Robert Tutterow

The seating is so cramped that buckling a seat belt is often difficult for average-size firefighters wearing street clothes. When wearing turnout gear, the problem worsens. If a firefighter is above average in size and wearing turnout gear, the task of buckling a seat belt can be most frustrating. To illustrate the cramped conditions, I recently had a discussion with a firefighter who was approximately six feet, three inches tall and 265 pounds with the build of a defensive end. He told me that when he drives his department's apparatus, without turnout gear, he has to keep the window down to allow room to maneuver his left elbow to safely turn the steering wheel.

Historical Perspective

Why has the fire service accepted such a bad seating arrangement for so long? It is certainly not a new problem. A small group of fire service personnel started addressing this problem more than eight years ago. This is evidenced by my September 2006 column in this publication. Several excerpts from that column are pertinent to the background of this issue:

"Seat belt usage, or the lack thereof, is definitely a 'front and center' topic in the industry. Fortunately, a few fire service organizations and key fire service leaders have decided to take action. This past April [2006], an ad-hoc group of interested persons representing the National Fallen Firefighters Foundation (NFFF), the International Association of Fire Chiefs (IAFC) Health & Safety Section, the Fire Apparatus Manufacturers' Association (FAMA), and the Safety Task Group [now defunct] of the National Fire Protection Association (NFPA) Technical Committee on Fire Apparatus met in Indianapolis, Indiana, to explore opportunities. It was not a pleasant meeting. The manufacturing sector could not understand why the fire service, with its paramilitary organizational structure, could not mandate seat belt usage. Granted, it is hard to argue with their position. However, fire service representatives pointed out the extreme difficulty in many fire apparatus cabs to buckle up. The seats are 'shoe-horned' around the engine compartment of custom cabs, the straps are hard to reach and get tangled with the self-contained breathing apparatus straps; the straps are too short. This was getting emotional.

"Luckily, a nonemotional thought process rose to the top, and a plan of action was formed. Foremost, a firefighter anthropometric study [human body measurements] was proposed. In the following weeks, representatives from FAMA quickly developed a comprehensive study [protocol]. The study includes almost 40 measurements (including weights) of a firefighter. The weights are recorded in street clothes and with full PPE. Lap belt and shoulder strap length requirements are measured. The Los Angeles (CA) and Charlotte (NC) Fire Departments were selected to do the pilot study. These two departments reacted immediately to measure 60 firefighters for validation and finetuning of the study. The data was presented at a second meeting of the ad-hoc multiorganizational group in [July].

"Three things were apparent from the initial analysis:

1. The study is very useful.
2. More firefighters need to be measured to represent a valid sampling.
3. There is an opportunity to improve seating and seat belt/shoulder strap accessibility.

"Though the initial measurements are preliminary, it appears firefighters are larger and heavier when wearing full PPE

By Alan M. Petrillo

Spreaders, cutters, combination tools, and rams all benefit from high-capacity batteries that allow for maximum operational time and greater power where it's needed.

Hurst Jaws of Life

1 Hurst Jaws of Life reduced the eDraulic 2.0 S 700E2 cutter to 48.1 pounds, but it still retains the same performance characteristics of its predecessor. (Photo courtesy of Hurst Jaws of Life.)

Bruce R. Johnston, director of marketing and product management for Hurst Jaws of Life, says Hurst introduced the first battery tool on the market in 2011-the eDraulic-and has since improved it to a 2.0 model earlier this year that also has proven successful. "We design our tools and equipment with three priorities in mind: innovation to prepare firefighters for future challenges, power to deal with the stronger metals in vehicles, and speed for faster removal of patients," Johnston says. "Our eDraulic 2.0 tools have been elevated with better performance and portability, faster speed, and easier deployment."

Hurst offers two cutters, two spreaders, two combination tools, and one ram in the eDraulic 2.0 product line.

2 The Hurst eDraulic 2.0 Sp 300EP spreader got a new hydraulic pump that reduces weight, making it easier to handle, yet still delivers powerful performance. (Photo courtesy of Hurst Jaws of Life.)

Johnston notes that the company trimmed down the eDraulic S 700E2 cutter's weight to to 48.1 pounds (from 54.1 pounds in its initial version), and the S 311E2 cutter is three pounds lighter at 39 pounds and still delivers the same performance characteristics. Hurst was able to shed the weight on the battery-operated tools through a sleeker more compact design, Johnston says, as well as a change in some of the materials used in manufacturing.

The eDraulic SP 310E2 spreader is stronger than its predecessor and features a newly designed hydraulic pump that delivers 72,800 pounds of spreading force. The Hurst SP 300E2 spreader also got a new hydraulic pump that reduces weight but continues to maintain its performance characteristics.

3 Genesis Rescue Systems makes the eForce C236 cutter as the largest of three cutter models, classifying it as a heavy-duty unit to handle the toughest materials. (Photo courtesy of Genesis Rescue Systems.)

Both of the eDraulic combi tools in the 2.0 line are more powerful and have reduced weights, Johnston points out. The SC 357E2 combi tool is more powerful and two pounds lighter than the previous version and uses a compact, single integrated design to house

Richard Marinucci

Some estimates are that 97 percent of the 200 largest cities in America use the fire service to provide EMS. One would be hard-pressed to find many organizations that don't have some role in the delivery of medical care. The result of this has been the fire service's significant transformation in many different ways. Obviously, responses have increased, and the public's expectations have changed. Customer service and bedside manner are very important, and dealing directly with other people is something that all fire-based EMS personnel must do. Think about it. When responding to a fire, most firefighters don't ever have to deal with the public. Yet for an EMS call, there is personal contact every time. Personalities and relationships with the citizens have become more important.

The Fire Service and Other Industries

Prior to EMS, the fire service really had no connection to other professions in the way that EMS aligns itself with others in the medical profession. Obviously there is a direct tie-in to emergency rooms, but there is much more to it than that. Depending on the level of service, whether as a medical first responder or paramedics who transport patients, there is a certain level of performance expected. Further, licensure, not just certification, along with continuing education is required. Alignment with the medical profession mandates the types of requirements to continue involvement not previously seen in the fire service.

There is much the fire service can learn from others in the health care industry. It behooves organizations to look at the broad picture and view various perspectives and options for improving the service. There are clear examples of how this can work by enhancing services. For example, paramedics have always used three-lead EKG technology. Hospital and office settings used much more sophisticated 12-lead devices. Eventually many EMS providers transitioned to the EKG that offers more diagnostic information.

Relationships

Organizations and individuals need to pay attention to medical advances that may someday reach the fire service for field use. One way to do this is to establish relationships with medical professionals and facilities. Build these relationships through regular contacts and by demonstrating a sincere interest in quality care. They can be with professionals in emergency rooms, operating rooms, critical care units, and perhaps outpatient clinics. Fire service organizations can press the issue by extending an invite to other health care professionals to ride along to see how they deliver medicine outside controlled environments. Mutual understanding and respect goes a long way and only improves through interaction.

Marketing

Another area to consider when looking for trends and ideas is marketing. There is so much to learn from others in the profession regarding service delivery. You can listen to advertisements on the radio or television and get a good idea of what professional marketers deem important, relevant, and the real selling points. If you listen, you will hear them tout their professional staff, their commitment to quality service, their use of the latest technology, and the speed with which you will likely receive service. They will use cases, without revealing names or compromising identities, to demonstrate positive outcomes. Occasionally, a patient will act as a spokesperson. These particulars must be effecti

By Alan M. Petrillo

Manufacturers say that customizing ambulances for customer needs has become so commonplace that it is almost expected in some measure for every vehicle they build.

Staying Within Reach

David Cole, vice president of sales and marketing for Horton Emergency Vehicles, says that custom manufacturing an ambulance is driven chiefly by customer experience and needs. "We've been making high-quality ambulances for 47 years and custom engineering them in a safe and reliable manner," Cole says. "Our focus has been on safety, so we offer a crash barrier design with a side entry door near the front of the module that moves equipment inside the box closer to the patient. It also allows the medics to stay seated and belted but still be able to reach equipment from a safe position."

1 Horton Emergency Vehicles built a custom ambulance on an International 4300 chassis for the Ocean City (MD) Fire Department that includes the Horton Occupant Protection System, a crash barrier safety configuration, a heated cabinet at the head of the bench, and rear- and side-view cameras. (Photo courtesy of Horton Emergency Vehicles.)

Horton has put a standard safety system in place for its ambulances, Cole points out. "In terms of occupant protection, we have a series of three-point seat belts, extra padding and cushioning material in various head and other strike zones, and tubular structure air bags and air curtains to provide a safer environment in the back of the ambulance," he says. "This is standard on all our ambulances, providing the design meets the requirements for installing the occupant protection system. Our goal is to build the most custom ambulance possible that still meets the design and has safety in mind."

Randy Barr, sales manager for American Emergency Vehicles (AEV), says his company has been designing the interiors of ambulances so the medics can easily reach equipment and cabinets and still stay buckled in their seats. "In the past year, we've seen a strong demand for customization in the backs of ambulances," he says, "and we have been meeting those requests."

2 The University Heights (OH) Fire Department had Horton Emergency Vehicles customize its ambulance with a bench-side crash barrier, a five-point sliding attendant seat, a dual-position CPR seat, dual electrical control panels, and a slide-out oxygen bottle bracket mount. (Photo courtesy of Horton Emergency Vehicles.)

Chassis Platforms

Barr notes that AEV "has seen a huge increase in the use of Ford