An ambulance is a vehicle for transportation, from or between places
of treatment, 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
The term ambulance does, however, extend to a wider range of vehicles
other than those with flashing warning lights and sirens. The term
also includes a large number of non-urgent ambulances which are for
transport of patients without an urgent acute condition (see below:
Functional types) and a wide range of urgent and non-urgent vehicles
including trucks, vans, bicycles, motorbikes, station wagons, buses,
helicopters, fixed-wing aircraft, boats, and even hospital ships (see
The term ambulance comes from the
Latin word "ambulare" as meaning "to
walk or move about" which is a reference to early medical care
where patients were moved by lifting or wheeling. The word originally
meant a moving hospital, which follows an army in its movements.
Ambulances (Ambulancias in Spanish) were first used for emergency
transport in 1487 by the Spanish forces during the siege of Málaga by
the Catholic Monarchs against the Emirate of Granada. During the
American Civil War
American Civil War vehicles for conveying the wounded off the field of
battle were called ambulance wagons. Field hospitals 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 (sometimes called an ambulette). 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-cars. In these cases a patient who
requires transportation to hospital will require a patient-carrying
ambulance to attend in addition to the first responder.
2 Functional types
Vehicle type gallery
4 Design and construction
4.4 Intermediate technology
5 Appearance and markings
5.1 Passive visual warnings
5.2 Active visual warnings
5.3 Audible warnings
6 Service providers
9 Military use
10 Reuse of retired ambulances
11 See also
12 References and notes
13 External links
Early car-based ambulances, like this 1948 Cadillac Meteor, were
sometimes also used as hearses.
U.S. ambulance in 1949
Main article: History of the ambulance
The history of the ambulance begins in ancient times, with the use of
carts 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
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 vans, boats, helicopters, fixed-wing aircraft (known as air
ambulances) 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 dialysis center, for non-urgent care. These can be
vans, buses or other vehicles.
Response unit – Also known as a fly-car or a [Quick Response
Vehicle], 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. These units can function as a vehicle for officers or
supervisors (similar to a fire chief's vehicle, but for ambulance
services). Fire & Rescue services in North America often staff
EMTs or Paramedics to their apparatuses to provide medical care
without the need to wait for an ambulance.
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' project. These are usually based on a bus.
Bariatric ambulance – A special type of patient transport ambulance
designed for extremely obese patients equipped with the appropriate
tools to move and manage these patients.
In the US, there are four types of ambulances. There are Type I, Type
II, Type III and Type IV. Type I is based upon a heavy truck chassis
and is used primarily for Advanced Life Support and rescue work. Type
II is a van based ambulance with little modifications except for a
raised roof. Its use is for basic life support and transfer of
patients. The Type III is a van chassis but with a custom made rear
compartment and has the same use as Type I ambulances. Type IV's are
nomenclature for smaller ad hoc patient transfer using smaller utility
vehicles where passenger vehicles and trucks would have difficulty in
traversing, such as large industrial complexes, commercial venues, and
special events with large crowds. These do not, generally, fall under
Ambulances can be based on many types of vehicle, although emergency
and disaster conditions may lead to other vehicles serving as
A Modern American
Ambulance built on the
Chassis of a
Ford F-450 truck
Van or pickup truck – A typical ambulance is based on either the
chassis of a van (vanbulance) or pickup truck. This chassis is then
modified to the designs and specifications of the purchaser.
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 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) hearses, as these were some of the few
vehicles able to accept a human body in a supine position.
Motorcycle – 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. Trailers or sidecars can make these patient
transporting units. See also motorcycle ambulance.
Mercedes-Benz Sprinter ambulance of the HSE National ambulance service
in Ireland. This type of ambulance is typically used in England,
Wales, Ireland and Northern Ireland.
Bicycle – 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
All-terrain vehicle (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 rescue
in inaccessible areas.
Golf cart or Neighborhood Electric
Vehicle – Used for rapid response
at events or on campuses. These function similarly to ATVs, with
less rough terrain capability, but with less noise.
Helicopter – 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
Helicopter and fixed-wing ambulances are discussed in
greater detail at air ambulance.
Fixed-wing aircraft – These can be used for either acute emergency
care in remote areas (such as in Australia, with the 'Flying
Doctors'), 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
Boat – Boats can be used to serve as ambulances, especially in
island areas or in areas with a large number of canals, such as
the Venetian water ambulances. Some lifeboats or lifeguard vessels may
fit the description of an ambulance as they are used to transport a
Ship – Ships can be used as hospital ships, 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 disaster or war zones to provide care for the
casualties of these events.
Bus – 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 incidents, or to deal with specific problems
such as drunken patients in town centres.
Ambulance busses are
discussed at greater length in their own article.
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 train – 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 hospital services to the
local population. Hospital trains also find use in disaster
Fire Engine - Fire services (especially in North America) often train
Firefighters in emergency medicine and most apparatuses carry at least
basic medical supplies. By design, apparatuses cannot transport
Vehicle type gallery
Fly-car in Sweden
A paramedic's scooter in Israel
In large, congested cities, paramedics may travel by bicycle, such as
this one of the London
An air ambulance in Austria
An air ambulance in Turkey
A water ambulance in the Scilly Isles
A Russian hospital train
Design and construction
Ambulance design must take into account local conditions and
infrastructure. Maintained roads 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.
Car-based ambulance in Sweden
Truck-based ambulance in Columbus, Ohio using a pre-built box system
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 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
Ambulances often have two manufacturers. The first is frequently a
manufacturer of light trucks 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
engines, 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
Many regions have prescribed standards which ambulances should, or
must, meet in order to be used for their role. These standards may
have different levels which reflect the type of patient which the
ambulance is expected to transport (for instance specifying a
different standard for routine patient transport than high
dependency), or may base standards on the size of vehicle.
For instance, in Europe, the European Committee for Standardization
publishes the standard CEN 1789, which specifies minimum compliance
levels across the build of ambulance, including crash resistance,
equipment levels, and exterior marking. In the United States,
standards for ambulance design have existed since 1976, where the
standard is published by the
General Services Administration
General Services Administration and known
as KKK-1822-A. This standard has been revised several times, and
is currently in version 'F' change #10, known as KKK-A-1822F, although
not all states have adopted this version. The National Fire Protection
Association has also published a design standard, NFPA 1917, which
some administrations are considering switching to if KKK-A-1822F is
withdrawn.. The Commission on Accreditation of
(CAAS) has published its Ground
Vehicle Standard for Ambulances
effective July 2016. This standard is similar to the KKK-A-1822F and
NFPA 1917-2016 specifications.
The move towards standardisation is now reaching countries without a
history of prescriptive codes, such as India, which approved its first
national standard for ambulance construction in 2013.
A video on ambulance crash testing
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 belts. 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 cars. 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 died during
ambulance trips in the US between 1991 and 2006.
Interior of a mobile intensive care unit (MICU) ambulance from Graz,
Four stages of deployment on an inboard ambulance tail lift
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
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
ASHICE message to
alert the hospital of the impending arrival of a critical
patient.) More recently many services worldwide have moved
from traditional analog UHF/
VHF sets, which can be monitored
externally, to more secure digital systems, such as those working on a
GSM system, such as TETRA.
Mobile data terminal – Some ambulances are fitted with Mobile data
terminals (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
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 malpractice.
Tail lift 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 beds. There may
also be equipment linked to this such as winches which are designed to
pull heavy patients into 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 photosensitive.
Air conditioning – 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
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 animals. Animal-powered
ambulances can be particularly useful in regions that are subject to
flooding. Motorcycles fitted with sidecars (or motorcycle ambulances)
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
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
Appearance and markings
An ambulance on an oncoming lane in Moscow
Emergency ambulances are highly likely to be involved in hazardous
situations, including incidents such as a road traffic collision, 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's illness or injury. 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.
Passive visual warnings
North West Ambulance Service
North West Ambulance Service ambulance displays reversed wording and
the Star of Life, with flashing blue grille lights and wig-wagging
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-reflective 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, though
classic white or red are also common. Fire Department-operated
Ambulances are often painted similarly to their apparatuses for ease
of identification and the fact that bright red is a very striking
color appropriate for this type of vehicle.
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.
Star of Life
Star of Life represents emergency medical services.
Star of Life
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
St. John Ambulance
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
Active visual warnings
Main article: Emergency vehicle lighting
An ambulance in Denmark with roof-integrated LED lights, plus
side-view mirror, grill and front fend-off lights, and fog lamps
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
There are several technologies in use to achieve the flashing effect.
These include flashing a light bulb or LED, flashing or rotating
halogen, and strobe lights, which are usually brighter than
incandescent lights. Each of these can be programmed 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 programmed to burn steadily, without flashing,
which is required in some provinces.
Emergency lights may simply be mounted directly on the body, or may be
housed in special fittings, such as in a lightbar or in special
flush-mount designs (as seen on the Danish ambulance to the right), 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 programmed to flash. Flashing headlights
(typically the high beams, flashed alternately) are known as a
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. The roof, front grille, sides of the
body, and front fenders are common places to mount emergency lights. A
certain balance must be made when deciding on the number and location
of lights: too few and the ambulance may not be noticed easily, too
many and it becomes a massive distraction for other road users more
than it is already, increasing the risk of local accidents.
See also Emergency vehicle equipment.
Main article: Audible warning devices
A Whelen(R) siren with wail, yelp and phaser tones is a common sound
in many cities
In addition to visual warnings, ambulances can be 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, 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
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, or
may be fitted with extremely loud two-tone airhorns as their primary
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 into 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.
An ambulance from
St John Ambulance
St John Ambulance WA in Perth
A volunteer ambulance crew in Modena, Italy
A city fire service ambulance from the Tokyo Fire Department.
Non-acute patient transport ambulance from New Zealand.
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.
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 the
United Kingdom almost all emergency ambulances are part of a
nationwide system under the National Health Service. In Canada
ambulance services are normally operated by local municipalities or
provincial health agencies as a separate entity from fire or police
Fire or Police Linked Service – In countries such as the United
States, Japan, Hong Kong and France ambulances can be operated by the
local fire or police service, more commonly the fire service due to
overlapping calls. This is particularly common in rural areas, where
maintaining a separate service is not necessarily cost effective, or
by service preference such as in
Los Angeles where the Los Angeles
Fire Department prefers to handle all parts of emergency medicine
in-house. In some cases this can lead to an illness or injury being
attended by a vehicle other than an ambulance, such as a fire truck,
and firefighters must maintain higher standards of medical capability.
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 department,
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 organisations such as St John Ambulance and
the Order of Malta
Ambulance Corps. 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 and
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. nonurgent or ambulatory transport), 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 Falck, Acadian Ambulance, and American
Medical Response 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 patient transfers or for private functions only.
Combined Emergency Service – these are full service emergency
service agencies, which may 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 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
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.
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.
Ambulance – Many large factories and other industrial
centres, such as chemical plants, 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
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
government (through their normal taxation).
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).
Various ambulance crews help to load a patient into an air ambulance
There are differing 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. In some locations, an advanced life
support ambulance may be crewed by one paramedic and one EMT-Basic.
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
cardiopulmonary resuscitation (CPR) or using an automated external
defibrillator (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. 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, as 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 are
stored in the ambulance.
Ambulance Care Assistant – 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 wheelchair
cases), rather than acute care. Dependent on provider, they may be
trained in first aid or extended skills such as use of an AED, oxygen
therapy and other lifesaving 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 Care Assistant/Emergency Care Support Workers – Also known
as ECA/ECSW are members of a frontline ambulance that drive the
vehicles under both emergency and non-emergency conditions to
incidents. Their role is to assist the clinician that they are working
with, either a Technician or Paramedic, in their duties, whether that
be drawing up drugs, setting up fluids (but not attaching), doing
basic observations or performing 12 lead ECG assessments.
Emergency medical technician
Emergency medical technician – Also known as
Technicians are usually able to perform a wide range of emergency care
skills, such as defibrillation, spinal immobilization, bleeding
control, splinting of suspected fractures, assisting the patient with
certain medications, and oxygen therapy. Some countries split this
term into levels (such as in the US, where there is EMT-Basic and
Registered nurse (RN) – Nurses can be involved in ambulance work
dependent on the jurisdiction, and as with doctors, this is mostly as
air-medical rescuers often in conjunction with a technician or
paramedic. They may bring different 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.
Paramedic – This is a high level of medical training and usually
involves key skills not permissible for technicians, such as
cannulation (and with it the ability to administer a range of drugs
such as morphine), tracheal intubation and other skills such as
performing a cricothyrotomy. Dependent on jurisdiction, the title
"paramedic" can be a protected title, and use of it without the
relevant qualification may result in criminal prosecution.
Emergency Care Practitioner – This position, sometimes called 'Super
Paramedic' in the media, is designed to bridge the link between
ambulance care and the care of a general practitioner. ECPs are
already qualified paramedics who have undergone further training,
and are trained to prescribe medicines for longer term care, such as
antibiotics, as well as being trained in a range of additional
Doctor – 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
URO VAMTAC ambulance of the
Spanish Army emblazoned with the Red
Red Cross ambulance
Military ambulances have historically included vehicles based on
civilian designs and at times also included armored, but unarmed,
vehicles ambulances based upon armoured personnel carriers (APCs). In
the Second World War vehicles such as the Hanomag Sd Kfz 251 halftrack
were pressed into service as ad hoc ambulances, and in more recent
times purpose built AFVs such as the U.S.
M1133 Medical Evacuation
Vehicle serve the exclusive purpose of armored medical vehicles.
Civilian based designs may be painted in appropriate colours,
depending on the operational requirements (i.e. camouflage for field
use, white for United Nations peacekeeping, etc.). For example, the
Royal Army Medical Corps
Royal Army Medical Corps has a fleet of white ambulances,
based on production trucks. Military helicopters have also served both
as ad hoc and purpose-built air ambulances, since they are extremely
useful for MEDEVAC. In terms of equipment, military ambulances are
barebones, often being nothing more than a box on wheels with racks to
place manual stretchers, though for the operational conditions and
level of care involved this is usually sufficient.
Since laws of war demand ambulances be marked with one of the Emblems
Red Cross not to mount offensive weapons, military ambulances
are often unarmed. 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 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
USNS Mercy, a U.S. Navy hospital ship
Recently, the Israeli Defense Forces has modified a number 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 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 devices, 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.[citation
needed] For use as ground ambulances and treatment & evacuation
United States military
United States military currently employs the M113, the
Stryker Medical Evacuation
Vehicle (MEV), and the
RG-33 Heavily Armored Ground
Ambulance (HAGA) as treatment and
evacuation vehicles, with contracts to incorporate the newly designed
M2A0 Armored Medical Evacuation
Vehicle (AMEV), a variant of the M2
Vehicle (formerly known as the ATTV).
Some navies operate ocean-going hospital ships 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 confer protection
under the appropriate Geneva convention. However, this designation has
not always protected hospital ships from enemy fire.
Reuse of retired ambulances
Retired ambulances may find reuse in less-demanding emergency
services, such as this logistics unit, such as this
When an ambulance is retired, it may be donated or sold to another EMS
provider. Alternately, it may be adapted into a storage and
transport vehicle for crime scene identification equipment, a command
post at community events, or support vehicle, such as a logistics
unit. Others are refurbished and resold, or may just have
their emergency equipment removed to be sold to private businesses or
individuals, who then can use them as small recreational vehicles.
Toronto's City Council has begun a "Caravan of Hope" project to
Toronto ambulances a second life by donating them to
the people of El Salvador. Since the Province of Ontario requires that
ambulances be retired after just four and a half years in service in
Ontario, the City of
Toronto decommissions and auctions 28 ambulances
Cutaway van chassis
Emergency medical dispatcher
Emergency medical dispatcher
Emergency medical services
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