Alternative Options for Patient Transport

Ambulances are synonymous with EMS, but what happens when patients are located someplace an ambulance can’t go—a heavily wooded hiking trail, a crowded urban area in the midst of a major outdoor sporting event, a community devastated by a natural disaster?

Those are times when alternative vehicles like ATVs and UTVs become vital pieces of equipment, more than justifying their expense. And while they may be small, ATVs used in EMS are still outfitted with much of the same equipment as a standard ambulance, meaning quality patient care doesn’t need to be sacrificed for the sake of mobility.

Real-World Applications

After the events of September 11, 2001, many EMS agencies began building on the observed successes of the use of ATVs and UTVs by FDNY EMS during its response to the World Trade Center attacks, says Henry Cortacans, MAS, CEM, NREMT-P, state planner for the New Jersey EMS Task Force. Once the New Jersey EMS Task Force was formalized in 2004—through the Homeland Security grant program—it began building its capacity. To date, says Cortacans, the New Jersey EMS Task Force has more than 30 such assets in a fleet of more than 100 pieces of apparatus.

“These assets are utilized for many types of special events,” Cortacans says, including concerts, marathons, community festivals, military air shows and more. “Because they can quickly maneuver through large crowds and tight spaces, it makes them ideal for these types of events.”

Specifically, the New Jersey EMS Task Force has utilized its ATVs during the New Jersey Marathon, Ironman Triathlon, Joint Base Air Show and Super Bowl XLVIII.

ATVs are used for much the same purpose in Wilmington, NC, where Aaron Kasulis, EMT-P, EMS manager/battalion chief for New Hanover Regional Medical Center, notes his agency has been using them for 15 years. “We use them at mass gatherings—predominantly downtown events when roads are blocked off, high school football games, Civil War reenactments, etc. Really, anyplace where crowd size and geographic terrain may make for limited access. The Gators can transport patients safely and efficiently out of a crowd to a designated triage/transport site.”

“We use these for responses as well,” states Cortacans. “During Tropical Storm Irene a ‘strike team’ of these assets was deployed to Paterson, NJ, to assist with the evacuation of a large apartment complex where flood waters were encroaching. During Superstorm Sandy, these assets were deployed all over New Jersey to assist with search and rescue/recovery. Roads were difficult to navigate due to debris from downed trees, power lines and structure damage, and along the coast where up to 10 feet of sand was deposited on roadways—the ATVs navigated through those challenges.”

Cortacans notes the agency’s ATVs were also used successfully during the “record setting” blizzard of December 26–27, 2010, during which 2–3 feet of snow was deposited in many portions of New Jersey. “These assets assisted with transferring patients from disabled ambulances, actually responding on some 9-1-1 calls,” Cortacans explains, “and there was an instance where one was deployed to a highway to help rescue individuals from stranded vehicles in the roadway.”

Fitting Into the Fleet

As ATVs and UTVs play a unique role in EMS, special considerations need to be made when budgeting for the vehicles and determining how to best make use of these resources.

In the case of New Hanover Regional Medical Center, Kasulis says a separate “cost center” is established aside from their normal operation budget, allowing for separation of monies. New Hanover has two Gator ATVs, a 2006 John Deere Med-Bed and 2014 John Deere XUV, as well as a Kimtek MTSTR-104 Med Bed. For large events where there will be an EMS presence, event organizers are charged a small hourly fee to have the ATVs on site, and a binding contract with the EMS agency provides for the Gator plus a medic for the duration of the event.

The New Jersey EMS Task Force presents a different case, as each ATV/UTV asset is hosted by a member agency of the task force, says Cortacans. The asset is used locally as appropriate for that agency. However, when a request to mobilize these assets is made, they are assembled into a strike team or task force and deployed as necessary.

New Jersey has ATVs from a number of different manufacturers, notes Cortacans, but “our most popular model is the ASAP Off-Road Specialty Vehicles from Alternative Support Apparatus (ASAP). We purchase these through the available funds from the Homeland Security grant program. In order to purchase the asset through the rules of the grant program, they have to be used on a regional basis, which is why they are under the umbrella of the state EMS task force.”

Equipping and Staffing a ‘Mini Ambulance’

Cortacans says the New Jersey EMS Task Force treats its ATVs and UTVs like mini ambulances. “They have almost everything you’d find in a regular ambulance, except in less quantity and smaller-sized items,” he explains. “The ASAPs come with a stretcher. There’s room for an attendant in the back and it’s fully enclosed so we can mitigate against the effects of weather. Generally, these are staffed by EMTs; however, we have had instances of paramedics staffing the asset(s) during extreme circumstances and with approval from the New Jersey Department of Health.”

Kasulis concurs. “The Gators’ equipment mirrors the ambulance’s—ALS jump bag, O₂, cardiac monitor, backboard, splints—and they even include medications and emergency airway equipment.” Paramedics who meet New Hanover’s ‘unrestricted’ status are allowed to work the Gator, but staff must first successfully pass Gator training and achieve competency before operating the vehicle.

Cortacans adds the vehicles are extremely beneficial for agencies. “They offer us flexibility in offering enhanced EMS coverage for special events, and give us a capability to respond to disasters by allowing us to get there. We even had a cardiac arrest resuscitation in one of them during a densely populated street festival early on when we only had a couple of the vehicles.”

A Vehicle to Fit Every Need

Just as there are different ambulance body types and interior designs to fit the specific needs of EMS agencies and their patient populations, EMS ATVs and UTVs come in all shapes and sizes, and from a wide array of manufacturers.

Two of those manufacturers, Alternative Support Apparatus (ASAP) and Kimtek, offer different takes to suit very specific needs.

Kimtek’s MEDLITE Transport skid units are made for budget-minded departments. These capable, no-nonsense rugged skid units are built to last. Designed for off-road rescue and large-event patient transport, the MEDLITE is universal in nature and can be mounted on most of the large UTV side-by-side chassis on the market today. Kimtek MEDLITE Transports can carry an EMS long board, stretcher, Stokes basket or full-size wheeled ambulance cot. The MEDLITE is also perfect for your search and rescue operations.

ASAP’s MedStat is an off-road ambulance that features a fully enclosed, all-aluminum patient compartment that secures a full-size cot and seating for up to two attendants and a driver. The MedStat unit has three base models—the MS 100, MS 250 and MS 500—that range from a basic entry-level product up to a fully loaded high-end version. Each model comes with an extensive list of options that gives the customer the flexibility to build the MedStat unit that best fits their needs.

Jason Busch is an associate editor for EMS World.