it is, does not seem like a practical one. But understanding that its for secondary use, maybe it will work well for them. Would be interesting to follow up on after its in service for a few months?

[FireMedic049 597]

Isolated company with occasional 20 minute waits and 30 mile transports seems like all the more reason for a dedicated EMS vehicle. I'd like to see how many structure fires vs how many hospital admissions that area generates. If we're talking about saving lives then an ambulance with added firefighting capacity would make more sense than an engine with added EMS capacity. I'm not saying there shouldn't be an engine there, more questioning why its acceptable to cut corners with EMS.

What corners are being cut with EMS by deploying this vehicle?

An ambulance is the primary transport unit for that area. The engine is a secondary transport unit option. If FL EMS laws are anything like PA, then the unit would have to meet all of the requirements that ambulances have to meet in order to transport a patient - including the appropriate certifications for those staffing the unit.

[FireMedic049 597]

CAFS for class B fires? Wouldn't it make more sense to go with a class B system?

Or instead of the money, complication and maintenance, add 2) 20Ibs DC & 2) 2.5 gal AFFF. Very few ambulances carry that simple "fire" power.

I don't believe that all car fires are class B fires. Class B is flammable or combustible liquid/gases. The vast majority of vehicle fires I've dealt with have not directly involved Class B materials and plain water has easily extinguished them. So I'm not quite following your thought.

[Mark Z 18]

I can't say how it will work out and don't know much about their operation. As for doing the transport in this unit, I suppose it's probably better than sitting on scene for 20+ minutes with a critical patient waiting for an ambulance to get there.

Why is CAFS on an ambulance dumb? How does CAFS on an ambulance leave you with "a vehicle that doesn't do either job well"? What are the two jobs that it isn't doing well?

An EMS and Rescue service near me acquired two atypical ambulances a year or so ago. (A little background - The service a large township (with lots of MVAs) operating traditional ambulances and a heavy rescue style vehicle. Back when they started, they provided the rescue services to the township, predominately with home response personnel including people who were also FD members. Over the years, the various VFDs in the township have over-duplicated the rescue services. These days, they are mostly a career department and I don't think they rely on "off-duty" personnel to staff the unit, so there are times in which their rescue may not be able to respond and are reliant on the VFDs. However, the VFDs suffer from the same response issues that most other VFDs do and are thus inconsistent with their responses.)

The two ambulances are on medium duty chassis and have a small CAFS system and a HRT with a small power unit. Aside from having a different layout, the units are fairly identical to units I've operated at other EMS agencies and have performed well as an ambulance. Now if these units were designed to replace a structural pumper and a heavy rescue truck, then sure they'd have a hard time doing those jobs well. However, they weren't designed to replace those units. They were designed to address the response issues of the VFDs.

The CAFS is not for fighting a house fire, it's predominately for patient/crew protection in the event of a MVA/vehicle fire. The rescue tools carried are not intended for them to work a heavy entrapment by themselves (and then clean up before transporting), they are predominately intended for minor extrication situations, like a simple door pop, where the VFDs are slow to respond and their rescue doesn't have staffing. They can quickly pop the door and get on with taking care of the patient instead of "wasting time" waiting for them to arrive and perform a "30 second extrication". Seems to be working so far.

Combination units do typically tend to represent a certain degree of compromise compared to separate units, but that doesn't necessarily automatically translate into not being able to do different jobs well. Sometimes they aren't intended to do everything and can do what a department needs them to do quite well.

I am not fond of the medium duty or whatever you want to call the ambulances on the international or freightliner chassis and don't think they work well as an ambulance so adding a cafs unit just adds something else they don't do well. I have seen too many meetings where politicians want to buy one of those monsters with a CAFS unit so as to cut another truck "Because it can do both" I have worked in that type of unit and find them horrible due to nothing being close at hand and everybody wanting to throw more on the truck because we have the cabinet space. You are entitled to your opinion as am I, time will tell if the idea works for Broward, I won't bet on it working! In my limited experience it isn't an idea that works very well and it may work for them, time will tell and I will reserve judgement until the units are in service for a while.

Edited September 19, 2011 by Mark Z

[sympathomedic 383]

Holy Wheelbase!!

Some thoughts: When it goes down for service, it is like two units being down.

How does the Pt feel being moved sideways? Hard stops will throw the Pt sideways off the board/cot, not into it like a traditional ambulance and a sitting up Pt. I would like to take a long stretcher ride it it over curves hills and bumps. After all, we work for the person on the bed.

[FireMedic049 597]

I am not fond of the medium duty or whatever you want to call the ambulances on the international or freightliner chassis and don't think they work well as an ambulance so adding a cafs unit just adds something else they don't do well.

Your experience may not have been favorable with medium duty ambulances, however my 10 years experience working in them along with working in pretty much every (american) style ambulance over 18+ years says they work very well as an ambulance. What is it that they "don't do well" regarding having a CAFS unit on board?

I have worked in that type of unit and find them horrible due to nothing being close at hand and everybody wanting to throw more on the truck because we have the cabinet space.

Sounds like a design problem to me. The ones I've worked in have had just about everything I needed within arms reach. Depending on what's being put on, where's the problem with carrying more stuff if you aren't leaving something essential off the unit or overloading the vehicle (weight wise)?

I have seen too many meetings where politicians want to buy one of those monsters with a CAFS unit so as to cut another truck "Because it can do both"

Please show us where this has taken place. I seriously doubt that any significant number of meetings has taken place where somebody is legitimately trying to eliminate a full-fledged suppression unit in favor of an ambulance with CAFS.

[FireMedic049 597]

Holy Wheelbase!!

Some thoughts: When it goes down for service, it is like two units being down.

Probably not since it's a secondary transport unit. A reserve engine is probably put in service, so only the secondary transport aspect is lost.

How does the Pt feel being moved sideways?

How do they feel riding backwards?

Hard stops will throw the Pt sideways off the board/cot, not into it like a traditional ambulance and a sitting up Pt.

Is this really that much different than the patient being moved sideways because of a hard turn? Besides, if a hard stop throws your patient off the board/cot, then you didn't secured them properly.

[Bnechis 3,961]

I don't believe that all car fires are class B fires. Class B is flammable or combustible liquid/gases. The vast majority of vehicle fires I've dealt with have not directly involved Class B materials and plain water has easily extinguished them. So I'm not quite following your thought.

All are not class B, but many are, In addition to the fuels, much of the foam in seating when heated becomes class B as does some of the plastics. I have seen many car fires that needed 500+ gallons to extingush and even with CAFS being more efficient how much water/class A foam can an ambulance carry (100 gal or so)? How many of those fires involved a trapped occupant? If you start off with too little, you have bought the patient a minute or two, with a more effective agent you may gain more time.

Please show us where this has taken place. I seriously doubt that any significant number of meetings has taken place where somebody is legitimately trying to eliminate a full-fledged suppression unit in favor of an ambulance with CAFS.

The ICMA (International City Managers Assoc.) has been agressivly pushing the concept of replacing class A pumpers with pick-up trucks with CAFS sliders as a way to cut cost. In particular they claim that a 1 man CAFS pick-up is as effective as a 3 man class A pumper. It was pushed in the August issue of their magazine and was highlighted in a study they did in Sandusky Oh.

[Bnechis 3,961]

That's sooooooome wheelbase. Don't forget to figure in the price of the repairs after sideswiping things.

Good point.

Here's another one. While on a final inspection at Pierce 2 years ago I noticed that our rub rails did not come out far enough. That means if we side swipe something, the expensive to repair roll down doors take the hit and protect the less expensive sacraficial rub rails. So we looked around the factory and found this was true of every rig with roll down doors. It apears the design was based on pan doors and no one ever checked it. Thats 1,000's of rigs from that manufacturer alone. We brought this to the engineers and they were stunned (they had 30 or so look at it) and fixed ours. To this day I have seen the same issue with almost every manufacturer.

Most buyers are more concerned with how it looks and not concerned with potential damage during its life time.

Another common one is the Q2 sticking out beyond the bumper without protecting it in some way. In particular when mounted above the bumper it often sticks out 1 inch beyond it. Let the bumper take the hit. Or add bumper guards.

[sympathomedic 383]

I can't do those neato quote the previous post things you guys can do. I did not mean to say get thrown off the cot/board, I meant to convey that in a rear-facing seat, which is what a conventional amb cot is, a hard stop is not so bad. Getting pushed sideways into 3 3" wide cot straps is, shall we say, different?

Yes some folks feel funny and get car sick facing the back. But I can't think of any other transportation, Taxi's, trains, cars, ferries, planes that sit folks sideways. Maybe some wheelchair vans. I bet if you built a side-facing car seat, it would not sell. There is a reason. I am not looking to argue, I am just advocating for the sick people who would prefer a safe comfortable ride, and not one that has been modified for the purposes of fire suppression.

[Bnechis 3,961]

I can't do those neato quote the previous post things you guys can do.

If you go to the post you want to comment on (in this case yours #22) then hit the reply button (not the "add a reply" button)or go to multiple posts on on each one hit the "multiquote button" You will see the posts you want to comment on in the typing space.

Also use the preview button to see if you got it correct, before posting

Edited September 20, 2011 by Bnechis

[sympathomedic 383]

If you go to the post you want to comment on (in this case yours #22) then hit the reply button (not the "add a reply" button)or go to multiple posts on on each one hit the "multiquote button" You will see the posts you want to comment on in the typing space.

Also use the preview button to see if you got it correct, before posting

OK, here we go....

[x129K 1,393]

OK, here we go....

Very proud of you Billy! Welcome to the Internetz!

[FireMedic049 597]

All are not class B, but many are, In addition to the fuels, much of the foam in seating when heated becomes class B as does some of the plastics. I have seen many car fires that needed 500+ gallons to extingush and even with CAFS being more efficient how much water/class A foam can an ambulance carry (100 gal or so)? How many of those fires involved a trapped occupant? If you start off with too little, you have bought the patient a minute or two, with a more effective agent you may gain more time.

True, some aspects of a vehicle fire, specifically the fuel is Class B. I'll concede that the synthetics may not be Class A, but I really don't think they qualify as a flammable/combustible liquid or gas. That aside, you'll find lots of foam and plastics in building fires and plain water, CAFS and other Class A foam products seem to work, so I'm not sure if Class B foam is necessarily the better option.

Sure, in all likelihood an ambulance will not be carrying much water/foam, but is that necessarily a problem if the goal is occupant protection vs actual extinguishment? Maybe in some cases it won't be enough. Is it better than a handful of extinguishers? I don't know, but it's definitely better than nothing or the state required fire extinguisher for an ambulance.

The ICMA (International City Managers Assoc.) has been agressivly pushing the concept of replacing class A pumpers with pick-up trucks with CAFS sliders as a way to cut cost. In particular they claim that a 1 man CAFS pick-up is as effective as a 3 man class A pumper. It was pushed in the August issue of their magazine and was highlighted in a study they did in Sandusky Oh.

Yes, I'm aware of this, however I don't believe this is what he appeared to be talking about and definitely wasn't what I was referring to. He appeared to be referring to ambulances with firefighting capability (small CAFS units) replacing suppression units and that it was not an isolated situation. I don't believe that's happening.

[FireMedic049 597]

I can't do those neato quote the previous post things you guys can do. I did not mean to say get thrown off the cot/board, I meant to convey that in a rear-facing seat, which is what a conventional amb cot is, a hard stop is not so bad. Getting pushed sideways into 3 3" wide cot straps is, shall we say, different?

Sure, but is this that much different than being pushed sideways in a hard turn?

Yes some folks feel funny and get car sick facing the back. But I can't think of any other transportation, Taxi's, trains, cars, ferries, planes that sit folks sideways. Maybe some wheelchair vans.

Well............Pretty all of the public buses in my area have some sideways seating and it does get used. Stretch limos have some sideways seating. Some private jets have sideways seating. I've even seen sideways seating in some fire trucks and pretty much every ambulance has it for the care providers in the back.

I bet if you built a side-facing car seat, it would not sell. There is a reason. I am not looking to argue, I am just advocating for the sick people who would prefer a safe comfortable ride, and not one that has been modified for the purposes of fire suppression.

How do you know for sure that a patient transported in this unit will not get a safe, comfortable ride? I'm not interested in arguing either, but I will challenge what I think are essentially baseless or incorrect assertions.

[PEMO3 523]

How does the Pt feel being moved sideways? Hard stops will throw the Pt sideways off the board/cot, not into it like a traditional ambulance and a sitting up Pt.

Hard stops either in a rear facing stretcher or sideways facing one should not occur if the apparatus operator is driving in a prudent and safe manner except under what would be "accident avoidance" conditions and this aggressive maneuvers should be minimized if not non-existent during patient transport . Sideway facing stretchers are not new. A large number medivacs have their stretchers sideways mounted for space reasons and patient transport position is not questioned. Regardless of the stretcher position the primary goal is safe, expeditious patient transport to a medical facility. As I said in my recent post, my only concern was that during commitment to patient transport the service has essentially two pieces of apparatus unavailable. If this is a secondary transport option and it improves patient care as a bottom line then I would consider it a unique solution. I would be interested in seeing how often it is used for patient transport if at all. I guess it is like air bags in a car - they are an added expense, almost never used but when they do go off you were glad you spent the additional funds to install them.

Edited September 20, 2011 by PEMO3

[IzzyEng4 427]

Seagrave in the early 1990s offered engine or rescue configuration medical transport cabs. Sycamore Township in Ohio still has two medic transport engines in service along with two standard ambulances.

http://sycamoretownship.org/Apparatus.cfm

[JCESU 20]

Thats pretty funny. It even has an air-dam on top of the cab next to the 'Broward County Sheriff' graphics. Bottom line is that its just plane silly and dangerous. Staff an engine and an ambulance 24/7 like they should be as well as the manpower and resources needed for coverage.