Riv nut tool: I bought mine from Grainger, but McMaster and Amazon would probably have comparable tools. I have two of them - one is a Marson hand tool for close quarters, and the other is a large Marson for larger Riv-Nuts. The McMaster part number is 95603A770 (
www.mcmaster.com), and I see that Amazon has pages of them, probably with many being imports. Regardless of who the manufacturer is, be sure that you can get different sized mandrels if they aren't included with the tool - I have mandrels from 10-32 to 3/8". Riv-Nuts can be reasonably priced (particularly when the alternative is a very ugly tunneling project to get to the rear side of whatever) - I stocked up about 4 years ago when Grainger was changing their supplier, and they had blow-out prices. Riv-Nuts are available in steel, stainless steel, and aluminum - all available in open and closed end versions. Lengths vary according to the metal thickness. Closed end are intended for locations where you need to keep water out, but an open end Riv-Nut with some silicone can be used in probably 95% or so of the applications. I try to use the heavy duty Riv-Nuts whenever I can since they are knurled and get a pretty good grip, but regardless, I wipe some epoxy on the side of the nut before I install it to help ensure that it will stay there. When you start tunneling into an ambulance, you will find that the side skins are about 0.010" (1/10"), and that a Riv-Nut will do the job for darn near anything.
When you install a Riv-Nut, drill the right sized hole (it needs to be a clean, circular hole). I use a step drill to get it as close as possible, then a final pass with the exact drill specified. For instance, a 1/4" knurled Riv-Nut (McMaster 95105A143) requires a 25/64" hole. Since this is 1/64" larger than 3/8", I drill the initial hole to 3/8" with a step bit, then a final pass with a 25/64" bit. Once you drill the hole, you can see the hole thickness, and pick the right size Riv-Nut. I like to drill a trial hole in a chunk of scrap aluminum so I can verify that I have the right stroke set on the installation tool.
I've used Riv-Nuts on aluminum military radio shelters where there was no other way to install a screw - the shelters use a sandwich construction with an 0.050" aluminum inner layer bonded to 2" of urethane foam - they did the job perfectly.
On to batteries: I have the advantage that my battery installation was designed by Medic-Master/Freightliner. I have four Group 31 batteries in parallel for both engine start and to run the module when the engine isn't running. Since the module includes a lot of internal lighting (at about 5 amps per bulb) and external warning and scene lights, the ambulance has a 270 amp engine alternator. There is a test tag in the module that shows the actual power demand with everything operating (236 amps), and with optional equipment shut down (164 amps). Various ambulance designs use from 2-4 batteries, with the smaller ambulances (usually Ford chassis) using only 2 and the larger medium ambulances usually using 3-4 batteries.
Unfortunately, if you have one bad battery, you need to replace all of them to ensure that they are all alike. The Fire Chief's association recommends that they be replaced every year for in-service ambulances, but I assume that this stretched to a bit longer at times, particularly with a reserve ambulance. My batteries were replaced in 2013, so I should be able to get 4-5 years out of them if I keep them in good condition. Replacing a Group 31 battery runs about $ 125 or so per battery. I've kept my eyes open when I see them to see what the range seems to be, and $125 seems to be about what they cost. The battery manufacturer choice is wide open - SAMS club sells Energizer, and Interstate Batteries are available about anywhere through Batteries Plus, but I think my next batteries will be Alliance (
http://alliancetruckparts.com/Catalogs/batteries/3?s=1001). I just found out about them a while ago - they are sold through truck dealers, such as Freightliner, and are designed for heavy duty use.
I'm also installing one more battery - a deep cycle battery that will be dedicated to the refrigerator, and possibly some added internal LED lighting. That way, I can leave the refrigerator running without worrying about running down the starting batteries. It will be charged with an Xantrex Echo Charge unit - this supplies up to 15 amps when the engine is running. I'll also add a dedicated 10 amp Xantrex charger to this battery as well for times when the ambulance is sitting and 120 volt power is available.
Any battery connections must be correctly done - don't try to get by with hardware store terminals - use marine terminals for battery connections. I use a hydraulic lugger on all the terminals I install.
Check the Blue Sea web site for cable sizing information - they will be larger than you thought you would need due to voltage drop. Most wire sizing charts are based on the total wire length - positive and negative must be added together. I have #2 cables running from my inverter to the batteries - this works since they are only 8 feet apart. I'm planning on my new DC panel having a load of no more than 40 amps, but I'm feeding it with #6 cable.
Ambulances use a stud terminal (3/8-16) to both simplify paralleling, and also connecting additional taps to the terminals.
All food for thought-