(NSI News Source Info) January 9, 2009: So medics can go where the warfighters go, Mine-Resistant, Ambush-Protected (MRAP) ambulances are being used in Iraq and Afghanistan. MRAPs were designed to increase safety of troops operating in an environment heavy with mines, improvised explosive devices and ambushes. Their heavy armor and "v-shaped" profiles deflect blasts from below the vehicle, and MRAPs have proven to be lifesavers in Iraq, where thousands have been deployed.
In Afghanistan, the original MRAP vehicles ran into a different set of problems, as the weight of the vehicle proved too much for many poorly developed road shoulders and bridges. So a smaller, lighter MRAP was designed and is being sent to that country. 
With fighting forces deploying these new vehicles, the need for an ambulance that could accompany them with similar protection was evident. Over nine months in 2007 a modified MRAP for ambulance duty was designed, developed, tested and produced.
"Unlike the M997 Humvee ambulance, these ambulances are almost rolling emergency rooms - complete with oxygen concentrators, oxygen tank and a vital-sign monitor," said Sgt. 1st Class Jennifer A. Zavala of the force modernization training branch at the AMEDD Center and School. "The old ambulance had oxygen but limited suction. [Oxygen] lines are fitted so they don't run across the vehicle or patients, tanks are mounted so they don't have to sit between the patient's legs."
"They also include combat casualty treatment bags with rapid trauma treatment supplies; en route care bag with breathing, airway, bleeding, intravenous and splinting supplies to maintain care of the patient; and a trauma panel with morebreathing, airway and splinting supplies, but also oxygen and hypothermia supplies. It has a resupply chest for long missions as well," she added.
Zavala explained that development of the MRAP ambulances has changed the usual process by taking an essentially finished vehicle designed for the infantry and modifying it for ambulance use, instead of starting from scratch.
Fielding to the combat theater began in January 2008. The two designs are the RG33L (originally called the HAGA, or Heavy Armored Ground Ambulance) and the lighter MaxxPro Plus.
The RG33L carries three litter patients, the MaxxPro Plus can fit two. The RG33L is made by BAE, while the MaxxPro Plus is made by Navistar. Both are being fielded in theater. While the heavy vehicles have proven effective in reducing blast injuries, their high center of gravity and powerful engines make them prone to rollover accidents, and to contact with electric lines strung above streets. Department of Defense safety officials prescribe enhanced training and troop awareness to reduce these hazards.
"We do not separate safety from survivability in this program. They are inextricably bonded. You cannot separate the two," said Jennifer Malone, DoD's lead safety officer for MRAPs.
Hands-on training is required before any driver gets behind the wheel of an MRAP. "These are big vehicles, and you have got to follow all the operational procedures and restrictions you are given to operate them safely," Malone said. "You have to be aware of speed restrictions, terrain restrictions [and] maneuverability restrictions. And that's what the training programs emphasize."
Troops that will use MRAPs in theater usually receive a week of training by forward support training teams when they receive the vehicle during their deployment. Zavala said the AMEDD Center and School is in the process of planning home-station training.
"We have to look at how many vehicles we will need, and can we train on simulators instead of real vehicles," she said.
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