When I got out of the academy and was sent to my first professional assignment at Engine 46's house on Ambulance 9, nothing could prepare me for the shock of walking in and seeing a vintage (well, not really) 'professional car' style ambulance sitting in the bay in front of the hook and ladder. I was stunned. Even my old volunteer suburban department had up-dated equipment and had done a community drive to fund a brand new "box" style ambulance with all the bells and whistles. So here I am, on a major metropolitan fire department EMS service, working with a fireman with little or no formal training (yes, he was in charge too), and running EMS calls with little or no equipment, no first aid kit and an antiquated oxygen set up, AND I am in a 'caddy low-rider' that had very little room in the back to do much of anything. Now these 'professional cars' (fig. 1) do have a long history, mostly back to the funeral industry. It's too long to go into here, but for the sake of our discussion, the fate of that 'professional car' was doomed as an ambulance when the Feds finally issued federal guidelines for ambulance specifications in 1977. By then EMS was way ahead of them in the needs of pre-hospital care.
Now the real early ambulance in professional EMS was the 'Type I', box style rig that is still popular today. (Fig. 2) It consisted of a standard cab and truck chassis with a custom ambulance "box", or patient compartment, placed on the back. It was even hoped that the "box" could be recycled from one chassis to the next as an additional cost savings. This did not often work out as the patient compartment suffered the same wear and tear that the chassis did with the miles. The 'Type I' offered excellent storage and room in the back for patient care duties and could easily be modified to carry up to four patients in a disaster situation. The catch was that they were expensive to buy and maintain (they still are, although what these days isn't) and many of the early model chassis and engines were NOT designed for the extra weight and suffered accordingly.
With the extreme cost of the "box" style ambulance a more cost effective design was sought in the "Type II". (Fig. 3) This 'van' style ambulance was introduced to try and cut some of the costs when vast amounts of room may not have been needed for patient care, and transportation may have been the primary consideration. While these were tested for initial responses, many departments abandoned them as they just did not stand up to the rigor of first-line defense and the patient compartments were cramped.
The "Type III" (fig. 4) (you think they could get more inventive for names than this, right?) was an expansion of the Type I, beefing up the chassis and often adding diesel power to further help drive the weight. These probably were the first real "design" ambulances that may have used stock chassis but were truly built from the ground up as the vehicles they were designed to be. Years of providing EMS had given the brothers and sisters plenty of insight as to what they wanted in an EMS vehicle. Many had walk-through cabs, although that luxury went out in later years in many models. Light-weight truck frames were still being used, with added components making them much heavier then normal and the added weight often required dual tires in the rear. Still, some providers were not able to get more than 150k miles out of them due to the severe wear and tear that goes with the turf. This was true from the 'Type I' through the 'Type III'. There was just no durability that was available in these custom rigs. At $75-125k+ a pop just for the rig, lights, and radio, any EMS manager with a sizable fleet could be constantly faced with capitol replacement costs that could kill any reasonably sized budget. The issue of durability is one that has not gone away. EMS rigs are very susceptible to heavy wear and tear, unlike the extinguishment rigs that seem to carry-on forever! As a result, many departments are moving to an even bigger form of apparatus.
Enter the Type IIIa. (Fig. 5), a much bigger version than the traditional ambulance we are used to and much more of a TRUCK. Many are built on an International? or similar chassis and are much more indicative of traditional apparatus than EMS is used to. These are BEEFY rigs, built with big diesel drive trains to power them. While the back will be a traditional ambulance setup, the rides will not and will have a distinctly truck like feel. The addition of a rear airbag support system will help and can also assist in the loading and unloading of patients out of the rear compartment. They also carry a heavier price tag with some coming in at over $170K depending on the original specifications and the extras wanted. Hopefully they will be worth the extra cash layout with some real durability and mileage.
Bigger, better, more mileage, more everything! Finally, some real apparatus that may be operational for EMS. I always had to laugh when, trying to justify keeping low-rider Cadillac Ambulances. Former Chicago Fire Commissioner Robert Quinn had said, "People want to go out in style". Still, you have to miss that ride, because nothing rode like that caddy..... God bless the old man, you had to love him. o
William R. Kerney, MA-EMTP-A is a professor of emergency medical services at the Community College of Southern Nevada.