Motor Ambulances.
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By Henry Sturmey.
The steady and inevitable absorption of the motor vehicle into the service of those who have hitherto depended entirely upon horses is now, slowly, yet surely, bringing the motor into use as a necessary part of hospital equipment and one after another, all over the country, hospital authorities and fire-brigade committees are installing motor ambulances as part of their vehicular outfits. In this they are no doubt right and in making the change from animal to mechanical traction they are doing so, not so much for the reasons which usually induce such a change, to wit economy—although upon this important point the advantages are obvious—but on account of the greater facility of operation and the celerity with which the work can be carried out. In many cases—especially in accident cases it is often of the most vital importance that not a moment should ler lost in reaching the hospital with the patient, and whilst, high speed of travel—as the motorist, understands high speed with a patient on board, is not only not desirable, but to he avoided, the steady travelling pace of a loaded motor ambulance can be three itnes that of a horsed ambulance, t hits effecting a saving of two thirds the time in transit. Of course, in reaching the patient with an empty vehicle, the saving in point of time can be considerably greater than this, where road and traffic conditions permit, so that., by the use of motors, a saving in time of something like 75 per cent, can be effected between !he time of receiving the call and delivering the patient to the care of the medical staff in the ward. It muse I think, also be admitted that the motor vehicle has another advantage of peculiar interest where hospitals are concerned and that is its cleanliness. The horse is admittedly an insanitary beast and to remove from the contiguity of the hospital buildings the stable yard and all that attaches thereto, must be a distinct gain, for a clean, well-ordered motor garage can present no disadvantages from this point of view.
In filling the wants of the hospital people it has to be borne in mind that several requirements have to be met and that not only body, but chassis, to be entirely successful, must be designed for
the work. This is a branch or motorcar work—like that of cal, building in which the nleasure car builder and agent will be and is already stepping in with the sug gestion that, as the loads are light, a pleasure-car chassis will suit the work. But this work, although not so essentially so as where heavier loads are dealt with, belongs more correctly and legitimately to the commercial-vehicle builder, whose province it is to design special vehicles for special purposes and whose work as a rule possesses, in a higher degree, that quality of reliability and.durability which are essentials as much for a hospital ambulance as for a tradesman's van, and in the special models now being produced by some of the commercial-vehicle people, all the refinements of silence, smoothness and comfort of travel necessary for this work have been combined in a highly successful manner.
What has to be kept in view, both in design and selection, is not only the quietness arid smoothness of running of the engine and of the car as a whcile, but it has to be remembered that. patients are very often carried who are in a state of collapse and almost in extremis, to Whom the slightest noise, jerk, jar, or jolt is not only distressing, hut dangerous, and hence happenings which would pass unnoticed by healthy individuals, seated in a car, have a very different effect upon a collapsed person travelling in a recumbent position. Shocks which are taken vertically through the spine of a sitting person, as is the case with the rebound of the springs and tires in a touring ear, are not felt to anything like the same extent as when delivered upwards through the hack of a reclining individual, and it is the same in regard to side sv.ity. The healthy person sitting in a car, rocks, as it were, on his seat, when he body sways over on easy springs which have a side rock, whereas the unfortunate, one, prone on a stretcher, is moved over bodily with every roll of the body of the car. Hence it follows that, strange an it may at first sight appear, the springing system of a ear can, quite readily, be too easy for successful ambulance work ! Something is evidently wanted, in this connection, in the nature of a shock absorber which, whilst allowing a free play in yielding to the movement of the wheels over rough ground, shall check and minimize rebound and side rock.
This is a point, too, which requires consideration in regard to the internal fittings of an ambulance. At present patients are generally supported on lightly-sprung stretcher's, mounted on wheels, on which they are rolled into the body of the ear, and the springing of these stretchers rather accentuates the movements of the car springs than otherwise. I remember, a little while ago, when inspecting a horsed ambulance, one of the attendants drew my attention to this in a very practical manner. Placing himself upon the stretcher, which was in position in the vehicle, he said: ' Now, shake the body up and down." 1 did so, and his head and shoulders were jolted up a couple of inches off the cushions. " Why." was his comment, " I could not stand much of that. What about a patient.? " Our ambulance fittings people must, look into this matter. At present they are using the appliances designed for horsed vehicles.
This same consideration for the nerves and feelings of the patient requires to he carried into the design of the chassis, in other respects than the springing, and two points in particular present themselves. The first is noise and the second speed. Now, the use of quiet engines and worm drive will make most cars quiet in general running, but with the sliding gear which is used on the majority of cars to-day, it is difficult to change gear, either up, down, or reverse, without a jerk. lax and shock which must he very distressing indeed to a patient, so that, if the manufacturer is unable to introduce a silent and shockless gear change, he should 90 propor non power to his load and gearing ratio. that the necessity for gear
changes is reduced 1,o a minimum. In other words, the ear should be
designed, as far as possible, as a "top gear car." This point is important. too, because of its influence
on sneed. for a top gear car, which can be regnlarly worked on ton gear and not only so when on " fake "
demonstrations, cannot be a fast coat, and, as I have remarked, speed per se is distinctly not desirable.in an ambulance, and it is not desirable because, whatever the -epringing of the car may be, the effect of the jolting and rebound will be considerably increased as the speed goes up, and it will be found that, even on good roads, with the most perfect springing to-day available, not more than 16 or 17, or at most 20, miles an hour is permissible. Therefore, high speed in a motor ambulance, instead of being an advantage, is positively objectionable. Upon this subject I may incidentally remark, as showing how little the point is appreciated and how the pleasure-car man fails to recognize the need for building to special requirements of service, which the commercial-car builder is accustomed to deal with, that, not long since, I was present at a demonstration and inspection of chassis intended for ambulance work, in the grounds of one of our large hospitals, when, amongst others, an agent turned up with a 30 h.p.
cylinder touring car, the chassis of which was put forward as suitable for the work, and he was quite " great " on the point of explanation that it was capable of a speed of 60 miles an hour Ye gods and little fishes! Fancy a sick person being tossed over a crossing at 60 miles an hour. Se far as tires go, pneumatics — and pneumatics of large size—are, no doubt, desirable. although T cannot say that I am altogether certain of this. The pneumatic tire provides smooth and comfortable travel under ordinary conditions, but it does most decidedly accentuate the bumps by its bouncing or rebounding action, and if some other tire or tread can be found which, whilst giving softness of travel, will not give this rebound, it would be preferable. Perhaps Ptleumatic fittings would be better, but I have not tried them lately. Of course solids would not do. They are too harsh altogether. The pneumatic, furthermore, is not perfect for ambulance work, owing to its liability to puncture, and it will be readily recognized that it is important when taking a patient to hospital that there should be no delays en route. This can be guarded against to a large extent, where pneumatics are used, by the employment of tires of extra large size, fitted with Marshall jackets, with both outside and internal cuirasses as well, and by replacing covers when showing signs of wear. But these things add considerably to first cost.
The type of body selected and the length of wheelbase are further points for consideration, and these two are, to a certain extent, reactive on each other. All other things being equal, of course, comfort of travel is best secured by bringing, so far as possible, the whole of the body within the wheelbase, and where a wheelbase of moderate length is employed, the type of body used is important. Now ambulance bodies are of two types, viz., what is known as the van type and the brougham type. In both, of course, provision has to be made for the conveyance of a person stretched at full length in the car, and this cannot be done tinder about 6 ft. 6 in. The van type body is just a large box of about this inside measurement at the back of the driver's seat, and unless a wheelbase of inordinate length be employed, it is impossible to bring it even approximately within the wheelbase and the middle of the body will be just about over the rear axle, as in a goods van, unless the driver can be brought forward and placed over, or at the side of, instead of behind the engine, which cannot be done under the conventional system of construction.
The brougham type of body, on the other hand, utilizes the space under the driver's seat on the near side to accommodate the feet of the patient and the end of the stretcher, and such a body can be built to occupy about the same position on the chassis as a landau let body on an ordinary car, and for this reason is, I think, preferable to the van type, although the
latter possesses an advantage—
rarely, however, required to be utilized—in that it provides room
for more than one patient at a time. To lengthen the wheelbase may at first sight appear to be the logical way out of the difficulty, but to do this introduces another point, which is undesirable, and that is, a lengthened wheelbase considerably increases the lock, or turning circle, and the fact must not be lost sight of that an ambulance has to work in all sorts of confined situations and out-of-theway corners of our crowded cities, and facility of handling in a tight place is a point of moment, in which connection I am again reminded of a demonstration before hospital authorities which I once attended. There were a number of cars assembled, and a member of the committee was running over them all with a rule to see how far to the rear of the drivers' seats the end of the vehicle would be in relation to the chassis and back axle, and, seeing this, each and every one of the salesmeri present hastened to assure him that the chassis could be lengthened if wished, or that a longer chassis could be employed and some of them were considerably nonplussed when told that they would only result in increasing their steering lock, which was far too wide as it was ! On this ocasion I remember, too, that all the cars were taken in and out of a number of "tight places' about the ground, and in and out of buildings, an experiment which resulted very much to the discomfiture of the extra-long-base men, many of whose cars failed to make the passages without a lot of fuss, backing, filling and manoeuvring. From the above, I think it will be seen that to build a successful motor ambulance means something more than merely putting an ambulance body on a touring-car chassis, and that, to be satisfactory, the vehicle requires to be the result of some careful study of the special requirements of the work to be done, and that special modifications of design and details must be made to accord with the results arrived at.