Ambulance
From Wikipedia, the free encyclopedia
An ambulance is a vehicle designated for transporting people to or from a place of treatment for an illness or injury, or may be vehicle designed to bring the medical care to the patient. An ambulance may travel from the site of an accident or injury to a hospital, from a hospital to a patient's home, or between two points of treatment (such as between a doctor's surgery and a hospital with specialist facilities).
The term ambulance comes from the Latin word ambulare, meaning to walk or move about.[1] It is most commonly associated with the land based, motorized emergency vehicles seen throughout the world administering emergency care to those with acute illnesses or injuries, hereafter known as emergency ambulances. These are usually fitted with flashing warning lights and sirens in order to facilitate their movement through heavy traffic. It is these emergency ambulances that are most likely to display the Star of Life, shown on the right, which represents the six stages of prehospital medical care.
There are also several other types of ambulance used throughout the world. Probably the most common is the patient transport ambulance. These vehicles are not usually (although there are exceptions) equipped with a high level of equipment, and are usually crewed by staff with a lower qualification than those working on emergency ambulances. Their purpose is simply to collect patients from, or drop them off at, their place of medical treatment. In most countries, these are not equipped with flashing lights or sirens.
Throughout the world, the look of emergency and patient transport ambulances varies, although trucks, vans and station wagons are most commonly used. Other vehicles used as ambulances include buses, helicopters, airplanes, boats, and even hospital ships.
Contents |
[edit] Ambulance functional types
Ambulances can be based on many types of vehicle:
- Emergency Ambulance - The most recognised type of ambulance, which provide care to the patients with an acute illness or injury. These can be road going Vans, helicopters, fixed-wing aircraft (known as air ambulances or even specially 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 dialysis center, for non-urgent care. These can be vans, buses or other vehicles.
- Response Unit - Also known as a fly-car, 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 cars, to modified vans, motorcycles, pedal cycles, quad bikes or horses. In some services, these units also function as supervisors' vehicles (similar to a fire chief's vehicle, 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 Kingdom's 'Jumbulance'[1] project.[2] These are usually some form of bus.
[edit] Ambulance vehicle types
- Van - A typical ambulance is of a van construction, based on a standard chassis, usually with a maximum road weight loaded of between 3.5 and 7.5 tonnes.
- Car/SUV - Used either as a fly-car 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 stretcher with a recumbant patient, but this often requires the removal of the front passenger seat, or use a particularly long car (as with early ambulances which were converted hearse cars
- Motorcycle - Used almost exclusively for rapid response in an emergency as they can make it through heavy traffic much faster than a car or van.
- Bicycle - Also used for response, but usually in pedestrianised areas where road vehicles find access difficult.
- Quad Bike (All Terrain Vehicle) - Used for response off road, especially at events. Some Quad bikes are modified to carry a stretcher, and are used for tasks such as mountain rescue in inaccessible areas.
- Golf cart - Also used for rapid response at events. Function similar to ATVs, with less rough terrain capability, but also less noise.
- Helicopter - Usually used for emergency care, either in places inaccessible by road, or in any area where speed is of the essence, as they are able to travel significantly faster than a road ambulance.
- Fixed-wing aircraft - Aeroplanes can be used for either acute emergency care in remote areas (such as in Australia, with their 'Flying Doctors') or for patient transport over long distances (usually a re-patriation following an illness or injury in a foreign country).
Emergency and disaster conditions may lead to makeshift ambulances, in which a vehicle designed for other uses is used to provide patient transport.
[edit] History

Perhaps the first ambulances, in the sense of a vehicle built for and dedicated (at least in part) to the transport of injured or ill persons to a treatment center, were the ambulance volantes designed by Dominique Jean Larrey (1766–1842), Napoleon Bonaparte’s chief physician. These were two or four-wheeled horse drawn wagons used to transport fallen soldiers form the battlefield after they had received early treatment in the field. Half a century later, during the United States’ Civil War, military physicians Joseph Barnes and Jonathan Letterman built upon Larrey’s work and designed a prehospital care system for that included transporting wounded soldiers to treatment facilities by railroad.[3]

In 1867, the city of London's Metropolitan Asylums Board, in the United Kingdom, received six horse-drawn ambulances for the purpose of conveying smallpox and fever patients from their homes to a hospital. These ambulances were designed to resemble private carriages, but were equipped with rollers in their floors and large rear doors to allow for a patient, lying on a specialized bed, to be easily loaded. Space was also provided for an attendant to ride with the patient, and the entire patient compartment was designed to be easily cleaned and decontaminated. Anyone willing to pay the cost of horse hire could summon the ambulance by telegram or in person.[4]
Other cities, such as Cincinnati, New York, and Paris also developed their early ambulance services due to the lessons learned from Barnes’ and Letterman’s work. In New York City, Edward Dalton, a former surgeon in the Union army, organized ambulance services to provide faster, more comfortable transportation to the hospital. These ambulances carried medical equipment, such as splints, a stomach pump, morphine, and brandy, reflecting contemporary medicine. By the turn of the century, interns accompanied New York City ambulances, treated patients on scene, and often left them at home.[3]
At much the same time, the automobile was being developed, and in addition to horse-drawn models, early twentieth century ambulances were powered by steam, gasoline, and electricity, reflecting the competing automotive technologies then in existence. Dedicated ambulance services were frequently managed or dispatched by individual hospitals, though in some areas, telegraph and telephone services enabled police departments to handle dispatch duties.[3]
The equipment carried by the ambulance was also changing. Traction splints were introduced during World War I, and were found to have a positive effect on the morbidity and mortality of patients with leg fractures. Two-way radios became available shortly after World War I, enabling for more efficient radio dispatch of ambulances in some areas. Shortly before World War II, then, a modern ambulance carried advanced medical equipment, was staffed by a physician, and was dispatched by radio. In many locations, however, ambulances were hearses - the only available vehicle that could carry a recumbent patient - and were thus frequently run by funeral homes. In some cases, combination vehicles were used, which could serve alternately as an ambulance or a hearse, as the occasion demanded.[3][5]

Ambulances were also taking to the sky. In 1917, Lieutenant Clifford Peel, a medical student, outlined a system of airplanes and ground facilities designed to provide medical services to the Australian Outback. These ideas became reality under the guidance of the Very Reverend John Flynn in 1928 when the Australian Inland Mission service established the Aerial Medical Service, a one year experimental program. Physicians in this program had several responsibilities, one of which was to fly out to a patient, treat the patient, and fly the patient to a hospital if the physician could not deliver adequate care on scene. Eventually, this experiment became the Royal Flying Doctor Service of Australia.[6]

In the United States, ambulance quality fell sharply during the second world war, as physicians, needed by the armed services, were pulled off of ambulances. In England, during the Battle of Britain, the need for ambulances was so great that service vans were commandeered and pressed into service, often carrying several victims at once. Following the war, physicians would continue to ride ambulances in some countries, but not in others. In the United States, postwar ambulances were often hearses (the only vehicles that could easily accommodate a patient on lying on a stretcher) staffed by poorly trained mortuary workers. Only some of these vehicles were combination vehicles, which could be switched between ambulance and hearse configurations. The use of police, fire, and other nondedicated vehicles for patient transport was also common.[7][3]
This situation persisted into the 1960s, when several events occurred that led to a redesign of the services provided by ambulance crews, and thus of the ambulance itself: CPR was developed and accepted as the standard of care for out-of-hospital cardiac arrest; defibrillation, based in part on an increased understanding of the pathophysiology of heart arrrythmias, was introduced, as were new pharmaceuticals to be used in cardiac arrest situations; in Ireland, a mobile coronary care ambulance successfully resuscitated patients using these technologies; and well-developed studies demonstrated the need for overhauling ambulance services. These studies placed pressure on governments to improve emergency care in general, including the care provided by ambulance services. Part of the result was the creation of standards in ambulance construction concerning the internal height of the patient care area (to allow for an attendant to continue to care for the patient during transport), in the equipment (and thus weight) that an ambulance had to carry, and several other factors. Few, or perhaps none of the then-available ambulances could meet these standards. Most contemporary ambulances were built on car chasses, which could not accept the weight and other demands of the new standards; van (and later, light truck) chasses would have to be used instead.[3][8]


Ambulance design therefore underwent major changes in the 1970s. The early van-based ambulances looked very similar to their civilian counterparts, having been given some emergency vehicle equipment (flashing lights, a siren), and the internal (and thus, generally hidden) fittings for carrying medical equipment and a stretcher. As time went on, ambulances matured in parallel to the newly developed EMS, gaining the capacity to carry additional equipment (both portable and permanently installed) as EMTs and paramedics added this equipment to their arsenal. This, coupled with the general trends of vehicle design and improvements in warning equipment (lights, sirens, etc) has led to the ambulance design of the early 21st century, and continues to influence the design of new ambulances. New influences are also being felt, including the need to protect the ambulance and its crew from traffic accidents and terrorist activities.
[edit] Design and construction
Ambulance design must take local conditions and infrastructure into account. The over-the-road ambulances that are familiar to many readers must rely heavily on an area's infrastructure if they are to be successful. Maintained roads are necessary for these ambulances to arrive on scene and then transport the patient to a hospital, though in some areas four-wheel drive or all-terrain vehicles can make up for a paucity of good roads. Appropriate fuel must be readily 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, many modern ambulances are equipped with two-way radios 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 physicians do not form part of the ambulance's crew, to confer with a physician for medical control.
Ambulances often have two manufacturers. The first is frequently a manufacturer of light trucks (or previously, cars) such as Mercedes-Benz or Ford. The second 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 simply finished off.
Modern ambulances are typically powered by internal combustion engines - whether diesel powered or gasoline powered varies from one location to the next. Colder regions may favor gasoline powered engines, as diesels can be difficult to start when they are cold. Warmer regions may favor diesel engines, as they tend to be more efficient and more durable. Also in favor of diesel power are a series of fires involving gasoline powered ambulances during the 1980s; many of these fires were ultimately attributed in part to gasoline's higher volatility in comparison to diesel fuel.[9] In some cases, the type of engine may be determined by the manufacturer: Ford[10][11][12] will only sell vehicles for ambulance conversion if they are diesel powered.
[edit] Intermediate technology ambulances
In parts of the world which lack a high level of infrastructure, ambulances are designed to meet local conditions. In some areas, ambulances are trailers, which are pulled by bicycles, motorcycles, tractors, or animals. Animal-powered ambulances can particularly useful in regions that are subject to flooding. Three-wheeled motorcycles 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.[13][14]
The design of intermediate technology ambulances must take into account not only the operation and maintenance of the ambulance, but also its construction. The robustness of the design also becomes important, as does the nature of the skills required to properly operate the vehicle. Cost-effectiveness can be a high priority.[15]
[edit] Appearance and markings

Emergency ambulances are highly likely to be involved in hazardous situations (as these situations lead to injuries, which require the presence of the ambulance), including relatively common incidents such as a road traffic collision. They are also 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 ('give way') sign, or be permitted to break the speed limit.
For these reasons, emergency ambulances in many countries worldwide, are fitted with visual and/or audible warnings to alert members of the public (and in particular, other motorists and road users).
Visual warnings on an ambulance can be of two types - either passive or active.
[edit] Passive visual warnings
The passive visual warnings are usually inherently linked to 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 the retro-reflective designs which reflect light from car headlights or torches (and was invented by 3M). Popular patterns include 'checker board' (alternate coloured squares, sometimes also 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 or retro-reflective device introduced, as the original 3M reflective material only came in tape form). In some countries, in addition to retro-reflective markings, the vehicles are now painted in a bright yellow or orange colour underneath, in order to maximise visual impact.
Another passive marking form is the word ambulance 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 also display the name of their owner or operator, and a telephone number which may be used to summon the ambulance.
Ambulances may also carry an emblem (either as part of the passive warning markings or not). Some ambulances may display a Red Cross, Red Crescent or Red Diamond (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, organisation 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 (more detail below in “military ambulances”), 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 is not recognised beyond Israeli borders.
Many countries now use the Star of Life, shown at the top of this document, which was originally designed and governed by the U.S. National Highway Traffic Safety Administration, after legal action by the Red Cross over alleged misuse of their symbol (by using a bright orange cross, felt to be too similar to the Red Cross device). It indicates that the vehicle's operators can render their given level of care represented on the six pointed star.
[edit] Active visual warnings
The active visual warnings are usually in the form of flashing coloured lights (also known as 'beacons' or 'lightbars'). 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 and red, and this varies by country (and sometimes by operator). The beacons can be made to flash via a range of techniques, dependant on the technology used. The original method was to place a spinning mirror which moves around a light bulb, called a 'rotating beacon'. More modern methods include the use of strobe lights, which are usually brighter, and can be programmed to produce specific patterns (such as a left -> right pattern when parked on the left hand side of the road, indicating to other road users that they should move out away from the vehicle). There is also the more widespread use of LED flashing lights as they are low profile and low energy. More information on Emergency vehicle equipment.
[edit] Audible warnings
In addition to visual warnings, many ambulances are also fitted with audible warnings, sometimes known as sirens, 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, which can produce a range of different noises. Ambulance driving training often includes the use of different noises depending on traffic conditions and manoeuvre being performed. For instance, on a clear road, approaching a junction, the 'sail' setting may be used, which gives a long up and down variation, with a unbroken tone, whereas, in heavy slow traffic, a 'yelp' setting may be preferred, which is like a wail, but sped up. The speakers for modern sirens can be located in several places on the vehicle, including being integral to the lightbar, or hidden in the grill. Some ambulances may also be fitted with airhorn audible warnings.
A more recent development is the use of the RDS system of car radios, whereby the ambulance can be 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 all RDS radios 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, although is not able to alert pedestrians and non-RDS radio users.
[edit] Ambulance service providers
Depending on your country, area within in country, or clinical need, an Ambulance may be provided by one (or several) organisations, with different reasons for operating the ambulance. Some countries closely regulate the industry (and may require anyone working on a ambulacne 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 Britain, almost all emergency ambulances are part of the NHS
- Fire or Police Linked Service - In many countries (USA, France), many ambulances are operated by the local fire or police service. This is particularly common in rural areas, where maintaining a separate servide is not necessarily cost effective. This can lead, in some instances, to an illness or injury being attended by a vehicle other than an ambulance, such as Fire truck
- Voluntary Ambulance Service - Some charities or non-profit companies operate ambulances, both the an emergency and patient transport function. This may be along similar lines to volunteer Fire companies and either community or privately owned. They may be linked to a voluntary fire service, with volunteers providing both services. There are also charities who focus on providing ambulances for the community, or for cover at private events (sports etc.). The Red Cross provides this service in many countries across the world on a volunteer basis (and in others as a Private Ambulance Service), as do some other smaller organisations such as St John Ambulance. In some countries, these volunteer ambulances may be seen providing support to the full time ambulance crews during times of emergency.
- Private Ambulance Service - Normal commercial companies with paid employees, but often on contract to the local or national government. Many private companies provide only the patient transport elements of ambulance care (i.e. non urgent), but in some places, they are also contracted to provide emergency care, or to form a 'second tier' response, where they only respond to emergencies when all of the full-time emergency ambulance crews are busy. In some areas, private ambulance services also respond to non-emergency home calls, such as "pick up and put back" calls, which are made when a person falls without injury, but needs help getting up. They might also provide "first aid only" services, such as providing bandages (but not a trip to the hospital emergency room) to a child who skinned his/her knees at a playground.
- Combined Emergency Service - these are full service emergency service agencies, which mya be found in places such as airports or large colleges and universities. 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 can also be found in some smaller towns and cities may also have them. 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 - Some 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 dependant 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 [2]
[edit] Costs
Ambulance operations may funded by several sources, usually dependant on the type of ambulance which the patient travels in. In the case of a government service, it may be provided free of charge (funded through taxes), or the patient may receive a bill afterwards, to be paid by themselves or any insurance they may have. There may be a combined system where payment is from a combination of user fees for those who can afford to pay for the service, and taxpayer subsidies for those who can't In some instances, patients are not charged if they have a genuine illness or injury, but receive a bill if they make a hoax or unnecessary request for the service, which is to deter people from calling if they do not really require an ambulance.
[edit] Fake ambulance service
In China, ambulance services provide business for the hospitals they serve. There have been reported cases that a hospital which was not authorized to run an ambulance service illegally did so, in an effort to increase its business.[16]
[edit] Ambulance crew
Dependant on the country, area, type and service provider of the ambulance, there are several different levels of qualification that the ambulance crew may hold, from holding no formal qualification to having a fully qualified doctor 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.
Common ambulance crew qualifications are:
- First Responder - A person who arrives first at the scene of an incident, and whose job is to provide early critical care such as CPR or using an 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 police 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
- Patient Transport Assistant - Also known as care assistants, they have varying levels of training across the world, but these staff are only required to perform patient transport duties (which can include stretcher or wheelchair cases), rather than acute care.
- Emergency medical technician - Also known as Ambulance Technician. Technicians are usually able to perform a wide range of emergency care skills, such as defibrillation, spinal care, and oxygen therapy. Some countries split this term in to several levels (such as in the US, where where is EMT-I and EMT-II)
- Paramedic - This is a high level of medical training and usually involves key skills not permissible for technicians, are cannulation (and with it the ability to use a range of drugs such as morphine), intubation and other skills such as performing a cricothyrotomy. In many countries, this is a protected title, and use of it without the relevant qualification may result in criminal prosecution.
- Emergency Care Practitioner - This is a position sometimes called a 'super paramedic' and is designed to bridge the link between ambulance care and the care of a general practitioner. ECPs are qualified paramedics who have undergone further training, and are authorised 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
- Doctor - Some ambulance services - most notably air ambulances - will employ physicians to attend on the ambulances, brining a full range of additional skills such as use of prescription medicines
[edit] Military ambulances
Military ambulances include both ambulances based on civilian desings and armoured but unarmed ambulances based upon APCs such as the FV104 Samaritan. Civilian based designs may be painted in olive though some may be white — the British Royal Army Medical Corps has a fleet of white ambulances, based on production trucks. Military helicopters often function as aerial ambulances, since they are extremely useful for MEDEVAC.
Due to the high level of danger in battlefields, military ambulances are often armored, or based upon armoured fighting vehicles (AFV). Since laws of war demand ambulances marked with one of the Emblems of the Red Cross not to mount any weapon, an ambulance AFV is disarmed. It is a generally accepted practice in most countries to classify the personnel attached to military vehicles marked as ambulances as non-combatants; however, this application does not always exempt medical personnel from enemy fire —deliberate or accidental. As a result, medics and other medical personnel attached to military ambulances are usually put through basic military training on the assumption that they will have to fire weaponry in a combat zone when not attending to injured personnel. The laws of war also allow non-combatant military personnel to carry individual weapons for protecting themselves and casualties, but not all militaries exercise this right.
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-armoured ambulances are not sufficiently protected against anti-tank weapons and improvised explosive devices, it was decided to use the heavily armoured 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 fire at ambulances whether emblazoned or not.
[edit] Ambulances around the world
Ambulance and Emergency Medical provision around the world varies widely, in terms of the service offered, the funding for it, and the qualifications required of the crew members. There is more information on these on their own Wiki pages
- Emergency Medical Services in the United States - The US contains a large range of ambulance services, with varying regulation and command structures.
- Emergency Medical Services in Canada - Each Canadian province sets it's own standards for ambulance care, and the service varies on this geographical bases
- Emergency Medical Services in France
- Emergency Medical Services in the United Kingdom - A highly regulated system, with almost all emergency ambulances being operated by the government's National Health Service
- Emergency Medical Services in Germany
- Emergency Medical Services in Austria
- Emergency Medical Services in Norway
[edit] See also
- Fly-car
- Air ambulance
- MEDEVAC
- Blues and twos A UK term to describe the use of blue lights and two-tone sirens on ambulances
- Rescue squad
- Magen David Adom the Israeli ambulance service
- Scottish Ambulance Service
- National Health Service (Great Britain)
- SAMU The Emergency Medical Assistance Service of France
- St. John Ambulance
- Red Cross
- Stretcher
- Hearse
[edit] References and notes
- ^ How Products Are Made: Ambulance
- ^ Questions and Answers. New Jumbulance Travel Trust. n.d. Retrieved 4 February 2007.
- ^ a b c d e f Kuehl, Alexander E. (Ed.). Prehospital Systems and Medical Oversight, 3rd edition. National Association of EMS Physicians. 2002. @ ch. 1.
- ^ Higginbotham, Peter. The MAB Land Ambulance Service. Workhouses. October 2006. Retrieved 5 January 2007.
- ^ "Miller-Meteor History". Miller-Meteor. n.d. Retrieved 23 February 2007
- ^ History (and subsequent pages). Royal Flying Doctor Service of Australia. n.d. Retrieved 8 January 2007.
- ^ King, Dean. Patrick O'Brian: a Life. Owl Books. 2001 @ p. 81
- ^ National Academy of Sciences. Accidental Death and Disability: The Neglected Disease of Modern Society. 1966. @ pp. 5, 6, 13, 15.
- ^ National Highway Traffic Safety Administration campaign ID #s 87V111000 & 87V113000
- ^ 2006 Ford E-Series Cutaway Chassis: Specifications. Ford. n.d. Retrieved 1 January 2007.
- ^ 2006 Ford F-Series Super Duty Chassis Cab Ambulance: Specifications. Ford. n.d. Retrieved 1 January 2007.
- ^ 2006 Ford E-Series Van Ambulance: Specifications. Ford. n.d. Retrieved 1 January 2007.
- ^ Heyen-Perschon, Jürgen. "Report on Current Situation in the Health Sector of Ghana and Possible Roles for Appropriate Transport Technology and Transport Related Communication Interventions." (pdf) Institute for Transportation and Development Policy. 2005. Retrieved 17 February 2007.
- ^ "Motorcycle Trailer-Ambulance." (pdf) IT Transport LTD. n.d. Retrieved 17 February 2007.
- ^ "Press release: Motorcycle Ambulance Trailer Project Gets Off the Ground with MAN ERF UK." Transaid. 4 July 2006. Retrieved 19 February 2007.
- ^ Zhixin, Dong. "Fake ambulance carries patient to death" China Daily 22 June 2006. Retrieved 6 February 2007.
[edit] Additional material from
- Meisel, Zachary (November 8, 2005). "Ding-a-Ling-a-Ling". Slate.
Procedures: First aid, Cardiopulmonary resuscitation (CPR), Basic life support (BLS), Advanced Life Support (ALS), Advanced cardiac life support (ACLS), Advanced Trauma Life Support (ATLS), Advanced Pediatric Life Support (APLS), Pediatric Advanced Life Support (PALS)
Trauma centers: Level I, Level II, Level III, Level IV
Equipment: ambulance, bag valve mask, chest tube, defibrillation (AED, ICD), electrocardiogram (ECG/EKG), intubation, intravenous therapy (IV)
People: certified first responder, emergency medical technician (EMT), paramedic, emergency physician
Drugs: atropine, epinephrine
Other: golden hour, emergency department, emergency medical services, triage