By Aditya Shekhar
The advent of hybrid-style engine/ambulances or transport-capable apparatuses took the fire vehicle world by storm a few years ago, garnering a lot of positive and negative attention. Supporters of the concept of a hybrid engine/ambulance appreciated how the vehicle could perform two very important roles within the fire service: suppression and EMS transport. Despite this versatility, orders were low. Critics of the design argued that, while these vehicles could theoretically perform both roles, they aren’t capable of performing each role at a level comparable to dedicated single-role vehicles. As a fire apparatus, engine/ambulances devote a significant amount of space to the patient compartment, decreasing available storage for water, hoseline and other tools.
As an EMS transport unit, a hybrid engine/ambulance is more expensive to operate and maintain than a traditional ambulance, can be difficult to load and unload a patient on a stretcher, might not fit in all emergency department bays and is slower and less maneuverable than a typical ambulance. These shortcomings in both areas meant that adoption of engine/ambulances has been low, and many departments with these units have still seen the need for both single-role engines and ambulances. In other words, these haven’t proven to be true one-unit-for-two-jobs vehicles or the future vehicle of choice for dual-role fire/EMS departments.
However, I think there might be a different way to approach the idea of combination vehicles that might produce a new type of truck that can uniquely meet the needs of many departments nationwide. The fundamental philosophy behind the criticized engine/ambulance was to start with a traditional fire engine and add patient transport capabilities. Unfortunately, the result was a vehicle that was regarded by many to be subpar at both. However, to create a vehicle that could do both effectively, why not start with a traditional ambulance and add small-scale, basic firefighting capabilities to it?
The resulting vehicle, as I envision it, would likely be a cross between mini-pumper – a light rescue with suppression capabilities built on a heavy-duty pickup chassis – and a Type 1 ambulance on a similar chassis. It’s worth noting that a vehicle like this will never replace a full-size apparatus, but it will allow departments to provide quick-attack and transport in one easy-to-manage vehicle. Many suburban fire/EMS departments provide ambulance transport to citizens, in addition to EMS first-response, traditional fire suppression and rescue services. These departments might receive several thousand calls per year, and up to 90% of them might be entirely medical calls.
The remaining 10% might consist of rescues or extrications, hazardous materials incidents, and small fires – these calls could likely be dealt with just using the resources inside a mini-pumper-style vehicle. With that logic, having a firefighting ambulance and using it on these types of calls will allow many departments to save wear and tear on their frontline engine by reserving it for calls that actually warrant a full-size apparatus, such as large-scale structure fires. Furthermore, departments that replace their ambulances with firefighting ambulances improve their fire suppression capabilities.
Specialized ambulances that offer more functionality than just patient transport is nothing new. In New York City, FDNY EMS runs a fleet of “Rescue Medic” ambulances that each contain specialized rescue equipment and are staffed with specially-trained paramedics. These units reduce the workload on already-busy engine, ladder, or truck companies by responding to intense medical calls that would’ve previously required an apparatus response.
Additionally, many fire-based EMS departments nationwide currently place SCBAs and turnout gear in their ambulances for cross-trained personnel to use at fires. In addition to a fully featured patient compartment and medical capabilities at the ALS or BLS level, a firefighting ambulance could likely contain some hose, rescue tools, pumping capabilities and a small water tank. To make the most use of space on a firefighting ambulance, one interesting option would be to use a Compressed Air Foam System (CAFS), which would decrease the amount of water needed to be carried and could dramatically improve the suppression capability of a relatively small firefighting ambulance.
As mentioned earlier, the design of a firefighting ambulance would likely contain elements found in mini-pumpers and Type 1 ambulances. The cab could contain one or two rows of seats, with the potential for a second row featuring SCBA-holstering seats. Just behind the cab, there could be a driver’s side exterior pump panel to control firefighting aspects of the truck. The ambulance module itself would then be behind this pump panel section and would have the normal compartments found on traditional ambulances.
Since the vehicle’s purpose is multidisciplinary in nature, these compartments could contain medical, rescue and firefighting gear – such as splints, rescue tools, hose, fire extinguishers, HAZ-MAT cleanup supplies, SCBAs, turnout gear and other equipment. The interior of the ambulance would likely be laid out identical to a traditional ambulance, but since there is a firefighting section between the cab and the patient module, the attendant might have to communicate with the cab through an intercom or headset system.
A normal stretcher loading system – powered or manual – could be installed, and there wouldn’t be a need for a specially designed loading system, since the module would be at the same height as a normal ambulance. Most notably, a firefighting ambulance sharing elements with a mini-pumper would be incredibly maneuverable and still be able to fit in most emergency department ambulance bays. Firefighting ambulances could easily respond to small fires – kitchens, vehicles, garages, and dumpsters, for example – rescue operations and medical calls. If heavy-duty help is needed, they can always call for assistance from a larger vehicle, such as a heavy rescue, engine or ladder. Even on larger fires, firefighting ambulances can assist in the overall suppression, a role ambulances previously normally cannot undertake.
While they might not be universally well-received as a concept, firefighting ambulances might be the perfect solution for departments needing a replacement for a traditional ambulance and also see the value in having extra suppression capabilities for their department. Being that they’d likely be significantly more-affordable than full-size apparatus, firefighting ambulances can allow departments to save wear and tear on engines or ladder units by utilizing them on incidents that don’t require a large truck to respond.
Considering their benefits and potential to help departments, it’s surprising that this concept hasn’t been further explored, and it’ll be exciting if departments and fire apparatus manufacturers support the development of concepts such as this. The launch of a truly capable firefighting ambulance has the potential to radically redefine the world of fire-based EMS.