Ambulance
Encyclopedia
An ambulance is a vehicle
for transportation of sick or injured people to, from or between places of treatment for an illness
or injury
, and in some instances will also provide out of hospital medical care to the patient. The word is often associated with road going emergency ambulances which form part of an emergency medical service, administering emergency care
to those with acute medical problems.
The term ambulance does however extend to a wider range of vehicles other than those with flashing warning lights and sirens
, including a large number of non-urgent ambulances which are for transport of patients without an urgent acute condition and a wide range of vehicles including trucks, vans, bicycles, motorbikes
, station wagons, bus
es, helicopter
s, fixed-wing aircraft
, boat
s, and even hospital ship
s.
The term ambulance comes from the Latin
word ambulare, meaning to walk or move about which is a reference to early medical care where patient
s were moved by lifting or wheeling. The word originally meant a moving hospital, which follows an army in its movements. During the American Civil War
vehicles for conveying the wounded off the field of battle were called ambulance wagons. Field hospital
s were still called ambulances during the Franco-Prussian War
of 1870 and in the Serbo-Turkish war of 1876 even though the wagons were first referred to as ambulances about 1854 during the Crimean War
.
There are other types of ambulance, with the most common being the patient transport ambulance. These vehicles are not usually (although there are exceptions) equipped with life-support equipment, and are usually crewed by staff with fewer qualifications than the crew of emergency ambulances. Their purpose is simply to transport patients to, from or between places of treatment. In most countries, these are not equipped with flashing lights or sirens. In some jurisdictions there is a modified form of the ambulance used, that only carries one member of ambulance crew to the scene to provide care, but is not used to transport the patient. Such vehicles are called fly-car
s. In these cases a patient who requires transportation to hospital will require a patient-carrying ambulance to attend in addition to the fast responder.
The history of the ambulance begins in ancient times
, with the use of cart
s to transport incurable patients by force. Ambulances were first used for emergency transport in 1487 by the Spanish, and civilian variants were put into operation during the 1830s. Advances in technology throughout the 19th and 20th centuries led to the modern self-powered ambulances.
and disaster
conditions may lead to other vehicles serving as makeshift ambulances:
s are necessary for road going ambulances to arrive on scene and then transport the patient to a hospital, though in rugged areas four-wheel drive
or all-terrain vehicles can be used. Fuel
must be available and service facilities are necessary to maintain the vehicle
.
Methods of summoning (e.g. telephone
) and dispatching
ambulances usually rely on electronic
equipment, which itself often relies on an intact power grid. Similarly, modern ambulances are equipped with two-way radio
s or cellular telephones
to enable them to contact hospitals, either to notify the appropriate hospital of the ambulance's pending arrival, or, in cases where physician
s do not form part of the ambulance's crew, to confer with a physician for medical oversight.
Ambulances often have two manufacturers. The first is frequently a manufacturer of light truck
s or full-size vans (or previously, cars) such as Mercedes-Benz
, Nissan, Toyota, or Ford. The second manufacturer (known as second stage manufacturer
) purchases the vehicle (which is sometimes purchased incomplete, having no body or interior behind the driver's seat
) and turns it into an ambulance by adding bodywork, emergency vehicle equipment
, and interior fittings. This is done by one of two methods – either coachbuilding, where the modifications are started from scratch and built on to the vehicle, or using a modular system, where a pre-built 'box' is put on to the empty chassis
of the ambulance, and then finished off.
Modern ambulances are typically powered by internal combustion engine
s, which can be powered by any conventional fuel, including diesel, gasoline
or liquefied petroleum gas, depending on the preference of the operator and the availability of different options. Colder regions often use gasoline powered engines, as diesels can be difficult to start when they are cold. Warmer regions may favor diesel engines, as they are thought to be more efficient and more durable. Diesel power is sometimes chosen due to safety concerns, after a series of fires involving gasoline powered ambulances during the 1980s. These fires were ultimately attributed in part to gasoline's higher volatility
in comparison to diesel fuel. The type of engine may be determined by the manufacturer: in the past two decades, Ford would only sell vehicles for ambulance conversion if they are diesel powered. Beginning in 2010, Ford will sell its ambulance chassis with a gasoline engine in order to meet emissions requirements.
s. Research has shown that ambulances are more likely to be involved in motor vehicle collisions
resulting in injury or death than either fire trucks or police car
s. Unrestrained occupants, particularly those riding in the patient-care compartment, are particularly vulnerable. When compared to civilian
vehicles of similar size, one study found that on a per-accident basis, ambulance collisions tend to involve more people, and result in more injuries. An 11-year retrospective study concluded in 2001 found that although most fatal ambulance crashes occurred during emergency runs, they typically occurred on improved, straight, dry roads, during clear weather. Furthermore, paramedics are also at risk in ambulances while helping patients, as 27 paramedics have died during ambulance trips in the US since 1991.
In addition to the equipment directly used for the treatment of patients, ambulances may be fitted with a range of additional equipment which is used in order to facilitate patient care. This could include:
s. Animal-powered ambulances can be particularly useful in regions that are subject to flooding. Motorcycles fitted with sidecars (or motorcycle ambulance
s) are also used, though they are subject to some of the same limitations as more traditional over-the-road ambulances. The level of care provided by these ambulances varies between merely providing transport to a medical clinic to providing on-scene and continuing care during transport.
The design of intermediate technology ambulances must take into account not only the operation and maintenance of the ambulance, but its construction as well. The robustness of the design becomes more important, as does the nature of the skills required to properly operate the vehicle. Cost-effectiveness can be a high priority.
, as these emergencies create people who are likely to be in need of treatment. They are required to gain access to patients as quickly as possible, and in many countries, are given dispensation from obeying certain traffic laws. For instance, they may be able to treat a red traffic light
or stop sign as a yield sign
('give way'), or be permitted to break the speed limit. Generally, the priority of the response to the call will be assigned by the dispatcher, but the priority of the return will be decided by the ambulance crew based on the severity of the patient. Patients in significant danger to life and limb (as determined by triage
) require urgent treatment by advanced medical personnel, and because of this need, emergency ambulances are often fitted with passive and active visual and/or audible warnings to alert road users.
designs, which reflects light from car headlights or torches. Popular patterns include 'checker board' (alternate coloured squares, sometimes called 'Battenburg
', named after a type of cake), chevrons (arrowheads – often pointed towards the front of the vehicle if on the side, or pointing vertically upwards on the rear) or stripes along the side (these were the first type of retro-reflective device introduced, as the original reflective material, invented by 3M
, only came in tape form). In addition to retro-reflective markings, some services now have the vehicles painted in a bright (sometimes fluorescent
) yellow
or orange
for maximum visual impact.
Another passive marking form is the word ambulance (or local language variant) spelled out in reverse on the front of the vehicle. This enables drivers of other vehicles to more easily identify an approaching ambulance in their rear view mirrors. Ambulances may display the name of their owner or operator, and an emergency telephone number
for the ambulance service.
Ambulances may also carry an emblem (either as part of the passive warning markings or not), such as a Red Cross, Red Crescent or Red Crystal (collective known as the Protective Symbols
). These are symbols laid down by the Geneva Convention, and all countries signatory to it agree to restrict their use to either (1) Military Ambulances or (2) the national Red Cross or Red Crescent society. Use by any other person, organization or agency is in breach of international law. The protective symbols are designed to indicate to all people (especially combatants in the case of war
) that the vehicle is neutral and is not to be fired upon, hence giving protection to the medics and their casualties, although this has not always been adhered to. In Israel, Magen David Adom
, the Red Cross member organization use a red Star of David
, but this does not have recognition beyond Israeli borders, where they must use the Red Crystal.
The Star of Life
is widely used, and was originally designed and governed by the U.S. National Highway Traffic Safety Administration
, because the Red Cross symbol is legally protected by both National and international law. It indicates that the vehicle's operators can render their given level of care represented on the six pointed star.
Ambulance services that have historical origins such as the Order of St John
, the Order of Malta Ambulance Corps
and Malteser International
often use the Maltese cross
to identify their ambulances. This is especially important in countries such as Australia
, where St. John Ambulance
operate one state and one territory ambulance service, and all of Australia's other ambulance services use variations on a red Maltese cross.
Fire service operated ambulances may display the Cross of St. Florian
(often, incorrectly, called a Maltese cross) as this cross is frequently used as a fire department logo (St. Florian being the patron saint of firefighter
s).
There are several technologies in use to achieve the flashing effect. These incluse flashing a light bulb
or LED
, and strobe light
s, which are usually brighter than incandescent lights. Each of these can be programed to flash singly or in groups, and can be programmed to flash in patterns (such as a left -> right pattern for use when the ambulance is parked on the left hand side of the road, indicating to other road users that they should move to the right (away from the ambulance). Incandescent and LED lights may also be programed to burn steadily, without flashing.
Emergency lights may be housed in special fittings, such as in a lightbar, or may be hidden in a host light (such as a headlamp
) by drilling a hole in the host light's reflector and inserting the emergency light. These hidden lights may not be apparent until they are activated. Additionally, some of the standard lights fitted to an ambulance (e.g. headlamps, tail lamps) may be programed to flash. Flashing headlights (typically the high beams, flashed alternately) are known as a wig-wag
.
In order to increase safety, it is best practice to have 360° coverage with the active warnings, improving the chance of the vehicle being seen from all sides. In some countries, such as the United States, this may be mandatory.
See also Emergency vehicle equipment
.
s, which can alert people and vehicles to the presence of an ambulance before they can be seen. The first audible warnings were mechanical bells, mounted to either the front or roof of the ambulance. Most modern ambulances are now fitted with electronic sirens, producing a range of different noises which ambulance operators can use to attract more attention to themselves, particularly when proceeding through an intersection or in heavy traffic.
The speakers for modern sirens can be integral to the lightbar, or they may be hidden in or flush to the grill to reduce noise inside the ambulance that may interfere with patient care and radio communications. Ambulances can additionally be fitted with airhorn audible warnings to augment the effectiveness of the siren system.
A recent development is the use of the RDS
system of car radios
. The ambulance is fitted with a short range FM
transmitter, set to RDS code 31, which interrupts the radio of all cars within range, in the manner of a traffic broadcast, but in such a way that the user of the receiving radio is unable to opt out of the message (as with traffic broadcasts). This feature is built in to every RDS radio for use in national emergency broadcast systems, but short range units on emergency vehicles can prove an effective means of alerting traffic to their presence. It is, however, unlikely that this system could replace audible warnings, as it is unable to alert pedestrians, those not using a compatible radio or even have it turned off.
Some countries closely regulate the industry (and may require anyone working on an ambulance to be qualified to a set level), whereas others allow quite wide differences between types of operator.
Private services in Canada operate non-emergency or for private functions only.
on board. Most ambulance services require at least two crew members to be on every ambulance (one to drive, and one to attend the patient), although response cars may have a sole crew member, possibly backed up by another double-crewed ambulance. It may be the case that only the attendant need be qualified, and the driver might have no medical training. In some locations, an advanced life support
ambulance may be crewed by one paramedic and one EMT-Basic.
Common ambulance crew qualifications are:
s (APCs) such as the FV104 Samaritan
. Civilian based designs may be painted in olive, white or other colours, depending on the operational requirements – the British Royal Army Medical Corps
has a fleet of white ambulances, based on production trucks. Military helicopters often function as air ambulances, since they are extremely useful for MEDEVAC
.
Due to the inherently hazardous situation of a battle ground, military ambulances are often armored, or based upon armored fighting vehicles (AFV). Since laws of war
demand ambulances marked with one of the Emblems of the Red Cross
not to mount offensive weapon
s, an ambulance AFV is often unarmed. It is a generally accepted practice in most countries to classify the personnel attached to military vehicles marked as ambulances as non-combatant
s; however, this application does not always exempt medical personnel from catching enemy fire —accidental or deliberate. As a result, medics and other medical personnel attached to military ambulances are usually put through basic military training, on the assumption that they may have to use a weapon. The laws of war do allow non-combatant military personnel to carry individual weapons for protecting themselves and casualties. However, not all militaries exercise this right to their personnel.
Recently, Israel
has modified a number of its Merkava
main battle tank
s with ambulance features in order to allow rescue operations to take place under heavy fire in urban warfare
. The modifications were made following a failed rescue attempt in which Palestinian
gunmen killed two soldiers who were providing aid for a Palestinian woman in Rafah
. Since M-113
armored personnel carriers and regular up-armored ambulances are not sufficiently protected against anti-tank weapons and improvised explosive device
s, it was decided to use the heavily armored Merkava tank. Its rear door enables the evacuation of critically wounded soldiers. Israel did not remove the Merkava's weaponry, claiming that weapons were more effective protection than emblems since Palestinian militants would disregard any symbols of protection and fire at ambulances anyway.
Some navies operate ocean-going hospital ship
s to lend medical assistance in high casualty situations like wars or natural disasters. These hospital ships fulfill the criteria of an ambulance (transporting the sick or injured), although the capabilities of a hospital ship are more on par with a Mobile Army Surgical Hospital
. In line with the laws of war
, these ships can display a prominent Red Cross or Red Crescent to infer protection under the appropriate Geneva convention, however, this designation has not always protected hospital ships from enemy fire.
or air supply (fire suppression) unit. Being adopted into providing first aid services (via the St John Ambulance Brigade) is also common.http://www.york.ca/NR/rdonlyres/2oh662sqs5hsdwikhm45umbhbqsyaks5thf4sjekdbyi3ginngge5ucpweymvgapsszni3fvbsthg5jnam4eu4hxbd/rpt+8+cls+3.pdf Alternately, the vehicle may be retired entirely from emergency service work, and be reused as a carpenter's, plumber's, or other handyman's truck.
Vehicle
A vehicle is a device that is designed or used to transport people or cargo. Most often vehicles are manufactured, such as bicycles, cars, motorcycles, trains, ships, boats, and aircraft....
for transportation of sick or injured people to, from or between places of treatment for an illness
Illness
Illness is a state of poor health. Illness is sometimes considered another word for disease. Others maintain that fine distinctions exist...
or injury
Injury
-By cause:*Traumatic injury, a body wound or shock produced by sudden physical injury, as from violence or accident*Other injuries from external physical causes, such as radiation injury, burn injury or frostbite*Injury from infection...
, and in some instances will also provide out of hospital medical care to the patient. The word is often associated with road going emergency ambulances which form part of an emergency medical service, administering emergency care
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...
to those with acute medical problems.
The term ambulance does however extend to a wider range of vehicles other than those with flashing warning lights and sirens
Siren (noisemaker)
A siren is a loud noise making device. Most modern ones are civil defense or air raid sirens, tornado sirens, or the sirens on emergency service vehicles such as ambulances, police cars and fire trucks. There are two general types: pneumatic and electronic....
, including a large number of non-urgent ambulances which are for transport of patients without an urgent acute condition and a wide range of vehicles including trucks, vans, bicycles, motorbikes
Motorcycle ambulance
Motorcycle ambulances are a type of emergency vehicle which either carries a solo paramedic or first responder to a patient; or is used with a trailer or sidecar for transporting patients...
, station wagons, bus
Bus
A bus is a road vehicle designed to carry passengers. Buses can have a capacity as high as 300 passengers. The most common type of bus is the single-decker bus, with larger loads carried by double-decker buses and articulated buses, and smaller loads carried by midibuses and minibuses; coaches are...
es, helicopter
Helicopter
A helicopter is a type of rotorcraft in which lift and thrust are supplied by one or more engine-driven rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forwards, backwards, and laterally...
s, fixed-wing aircraft
Fixed-wing aircraft
A fixed-wing aircraft is an aircraft capable of flight using wings that generate lift due to the vehicle's forward airspeed. Fixed-wing aircraft are distinct from rotary-wing aircraft in which wings rotate about a fixed mast and ornithopters in which lift is generated by flapping wings.A powered...
, boat
Boat
A boat is a watercraft of any size designed to float or plane, to provide passage across water. Usually this water will be inland or in protected coastal areas. However, boats such as the whaleboat were designed to be operated from a ship in an offshore environment. In naval terms, a boat is a...
s, and even hospital ship
Hospital ship
A hospital ship is a ship designated for primary function as a floating medical treatment facility or hospital; most are operated by the military forces of various countries, as they are intended to be used in or near war zones....
s.
The term ambulance comes from the Latin
Latin
Latin is an Italic language originally spoken in Latium and Ancient Rome. It, along with most European languages, is a descendant of the ancient Proto-Indo-European language. Although it is considered a dead language, a number of scholars and members of the Christian clergy speak it fluently, and...
word ambulare, meaning to walk or move about which is a reference to early medical care where patient
Patient
A patient is any recipient of healthcare services. The patient is most often ill or injured and in need of treatment by a physician, advanced practice registered nurse, veterinarian, or other health care provider....
s were moved by lifting or wheeling. The word originally meant a moving hospital, which follows an army in its movements. During the American Civil War
American Civil War
The American Civil War was a civil war fought in the United States of America. In response to the election of Abraham Lincoln as President of the United States, 11 southern slave states declared their secession from the United States and formed the Confederate States of America ; the other 25...
vehicles for conveying the wounded off the field of battle were called ambulance wagons. Field hospital
Field hospital
A field hospital is a large mobile medical unit that temporarily takes care of casualties on-site before they can be safely transported to more permanent hospital facilities...
s were still called ambulances during the Franco-Prussian War
Franco-Prussian War
The Franco-Prussian War or Franco-German War, often referred to in France as the 1870 War was a conflict between the Second French Empire and the Kingdom of Prussia. Prussia was aided by the North German Confederation, of which it was a member, and the South German states of Baden, Württemberg and...
of 1870 and in the Serbo-Turkish war of 1876 even though the wagons were first referred to as ambulances about 1854 during the Crimean War
Crimean War
The Crimean War was a conflict fought between the Russian Empire and an alliance of the French Empire, the British Empire, the Ottoman Empire, and the Kingdom of Sardinia. The war was part of a long-running contest between the major European powers for influence over territories of the declining...
.
There are other types of ambulance, with the most common being the patient transport ambulance. These vehicles are not usually (although there are exceptions) equipped with life-support equipment, and are usually crewed by staff with fewer qualifications than the crew of emergency ambulances. Their purpose is simply to transport patients to, from or between places of treatment. In most countries, these are not equipped with flashing lights or sirens. In some jurisdictions there is a modified form of the ambulance used, that only carries one member of ambulance crew to the scene to provide care, but is not used to transport the patient. Such vehicles are called fly-car
Fly-car
An ambulance emergency response vehicle is a vehicle operated by an emergency medical service to respond to medical emergencies either in addition to, or in place of, an ambulance capable of transporting patients....
s. In these cases a patient who requires transportation to hospital will require a patient-carrying ambulance to attend in addition to the fast responder.
History
Ancient history
Ancient history is the study of the written past from the beginning of recorded human history to the Early Middle Ages. The span of recorded history is roughly 5,000 years, with Cuneiform script, the oldest discovered form of coherent writing, from the protoliterate period around the 30th century BC...
, with the use of cart
Cart
A cart is a vehicle designed for transport, using two wheels and normally pulled by one or a pair of draught animals. A handcart is pulled or pushed by one or more people...
s to transport incurable patients by force. Ambulances were first used for emergency transport in 1487 by the Spanish, and civilian variants were put into operation during the 1830s. Advances in technology throughout the 19th and 20th centuries led to the modern self-powered ambulances.
Functional types
Ambulances can be grouped into types depending on whether or not they transport patients, and under what conditions. In some cases, ambulances may fulfil more than one function (such as combining emergency ambulance care with patient transport).- Emergency ambulance – The most common type of ambulance, which provide care to patients with an acute illness or injury. These can be road-going vanVanA van is a kind of vehicle used for transporting goods or groups of people.In British English usage, it can be either specially designed or based on a saloon or sedan car, the latter type often including derivatives with open backs...
s, boats, helicopters, fixed-wing aircrafts (known as air ambulanceAir ambulanceAn air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....
s) or even converted vehicles such as golf carts. - Patient transport ambulance – A vehicle, which has the job of transporting patients to, from or between places of medical treatment, such as hospital or dialysisDialysisIn medicine, dialysis is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement for lost kidney function in people with renal failure...
center, for non-urgent care. These can be vans, buses or other vehicles. - Response unit – Also known as a fly-carFly-carAn ambulance emergency response vehicle is a vehicle operated by an emergency medical service to respond to medical emergencies either in addition to, or in place of, an ambulance capable of transporting patients....
, which is a vehicle which is used to reach an acutely ill patient quickly, and provide on scene care, but lacks the capacity to transport the patient from the scene. Response units may be backed up by an emergency ambulance which can transport the patient, or may deal with the problem on scene, with no requirement for a transport ambulance. These can be a wide variety of vehicles, from standard carČarČar is a village in the municipality of Bujanovac, Serbia. According to the 2002 census, the town has a population of 296 people.-References:...
s, to modified vans, motorcycleMotorcycleA motorcycle is a single-track, two-wheeled motor vehicle. Motorcycles vary considerably depending on the task for which they are designed, such as long distance travel, navigating congested urban traffic, cruising, sport and racing, or off-road conditions.Motorcycles are one of the most...
s, pedal cyclesBicycleA bicycle, also known as a bike, pushbike or cycle, is a human-powered, pedal-driven, single-track vehicle, having two wheels attached to a frame, one behind the other. A person who rides a bicycle is called a cyclist, or bicyclist....
, quad bikeQuad bikeA Quad bike is recognised by UK law as a vehicle with four wheels and a mass of less than 550 kg.To drive a quad bike on a public road, in the UK, requires a B1 licence as well as tax, insurance and registration.-19th century:...
s or horses. These units can function as a vehicle for officers or supervisors (similar to a fire chief's vehicleFire chief's vehicleA fire chief's vehicle, also called a "chief unit" or a "fire chief's car", "Fly Car", "Fly Vehicle", a "fire car", or sometimes even called a "Buggy" , is a car, truck, or SUV that is used by a fire chief at fire scenes...
, but for ambulance services). - Charity ambulance – A special type of patient transport ambulance is provided by a charity for the purpose of taking sick children or adults on trips or vacations away from hospitals, hospices or care homes where they are in long term care. Examples include the United KingdomUnited KingdomThe United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
's 'Jumbulance' project. These are usually based on a bus.
Vehicle types
Ambulances can be based on many types of vehicle, although emergencyEmergency
An emergency is a situation that poses an immediate risk to health, life, property or environment. Most emergencies require urgent intervention to prevent a worsening of the situation, although in some situations, mitigation may not be possible and agencies may only be able to offer palliative...
and disaster
Disaster
A disaster is a natural or man-made hazard that has come to fruition, resulting in an event of substantial extent causing significant physical damage or destruction, loss of life, or drastic change to the environment...
conditions may lead to other vehicles serving as makeshift ambulances:
- VanVanA van is a kind of vehicle used for transporting goods or groups of people.In British English usage, it can be either specially designed or based on a saloon or sedan car, the latter type often including derivatives with open backs...
or pickup truckPickup truckA pickup truck is a light motor vehicle with an open-top rear cargo area .-Definition:...
– A typical ambulance is based on either the chassis of a van or pickup truck. This chassis is then modified to the designs and specifications of the purchaser. - CarČarČar is a village in the municipality of Bujanovac, Serbia. According to the 2002 census, the town has a population of 296 people.-References:...
/SUVSport utility vehicleA sport utility vehicle is a generic marketing term for a vehicle similar to a station wagon, but built on a light-truck chassis. It is usually equipped with four-wheel drive for on- or off-road ability, and with some pretension or ability to be used as an off-road vehicle. Not all four-wheel...
– Used either as a fly-carFly-carAn ambulance emergency response vehicle is a vehicle operated by an emergency medical service to respond to medical emergencies either in addition to, or in place of, an ambulance capable of transporting patients....
for rapid response or for patients who can sit, these are standard car models adapted to the requirements of the service using them. Some cars are capable of taking a stretcherStretcherA stretcher is a medical device used to carry casualties or an incapacitated person from one place to another. It is a simple type of litter, and still called by that name in some cases....
with a recumbent patient, but this often requires the removal of the front passenger seat, or the use of a particularly long car. This was often the case with early ambulances, which were converted (or even serving) hearseHearseA hearse is a funerary vehicle used to carry a coffin from a church or funeral home to a cemetery. In the funeral trade, hearses are often called funeral coaches.-History:...
s, as these were some of the few vehicles able to accept a human body in a supine positionSupine positionThe supine position is a position of the body: lying down with the face up, as opposed to the prone position, which is face down, sometimes with the hands behind the head or neck. When used in surgical procedures, it allows access to the peritoneal, thoracic and pericardial regions; as well as the...
).
- MotorcycleMotorcycleA motorcycle is a single-track, two-wheeled motor vehicle. Motorcycles vary considerably depending on the task for which they are designed, such as long distance travel, navigating congested urban traffic, cruising, sport and racing, or off-road conditions.Motorcycles are one of the most...
– In developed areas, these are used for rapid response in an emergency as they can travel through heavy traffic much faster than a car or van. TrailerTrailer (vehicle)A trailer is generally an unpowered vehicle pulled by a powered vehicle. Commonly, the term trailer refers to such vehicles used for transport of goods and materials....
s or sidecarSidecarA sidecar is a one-wheeled device attached to the side of a motorcycle, scooter, or bicycle, producing a three-wheeled vehicle.-History:A sidecar appeared in a cartoon by George Moore in the January 7, 1903, issue of the British newspaper Motor Cycling. Three weeks later, a provisional patent was...
s can make these patient transporting units. See also motorcycle ambulanceMotorcycle ambulanceMotorcycle ambulances are a type of emergency vehicle which either carries a solo paramedic or first responder to a patient; or is used with a trailer or sidecar for transporting patients...
. - BicycleBicycleA bicycle, also known as a bike, pushbike or cycle, is a human-powered, pedal-driven, single-track vehicle, having two wheels attached to a frame, one behind the other. A person who rides a bicycle is called a cyclist, or bicyclist....
– Used for response, but usually in pedestrian only areas where large vehicles find access difficult. Like the motorcycle ambulance, a bicycle may be connected to a trailer for patient transport, most often in the developing world. See also cycle responderCycle responderA cycle responder is a medically trained responder, such as a paramedic or first aider that uses a bicycle to respond to a medical emergency. They are used by professional ambulance services to respond to emergency calls and also by private and voluntary providers of medical cover at events.Cycle...
. - All-terrain vehicleAll-terrain vehicleAn all-terrain vehicle , also known as a quad, quad bike, three wheeler, or four wheeler, is defined by the American National Standards Institute as a vehicle that travels on low pressure tires, with a seat that is straddled by the operator, along with handlebars for steering control...
(ATV) – for example quad bikes; these are used for response off road, especially at events. ATVs can be modified to carry a stretcher, and are used for tasks such as mountain rescueMountain rescueMountain rescue refers to search and rescue activities that occur in a mountainous environment, although the term is sometimes also used to apply to search and rescue in other wilderness environments. The difficult and remote nature of the terrain in which mountain rescue often occurs has resulted...
in inaccessible areas. - Golf cart or Neighborhood Electric VehicleNeighborhood electric vehicleA Neighborhood Electric Vehicle is a U.S. denomination for battery electric vehicles that are legally limited to roads with posted speed limits as high as depending on the particular laws of the state, usually are built to have a top speed of , and have a maximum loaded weight of 3,000 lbs...
– Used for rapid response at events or on campusCampusA campus is traditionally the land on which a college or university and related institutional buildings are situated. Usually a campus includes libraries, lecture halls, residence halls and park-like settings...
es. These function similarly to ATVs, with less rough terrain capability, but with less noise. - HelicopterHelicopterA helicopter is a type of rotorcraft in which lift and thrust are supplied by one or more engine-driven rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forwards, backwards, and laterally...
– Usually used for emergency care, either in places inaccessible by road, or in areas where speed is of the essence, as they are able to travel significantly faster than a road ambulance. Helicopter and fixed-wing ambulances are discussed in greater detail at air ambulanceAir ambulanceAn air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....
. - Fixed-wing aircraftFixed-wing aircraftA fixed-wing aircraft is an aircraft capable of flight using wings that generate lift due to the vehicle's forward airspeed. Fixed-wing aircraft are distinct from rotary-wing aircraft in which wings rotate about a fixed mast and ornithopters in which lift is generated by flapping wings.A powered...
– These can be used for either acute emergency care in remote areas (such as in Australia, with the 'Flying DoctorsRoyal Flying Doctor Service of AustraliaThe Royal Flying Doctor Service of Australia is an emergency and primary health care service for those living in rural, remote and regional areas of Australia...
'), for patient transport over long distances (e.g. a re-patriation following an illness or injury in a foreign country), or transportation between distant hospitals. Helicopter and fixed-wing ambulances are discussed in greater detail at air ambulanceAir ambulanceAn air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....
. - BoatBoatA boat is a watercraft of any size designed to float or plane, to provide passage across water. Usually this water will be inland or in protected coastal areas. However, boats such as the whaleboat were designed to be operated from a ship in an offshore environment. In naval terms, a boat is a...
– Boats can be used to serve as ambulances, especially in islandIslandAn island or isle is any piece of sub-continental land that is surrounded by water. Very small islands such as emergent land features on atolls can be called islets, cays or keys. An island in a river or lake may be called an eyot , or holm...
areas or in areas with a large number of canals, such as the VenetianVeniceVenice is a city in northern Italy which is renowned for the beauty of its setting, its architecture and its artworks. It is the capital of the Veneto region...
water ambulances. Some lifeboatLifeboat (rescue)A rescue lifeboat is a boat rescue craft which is used to attend a vessel in distress, or its survivors, to rescue crewmen and passengers. It can be hand pulled, sail powered or powered by an engine...
s or lifeguardLifeguardA lifeguard supervises the safety and rescue of swimmers, surfers, and other water sports participants such as in a swimming pool, water park, or beach. Lifeguards are strong swimmers and trained in first aid, certified in water rescue using a variety of aids and equipment depending on...
vessels may fit the description of an ambulance as they are used to transport a casualty. - ShipShipSince the end of the age of sail a ship has been any large buoyant marine vessel. Ships are generally distinguished from boats based on size and cargo or passenger capacity. Ships are used on lakes, seas, and rivers for a variety of activities, such as the transport of people or goods, fishing,...
– Ships can be used as hospital shipHospital shipA hospital ship is a ship designated for primary function as a floating medical treatment facility or hospital; most are operated by the military forces of various countries, as they are intended to be used in or near war zones....
s, mostly operated by national military services, although some ships are operated by charities. They can meet the definition of ambulances as they provide transport to the sick and wounded (along with treatment). They are often sent to disasterDisaster responseDisaster response is a phase of the disaster management cycle. Its preceding cycles aim to reduce the need for a disaster response, or to avoid it altogether.The level of disaster response depends on a number of factors and particular situation awareness...
or war zones to provide care for the casualties of these events. - BusBusA bus is a road vehicle designed to carry passengers. Buses can have a capacity as high as 300 passengers. The most common type of bus is the single-decker bus, with larger loads carried by double-decker buses and articulated buses, and smaller loads carried by midibuses and minibuses; coaches are...
- In some cases, buses can be used for multiple casualty transport, either for the purposes of taking patients on journeys, in the context of major incidentsDisaster responseDisaster response is a phase of the disaster management cycle. Its preceding cycles aim to reduce the need for a disaster response, or to avoid it altogether.The level of disaster response depends on a number of factors and particular situation awareness...
, or to deal with specific problems such as drunken patients in town centres. Ambulance bussesAmbulance busAn ambulance bus, medical ambulance bus or MAB is a type of ambulance used to transport and treat multiple patients who require ambulance level care...
are discussed at greater length in their own articleAmbulance busAn ambulance bus, medical ambulance bus or MAB is a type of ambulance used to transport and treat multiple patients who require ambulance level care...
. - Trailer - In some instances a trailer, which can be towed behind a self-propelled vehicle can be used. This permits flexibility in areas with minimal access to vehicles, such as on small islands.
- Horse and cart - Especially in developing world areas, more traditional methods of transport include transport such as horse and cart, used in much the same way as motorcycle or bicycle stretcher units to transport to a local clinic.
- Hospital trainHospital trainA hospital train is a railway train with carriages equipped for the provision of healthcare. Historically this has ranged from trains equipped to transport wounded soldiers, with basic nursing and first aid facilities on board, to fully equipped mobile medical centres, sometimes including operating...
- Early hospital trains functioned to carry large numbers of wounded soldiers. Similar to other ambulance types, as Western medicine developed, hospital trains gained the ability to provide treatment. In some rural locations, hospital trains now function as mobile hospitals, traveling by rail from one location to the next, then parking on a siding to provide hospitalHospitalA hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
services to the local population. Hospital trains also find use in disaster responseDisaster responseDisaster response is a phase of the disaster management cycle. Its preceding cycles aim to reduce the need for a disaster response, or to avoid it altogether.The level of disaster response depends on a number of factors and particular situation awareness...
Design and construction
Ambulance design must take into account local conditions and infrastructure. Maintained roadRoad
A road is a thoroughfare, route, or way on land between two places, which typically has been paved or otherwise improved to allow travel by some conveyance, including a horse, cart, or motor vehicle. Roads consist of one, or sometimes two, roadways each with one or more lanes and also any...
s are necessary for road going ambulances to arrive on scene and then transport the patient to a hospital, though in rugged areas four-wheel drive
Four-wheel drive
Four-wheel drive, 4WD, or 4×4 is a four-wheeled vehicle with a drivetrain that allows all four wheels to receive torque from the engine simultaneously...
or all-terrain vehicles can be used. Fuel
Fuel
Fuel is any material that stores energy that can later be extracted to perform mechanical work in a controlled manner. Most fuels used by humans undergo combustion, a redox reaction in which a combustible substance releases energy after it ignites and reacts with the oxygen in the air...
must be available and service facilities are necessary to maintain the vehicle
Auto mechanic
An auto mechanic is a mechanic with a variety of car makes or either in a specific area or in a specific make of car. In repairing cars, their main role is to diagnose the problem accurately and quickly...
.
Telephone
The telephone , colloquially referred to as a phone, is a telecommunications device that transmits and receives sounds, usually the human voice. Telephones are a point-to-point communication system whose most basic function is to allow two people separated by large distances to talk to each other...
) and dispatching
Dispatch (logistics)
Dispatch is a procedure for assigning employees or vehicles to customers. Industries that dispatch include taxicabs, couriers, emergency services, as well as home and commercial services such as maid services, plumbing, HVAC, pest control and electricians.With vehicle dispatching, clients are...
ambulances usually rely on electronic
Electronics
Electronics is the branch of science, engineering and technology that deals with electrical circuits involving active electrical components such as vacuum tubes, transistors, diodes and integrated circuits, and associated passive interconnection technologies...
equipment, which itself often relies on an intact power grid. Similarly, modern ambulances are equipped with two-way radio
Two-way radio
A two-way radio is a radio that can both transmit and receive , unlike a broadcast receiver which only receives content. The term refers to a personal radio transceiver that allows the operator to have a two-way conversation with other similar radios operating on the same radio frequency...
s or cellular telephones
Mobile phone
A mobile phone is a device which can make and receive telephone calls over a radio link whilst moving around a wide geographic area. It does so by connecting to a cellular network provided by a mobile network operator...
to enable them to contact hospitals, either to notify the appropriate hospital of the ambulance's pending arrival, or, in cases where physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
s do not form part of the ambulance's crew, to confer with a physician for medical oversight.
Ambulances often have two manufacturers. The first is frequently a manufacturer of light truck
Truck
A truck or lorry is a motor vehicle designed to transport cargo. Trucks vary greatly in size, power, and configuration, with the smallest being mechanically similar to an automobile...
s or full-size vans (or previously, cars) such as Mercedes-Benz
Mercedes-Benz
Mercedes-Benz is a German manufacturer of automobiles, buses, coaches, and trucks. Mercedes-Benz is a division of its parent company, Daimler AG...
, Nissan, Toyota, or Ford. The second manufacturer (known as second stage manufacturer
Second stage manufacturer
A second stage manufacturer, known in the industry as "bodybuilder," builds such products as bus and truck bodies, ambulances, motor homes, and other specialized vehicles....
) purchases the vehicle (which is sometimes purchased incomplete, having no body or interior behind the driver's seat
Cutaway van chassis
Cutaway van chassis are used by second stage manufacturers for a wide range of completed motor vehicles. Especially popular in the United States, they are usually based upon incomplete vans made by manufacturers such as Chrysler Corporation, Ford Motor Company, and General Motors which are...
) and turns it into an ambulance by adding bodywork, emergency vehicle equipment
Emergency vehicle equipment
Emergency vehicle equipment is the equipment fitted to, or carried by, an emergency vehicle, which is additional to any equipment such as headlights, steering wheels or windshield/windscreens that a standard non-emergency vehicle is fitted with....
, and interior fittings. This is done by one of two methods – either coachbuilding, where the modifications are started from scratch and built on to the vehicle, or using a modular system, where a pre-built 'box' is put on to the empty chassis
Chassis
A chassis consists of an internal framework that supports a man-made object. It is analogous to an animal's skeleton. An example of a chassis is the underpart of a motor vehicle, consisting of the frame with the wheels and machinery.- Vehicles :In the case of vehicles, the term chassis means the...
of the ambulance, and then finished off.
Modern ambulances are typically powered by internal combustion engine
Internal combustion engine
The internal combustion engine is an engine in which the combustion of a fuel occurs with an oxidizer in a combustion chamber. In an internal combustion engine, the expansion of the high-temperature and high -pressure gases produced by combustion apply direct force to some component of the engine...
s, which can be powered by any conventional fuel, including diesel, gasoline
Gasoline
Gasoline , or petrol , is a toxic, translucent, petroleum-derived liquid that is primarily used as a fuel in internal combustion engines. It consists mostly of organic compounds obtained by the fractional distillation of petroleum, enhanced with a variety of additives. Some gasolines also contain...
or liquefied petroleum gas, depending on the preference of the operator and the availability of different options. Colder regions often use gasoline powered engines, as diesels can be difficult to start when they are cold. Warmer regions may favor diesel engines, as they are thought to be more efficient and more durable. Diesel power is sometimes chosen due to safety concerns, after a series of fires involving gasoline powered ambulances during the 1980s. These fires were ultimately attributed in part to gasoline's higher volatility
Volatility (chemistry)
In chemistry and physics, volatility is the tendency of a substance to vaporize. Volatility is directly related to a substance's vapor pressure. At a given temperature, a substance with higher vapor pressure vaporizes more readily than a substance with a lower vapor pressure.The term is primarily...
in comparison to diesel fuel. The type of engine may be determined by the manufacturer: in the past two decades, Ford would only sell vehicles for ambulance conversion if they are diesel powered. Beginning in 2010, Ford will sell its ambulance chassis with a gasoline engine in order to meet emissions requirements.
Safety
Ambulances, like other emergency vehicles, are required to operate in all weather conditions, including those during which civilian drivers often elect to stay off the road. Also, the ambulance crew's responsibilities to their patient often preclude their use of safety devices such as seat beltSeat belt
A seat belt or seatbelt, sometimes called a safety belt, is a safety harness designed to secure the occupant of a vehicle against harmful movement that may result from a collision or a sudden stop...
s. Research has shown that ambulances are more likely to be involved in motor vehicle collisions
Car accident
A traffic collision, also known as a traffic accident, motor vehicle collision, motor vehicle accident, car accident, automobile accident, Road Traffic Collision or car crash, occurs when a vehicle collides with another vehicle, pedestrian, animal, road debris, or other stationary obstruction,...
resulting in injury or death than either fire trucks or police car
Police car
A police car is a ground vehicle used by police, to assist with their duties in patrolling and responding to incidents. Typical uses of a police car include transportation for officers to reach the scene of an incident quickly, to transport criminal suspects, or to patrol an area, while providing a...
s. Unrestrained occupants, particularly those riding in the patient-care compartment, are particularly vulnerable. When compared to civilian
Civilian
A civilian under international humanitarian law is a person who is not a member of his or her country's armed forces or other militia. Civilians are distinct from combatants. They are afforded a degree of legal protection from the effects of war and military occupation...
vehicles of similar size, one study found that on a per-accident basis, ambulance collisions tend to involve more people, and result in more injuries. An 11-year retrospective study concluded in 2001 found that although most fatal ambulance crashes occurred during emergency runs, they typically occurred on improved, straight, dry roads, during clear weather. Furthermore, paramedics are also at risk in ambulances while helping patients, as 27 paramedics have died during ambulance trips in the US since 1991.
Equipment
- Two-way radio – One of the most important pieces of equipment in modern emergency medical services as it allows for the issuing of jobs to the ambulance, and can allow the crew to pass information back to control or to the hospital (for example a priority ASHICEASHICEASHICE is mnemonic acronym used by emergency medical services to pass the important details of a patient over to a receiving hospital, or other definitive care provider.The word is treated as a noun by ambulances crews, who refer to 'passing an ASHICE'...
message to alert the hospital of the impending arrival of a critical patient.) More recently many services world wide have moved from traditional UHF/VHF sets, which can be monitored externally, to more secure systems, such as those working on a GSM system, such as TETRATetrathumb|right|250px|Pristella tetra — [[Pristella maxillaris]].thumb|right|250px|Golden Pristella tetra, a [[morph |morph]] of [[Pristella maxillaris]].thumb|right|250px|[[Silvertip tetra]] — Hasemania nana....
. - Mobile data terminalMobile data terminalA mobile data terminal is a computerized device used in public transit vehicles, taxicabs, courier vehicles, service trucks, commercial trucking fleets, military logistics, fishing fleets, warehouse inventory control, and emergency vehicles to communicate with a central dispatch office...
– Some ambulances are fitted with Mobile data terminalMobile data terminalA mobile data terminal is a computerized device used in public transit vehicles, taxicabs, courier vehicles, service trucks, commercial trucking fleets, military logistics, fishing fleets, warehouse inventory control, and emergency vehicles to communicate with a central dispatch office...
s (or MDTs), which are connected wirelessly to a central computer, usually at the control center. These terminals can function instead of or alongside the two-way radio and can be used to pass details of jobs to the crew, and can log the time the crew was mobile to a patient, arrived, and left scene, or fulfill any other computer based function. - Evidence gathering CCTV – Some ambulances are now being fitted with video cameras used to record activity either inside or outside the vehicle. They may also be fitted with sound recording facilities. This can be used as a form of protection from violence against ambulance crews, or in some cases (dependent on local laws) to prove or disprove cases where a member of crew stands accused of malpracticeMalpracticeIn law, malpractice is a type of negligence in, which the professional under a duty to act, fails to follow generally accepted professional standards, and that breach of duty is the proximate cause of injury to a plaintiff who suffers harm...
. - Tail liftTail liftA tail lift is a mechanical device permanently fitted to the back of van or lorry, which is designed to facilitate the materials handling of goods from ground level or a loading dock to the level of the load bed of the vehicle, or vice versa....
or ramp – Ambulances can be fitted with a tail lift or ramp in order to facilitate loading a patient without having to undertake any lifting. This is especially important where the patient is obese or specialty care transports that require large, bulky equipment such as a neonatal incubator or hospital bedHospital bedA hospital bed is a bed specially designed for hospitalized patients or others in need of some form of health care. These beds have special features both for the comfort and well-being of the patient and for the convenience of health care workers...
s. There may also be equipment linked to this such as winchWinchA winch is a mechanical device that is used to pull in or let out or otherwise adjust the "tension" of a rope or wire rope . In its simplest form it consists of a spool and attached hand crank. In larger forms, winches stand at the heart of machines as diverse as tow trucks, steam shovels and...
es which are designed to pull heavy patients in to the vehicle. - Trauma lighting – In addition to normal working lighting, ambulances can be fitted with special lighting (often blue or red) which is used when the patient becomes photosensitivePhotosensitivityPhotosensitivity is the amount to which an object reacts upon receiving photons, especially visible light.- Human medicine :Sensitivity of the skin to a light source can take various forms. People with particular skin types are more sensitive to sunburn...
. - Air conditioningAir conditioningAn air conditioner is a home appliance, system, or mechanism designed to dehumidify and extract heat from an area. The cooling is done using a simple refrigeration cycle...
– Ambulances are often fitted with a separate air conditioning system to serve the working area from that which serves the cab. This helps to maintain an appropriate temperature for any patients being treated, but may also feature additional features such as filtering against airborne pathogens. - Data Recorders - These are often placed in ambulances to record such information as speed, braking power and time, activation of active emergency warnings such as lights and sirens, as well as seat belt usage. These are often used in coordination with GPS units.
Intermediate technology
In parts of the world which lack a high level of infrastructure, ambulances are designed to meet local conditions, being built using intermediate technology. Ambulances can also be trailers, which are pulled by bicycles, motorcycles, tractors, or animalAnimal
Animals are a major group of multicellular, eukaryotic organisms of the kingdom Animalia or Metazoa. Their body plan eventually becomes fixed as they develop, although some undergo a process of metamorphosis later on in their life. Most animals are motile, meaning they can move spontaneously and...
s. Animal-powered ambulances can be particularly useful in regions that are subject to flooding. Motorcycles fitted with sidecars (or motorcycle ambulance
Motorcycle ambulance
Motorcycle ambulances are a type of emergency vehicle which either carries a solo paramedic or first responder to a patient; or is used with a trailer or sidecar for transporting patients...
s) are also used, though they are subject to some of the same limitations as more traditional over-the-road ambulances. The level of care provided by these ambulances varies between merely providing transport to a medical clinic to providing on-scene and continuing care during transport.
The design of intermediate technology ambulances must take into account not only the operation and maintenance of the ambulance, but its construction as well. The robustness of the design becomes more important, as does the nature of the skills required to properly operate the vehicle. Cost-effectiveness can be a high priority.
Appearance and markings
Emergency ambulances are highly likely to be involved in hazardous situations, including incidents such as a road traffic collisionCar accident
A traffic collision, also known as a traffic accident, motor vehicle collision, motor vehicle accident, car accident, automobile accident, Road Traffic Collision or car crash, occurs when a vehicle collides with another vehicle, pedestrian, animal, road debris, or other stationary obstruction,...
, as these emergencies create people who are likely to be in need of treatment. They are required to gain access to patients as quickly as possible, and in many countries, are given dispensation from obeying certain traffic laws. For instance, they may be able to treat a red traffic light
Traffic light
Traffic lights, which may also be known as stoplights, traffic lamps, traffic signals, signal lights, robots or semaphore, are signalling devices positioned at road intersections, pedestrian crossings and other locations to control competing flows of traffic...
or stop sign as a yield sign
Yield sign
In road transport, a ' or ' traffic sign indicates that each driver must prepare to stop if necessary to let a driver on another approach proceed. A driver who stops has yielded the right of way to another...
('give way'), or be permitted to break the speed limit. Generally, the priority of the response to the call will be assigned by the dispatcher, but the priority of the return will be decided by the ambulance crew based on the severity of the patient. Patients in significant danger to life and limb (as determined by triage
Triage
Triage or ) is the process of determining the priority of patients' treatments based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate,...
) require urgent treatment by advanced medical personnel, and because of this need, emergency ambulances are often fitted with passive and active visual and/or audible warnings to alert road users.
Passive visual warnings
The passive visual warnings are usually part of the design of the vehicle, and involve the use of high contrast patterns. Older ambulances (and those in developing countries) are more likely to have their pattern painted on, whereas modern ambulances generally carry retro-reflectiveRetroreflector
A retroreflector is a device or surface that reflects light back to its source with a minimum scattering of light. An electromagnetic wave front is reflected back along a vector that is parallel to but opposite in direction from the wave's source. The device or surface's angle of incidence is...
designs, which reflects light from car headlights or torches. Popular patterns include 'checker board' (alternate coloured squares, sometimes called 'Battenburg
Battenburg markings
Battenburg refers to a pattern of high-visibility markings used to maximise conspicuity, primarily used on vehicles of the emergency services, but also in other applications such as uniforms...
', named after a type of cake), chevrons (arrowheads – often pointed towards the front of the vehicle if on the side, or pointing vertically upwards on the rear) or stripes along the side (these were the first type of retro-reflective device introduced, as the original reflective material, invented by 3M
3M
3M Company , formerly known as the Minnesota Mining and Manufacturing Company, is an American multinational conglomerate corporation based in Maplewood, Minnesota, United States....
, only came in tape form). In addition to retro-reflective markings, some services now have the vehicles painted in a bright (sometimes fluorescent
Fluorescence
Fluorescence is the emission of light by a substance that has absorbed light or other electromagnetic radiation of a different wavelength. It is a form of luminescence. In most cases, emitted light has a longer wavelength, and therefore lower energy, than the absorbed radiation...
) yellow
Yellow
Yellow is the color evoked by light that stimulates both the L and M cone cells of the retina about equally, with no significant stimulation of the S cone cells. Light with a wavelength of 570–590 nm is yellow, as is light with a suitable mixture of red and green...
or orange
Orange (colour)
The colour orange occurs between red and yellow in the visible spectrum at a wavelength of about 585–620 nm, and has a hue of 30° in HSV colour space. It is numerically halfway between red and yellow in a gamma-compressed RGB colour space, the expression of which is the RGB colour wheel. The...
for maximum visual impact.
Another passive marking form is the word ambulance (or local language variant) spelled out in reverse on the front of the vehicle. This enables drivers of other vehicles to more easily identify an approaching ambulance in their rear view mirrors. Ambulances may display the name of their owner or operator, and an emergency telephone number
Emergency telephone number
Many countries' public telephone networks have a single emergency telephone number, sometimes known as the universal emergency telephone number or occasionally the emergency services number, that allows a caller to contact local emergency services for assistance. The emergency telephone number may...
for the ambulance service.
Ambulances may also carry an emblem (either as part of the passive warning markings or not), such as a Red Cross, Red Crescent or Red Crystal (collective known as the Protective Symbols
Emblems of the Red Cross
The emblems of the International Red Cross and Red Crescent Movement, under the Geneva Conventions, are to be placed on humanitarian and medical vehicles and buildings to protect them from military attack on the battlefield. There are four such emblems, three of which are in use: the Red Cross,...
). These are symbols laid down by the Geneva Convention, and all countries signatory to it agree to restrict their use to either (1) Military Ambulances or (2) the national Red Cross or Red Crescent society. Use by any other person, organization or agency is in breach of international law. The protective symbols are designed to indicate to all people (especially combatants in the case of war
War
War is a state of organized, armed, and often prolonged conflict carried on between states, nations, or other parties typified by extreme aggression, social disruption, and usually high mortality. War should be understood as an actual, intentional and widespread armed conflict between political...
) that the vehicle is neutral and is not to be fired upon, hence giving protection to the medics and their casualties, although this has not always been adhered to. In Israel, Magen David Adom
Magen David Adom
The Magen David Adom is Israel's national emergency medical, disaster, ambulance and blood bank service. The name means "Red Star of David"...
, the Red Cross member organization use a red Star of David
Star of David
The Star of David, known in Hebrew as the Shield of David or Magen David is a generally recognized symbol of Jewish identity and Judaism.Its shape is that of a hexagram, the compound of two equilateral triangles...
, but this does not have recognition beyond Israeli borders, where they must use the Red Crystal.
The Star of Life
Star of Life
The Star of Life is a blue, six-pointed star, outlined with a white border which features the Rod of Asclepius in the center, originally designed and governed by the U.S. National Highway Traffic Safety Administration...
is widely used, and was originally designed and governed by the U.S. National Highway Traffic Safety Administration
National Highway Traffic Safety Administration
The National Highway Traffic Safety Administration is an agency of the Executive Branch of the U.S. government, part of the Department of Transportation...
, because the Red Cross symbol is legally protected by both National and international law. It indicates that the vehicle's operators can render their given level of care represented on the six pointed star.
Ambulance services that have historical origins such as the Order of St John
Venerable Order of Saint John
The Most Venerable Order of the Hospital of Saint John of Jerusalem , is a royal order of chivalry established in 1831 and found today throughout the Commonwealth of Nations, Hong Kong, Ireland and the United States of America, with the world-wide mission "to prevent and relieve sickness and...
, the Order of Malta Ambulance Corps
Order of Malta Ambulance Corps
The Order of Malta Ambulance Corps is the largest voluntary ambulance and first aid organisation of its kind in Ireland. The Order of Malta is engaged in teaching first aid, providing ambulance cover at large events, patient transport, community and nursing services...
and Malteser International
Malteser International
Malteser International is the worldwide relief agency of the Sovereign Military Order of Malta for humanitarian aid. The organisation covers around 200 projects in about 30 countries in Africa, Asia, Europe and the Americas...
often use the Maltese cross
Maltese cross
The Maltese cross, also known as the Amalfi cross, is identified as the symbol of an order of Christian warriors known as the Knights Hospitaller or Knights of Malta and through them came to be identified with the Mediterranean island of Malta and is one of the National symbols of Malta...
to identify their ambulances. This is especially important in countries such as Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
, where St. John Ambulance
St. John Ambulance
St John Ambulance, branded as St John in some territories, is a common name used by a number of affiliated organisations in different countries dedicated to the teaching and practice of medical first aid and the provision of ambulance services, all of which derive their origins from the St John...
operate one state and one territory ambulance service, and all of Australia's other ambulance services use variations on a red Maltese cross.
Fire service operated ambulances may display the Cross of St. Florian
Saint Florian
Florian lived in the time of the Roman emperors Diocletian and Maximian, and was commander of the imperial army in the Roman province of Noricum. In addition to his military duties, he was also responsible for organizing firefighting brigades....
(often, incorrectly, called a Maltese cross) as this cross is frequently used as a fire department logo (St. Florian being the patron saint of firefighter
Firefighter
Firefighters are rescuers extensively trained primarily to put out hazardous fires that threaten civilian populations and property, to rescue people from car incidents, collapsed and burning buildings and other such situations...
s).
Active visual warnings
The active visual warnings are usually in the form of flashing lights. These flash in order to attract the attention of other road users as the ambulance approaches, or to provide warning to motorists approaching a stopped ambulance in a dangerous position on the road. Common colours for ambulance warning beacons are blue, red, amber, and white (clear). However the colours may vary by country and sometimes by operator.There are several technologies in use to achieve the flashing effect. These incluse flashing a light bulb
Incandescent light bulb
The incandescent light bulb, incandescent lamp or incandescent light globe makes light by heating a metal filament wire to a high temperature until it glows. The hot filament is protected from air by a glass bulb that is filled with inert gas or evacuated. In a halogen lamp, a chemical process...
or LED
Light-emitting diode
A light-emitting diode is a semiconductor light source. LEDs are used as indicator lamps in many devices and are increasingly used for other lighting...
, and strobe light
Strobe light
A strobe light or stroboscopic lamp, commonly called a strobe, is a device used to produce regular flashes of light. It is one of a number of devices that can be used as a stroboscope...
s, which are usually brighter than incandescent lights. Each of these can be programed to flash singly or in groups, and can be programmed to flash in patterns (such as a left -> right pattern for use when the ambulance is parked on the left hand side of the road, indicating to other road users that they should move to the right (away from the ambulance). Incandescent and LED lights may also be programed to burn steadily, without flashing.
Emergency lights may be housed in special fittings, such as in a lightbar, or may be hidden in a host light (such as a headlamp
Headlamp
A headlamp is a lamp, usually attached to the front of a vehicle such as a car or a motorcycle, with the purpose of illuminating the road ahead during periods of low visibility, such as darkness or precipitation. Headlamp performance has steadily improved throughout the automobile age, spurred by...
) by drilling a hole in the host light's reflector and inserting the emergency light. These hidden lights may not be apparent until they are activated. Additionally, some of the standard lights fitted to an ambulance (e.g. headlamps, tail lamps) may be programed to flash. Flashing headlights (typically the high beams, flashed alternately) are known as a wig-wag
Wig-wag (automobile)
A wig-wag is a device for flashing an automobile's headlights at a preset rate. Traditionally, the wig-wag will flash the right and left headlights alternately, but some designs will flash both headlights on and off together...
.
In order to increase safety, it is best practice to have 360° coverage with the active warnings, improving the chance of the vehicle being seen from all sides. In some countries, such as the United States, this may be mandatory.
See also Emergency vehicle equipment
Emergency vehicle equipment
Emergency vehicle equipment is the equipment fitted to, or carried by, an emergency vehicle, which is additional to any equipment such as headlights, steering wheels or windshield/windscreens that a standard non-emergency vehicle is fitted with....
.
Audible warnings
In addition to visual warnings, ambulances can be fitted with audible warnings, sometimes known as sirenSiren (noisemaker)
A siren is a loud noise making device. Most modern ones are civil defense or air raid sirens, tornado sirens, or the sirens on emergency service vehicles such as ambulances, police cars and fire trucks. There are two general types: pneumatic and electronic....
s, which can alert people and vehicles to the presence of an ambulance before they can be seen. The first audible warnings were mechanical bells, mounted to either the front or roof of the ambulance. Most modern ambulances are now fitted with electronic sirens, producing a range of different noises which ambulance operators can use to attract more attention to themselves, particularly when proceeding through an intersection or in heavy traffic.
The speakers for modern sirens can be integral to the lightbar, or they may be hidden in or flush to the grill to reduce noise inside the ambulance that may interfere with patient care and radio communications. Ambulances can additionally be fitted with airhorn audible warnings to augment the effectiveness of the siren system.
A recent development is the use of the RDS
Radio Data System
Radio Data System, or RDS, is a communications protocol standard for embedding small amounts of digital information in conventional FM radio broadcasts. RDS standardises several types of information transmitted, including time, station identification and programme information.Radio Broadcast Data...
system of car radios
Car audio
Car audio/video , auto radio, mobile audio, 12-volt and other terms are used to describe the sound or video system fitted in an automobile. While 12-volt audio and video systems are also used, marketed, or manufactured for marine, aviation, and buses, this article focuses on cars as the most common...
. The ambulance is fitted with a short range FM
Frequency modulation
In telecommunications and signal processing, frequency modulation conveys information over a carrier wave by varying its instantaneous frequency. This contrasts with amplitude modulation, in which the amplitude of the carrier is varied while its frequency remains constant...
transmitter, set to RDS code 31, which interrupts the radio of all cars within range, in the manner of a traffic broadcast, but in such a way that the user of the receiving radio is unable to opt out of the message (as with traffic broadcasts). This feature is built in to every RDS radio for use in national emergency broadcast systems, but short range units on emergency vehicles can prove an effective means of alerting traffic to their presence. It is, however, unlikely that this system could replace audible warnings, as it is unable to alert pedestrians, those not using a compatible radio or even have it turned off.
Service providers
Some countries closely regulate the industry (and may require anyone working on an ambulance to be qualified to a set level), whereas others allow quite wide differences between types of operator.
- Government Ambulance Service – Operating separately from (although alongside) the fire and police service of the area, these ambulances are funded by local or national government. In some countries, these only tend to be found in big cities, whereas in countries such as Great BritainGreat BritainGreat Britain or Britain is an island situated to the northwest of Continental Europe. It is the ninth largest island in the world, and the largest European island, as well as the largest of the British Isles...
almost all emergency ambulances are part of a nationwide system under the National Health ServiceNational Health ServiceThe National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...
. In CanadaCanadaCanada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
ambulance services are normally operated by local municipalities or provincial health agencies as a separate entity from fire or police services. - Fire or Police Linked Service – In countries such as the United StatesUnited StatesThe United States of America is a federal constitutional republic comprising fifty states and a federal district...
, JapanJapanJapan is an island nation in East Asia. Located in the Pacific Ocean, it lies to the east of the Sea of Japan, China, North Korea, South Korea and Russia, stretching from the Sea of Okhotsk in the north to the East China Sea and Taiwan in the south...
, Hong KongHong KongHong Kong is one of two Special Administrative Regions of the People's Republic of China , the other being Macau. A city-state situated on China's south coast and enclosed by the Pearl River Delta and South China Sea, it is renowned for its expansive skyline and deep natural harbour...
and FranceFranceThe French Republic , The French Republic , The French Republic , (commonly known as France , is a unitary semi-presidential republic in Western Europe with several overseas territories and islands located on other continents and in the Indian, Pacific, and Atlantic oceans. Metropolitan France...
ambulances can be operated by the local fire or police service. This is particularly common in ruralRuralRural areas or the country or countryside are areas that are not urbanized, though when large areas are described, country towns and smaller cities will be included. They have a low population density, and typically much of the land is devoted to agriculture...
areas, where maintaining a separate service is not necessarily cost effective. In some cases this can lead to an illness or injury being attended by a vehicle other than an ambulance, such as a fire truckFire apparatusA fire apparatus, fire engine, fire truck, or fire appliance is a vehicle designed to assist in fighting fires by transporting firefighters to the scene and providing them with access to the fire, along with water or other equipment...
. - Volunteer Ambulance Service – Charities or non-profit companies operate ambulances, both in an emergency and patient transport function. This may be along similar lines to volunteer fire companies, providing the main service for an area, and either community or privately owned. They may be linked to a voluntary fire departmentFire departmentA fire department or fire brigade is a public or private organization that provides fire protection for a certain jurisdiction, which typically is a municipality, county, or fire protection district...
, with volunteers providing both services. There are charities who focus on providing ambulances for the community, or for cover at private events (sports etc.). The Red Cross provides this service across the world on a volunteer basis. (and in others as a Private Ambulance Service), as do other smaller organisations such as St John Ambulance and the Order of Malta Ambulance CorpsOrder of Malta Ambulance CorpsThe Order of Malta Ambulance Corps is the largest voluntary ambulance and first aid organisation of its kind in Ireland. The Order of Malta is engaged in teaching first aid, providing ambulance cover at large events, patient transport, community and nursing services...
. These volunteer ambulances may be seen providing support to the full time ambulance crews during times of emergency. In some cases the volunteer charity may employ paid members of staff alongside volunteers to operate a full time ambulance service, such in some parts of Australia and in Ireland. - Private Ambulance Service – Normal commercial companies with paid employees, but often on contract to the local or national government. Private companies may provide only the patient transport elements of ambulance care (i.e. non urgent), but in some places, they are contracted to provide emergency care, or to form a 'second tier' response. In many areas private services cover all emergency transport functions and government agencies do not provide this service. Companies such as FalckFalck (Denmark)Falck A/S is a Nordic-based organisation with activities in most areas of Europe and representation on three continents. The four business areas: Healthcare, Assistance, Training and Emergency together make up Falck’s business...
, Acadian AmbulanceAcadian AmbulanceAcadian Ambulance is an ambulance service that covers most of the state of Louisiana.Headquartered in Lafayette, Louisiana, Acadian Ambulance maintains a fleet of more than 200 ground ambulances, as well as eight medical transport helicopters and five fixed-wing aircraft that provide aerial...
, and American Medical ResponseAmerican Medical ResponseAmerican Medical Response, Inc. or is an American provider of emergency and non-emergency medical transportation, operating in 38 states and the District of Columbia. It employs around 17,000 personnel and has a fleet of 4,400 vehicles...
are some of the larger companies that provide such services. These organisations may also provide services known as 'Stand-by' cover at industrial sites or at special events . From April 2011 all private ambulance services in the UK must be Care Quality Commission (CQC) registered.
Private services in Canada operate non-emergency or for private functions only.
- Combined Emergency Service – these are full service emergency service agencies, which may be found in places such as airportAirportAn airport is a location where aircraft such as fixed-wing aircraft, helicopters, and blimps take off and land. Aircraft may be stored or maintained at an airport...
s or large collegeCollegeA college is an educational institution or a constituent part of an educational institution. Usage varies in English-speaking nations...
s and universitiesUniversityA university is an institution of higher education and research, which grants academic degrees in a variety of subjects. A university is an organisation that provides both undergraduate education and postgraduate education...
. Their key feature is that all personnel are trained not only in ambulance (EMT) care, but as a firefighter and a peace officer (police function). They may be found in smaller towns and cities, where size or budget does not warrant separate services. This multi-functionality allows to make the most of limited resource or budget, but having a single team respond to any emergency.
- Hospital Based Service – Hospitals may provide their own ambulance service as a service to the community, or where ambulance care is unreliable or chargeable. Their use would be dependent on using the services of the providing hospital.
- Charity Ambulance – This special type of ambulance is provided by a charity for the purpose of taking sick children or adults on trips or vacations away from hospitals, hospices or care homes where they are in long term care. Examples include the UK's 'Jumbulance' project.
- Company Ambulance - Many large factories and other industrial centres, such as chemical plantChemical plantA chemical plant is an industrial process plant that manufactures chemicals, usually on a large scale. The general objective of a chemical plant is to create new material wealth via the chemical or biological transformation and or separation of materials. Chemical plants use special equipment,...
s, oil refineries, breweries and distilleries, have ambulance services provided by employers as a means of protecting their interests and the welfare of their staff. These are often used as first response vehicles in the event of a fire or explosion.
Costs
The cost of an ambulance ride may be paid for from several sources, and this will depend on the type of service being provided, by whom, and possibly who to.- Government funded service – The full or the majority of the cost of transport by ambulance is borne by the local, regional, or national governmentGovernmentGovernment refers to the legislators, administrators, and arbitrators in the administrative bureaucracy who control a state at a given time, and to the system of government by which they are organized...
(through their normal taxTaxTo tax is to impose a financial charge or other levy upon a taxpayer by a state or the functional equivalent of a state such that failure to pay is punishable by law. Taxes are also imposed by many subnational entities...
ation). - Privately funded service – Transport by ambulance is paid for by the patient themselves, or through their insurance company. This may be at the point of care (i.e. payment or guarantee must be made before treatment or transport), although this may be an issue with critically injured patients, unable to provide such details, or via a system of billing later on.
- Charity funded service – Transport by ambulance may be provided free of charge to patients by a charity, although donations may be sought for services received.
- Hospital funded service – Hospitals may provide the ambulance transport free of charge, on the condition that patients use the hospital's services (which they may have to pay for).
Crewing
There are differing levels of qualification that the ambulance crew may hold, from holding no formal qualification to having a fully qualified doctorPhysician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
on board. Most ambulance services require at least two crew members to be on every ambulance (one to drive, and one to attend the patient), although response cars may have a sole crew member, possibly backed up by another double-crewed ambulance. It may be the case that only the attendant need be qualified, and the driver might have no medical training. In some locations, an advanced life support
Advanced Life Support
Advanced Life Support is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation .-Components of ALS:These include:...
ambulance may be crewed by one paramedic and one EMT-Basic.
Common ambulance crew qualifications are:
- First responderCertified first responderA certified first responder is a person who has completed a course and received certification in providing pre-hospital care for medical emergencies. They have more skill than someone who is trained in basic first aid but they are not a substitute for advanced medical care rendered by emergency...
– A person who arrives first at the scene of an incident, and whose job is to provide early critical care such as cardiopulmonary resuscitationCardiopulmonary resuscitationCardiopulmonary resuscitation is an emergency procedure which is performed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person in cardiac arrest. It is indicated in those who are unresponsive...
(CPR) or using an automated external defibrillatorAutomated external defibrillatorAn automated external defibrillator or AED is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient, and is able to treat them through defibrillation, the application of...
(AED). First responders may be dispatched by the ambulance service, may be passers-by, or may be dispatched to the scene from other agencies, such as the policePoliceThe police is a personification of the state designated to put in practice the enforced law, protect property and reduce civil disorder in civilian matters. Their powers include the legitimized use of force...
or fire departments. - Ambulance Driver – Some services employ staff with no medical qualification (or just a first aid certificate) whose job is to simply drive the patients from place to place. In some emergency ambulance contexts this term is a pejorative toward qualified providers implying that they perform no function but driving, although it may be acceptable for patient transport or community operations. In some areas, these drivers would survey, and study the local network of routes for better performance of service. Because some road routes may be blocked and the driver must know another route to the patient or to the hospital. The driver would gather the local weather and traffic status reports before and in-between emergencies. They may also have training in using the radio and knowing where medical supplies stored in the ambulance.
- Ambulance Care AssistantAmbulance Care AssistantAmbulance Care Assistants , transport non-emergency patients to and from hospital for pre-arranged appointments. They also work to discharge, transfer and admit patients. Working for the Patient Transport Service, they help patients in and out of the ambulance and take them to their appointment...
– Have varying levels of training across the world, but these staff are usually only required to perform patient transport duties (which can include stretcher or wheelchairWheelchairA wheelchair is a chair with wheels, designed to be a replacement for walking. The device comes in variations where it is propelled by motors or by the seated occupant turning the rear wheels by hand. Often there are handles behind the seat for someone else to do the pushing...
cases), rather than acute care. Dependent on provider, they may be trained in first aid or extended stills such as use of an AED, oxygen therapy and other life saving or palliative skills. They may provide emergency cover when other units are not available, or when accompanied by a fully qualified technician or paramedic. - Emergency medical technicianEmergency medical technicianEmergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...
– Also known as Ambulance Technician. Technicians are usually able to perform a wide range of emergency care skills, such as defibrillationDefibrillationDefibrillation is a common treatment for life-threatening cardiac arrhythmias, ventricular fibrillation and pulseless ventricular tachycardia. Defibrillation consists of delivering a therapeutic dose of electrical energy to the affected heart with a device called a defibrillator...
, spinal immobilization, bleeding control, splinting of suspected fractures, assisting the patient with certain medications, and oxygen therapyOxygen therapyOxygen therapy is the administration of oxygen as a medical intervention, which can be for a variety of purposes in both chronic and acute patient care...
. Some countries split this term in to levels (such as in the US, where there is EMT-Basic and EMT-Intermediate). - ParamedicParamedicA paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...
– This is a high level of medical training and usually involves key skills not permissible for technicians, such as cannulationIntravenous therapyIntravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...
(and with it the ability to administer a range of drugs such as morphineMorphineMorphine is a potent opiate analgesic medication and is considered to be the prototypical opioid. It was first isolated in 1804 by Friedrich Sertürner, first distributed by same in 1817, and first commercially sold by Merck in 1827, which at the time was a single small chemists' shop. It was more...
), tracheal intubationTracheal intubationTracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...
and other skills such as performing a cricothyrotomyCricothyrotomyA cricothyrotomy is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, or massive...
. Dependent on jurisdiction, the title "paramedic" can be a protected title, and use of it without the relevant qualification may result in criminal prosecution. - Registered nurseRegistered nurseA registered nurse is a nurse who has graduated from a nursing program at a university or college and has passed a national licensing exam. A registered nurse helps individuals, families, and groups to achieve health and prevent disease...
(RN) – Nurses can be involved in ambulance work, and as with doctors, this is mostly as air-medical rescuers or critical care transport providers, often in conjunction with a technician or paramedic. They may bring extra skills to the care of the patient, especially those who may be critically ill or injured in locations that do not enjoy close proximity to a high level of definitive care such as trauma, cardiac, or stroke centers. - Emergency Care PractitionerEmergency Care PractitionerAn Emergency Care Practitioner may come from either a paramedic, nursing or allied health professional background and most have additional academic qualifications, usually at university, with enhanced skills in medical assessment and extra clinical skills over and above those of a standard...
– This position, sometimes called 'Super Paramedic' in the media, is designed to bridge the link between ambulance care and the care of a general practitionerGeneral practitionerA general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
. ECPs are already qualified paramedics who have undergone further training, and are trained to prescribe medicines (from a limited list) for longer term care, such as antibiotics, as well as being trained in a range of additional diagnostic techniques. - DoctorPhysicianA physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
– Doctors are present on some ambulances – most notably air ambulances – will employ physicians to attend on the ambulances, bringing a full range of additional skills such as use of prescription medicines.
Military use
Military ambulances include both ambulances based on civilian designs and armored, but unarmed ambulances based upon armoured personnel carrierArmoured personnel carrier
An armoured personnel carrier is an armoured fighting vehicle designed to transport infantry to the battlefield.APCs are usually armed with only a machine gun although variants carry recoilless rifles, anti-tank guided missiles , or mortars...
s (APCs) such as the FV104 Samaritan
FV104 Samaritan
The FV104 Samaritan is the British Army armoured ambulance variant of the CVR family. It has a capacity for up to 6 casualties.The Samaritan is one of the variants of the Combat Vehicle Reconnaissance family of armoured fighting vehicles developed by Alvis plc for the British military....
. Civilian based designs may be painted in olive, white or other colours, depending on the operational requirements – the British Royal Army Medical Corps
Royal Army Medical Corps
The Royal Army Medical Corps is a specialist corps in the British Army which provides medical services to all British Army personnel and their families in war and in peace...
has a fleet of white ambulances, based on production trucks. Military helicopters often function as air ambulances, since they are extremely useful for MEDEVAC
MEDEVAC
Medical evacuation, often termed Medevac or Medivac, is the timely and efficient movement and en route care provided by medical personnel to the wounded being evacuated from the battlefield or to injured patients being evacuated from the scene of an accident to receiving medical facilities using...
.
Due to the inherently hazardous situation of a battle ground, military ambulances are often armored, or based upon armored fighting vehicles (AFV). Since laws of war
Laws of war
The law of war is a body of law concerning acceptable justifications to engage in war and the limits to acceptable wartime conduct...
demand ambulances marked with one of the Emblems of the Red Cross
Emblems of the Red Cross
The emblems of the International Red Cross and Red Crescent Movement, under the Geneva Conventions, are to be placed on humanitarian and medical vehicles and buildings to protect them from military attack on the battlefield. There are four such emblems, three of which are in use: the Red Cross,...
not to mount offensive weapon
Weapon
A weapon, arm, or armament is a tool or instrument used with the aim of causing damage or harm to living beings or artificial structures or systems...
s, an ambulance AFV is often unarmed. It is a generally accepted practice in most countries to classify the personnel attached to military vehicles marked as ambulances as non-combatant
Non-combatant
Non-combatant is a term in the law of war describing civilians not taking a direct part in hostilities, as well as persons such as medical personnel and military chaplains who are regular soldiers but are protected because of their function as well as soldiers who are hors de combat ; that is, sick,...
s; however, this application does not always exempt medical personnel from catching enemy fire —accidental or deliberate. As a result, medics and other medical personnel attached to military ambulances are usually put through basic military training, on the assumption that they may have to use a weapon. The laws of war do allow non-combatant military personnel to carry individual weapons for protecting themselves and casualties. However, not all militaries exercise this right to their personnel.
Israel
The State of Israel is a parliamentary republic located in the Middle East, along the eastern shore of the Mediterranean Sea...
has modified a number of its Merkava
Merkava
The Merkava is a main battle tank used by the Israel Defense Forces. The tank began development in 1974 and was first introduced in 1978. Four main versions of the tank have been deployed. It was first used extensively in the 1982 Lebanon War...
main battle tank
Tank
A tank is a tracked, armoured fighting vehicle designed for front-line combat which combines operational mobility, tactical offensive, and defensive capabilities...
s with ambulance features in order to allow rescue operations to take place under heavy fire in urban warfare
Urban warfare
Urban warfare is combat conducted in urban areas such as towns and cities. Urban combat is very different from combat in the open at both the operational and tactical level...
. The modifications were made following a failed rescue attempt in which Palestinian
Palestinian people
The Palestinian people, also referred to as Palestinians or Palestinian Arabs , are an Arabic-speaking people with origins in Palestine. Despite various wars and exoduses, roughly one third of the world's Palestinian population continues to reside in the area encompassing the West Bank, the Gaza...
gunmen killed two soldiers who were providing aid for a Palestinian woman in Rafah
Rafah
Rafah , also known as Rafiah, is a Palestinian city in the southern Gaza Strip. Located south of Gaza, Rafah's population of 71,003 is overwhelmingly made up of Palestinian refugees. Rafah camp and Tall as-Sultan form separate localities. Rafah is the district capital of the Rafah Governorate...
. Since M-113
M113 armored personnel carrier
The M113 is a fully tracked armored personnel carrier that has formed the backbone of the United States Army's mechanized infantry units from the time of its first fielding in Vietnam in April 1962. The M113 was the most widely used armored vehicle of the U.S...
armored personnel carriers and regular up-armored ambulances are not sufficiently protected against anti-tank weapons and improvised explosive device
Improvised explosive device
An improvised explosive device , also known as a roadside bomb, is a homemade bomb constructed and deployed in ways other than in conventional military action...
s, it was decided to use the heavily armored Merkava tank. Its rear door enables the evacuation of critically wounded soldiers. Israel did not remove the Merkava's weaponry, claiming that weapons were more effective protection than emblems since Palestinian militants would disregard any symbols of protection and fire at ambulances anyway.
Some navies operate ocean-going hospital ship
Hospital ship
A hospital ship is a ship designated for primary function as a floating medical treatment facility or hospital; most are operated by the military forces of various countries, as they are intended to be used in or near war zones....
s to lend medical assistance in high casualty situations like wars or natural disasters. These hospital ships fulfill the criteria of an ambulance (transporting the sick or injured), although the capabilities of a hospital ship are more on par with a Mobile Army Surgical Hospital
Mobile Army Surgical Hospital
The Mobile Army Surgical Hospital refers to a United States Army medical unit serving as a fully functional hospital in a combat area of operations. The units were first established in August 1945, and were deployed during the Korean War and later conflicts. The U.S...
. In line with the laws of war
Laws of war
The law of war is a body of law concerning acceptable justifications to engage in war and the limits to acceptable wartime conduct...
, these ships can display a prominent Red Cross or Red Crescent to infer protection under the appropriate Geneva convention, however, this designation has not always protected hospital ships from enemy fire.
Reuse of retired ambulances
Due to the nature of their service, emergency response ambulances may be subjected to hard driving conditions. When an ambulance becomes too old or too worn for continued emergency use, it may be adapted into a support vehicle, such as a mobile crime labCrime Lab
A crime laboratory - often shortened to crime lab - is a scientific laboratory, using primarily forensic science for the purpose of examining evidence from criminal cases.- Lab personnel :A typical crime lab has two sets of personnel:...
or air supply (fire suppression) unit. Being adopted into providing first aid services (via the St John Ambulance Brigade) is also common.http://www.york.ca/NR/rdonlyres/2oh662sqs5hsdwikhm45umbhbqsyaks5thf4sjekdbyi3ginngge5ucpweymvgapsszni3fvbsthg5jnam4eu4hxbd/rpt+8+cls+3.pdf Alternately, the vehicle may be retired entirely from emergency service work, and be reused as a carpenter's, plumber's, or other handyman's truck.
See also
- Air ambulanceAir ambulanceAn air ambulance is an aircraft used for emergency medical assistance in situations where either a traditional ambulance cannot reach the scene easily or quickly enough, or the patient needs to be transported over a distance or terrain that makes air transportation the most practical transport....
- Ambulance busAmbulance busAn ambulance bus, medical ambulance bus or MAB is a type of ambulance used to transport and treat multiple patients who require ambulance level care...
- Ambulance stationAmbulance stationAn ambulance station is a structure or other area set aside for storage of ambulance vehicles, medical equipment, personal protective equipment, and other medical supplies. Most stations are made up of garage bays or a parking area, normally undercover...
- CEN 1789CEN 1789CEN 1789:2007 is the European Union standard for ambulances and medical transportation vehicles. This European standard specifies requirements for the design, testing, performance and equipping of road ambulances used for the transport and care of patients...
- Combination carCombination carFor the railroad vehicle, see Combine car.A combination car was a vehicle built upon a "professional car" chassis which could be employed either as a hearse or as an ambulance, and had the capability of being swapped between those roles without much difficulty...
- Emergency Medical DispatcherEmergency medical dispatcherAn Emergency medical dispatcher is a professional telecommunicator, tasked with the gathering of information related to medical emergencies, the provision of assistance and instructions by voice, prior to the arrival of Emergency Medical Services, and the dispatching and support of EMS resources...
- Emergency medical servicesEmergency medical servicesEmergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
- Fly-carFly-carAn ambulance emergency response vehicle is a vehicle operated by an emergency medical service to respond to medical emergencies either in addition to, or in place of, an ambulance capable of transporting patients....
- List of Ambulance Manufacturers
- Motorcycle ambulanceMotorcycle ambulanceMotorcycle ambulances are a type of emergency vehicle which either carries a solo paramedic or first responder to a patient; or is used with a trailer or sidecar for transporting patients...