Bigger and Bigger Buses

[Guest partyrock]

The vast majority of EMS in Westchester is BLS with ALS flycars. Tech rescue, extrication, etc are provided for by fire depts. Over the last 10 years BLS equipment and protocols has changed little. Why do we need such large vehicles?

White Plains and Yonkers are both covered by type II chassis BLS buses and seem to do quite well. Much more common and my personal preferance are type I. They offer the versatillity to transport two fully immobilized patients and can comfortable store more than enough equipment for BLS or ALS.

So this post didn't come completely out of my a$$ I checeked out a couple local vacs and these things are half empty. A full compartment just for the AED. A sealed compartment to ensure 800 compliance. Seating for 5 plus the patient. I've never met anyone who could perform effective CPR sitting down especially with the new protocols.

If your vehicles are being driven into the ground before being replaced maybe you can afford to speed up the replacement schedule by going with a smaller vehicle. Instead of rolling around on those mini wheeles and over burdended chasis you can get a vehicle that rides better and might last longer.

How about spend that money on the membership. Upgrade facilities, free uniforms, a stocked fridge, send the members to the EMS expo. Volunteers give up alot of their time and rewards are always appreciated. If you can't get volleys then spend the money to hire some coverage at rate they deserve instead of the prevaling wage.

Thanks for indulging my rant. Take it easy and be safe.

[trauma74 111]

The vast majority of EMS in Westchester is BLS with ALS flycars. Tech rescue, extrication, etc are provided for by fire depts. Over the last 10 years BLS equipment and protocols has changed little. Why do we need such large vehicles?

I know you mentioned Westchester here, but buses are getting bigger all over. Up here in Orange County pretty much everyone is getting bigger buses. We have two new Horton buses on the way. They are mounted on International chassis. Our reason for the bigger chassis is because we have found that FORD chassis along with the braking and suspension systems take too much of a beaten with the size of our box and the amount of weight we carry from the equpiment. FORD quality is also going down hill. There is always one issue or another and FORD is reluctant to want to fix the problems. FORD now limits what you can modify on the van chassis and it is becoming more of a pain in the a** when you try to spec out a new bus. With our new Internationals we will go thru brakes less often and have less issues with the suspension system.

White Plains and Yonkers are both covered by type II chassis BLS buses and seem to do quite well. Much more common and my personal preferance are type I. They offer the versatillity to transport two fully immobilized patients and can comfortable store more than enough equipment for BLS or ALS.

If you are going to transport two fully immobilized you should have the abilty to transport some walking wounded who either do not need or refuse spinal immobilization. You need room to move around in the back of the bus. A type 2 van is just way to small for that. Plus if you need a medic to get on board you need room for them to work.

So this post didn't come completely out of my a$$ I checeked out a couple local vacs and these things are half empty. A full compartment just for the AED. A sealed compartment to ensure 800 compliance. Seating for 5 plus the patient. I've never met anyone who could perform effective CPR sitting down especially with the new protocols.

Our new buses are going to have more cabinet/compartment space then our current buses. Our box is going to be six inches longer and six inches taller then what we have now. We do have a part 800 cabinet to always ensure that we have the proper equipment in the event of a surprise NYS DOH inspection. Our cabinets will be full. We have always overstocked our buses because if we get back go back jobs and we are unable to get back to the bay to restock we do not want to be our of service and unable to respond to a call in our town. We also carry fire rehab equipment on our buses such as cool mist fans, extra bottled water, extra backboards, extra 02 masks, folding chairs, coolers, extra spare 02 bottles. This is done because sometimes when we are short on manpower we can function for a while until we can get more buses to the scene.

There are times when we have 4 members riding the same shift. We need to have enough room for all 4 members on the bus, plus a medic if needed and do not forget about taking a patients family in the bus with you.

If your vehicles are being driven into the ground before being replaced maybe you can afford to speed up the replacement schedule by going with a smaller vehicle. Instead of rolling around on those mini wheeles and over burdended chasis you can get a vehicle that rides better and might last longer.

We do not drive our vehicles into the ground, but we do keep them for about 10 years. With the Internationals we can get a few more years out of them if needed. Our Town Board purchases our buses for us. They do not mind spending the extra money for what we need.

How about spend that money on the membership. Upgrade facilities, free uniforms, a stocked fridge, send the members to the EMS expo. Volunteers give up alot of their time and rewards are always appreciated. If you can't get volleys then spend the money to hire some coverage at rate they deserve instead of the prevaling wage.

We spend a lot of money on our membership. We have a new building, we give all members free uniforms (pants, shirts, jackets, boots, turnout gear, workshirts, t-shirts etc), We send our members to at least two EMS Expos a year, our kitchen cabinets and our fridge is always fully stocked. We are always giving away little perks to the membership.

So we have our big buses and we take care of everyone!

[mlfcemt093 0]

glad to see chester has such a vast budget great for the membership.......

[Guest partyrock]

I'm not trying to pick on you or your agency trauma. You guys apparently have a pretty good handle on things. Sadly the same isn't true every where.

You mentioned switching to international because the fords couldn't handle the load. Thats what I was getting at. When an ageny is swimming in extra space on their rigs why not go with a smaller type I or III. A type II doesn't really offer the versatility. Chester carry around all the fire rehab equipment this doesn't seem like an option. As far as carrying enough patient care equipment come on now. In a box half that size you can carry plenty of bandages, O2, and equioment. I still don't understand the part 800 compartment. As long as you were fully stocked before leaving your quarters your PCR's will cover the missing equipment during an inspection.

How many patients do you plan to transport? Two immobilized patients cover your bench and stretcher. I suppose you could put a patient in the CPR seat, but that just doesn't seem practical. Technically the captains chair should be for the tech but we all know most techs will stand or crouch unrestrained and put a patient there. Please don't suggest the tech sitting in the CPR chair, then how are you going to treat your patients?

My side job has me riding a type I with more than enough crap to run all night long. The only thing I could run out of is immobolization equipment, but 3 or 4 long boards, 3 KEDs (2 adult, 1 Ped), two Hare splints (1 peds 1 adult). I have only run out of KED's on a scene once, but that doesn't matter since I can't transport more than 2 immobilized. And in the end I usually get my junk back unless it has to be deconned in which case the bus usually has to as well.

Its good see you guys are being taken care of. Many others on this bord are not so lucky working out of out dated facilities with few if any perks for the members.

Edited February 4, 2007 by partyrock

[Remember585 815]

I agree with you Partyrock, it does seem like a lot of places are going bigger.

At the same time, I have seen agencies that bought bigger units go back to the smaller ones after realizing their downfalls. In all honesty, if you are handling the majority of your calls with a two-person crew then you should STRONGLY consider a smaller unit with a low-lift for the stretcher.

The absolute worst ambulance I've ever had to work in is the one in our FD - ambulance 55B1. I know that the rest of my fellow members and all the Medics that have had to deal with this thing will agree. The ambulance was originally mounted on a Ford F350 chasis. The chasis was destroyed in an accident several years ago and the box was remounted on a Ford F-Super Duty chasis. When I tell you that this thing has the worst ride in ambulance history, it's no exaggeration. The enormous downfall is the height of the box. We can't buy any stretchers with the "wheel drop release" because it won't reach the ground. We have to lower the cot all the way then pick the patient up to load them. Unloading is worst, we have to take the patient entirely out, put them on the ground, then lift the cot up again. There has been several times where members of not only the FD but our PD has injured their backs on scene.

I wish we could just replace it - however our Village has yet to comprehend how troublesome, difficult and hazardous it really is. Luckily our newer rig is a PL Custom and it works well. With luck we could get rid of the current 55B1 and replace it with a similar unit to 55B2.

Here's a pic of our 55B1. (The one on the right).

[Guest alsfirefighter]

Second on 585 motions that 55B1 sucks.

Also I agree with Party as well. I've been in and have had to operate ambulances that are entirely too long and some that their width is wider then some driving lanes, which in return has had them lose some driver's side mirrors.

As far as type II van's. They have plenty of room for a medic to work in. I've never had a problem when I was operating in one. If there are critical patients, I try to get 1 per bus. If I can't then you make due, it doesn't happen often even if your not in a van putting someone on a bench makes it difficult for any additional personnel in the back if you don't have a middle mount stretcher. A medic works around his surroundings...not the other way around. If that was the case every arrest, trauma etc. would be in the middle of a street. We're not performing emergency surgery...we're ditch docs and we do more with less...

You have 2 immobilized and you have a few walking wounded or those whom deny spinal immobilization

For me...they sit and wait. Until I get another ambulance or a small bus. They get triaged, they get a green tag somewhere on their body. They want to RMA fine. But they will not get an ambulance when 2 people are already in there. They aren't a priority at that point, even if those with spinal immobilization are fine...they still opted to go with the program and they can't like in the road all day.

[helicopper 1,050]

I worked in all three types of ambulances on a variety of chassis and think there are disadvantages and advantages to all of them.

I also think the wear and tear on ambulances has as much to do with driver training and procedures as it does with the chassis it is built on. Standing on the brakes traffic light to traffic light is going to burn through brakes on any chassis and I know we've all seen that done! I've seen plenty of commercial vehicles built on the same chassis as an ambulance, carrying more weight than an ambulance, and not suffering for it.

Personally, I think ambulances are getting ridiculously big - too big to fit on some driveways and even smaller roads. As ALS said, they're being built to be as wide or wider than traffic lanes and that is a problem!

If you need to transport multiple patients, get more ambulances - don't create a clown car with two backboarded and three ambulatory patients in one! What happens if one goes south, vomits, or anything else. There is no room to work with a baseball team in the back! I was also trained to believe that there should be no more than two patients to an EMT - one if the patient is critical - so transporting any more than two is difficult in any vehicle!

[nycemt728 49]

Totally see it aswell, it started w/ one agency and now more and more are getting these huge vehicles. I realize size can be a big help, but I think agencies need to evaluate their need and surroundings before jumping to order the largest, most tricked out ambulance. This is especially so in built-up urban areas such as NYC. There is NO need to have a Freightliner running around. Sometimes it doesnt even fit in ER bays, how irresponsible is that now; you have to squeeze it in or take up two spots or what happens most times park away from the entrance and work your stretcher in, extra time that just should not be watsted. In asking around, a number of people indicated the choice between van or mod is based on ALS vs BLS. Ok, so medics need a little more room to play, thats fine. However, for all the BLS agencies that buy them for space....for what?? In a multi-tiered system such as NYC, theres usually no reason to take more than one pt, there is normally an available unit, for pt saftey and our comfort, call for another bus!

People will also say, oh well FDNY runs all mods. Yes they do, and FDNY gets those mods scraped, damaged and stuck in some of the small streets of NYC. If you know your agency responds BLS AND had narrow areas like this, any advantage gained in working space is lost while you wait for a tow!

Finally, I preface the above argument by saying this does not apply to rurual areas; if your next due unit is 20 mins out, you cover alot of square miles and you also function as rescue, haz-tac etc...I would pretty much say a larger bus is warranted and quite useful.