Car Show

Ambulance

An ambulance is a vehicle designated for the transport of sick or injured people. The first ambulances called by that name were horse ambulances used in the American Civil War. The first practical ambulances were created by Dominique Jean Larrey, a French surgeon (1766–1842), for use in the Napoleonic Wars. Modern-day ambulances are typically large automobiles on a van or light truck chassis.

However, an ambulance can be any vehicle, including a bus, helicopter, or even a hospital ship. During the 1960s and 1970s, station wagons were used in some American cities (despite their limited space) and can be seen in motion pictures from that period.

In some countries civilian ambulances may use the symbol referred to as the "Star of Life," a blue six point star, originally designed and governed by the U.S. National Highway Traffic Safety Administration (NHTSA). Any unit displaying this star is said to be qualified to render its specific level of emergency care.

Under the laws of war, an ambulance marked by a red cross is not to be fired on and is to be permitted to carry out its duties in spite of the fighting. An ambulance may not mount weapons, although the Israeli EMS has produced a "tankbulance" that combines a Merkava main battle tank with ambulance features (see below).

Ambulances in North America

Ambulance types

A typical Type III Ambulance. Note that the front of the ambulance is a van, while the patient-care compartment is in the box-like module. This ambulance is run by the Harmon, NY volunteer fire department.

Ambulances in both the United States and Canada are defined by KKK-1822E requirements which defines several categories of ambulances.

• Type I Ambulances are based on the chassis-cabs of light duty pickup-trucks,
• Type II Ambulances are based in modern passenger/cargo vans,
• Type III Ambulances are based on chassis-cabs of light duty vans,
• Extreme Duty versions of both Type I and Type III are also now authorized based on the chassis-cabs of medium duty truck chassis.

Note that Type I's and Type III's are often called boxes by their crews with Type II's being called vanbulances; ambulances are also referred to as buses (which some EMTs and paramedics consider to be derogatory), mods or modulars (if type I or III), rigs etc.

• There are also fly-cars, which are large cars or SUVs. These units cannot provide patient transport, but are used variously by supervisors or as a source of additional personnel.
  
• A new and emerging industry, specifically in the Province of Ontario, is non-emergency patient transfers. Many companies who specialize in these transfers are creating their own vehicles with ambulance type equipment, but without emergency lights and sirens. One example is from Voyageur Transportation, based on the Dodge Sprinter Cargo Chassis. Aboutown Medical Transfer, has several varieties based on GMC/Chevy passenger chassis.

A typical Type II ambulance. Note how, in contrast to the Type III ambulance shown above, the basic shape of this ambulance is that of a standard full-sized van with a raised roof. This ambulance is operated by American Medical Response, a commercial for-profit company.

Ambulance Providers

Ambulance service providers come in several types in the USA:

1. Volunteer Ambulance Corps (VAC) or services - function similar to Volunteer Fire Companies. St. John Ambulance is the most common, providing world-wide service in locations ranging from New York City **Sorry, this is incorrect. There is a hospital in Elmhurst, Queens, NYC, called SVCMC St. John's Queens Hospital, which has an ambulance department which provides several units to the NYC 911 EMS system, however it has no relation to the UK's St. John Ambulance organization.** to small rural communites, but many VACs are independent corporations. VACs may be community owned or privately owned, but are typically organised as non-profit organizations. VACs may also be part of Volunteer Fire Companies; in some of these cases, EMTs and drivers are also firefighters. Up until recently, Harbor City Volunteer Ambulance Squad (HCVAS) in Melbourne, Florida was the largest volunteer ambulance squad in the United States.

2. Private Ambulance Service - Normal commercial companies with paid employees, of which the largest is AMR (American Medical Response). While many private companies provide inter-facility patient transfer, many communities' 911 needs are served by private services.

3. Municipal Third Service - Operate as a third service alongside fire and police departments. These are more likely to be found in areas with a high population density, such as a city or metropolitan area.

4. Municipal - Usually fire department owned and operated, though some systems are police department owned and operated.

5. Combined - these are full service emergency service agencies such as airport and college public safety offices. Some smaller towns and cities may also have them. Generally all personnel are crosstrained as EMT's/Firefighter/peace officer.

6. Hospital Based - Ambulance service such as ALS, BLS and CCT are offered by profit and non profit hospitals as a service to the community. Often these services do not support themselves and are funded by the hospital. Such as Enloe Medical Center out of Chico, Ca.

Ambulances in France

Ambulance in Lausanne (Switzerland)

A SMUR car in Lausanne

In France, the most general term is "vehicle adapted to patient transport", the term "ambulance" only applies for some categories of patient transport vehicles.

The word "ambulance" is reserved to transportation on medical prescription, including oral prescription in case of emergency. It does not apply to first responders vehicles (most of times firefighters), although they also transport casualties; their vehicles are called VSAV–véhicule de secours et d'assistance aux victimes (rescue and assistance to casualties vehicle), or VPS–véhicules de premiers secours (first responders vehicles) in case of volunteers from associations. The VSAV and VPS are considered as vectors that bring rescue workers and devices onsite, the evacuation being only the logical following of this intervention but not their main duty.

There are therefore two kinds of ambulance providers: hospitals and private companies.

The reglementation classifies the patient transport vehicles in four types:

• A-type : ambulance for rescue and emergency care (ambulance de secours et de soins d'urgence–Assu) : in these ambulances, the personnel can stand; only these vehicles can be used for emergency (sanitary duty and H-MICU, see below) ;
• B-type : rescue and assistance to casualty vehicles (VSAV), i.e. first responders vehicles, very close to the A-type ;
• C-type : ambulance : the personnel cannot stand, it only allows the transport of a lying patient and of a sitting ambulance technician besides ; due to the lack of room, cares cannot be performed during the transport (these vehicles tend to disappear) ;
• D -type: light vehicle (véhicule sanitaire léger–VSL) : normal car without any specific equipment, for patient who can sit.

The A, B and C-types are called "specially equipped" vehicles, and must follow the NF EN 1789 standard (December 1999).

First responders vehicles

A VSAV has three professional¹ CFR onboard, a VPS has five volunteer CFR.

The first responders of the VSAV and VPS are called secouristes and have 60 hours of initial education (plus additional continuous education) and perform non-medical, non-invasive acts. They use splints (including cervical collars, long spine boards and vacuum mattresses), oxygen first aid, and make the casualty lifting.

Note

1. some firefighters are not full-time professionals; they are called "pompiers volontaires", but they are paid for their work, whereas the volunteers from CFR associations (secouristes bénévoles) are not paid.

Hospital ambulances

There are two kind of hospital ambulances:

• internal ambulances, which drive the patients from a building to the other; these are sometimes simple vehicles without any medical equipment when the transport do not require any care (these are always very short transportations).
• the UMH–unité mobile hospitalière (H-MICU–hospital medical intensive care unit) from the SMURr–service mobile d'urgence et de réanimation (mobile emergency resuscitation service) : an ambulance with an MD, a nurse and an ambulance technician that do pre-hospital intervention and interhospital transportation under intensive care.

The H-MICU is often a light rapid-intervention vehicle, i.e. a car carrying the personnel and the material to the casualty; the transport itself is made with a VSAV or a private ambulance equipped with the medical unit.

Special warning devices and traffic law

The H-MICU (A-type) and VSAV (B-type) have a blue rotating light and a two-tones siren (high-low-high-low-high-low...). When these special warning devices are on and when the emergency of the mission justifies it and as long as they do not endanger the life of other people, the traffic law allow them to get rid of certain limitations such as speed limits, direction of driving, priorities and traffic light. In most states, this allows ambulances to travel no more than 5 miles per hour above the posted speed limit. Also, when approaching a red light, the ambulance must first stop, determine the intersection is clear, and then may proceed regardless of what color the light is.

The ambulance of private companies (A- and C-type) have a blue flashing light and a three-tones siren (high-low-high...high-low-high...). When these special warning devices are on and when the emergency of the mission justifies it and as long as they do not endanger the life of other people, traffic laws allow them to get rid of certain limitations such as speed limits while respecting lane priorities and traffic lights.

Ambulances in the UK

In the UK, ambulance services are provided under the National Health Service through local ambulance 'trusts'. Each trust is specific to a county or area, and so the country is divided across a number of ambulance trusts, in a similar way to the British Police are. There are 31 ambulance trusts in England but there are likely to be several mergers in 2006 which will result in fewer trusts.

Most trusts offer three levels of personnel for service: care assistants, technicians and paramedics. Care assistants operate PTS (Patient Transport Services), which is largely concerned with the moving of patients between hospital and home. Technicians and paramedics crew the emergency ambulances, providing more urgent transport and also paramedical care of casualties. Occasionally, when not attending emergency incidents, technicians and paramedics may help out with PTS duties. Ambulance Trust's performance is measured. The Governments targets are to reach 75% of Category A (life threatening) calls within 8 minutes. A number of initiatives have been introduced to assist meeting these targets, including Rapid Responders and Community Responders.

Ambulance crews work a shift rota, and working nights and public holidays is seen as part of the job. Many people start out in a PTS role to gain experience of patient care, and then progress onto additional technician training at a later date. This has always been the classic method of entry into the ambulance service, although more recently some Universities have started to offer paramedicine degrees, with guaranteed direct entry into technician status on completion. These courses are somewhat controversial, with some more experienced ambulance staff arguing that such a fast-track approach misses the experience of PTS where recruits learn vital interpersonal skills. Direct entry to paramedic is not available, and can only be achieved via the technician route. Many trusts receive several hundred applicants per place, and this allows them to be very discriminating.

Technician training in many trusts is a 10 week course, usually residential. The IHCD division of Edexcel provides the qualifications for ambulance technicians and paramedics, and qualifiers become known as "state registered" or "IHCD registered". Without this registration, crewing of emergency vehicles or administration of certain medical techniques is forbidden.

Private ambulance services are becoming more common in the UK, along with the traditional voluntary sectors, such as the Red Cross and St. John Ambulance. However both the voluntary and private services tend to be concerned with PTS, and it is rare (although not unheard of) to find an emergency being attended by a non-NHS ambulance. The relevant UK legislation applies to all ambulances with no discrimination as to who owns or operates them. The majority of UK Private Ambulance Services are members of the British Ambulance Association.

In the UK, a minority of NHS ambulance staff are highly critical of the voluntary and private services, and there may exist an elitist attitude within some trusts. This may stem from hatred incurred during the various ambulance strike actions, where private, voluntary and military ambulance services have stepped in to provide cover, being referred to as "scabs". Most trusts are more positive about the additional services, even welcoming them as a means to reduce their own workload.

Ambulances is Germany and Austria

A german ambulance and the smaller emergency physician car with blue signal lights on.

In the german-speaking countries of Germany and Austria preclinical care is not only provided by non-physician staff (Rettungssanitäter or Retttungassistent), but also by specially trained emergency phyicians (called "Notarzt"). Therefore there are different types of ambulances. A few years ago, an ambulance that was sent to a potential life-threatening situation (e.g. cardiac arrest), was usually staffed with two paramedics and one physician. This system's disadvantage was that if the situation wasn't that life-threatening at all (and therefore no emergency physician would be needed) the ambulance staff had to treat the patient and wasn't therefore able to respond to situations where they really would be needed. In the last few year the so-called "Rendezvous-System" took over, where the emergency physician is driven to the scene by a separate car (usually a SUV) and the paramedics with the ambulance. Therefore, if there is not physician needed, the doctor can leave and let the paramedics take care of the patient or - in the opposite situation - if an ambulance is deployed to a situation which didn't sound that serious to the operator, the paramedics can call for reinforcements and the emergency physician could respond. Also, the driver of the emergency phycician's car is usually a trained EMT too, so in case there is a very serios situation (resuscitation, heavy trauma), there are more trained people on the scene.

Military ambulances

A US M997 Ambulance

Inside of an ambulance VAB of the French Army.

Military ambulances include both regular ambulances painted in olive (though some may be white, like civil ones. The British Army Medical Corps has a fleet of white ambulances, based on production trucks) and armed ambulances based upon AFVs. Military helicopters often function as aerial ambulances, since they are extremely useful for MEDEVAC.

Due to the high level of danger in battle-fields, military ambulances are often armored, or based upon armored fighting vehicles (AFV). Since laws of war demand ambulances not to mount any weapon, an ambulance AFV is disarmed and marked by a red cross or another accepted medical marking.

Recently, Israel has modified some of its Merkava main battle tanks 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 aided a Palestinian woman in Rafah. Since M-113 armoured personnel carriers and regular up-armored ambulances are not protected enough against anti-tank weapons and improvised explosive devices, commonly used by Palestinian militants against both military and civilian Israeli vehicles, it was decided to use the Merkava tank, because it features heavy armor and a rear door enabling the evacuation of critically wounded soldiers. Though ambulances may not carry weapons, Israel did not remove the Merkava's weaponry, claiming that Palestinian militants do not adhere to international law by firing on ambulances. Therefore, it becomes necessary to protect troops that come to aid the wounded.

External links

• Ambulance manufacturers
  • Wheeled Coach
  • Horton
  • Nilsson Special Vehicles

References

• Meisel, Zachary (Nov. 8, 2005). "Ding-a-Ling-a-Ling". Slate.

Home | Up | Jam sandwich | Panda car | Ambulance | Police car | Paddywagon | SWAT van

Car Show, made by MultiMedia | Free content and software

This guide is licensed under the GNU Free Documentation License. It uses material from the Wikipedia.