By Michael Huber
As emergency service providers, we constantly preach prevention. We encourage fire prevention, routine physical examinations, visits to the dentist, etc. We know prevention saves lives, property, emotional stress, and money.
Prevention is equally important in protecting our tools of the trade, including medical transport units. Modern medical transport units are high-tech machines with complex systems—everything from multiplexing to diesel emissions. These sophisticated, modern units require a proactive maintenance plan and highly trained technicians.
To keep units running on a day-to-day basis, we must perform daily checks and routine preventive maintenance as well as regular inspections with documentation. These tasks yield benefits including improved reliability, durability, extended life expectancy, and increased resale value. Additionally, preventive maintenance decreases out-of-service time, an important bonus.
INSPECTION AND DOCUMENTATION
Pretrip inspection is one of the most important steps in an emergency service preventive maintenance program. These inspections will vary by organization and the demand for service. Optimally, perform pretrip inspections at every driver change. The inspection should be thorough and follow the manufacturer’s recommendations. Document inspection results and correct deficiencies in a timely manner.
Documentation is of paramount importance in preventive maintenance. Like patient care reporting, preventive maintenance reporting for fleet maintenance should pay attention to detail. Record keeping can involve simple, paper-based documentation or a commercially available fleet maintenance computer program stored on a hard drive or in the cloud. The technology matters less than the quality and consistency of the documentation.
Here are a few reasons documentation is so important:
- Liability exposure. Detailed documentation reduces your liability in the unfortunate event of a catastrophic accident. Someone will need to explain to a jury or during a deposition the who, what, why, and how of the repair.
- Cost analysis. Keeping a watchful eye on your lifetime maintenance costs will reveal the overall costs and whether that type of unit is a good purchase.
- Expectation on life of the unit. Given the expense of units and the delivery time of new units, it is crucial to know the unit’s reasonable expected life span.
Owner’s manuals usually recommend preventive maintenance intervals on commercial chassis. However, these manuals often do not take into account that the unit is used for the emergency services. Manufacturers usually recommend intervals in miles. This method does not consider idle time at the hospital or the possibility of extended idle time on the scene of an emergency. As a result, some owners of emergency units have opted for intervals based on hours of engine run time instead of miles traveled. Idle reduction technology is new to the industry. Although advantageous, this technology adds to a unit’s cost.
PHYSICAL PREVENTIVE MAINTENANCE
Physical preventive maintenance on a medical transport unit is critical for many reasons:
- Reliability and readiness. All transport units must be ready for immediate response to emergency and nonemergency patients. Regular maintenance helps ensure that all systems—including engine, brake, lights, and medical equipment—function as designed.
- Patient safety. Medical transport units provide care for patients, including the critically ill or injured. Properly maintained vehicles reduce the risk of accidents because of mechanical failures, ensuring patients are transported safely.
- Optimal performance. Routine maintenance keeps units operating at their best performance levels. This facilitates rapid response times, efficient navigation through traffic, and safe patient transportation.
- Extended lifespan. Proper routine maintenance can extend a unit’s lifespan. These vehicles involve significant investment. Prolonging their operational lives through maintenance saves money.
- Cost savings. Addressing potential issues early through routine maintenance can prevent small issues from becoming significant, high-cost problems.
- Minimize out-of-service time. Scheduled maintenance allows organizations to plan for maintenance, minimizing the impact on daily activities. Unplanned breakdowns can result in a service disruption for residents.
Preventive maintenance for a transport unit involves a comprehensive inspection and maintenance of various components. Here is a recommended preventive maintenance checklist:
- Engine and Mechanical Components
- Check and change engine oil and filter.
- Inspect and replace air filters, fuel filters, and cabin filters.
- Check and top off all fluid levels including coolant, transmission, brake, power steering, and windshield washer.
- Inspect belts and hoses for wear and proper tension.
- Test the batteries and charging system.
- Check tires for proper condition and pressure.
- Brake System
- Inspect brake pads, rotors, and brake lines for wear and damage.
- Check brake fluid level and condition (for air brakes, check for leaks and perform leak down testing).
- Test parking brake for proper function.
- Suspension and Steering
- Inspect shocks, struts, and springs for wear and condition.
- Check steering components and alignment.
- Lubricate suspension and steering components as needed.
- Check frame rail condition.
- Electrical System
- Inspect and test all exterior and interior lights, including head lights and tail lights.
- Test and maintain the unit’s electrical system under a load; include batteries and alternator.
- HVAC System
- Inspect and clean or replace cabin air filters.
- Test heating and air conditioning systems for proper operation.
- Transmission and Drivetrain
- Check transmission fluid level and condition.
- Inspect driveshaft, CV joints, and U-joints.
- Interior and Exterior
- Inspect seating, flooring, and storage compartments.
- Check exterior body panels for damage and corrosion.
- Test and maintain doors, windows, and locks.
- Emergency Equipment
- Inspect and test stretcher lift systems or manual stretcher locks.
- Test emergency lighting.
- Test siren and other warning devices.
- Safety Equipment
- Inspect seat belts and ensure proper function.
- Verify no supplemental restraint device (air bag) lights are illuminated.
- Verify ABS is functioning as designed.
- Leaks and Exhaust System
- Inspect the underside of the unit for excessive leaks.
- Check exhaust system for leaks, rust, and damage.
- Road Test
- Conduct a road test to assess the unit’s overall performance, handling, and braking.
Telematics is a current industry trend that can play a role in physical preventive maintenance. Telematics uses a device installed during or after construction that transmits data through wireless networks. The vehicle’s onboard diagnostics provide real-time data to fleet managers, who monitor check engine lights, malfunction indicator lights, miles, and hours. In addition, telematics data typically include location, speed, rapid acceleration and braking, fuel consumption, idle times, and vehicle faults. These data allow fleet managers to make informed decisions about fleet size, deployment, and a replacement cycle. The end result is better resource allocation and cost management.
In summary, preventive maintenance is crucial for maintaining an ambulance’s reliability, safety, performance, compliance with regulations, and overall effectiveness in responding to emergencies and providing critical medical care.
Clean and well-maintained units increase pride and morale among providers. Properly maintained units provide the lowest operating cost and are less likely to experience breakdowns. Equally important, well-maintained units project professionalism and enhance the agency’s public image.
Take care of your units so you can take care of residents in need.
MICHAEL HUBER is a fire apparatus driver/operator and fire apparatus fleet manager for the Baltimore County (MD) Fire Department.
