Array ( [0] => {{short description|Vehicle equipped for transporting and care for ill and wounded people}} [1] => {{Other uses}} [2] => {{more citations needed|date=December 2023}} [3] => {{Use dmy dates|date=July 2020}} [4] => [[File:Armstrong Ambulance P17.jpg|thumb|A [[Ford E-Series]] ambulance with its [[Emergency vehicle lighting|emergency lights]] on in [[Boston]], [[Massachusetts]], United States]] [5] => [6] => An '''ambulance''' is a [[Medical device|medically-equipped]] [[vehicle]] used to transport [[patient]]s to [[Health facility|treatment facilities]], such as [[hospital]]s.[[Henry Alan Skinner|Skinner, Henry Alan]] (1949), ''The Origin of Medical Terms''. Baltimore: Williams & Wilkins. {{oclc|459611759}}{{page?|date=August 2022}} Typically, out-of-hospital [[medical care]] is provided to the patient during the transport. Ambulances are used to respond to [[Medical emergency|medical emergencies]] by [[emergency medical services]] (EMS), and can rapidly transport [[paramedic]]s and other [[first responder]]s, carry equipment for administering [[emergency medicine|emergency care]], and transport patients to hospital or other definitive care. Most ambulances use a design based on [[van]]s or [[pickup truck]]s, though others take the form of [[Motorcycle ambulance|motorcycles]], [[Ambulance bus|buses]], [[limousine]]s, [[Air medical services|aircraft]] and [[Water ambulance|boats]]. [7] => [8] => Ambulances are generally considered [[emergency vehicle]]s authorized to be [[Emergency vehicle equipment|equipped]] with [[emergency vehicle lighting|emergency lights]] and [[Siren (alarm)|sirens]]. Generally, vehicles count as an ambulance if they can transport patients. However, it varies by jurisdiction as to whether a [[Patient transport|non-emergency patient transport]] vehicle (also called an [[#Ambulette|ambulette]]) is counted as an ambulance. These vehicles are not usually (although there are exceptions) equipped with life-support equipment, and are usually crewed by staff with fewer qualifications than the crew of emergency ambulances. Conversely, EMS agencies may also have [[nontransporting EMS vehicle]]s that cannot transport patients.{{cite web|url=http://www.carpages.co.uk/honda/honda_essex_ambulance_chooses_honda_power_24_07_04.asp|title=Essex Ambulance Response Cars|publisher=Car Pages|date=24 July 2004|access-date=27 June 2007}} [9] => [10] => The term ''ambulance'' comes from the [[Latin]] word "''[[wikt:ambulare|ambulare]]''" as meaning "to walk or move about"{{cite web|url=http://science.enotes.com/how-products-encyclopedia/ambulance|title=How Products Are Made: Ambulance|publisher=How products are made|access-date=2 June 2007|url-status=dead|archive-url=https://web.archive.org/web/20070325025913/http://science.enotes.com/how-products-encyclopedia/ambulance|archive-date=25 March 2007}} 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.''Oxford English Dictionary'' ambulance definition 1 Ambulances (''ambulancias'' in Spanish) were first used for emergency transport in 1487 by the Spanish forces during the [[Siege of Málaga (1487)|siege of Málaga]] by the Catholic Monarchs against the Emirate of Granada. During the [[American Civil War]] vehicles for conveying the wounded off the field of battle were called ambulance wagons.{{cite web|url=http://www.civilwarhome.com/ambulancewagons.htm|title=Civil War Ambulance Wagons|website=civilwarhome.com|access-date=25 March 2008|archive-date=17 July 2017|archive-url=https://web.archive.org/web/20170717144400/http://www.civilwarhome.com/ambulancewagons.htm|url-status=dead}} [[Field hospital]]s were still called ambulances during the [[Franco-Prussian War]]The memoirs of Charles E. Ryan ''With An Ambulance Personal Experiences And Adventures With Both Armies 1870–1871'' [http://www.ourstory.info/library/1-roots/Ryan/ambTC.html#TC] {{Webarchive|url=https://web.archive.org/web/20160401155426/http://www.ourstory.info/library/1-roots/Ryan/ambTC.html#TC|date=1 April 2016}} and of {{cite web |last1=Pearson |first1=Emma Maria |author-link1=Emma Maria Pearson |last2=McLaughlin |first2=Louisa |author-link2=Louisa McLaughlin |others=Annotated by McLaughlin, G. Harry. |title=Our Adventures During the War of 1870 |url=http://www.ukchnm.org/uploads/file/ouradventures.pdf |url-status=dead |archive-url=https://web.archive.org/web/20080410103613/http://www.ukchnm.org/uploads/file/ouradventures.pdf |archive-date=10 April 2008 |access-date=2008-03-25}} of 1870 and in the Serbo-Turkish war of 1876[[Emma Maria Pearson]] and [[Louisa McLaughlin]] ''Service in Servia Under the Red Cross'' {{cite web |url=http://www.ukchnm.org/uploads/file/serviceinservia.pdf |title=Archived copy |access-date=2016-02-07 |url-status=dead |archive-url=https://web.archive.org/web/20080709041433/http://www.ukchnm.org/uploads/file/serviceinservia.pdf |archive-date=9 July 2008}} even though the wagons were first referred to as ambulances about 1854 during the [[Crimean War]].''Oxford English Dictionary'' ambulance definition 2a [11] => [12] => ==History== [13] => [[File:DFVAC 1948 Cadillac Miller Meteor front passenger quarter.jpg|thumb|Early car-based ambulances, such this 1948 [[Cadillac]] [[Miller-Meteor|Meteor]], were sometimes also used as [[hearse]]s.]] [14] => {{Main|History of the ambulance}}[[File:Hrh Princess Elizabeth in the Auxiliary Territorial Service, April 1945 TR2832.jpg|thumb|[[Elizabeth II]] (then Princess) next to a [[British Army]] ambulance in 1945]]The history of the ambulance begins in [[Ancient history|ancient times]], with the use of [[cart]]s to transport incurable patients by force. Ambulances were first used for emergency transport in 1487 by the Spanish, and civilian variants were put into operation during the 1830s.{{cite book | author=Katherine T. Barkley | year=1990 | title=The Ambulance | publisher=Exposition Press}} Advances in technology throughout the 19th and 20th centuries led to modern self-powered ambulances. [15] => [16] => ==Functional types== [17] => [[File:FDNY ambulance, 1949.jpg|thumb|A [[New York City Fire Department]] [[ambulance bus]] in 1949]] [18] => Ambulances can be grouped into types depending on whether or not they transport patients, and under what conditions. In some cases, ambulances may fulfill more than one function (such as combining emergency ambulance care with patient transport: [19] => * '''Emergency ambulance''' – The most common type of ambulance, which provides care to patients with an acute illness or injury. These can be road-going vans, boats, helicopters, fixed-wing aircraft (known as [[air ambulance]]s), or even converted vehicles such as [[golf cart]]s. [20] => * '''[[Patient transport]] ambulance''' – A vehicle, which has the job of transporting patients to, from or between places of medical treatment, such as hospital or [[Kidney dialysis|dialysis]] center, for non-urgent care. These can be vans, buses, or other vehicles. [21] => * '''[[Ambulance bus]]''' – A large ambulance, usually based on a [[bus]] chassis, that can evacuate and transport a large number of patients. They are usually used in emergencies such as [[mass casualty incident]]s. [22] => * '''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.{{cite web|url=http://www.jumbulance.org.uk/faq.html |title=Questions and Answers |access-date=2 June 2007 |publisher=Jumbulance Travel Trust |archive-url=https://web.archive.org/web/20070702165512/http://www.jumbulance.org.uk/faq.html |archive-date=2 July 2007 |url-status=dead }} These are usually based on a bus. [23] => * '''[[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. [24] => * '''Rapid organ recovery ambulance''' – A special ambulance used to collect the bodies of people who have died to preserve their [[Organ (biology)|organs]].{{cite news |url=https://www.washingtonpost.com/wp-dyn/content/article/2008/05/23/AR2008052303006.html |title=N.Y. Planning Special Ambulance To Recover Organs |first=Rob |last=Stein |newspaper=[[The Washington Post]]|date=2008-05-24}}{{cite web |url=http://www.slate.com/blogs/blogs/humannature/archive/2008/05/27/meat-wagons.aspx |title=Meat Wagons |first=William |last=Saletan |author-link=William Saletan |work=Slate |date=2008-03-27 |access-date=25 July 2019 |archive-date=23 January 2011 |archive-url=https://web.archive.org/web/20110123175914/http://www.slate.com/blogs/blogs/humannature/archive/2008/05/27/meat-wagons.aspx |url-status=dead }} In 2008, [[New York City]] launched a [[Pilot experiment|pilot program]] deploying one such ambulance with a $1.5 million three-year [[Grant (money)|grant]]. [25] => * '''Psychiatric ambulance''' – A special ambulance dedicated to treat [[Emergency psychiatry|psychiatric emergencies]]. The idea was first tested as "Psykebilen" ("The Psych ambo") in [[Bergen]], [[Norway]] in 2005, and was soon adopted by other cities in Norway and [[Sweden]]. Tests from the time showed that an ambulance service with personnel specially trained in psychiatric treatment was highly effective, and reduced the use of force when treating patients in psychiatric crises.{{Cite web|url=https://www.napha.no/content/14442/psykiatrisk-ambulansetjeneste-i-bergen|title = Psykiatrisk Ambulansetjeneste i Bergen}}{{Cite web|url=https://www.politiforum.no/helse-psykiatri-psykiatriambulanse/tilpassede-biler-og-ansatte-med-spesiell-kompetanse-slik-har-egne-ambulanser-for-psykisk-syke-blitt-en-suksess-i-bergen-og-stavanger/143916|title=Tilpassede biler og ansatte med spesiell kompetanse: Slik har egne ambulanser for psykisk syke blitt en suksess i Bergen og Stavanger|date=20 March 2018}} [26] => [27] => ==Vehicle types== [28] => [29] => Ambulances can be based on many types of vehicle although emergency and [[disaster]] conditions may lead to other vehicles serving as makeshift ambulances: [30] => * '''Van''' or '''[[pickup truck]]''' – A typical general-purpose ambulance is based on either the chassis of a van ("vanbulance") or a light-duty truck. This chassis is then modified to the designs and specifications of the purchaser. Vans may either retain their original body and be upfitted inside, or may be based on a chassis without the original body with a modular box body fitted instead. Those based on pickup trucks almost always have modular bodies. Those vehicles intended for especially intensive care or require a large amount of equipment to be carried may be based on medium-duty trucks. [31] => * '''Car''' – Used either as a [[fly-car]] for rapid response or to transport 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) [[hearse]]s, as these were some of the few vehicles able to accept a human body in a [[supine position]]. Some operators use modular-body transport ambulances based on the chassis of a [[minivan]] or [[station wagon]]. [32] => * '''Motorcycle and motor scooter''' – In urban areas, these may be used for rapid response in an emergency{{cite web|url=http://www.southcentralambulance.nhs.uk/dynamicpage.php?pagerec=60 |title=South Central Ambulance Service NHS Trust – About Us |access-date=18 October 2009 |publisher=South Central Ambulance Service NHS Trust |url-status=dead |archive-url=https://web.archive.org/web/20090303174744/http://www.southcentralambulance.nhs.uk/dynamicpage.php?pagerec=60 |archive-date=3 March 2009}} as they can travel through heavy traffic much faster than a car or van. [[Trailer (vehicle)|Trailer]]s or [[sidecar]]s can make these patient transporting units.{{cite web|url=http://www.tnn.co.uk/WorldwideNews/plonearticle.2006-07-04.2967165399 |title=News Reference to Motorcycle Trailer Ambulance |access-date=2 June 2007 |publisher=TNN |url-status=dead |archive-url=https://web.archive.org/web/20070927160815/http://www.tnn.co.uk/WorldwideNews/plonearticle.2006-07-04.2967165399 |archive-date=27 September 2007}}{{cite web|url=http://www.ittransport.co.uk/documents/Bicycleambulance.pdf|title=Motorcycle Trailer-Ambulance Brochure|publisher=IT Transport LTD|access-date=2 June 2007|archive-url=https://web.archive.org/web/20070614021104/http://www.ittransport.co.uk/documents/Bicycleambulance.pdf|archive-date=14 June 2007|url-status=dead}} [33] => [34] => * '''Bicycle''' – Used for response, but usually in pedestrian-only areas where large vehicles find access difficult.{{cite web|url=http://www.londonambulance.nhs.uk/news/news_releases_and_statements/two-wheeled_medics_cover_more.aspx |title=Two-wheeled medics cover more ground in the capital |access-date=18 October 2009 |url-status=dead |archive-url=https://web.archive.org/web/20110427033036/http://www.londonambulance.nhs.uk/news/news_releases_and_statements/two-wheeled_medics_cover_more.aspx |archive-date=27 April 2011}}{{cite web|url=http://www.londonambulance.nhs.uk/news/news_releases_and_statements/square_mile_cycle-paramedics_b.aspx |title=Square-Mile cycle paramedics become the new City-Slickers |access-date=18 October 2009 |url-status=dead |archive-url=https://web.archive.org/web/20110427033022/http://www.londonambulance.nhs.uk/news/news_releases_and_statements/square_mile_cycle-paramedics_b.aspx |archive-date=27 April 2011}} Like the motorcycle ambulance, a bicycle may be connected to a trailer for patient transport, most often in the developing world.{{cite web|url=http://www.designfordevelopment.org/activities/bike_ambulance.html|title=Bike Ambulance Project|publisher=Design for Development|date=20 July 2005|access-date=14 July 2007|archive-url=https://web.archive.org/web/20070928191033/http://www.designfordevelopment.org/activities/bike_ambulance.html|archive-date=28 September 2007|url-status=dead}} [35] => * '''[[All-terrain vehicle]]''' – Used for response off-road,{{cite web|url=http://www.quadtech.co.uk/index.php?section_id=100|title=Information on Quadtech EMS quad|access-date=2 June 2007|publisher=Quadtech}} especially at events or in remote areas. ATVs can be modified to carry a stretcher, and are used for tasks such as [[mountain rescue]] in inaccessible areas. [36] => [37] => * '''[[Golf cart]]''' or '''[[Neighborhood Electric Vehicle]]''' – Used for rapid response at events{{cite web|url=http://www.diversifiedgolfcars.com/standardambulance.htm|title=EMS golf cart brochure|access-date=2 June 2007|publisher=Diversified Golf Cars |archive-url = https://web.archive.org/web/20070405122944/http://www.diversifiedgolfcars.com/standardambulance.htm |archive-date = 5 April 2007}} or on campuses. These function similarly to ATVs, with less rough terrain capability, but with less noise. [38] => * '''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 [[Disaster response|major incidents]], or to deal with specific problems such as drunken patients in town centers.{{cite web |date=18 December 2008 |title=Ambulance crews prepare for party night pressure |url=http://www.londonambulance.nhs.uk/news/news_releases_and_statements/ambulance_crews_prepare_for_p.aspx |url-status=dead |archive-url=https://web.archive.org/web/20160303202825/http://www.londonambulance.nhs.uk/news/news_releases_and_statements/ambulance_crews_prepare_for_p.aspx |archive-date=3 March 2016 |publisher=London Ambulance Service}}{{cite news |date=17 December 2007 |title=Aboard the 'Booze Bus' |url=http://news.bbc.co.uk/1/hi/magazine/7147646.stm |access-date=1 January 2010 |work=BBC News}} [[Ambulance bus]]es are discussed at greater length in [[Ambulance bus|their own article]]. [39] => * '''[[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 ambulance.{{cite web|url=http://www.highways.gov.uk/business/15658.aspx |title=Highways Agency – Air Ambulance |access-date=18 October 2009 |url-status=dead |archive-url=https://web.archive.org/web/20090603213633/http://www.highways.gov.uk/business/15658.aspx |archive-date=3 June 2009}} Helicopter and fixed-wing ambulances are discussed in greater detail at [[air ambulance]]. [40] => * '''[[Fixed-wing aircraft]]''' – These can be used for either acute emergency care in remote areas (such as in Australia, with the '[[Royal Flying Doctor Service of Australia|Flying Doctors]]'{{cite web|url=http://www.flyingdoctor.net/|title=Royal Flying Doctor Service of Australia|access-date=2 June 2007|publisher=Royal Flying Doctor Service of Australia|archive-url=https://web.archive.org/web/20070612073357/http://www.flyingdoctor.net/|archive-date=12 June 2007|url-status=dead}}), for patient transport over long distances (e.g. a re-patriation following an illness or injury in a foreign country{{cite web|url=http://www.heathrowairambulance.com/repatriation.html|title=Heathrow Air Ambulance Service|access-date=2 June 2007|publisher=Heathrow air ambulance|archive-url=https://web.archive.org/web/20070617031304/http://heathrowairambulance.com/repatriation.html|archive-date=17 June 2007|url-status=dead}}), or transportation between distant hospitals. Helicopter and fixed-wing ambulances are discussed in greater detail at [[air ambulance]]. [41] => * '''Boat''' – Boats can be used to serve as [[water ambulance]]s, especially in island areas{{cite news|url=http://news.bbc.co.uk/2/hi/uk_news/england/cornwall/3181602.stm|title=Islanders to get Ambulance Boat|publisher=BBC|access-date=18 October 2009 | date=10 October 2003}} or in areas with a large number of canals. Some [[Lifeboat (rescue)|lifeboat]]s or [[lifeguard]] vessels may fit the description of an ambulance as they are used to transport a casualty. [42] => * '''Train''' – In remote or hard-to-reach areas that are accessed primarily by [[railway]] connections, [[train]]s may be used to provide medical care as a mobile treatment facility or transport patients to better care in more accessible areas. These are generally called [[hospital train]]s. [43] => * '''Trailer''' – In some instances, a [[Trailer (vehicle)|trailer]], which can be towed behind a self-propelled vehicle, can be used as an ambulance. This permits flexibility in areas with minimal access to vehicles, such as on small islands.{{cite web |title=General Information – Medical Services |url=http://www.sark.info/index.cfm?fuseaction=gov.content&cmid=552 |url-status=dead |archive-url=https://web.archive.org/web/20120217064132/http://www.sark.info/index.cfm?fuseaction=gov.content&cmid=552 |archive-date=17 February 2012 |publisher=Isle of Sark Government}} [44] => * '''Horse and cart''' – Especially in the developing world, more traditional methods of transport include horse and cart, used in much the same way as motorcycle or bicycle stretcher units to transport to a local clinic. [45] => * '''[[Fire engine]]''' – Fire services (especially in North America) often train firefighters to respond to medical emergencies and most apparatuses carry at least basic medical supplies. By design, most apparatuses cannot transport patients unless they can sit in the cab. However, some fire trucks may be designed to have a large ambulance compartment behind the front of the cab, where the driver and officer's seats are located. [46] => [47] => === Vehicle type gallery === [48] => [49] => File:Washington DC Fire Department Ambulance 1.jpg|A [[Navistar]] truck ambulance operated by the [[District of Columbia Fire and Emergency Medical Services Department]] [50] => File:ToyotaHiaceKKM.jpg|A [[Toyota HiAce]] van ambulance operated by the [[Malaysia]] [[Ministry of Health (Malaysia)|Ministry of Health]] [51] => File:Amberg - Notarzt-PKW (Audi Avant, AM-RK70.jpg|An [[Audi A4|Audi A4 Avant]] [[nontransporting EMS vehicle]] operated by the [[German Red Cross]] [52] => File:Ambulance Motorbike (29274193644).jpg|A [[Honda ST series]] [[motorcycle ambulance]] operated by the [[London Ambulance Service]] [53] => File:NHS bicycle.jpg|A [[Cycle responder|paramedic bicycle]] operated by the London Ambulance Service [54] => File:2009-08 Przystanek Woodstock 3.jpg|An [[all-terrain vehicle]] ambulance with a [[Trailer (vehicle)|trailer]] operated by the [[Pol'and'Rock Festival]]'s Medical Patrol [55] => File:GRTW BFHB.JPG|A [[MAN Lion's City]] operated by the [[Bremen]] [[Feuerwehr]] [56] => File:Zepper-BK 117-C2-(EC145)-SchweizerischeRettungsflugwacht.jpg|A [[Eurocopter EC145]] helicopter [[air ambulance]] operated by [[Rega (air rescue)|Rega]] [57] => File:Royal Flying Doctor Service of Australia Central Operations (VH-FGS) Pilatus PC-12-45 at Wagga Wagga Airport.jpg|A [[Pilatus PC-12]] plane air ambulance operated by the [[Royal Flying Doctor Service]] [58] => File:Eyr Ytterholmen.jpg|A [[water ambulance]] operated by the [[Norwegian Society for Sea Rescue]] [59] => File:Surgeon Nikolay Pirogov 9.jpg|The "Surgeon [[Nikolay Pirogov]]" [[hospital train]] operated by [[Russian Railways]] [60] => File:Las Vegas Fire & Rescue 10 Paramedic (14415931546).jpg|A [[Pierce Manufacturing|Pierce Quantum]] operated by [[Las Vegas Fire & Rescue]]; note the "PARAMEDIC" text near the rear wheel [61] => [62] => [63] => ==Design and construction== [64] => [[File:Ambulance - Tokyo area - 2016-9-10.webm|thumb|left|An ambulance responding in [[Tokyo]], Japan]] [65] => [[File:MICU UZA Nationaal Defilé 2018.jpg|thumb|right|Truck-based ambulance in [[Antwerp]], Belgium]] [66] => 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 [[Auto mechanic|maintain the vehicle]]. [67] => [68] => Methods of summoning (e.g. telephone) and [[Dispatch (logistics)|dispatching]] ambulances usually rely on [[Electronics|electronic]] equipment, which itself often relies on an intact [[power grid]]. Similarly, modern ambulances are equipped with [[two-way radio]]s{{cite web|url=http://www.emergencyambulance.com/news-handheldradios.html |title=Handheld radios for Emergency Ambulance Service |date=16 January 2003 |access-date=28 June 2007 |publisher=Emergency Ambulance.com |url-status=dead |archive-url=https://web.archive.org/web/20070927020619/http://www.emergencyambulance.com/news-handheldradios.html |archive-date=27 September 2007}} or [[Mobile phone|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 oversight.{{cite news|url=http://www.cnn.com/TECH/computing/9904/07/lifelink.idg/index.html|title=New technology closes gap between accident victims and ER|publisher=CNN News|date=7 April 1999|access-date=27 June 2007}} [69] => [70] => Ambulances often have two stages of manufacturing. The first is frequently the manufacture of light or medium truck chassis-cabs or full-size vans (or in some places, cars) such as [[Mercedes-Benz]], [[Nissan]], [[Toyota]], or [[Ford Motor Company|Ford]].{{cite web|url=http://www.demers-ambulances.com/index.php?productId=50§ionId=95|archive-url=https://archive.today/20070619170810/http://www.demers-ambulances.com/index.php?productId=50§ionId=95|url-status=dead|archive-date=19 June 2007|title=Mystere – Chassis|publisher=Demers Ambulances|access-date=18 October 2009}} The second manufacturer (known as [[second stage manufacturer]]) modifies the vehicle (which is sometimes purchased [[Cutaway van chassis|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. [71] => [72] => Modern ambulances are typically powered by [[internal combustion engine]]s, which can be powered by any conventional fuel, including [[Diesel fuel|diesel]], gasoline or [[liquefied petroleum gas]],{{cite web|title=The Royal Air Force Motor Sports Association utilizes an LPG-powered ambulance|url=http://www.rafmsa.raf.mod.uk/rafmsa-text/rescue/rescue-front.htm|date=24 November 2005|access-date=2 June 2007|publisher=RAFMSA|archive-url=https://web.archive.org/web/20070701142554/http://www.rafmsa.raf.mod.uk/rafmsa-text/rescue/rescue-front.htm|archive-date=1 July 2007|url-status=dead}}{{cite web|title=The United States Air Force lists an LPG-powered ambulance on a 2001 vehicle roster|url=https://www.denix.osd.mil/denix/Public/Library/AFV/Reports/af_afv_report01.doc|date=13 November 2001|access-date=2 June 2007|format=DOC|archive-url=https://web.archive.org/web/20070614021105/https://www.denix.osd.mil/denix/Public/Library/AFV/Reports/af_afv_report01.doc|archive-date=14 June 2007|url-status=dead}} 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 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 (chemistry)|volatility]] in comparison to diesel fuel.{{cite web|title=National Highway Traffic Safety Administration, see campaign ID #s 87V111000 & 87V113000|url=http://www.nhtsa.dot.gov/|access-date=2 June 2007|publisher=NHTSA| archive-url= https://web.archive.org/web/20070530213217/http://www.nhtsa.dot.gov/| archive-date= 30 May 2007 | url-status= live}}{{cite web|title=Ford Ambulance/Van Fuel-Fed Fires|date=9 November 2002|url=http://www.autosafety.org/ford-ambulancevan-fuel-fed-fires|access-date=13 February 2010|publisher=Center for Auto Safety}} The type of engine may be determined by the manufacturer: in the past two decades, [[Ford Motor Company|Ford]]{{cite web|url=https://www.fleet.ford.com/showroom/specialty_vehicles/Ambulance_DisplayContent-Specs.asp?VehicleID=3|title=2006 Ford E-Series Cutaway Chassis: Specifications|access-date=2 June 2007|publisher=Ford|archive-date=21 November 2018|archive-url=https://web.archive.org/web/20181121021803/https://www.fleet.ford.com/showroom/specialty_vehicles/Ambulance_DisplayContent-Specs.asp?VehicleID=3|url-status=dead}}{{cite web|url=https://www.fleet.ford.com/showroom/specialty_vehicles/Ambulance_DisplayContent-Specs.asp?VehicleID=1|title=2006 Ford F-Series Super Duty Chassis Cab Ambulance: Specifications|access-date=2 June 2007|publisher=Ford|archive-date=20 November 2018|archive-url=https://web.archive.org/web/20181120221014/https://www.fleet.ford.com/showroom/specialty_vehicles/Ambulance_DisplayContent-Specs.asp?VehicleID=1|url-status=dead}}{{cite web|url=https://www.fleet.ford.com/showroom/specialty_vehicles/Ambulance_DisplayContent-Specs.asp?VehicleID=2|title=2006 Ford E-Series Van Ambulance: Specifications|access-date=2 June 2007|publisher=Ford|archive-date=21 November 2018|archive-url=https://web.archive.org/web/20181121021905/https://www.fleet.ford.com/showroom/specialty_vehicles/Ambulance_DisplayContent-Specs.asp?VehicleID=2|url-status=dead}} would only sell vehicles for ambulance conversion if they are diesel-powered. Beginning in 2010, Ford will sell its ambulance chassis with a gasoline engine in order to meet emissions requirements.{{cite web|url=http://www.jems.com/news_and_articles/articles/ford_to_offer_gasoline_ambulances_in_2010.html|title=Ford to Offer Gasoline Ambulances in 2010|author=James Philips|access-date=10 July 2009|archive-date=16 April 2009|archive-url=https://web.archive.org/web/20090416073953/http://www.jems.com/news_and_articles/articles/ford_to_offer_gasoline_ambulances_in_2010.html?|url-status=dead}} [73] => [74] => In the United Kingdom, the National Health Service has set a target for all ambulances to be fully electric as part of the Net Zero campaign by 2045.{{Cite news |last=Searles |first=Michael |last2=Donnelly |first2=Laura |date=2024-03-15 |title=Net zero ambulances could cost NHS half a billion pounds |url=https://www.telegraph.co.uk/news/2024/03/15/nhs-net-zero-ambulance-plans-cost-halfabillionpounds/ |access-date=2024-04-21 |work=The Telegraph |language=en-GB |issn=0307-1235}} [75] => {{clear left}} [76] => [77] => ===Standards=== [78] => [[File:Ambulance lane.jpg|thumb|upright|An ambulance [[lane]] in [[Warsaw]], Poland]] [79] => 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. [80] => [81] => 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]] and known as KKK-A-1822.{{cite journal |author =Vogt F |title=Equipment: Federal Specification, Ambulance KKK-A-1822 |journal=Emerg Med Serv |volume=5 |issue=3 |pages=58, 60–64 |year=1976 |pmid=1028572 }} This standard has been revised several times, and is currently in version 'F' change notice #13, known as KKK-A-1822F. The [[National Fire Protection Association]] has also published a design standard, [[NFPA 1917]], which offers an alternative to KKK-A-1822F.{{cite web|first=Dean|last=Cole|publisher=Nebraska EMS/Trauma Program|access-date=24 May 2013|url=http://dhhs.ne.gov/publichealth/NebraskaEMS/Documents/Ambulance%20Vehicle%20Design%20Specifications%20Revision.pdf|year=2013|title=Ambulance Vehicle Design Specifications Revision|archive-url=https://web.archive.org/web/20150430113312/http://dhhs.ne.gov/publichealth/NebraskaEMS/Documents/Ambulance%20Vehicle%20Design%20Specifications%20Revision.pdf|archive-date=30 April 2015|url-status=dead}} The Commission on Accreditation of Ambulance Services (CAAS) has published its Ground Vehicle Standard for Ambulances v2.0, effective July 2019. This standard is similar to the KKK-A-1822F and NFPA 1917–2019 specifications. The decision on which of the current (3) standards to require is left up to each individual state legislature or EMS director. Some states have no specific requirement, while others specify which standard is acceptable. Others, yet, allow the end user to decide which standard to comply to. [82] => [83] => In the United States and Canada, there are four types of ambulances: Type I, Type II, Type III, and Type IV. Type I is based on a [[heavy truck]] chassis-cab with a custom rear compartment that is often referred to as a "box" or "module", primarily used for Advanced Life Support (ALS) or Mobile Intensive Care Unit (MICU), as well as rescue work. Type II is based on a commercial heavy-duty van with few modifications except for a raised roof and a secondary air conditioning unit for the rear of the vehicle, primarily used for Basic Life Support (BLS) and transfer of patients, though they are occasionally also used for ALS and rescue. Type III is a van chassis-cab with a custom-made rear compartment, used for ALS and rescue. Type IV is for ''ad hoc'' patient transfer using smaller utility vehicles selected for maneuverability in special environments such as dense crowds at events; these are uncommon and are not subject to federal regulations in the United States.{{cite web |title=Index of Federal Specifications, Standards, and Commercial Item Descriptions |url=https://www.gsa.gov/buying-selling/purchasing-programs/requisition-programs/gsa-global-supply/supply-standards/index-of-federal-specifications-standards-and-commercial-item-descriptions |website=gsa.gov}}{{cite web |title=Ambulances – Type I, Type II, Type III and Type IV Ambulances |url=http://metronixinc.com/site/ambulances.html |website=metronixinc.com}}{{cite web |title=Untitled Page |url=https://ntea.com/WorkArea/DownloadAsset.aspx?id%3D1342 |url-status=dead |archive-url=https://web.archive.org/web/20141104202923/https://ntea.com/WorkArea/DownloadAsset.aspx?id=1342 |archive-date=4 November 2014 |access-date=2013-12-17}} [84] => [85] => 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.{{cite news|work=The Statesman|url=http://www.thestatesman.net/index.php?option=com_content&view=article&id=459973&catid=36|archive-url=https://archive.today/20130620012756/http://www.thestatesman.net/index.php?option=com_content&view=article&id=459973&catid=36|url-status=dead|archive-date=20 June 2013|title=Ministry gives its nod to national ambulance code|date=7 June 2013}} [86] => [87] => ===Safety=== [88] => [[File:Crash Testing an Ambulance.webm|thumb|A video on ambulance crash testing]] [89] => Ambulances, like other [[emergency vehicles]], are required{{citation needed|date=October 2018}} to operate in most 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 belt]]s. Research has shown that ambulances are more likely to be involved in [[Car accident|motor vehicle collisions]] resulting in injury or death than either [[fire truck]]s or [[police car]]s. Unrestrained occupants, particularly those riding in the patient-care compartment, are particularly vulnerable.{{cite journal |vauthors=Becker LR, Zaloshnja E, Levick N, Li G, Miller TR |title=Relative risk of injury and death in ambulances and other emergency vehicles |journal=Accid Anal Prev |volume=35 |issue=6 |pages=941–948 |date=November 2003 |pmid=12971929 |doi=10.1016/S0001-4575(02)00102-1}} 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.{{cite journal |vauthors=Ray AF, Kupas DF |s2cid=22922599 |title=Comparison of crashes involving ambulances with those of similar-sized vehicles |journal=Prehosp Emerg Care |volume=9 |issue=4 |pages=412–415 |date=October–December 2005 |pmid=16263674 |doi=10.1080/10903120500253813}} An 11-year retrospective study concluded in 2001 found that although most fatal ambulance crashes in the United States occurred during emergency runs, they typically occurred on improved, straight, dry roads, during clear weather.{{cite journal |vauthors=Kahn CA, Pirrallo RG, Kuhn EM |s2cid=24097668 |title=Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective analysis |journal=Prehosp Emerg Care |volume=5 |issue=3 |pages=261–269 |date=July 2001 |pmid=11446540|doi=10.1080/10903120190939751}} 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.{{cite web|url=http://www.dexigner.com/news/7262|title=New Ambulance Design Protects Paramedics|access-date=17 October 2009|publisher=WESH News|archive-url=https://web.archive.org/web/20131114043358/http://www.dexigner.com/news/7262|archive-date=14 November 2013|url-status=dead}} [90] => [91] => ===Equipment=== [92] => [[File:Ambulance Interior Details.jpg|thumb|right|Interior of a mobile intensive care unit (MICU) ambulance from [[Graz]], Austria]] [93] => [[File:Tail lift deploy.png|Four stages of deployment on an inboard ambulance [[tail lift]]|thumb|right]] [94] => In addition to the equipment directly used for the treatment of patients, ambulances may be fitted with a range of additional equipment which is used in order to facilitate patient care. This could include: [95] => * '''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]].{{cite web |url=https://www.motorola.com/staticfiles/Business/_Documents/Case%20studies/_Static%20files/case%20study%20ireland%20nationwide.pdf?localeId=252 |archive-url=https://wayback.archive-it.org/all/20120916002339/http://www.motorola.com/staticfiles/Business/_Documents/Case%20studies/_Static%20files/case%20study%20ireland%20nationwide.pdf?localeId=252 |url-status=dead |archive-date=16 September 2012 |title=Motorola and Tetra Ireland Consortium Deliver National Public Safety Network |publisher=Motorola |access-date=19 October 2009}} [96] => * '''[[Mobile data terminal]]''' – Some ambulances are fitted with [[mobile data terminal]]s (or MDTs), which are connected wirelessly to a central computer, usually at the control center. These terminals can function instead of or alongside the two-way radio and can be used to pass details of jobs to the crew, and can log the time the crew was mobile to a patient, arrived, and left the scene, or fulfill any other computer-based function.{{cite web|url=http://www.microbus.com/Mobile_Data/Market/Public_Safety.aspx |title=MDT Market Sectors |publisher=Microbus |access-date=13 June 2007 |url-status=dead |archive-url=https://web.archive.org/web/20100327104206/http://microbus.com/Mobile_Data/Market/Public_Safety.aspx |archive-date=27 March 2010}} [97] => * '''Evidence gathering [[CCTV]]''' – Some ambulances are now being fitted with video cameras used to record activity either inside or outside the vehicle. They may also be fitted with sound recording facilities. This can be used as a form of protection from violence against ambulance crews,{{cite news|url=http://news.bbc.co.uk/1/hi/england/merseyside/3925661.stm|title=CCTV to protect ambulance staff|date=26 July 2004|access-date=13 June 2007|work=BBC News}} or in some cases (dependent on local laws) to prove or disprove cases where a member of the crew stands accused of [[malpractice]]. [98] => * '''[[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 bed]]s. There may also be equipment linked to this such as [[winch]]es which are designed to pull heavy patients into the vehicle.{{cite web|url=http://www.rossandbonnyman.co.uk/specialist-lifts.html#aa|title=Ambulance Lifts|publisher=Ross and Bonnyman|access-date=27 June 2007|archive-url=https://web.archive.org/web/20070701055836/http://www.rossandbonnyman.co.uk/specialist-lifts.html#aa|archive-date=1 July 2007|url-status=dead}} [99] => * '''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 [[photosensitivity|photosensitive]]. [100] => * '''[[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 [[filter (air)|filter]]ing against airborne pathogens. [101] => * '''Data recorders''' – These are often placed in ambulances to record such information as speed, braking power and time, activation of active emergency warnings such as lights and sirens, as well as seat belt usage. These are often used in coordination with [[GPS]] units.{{cite web|url=http://www.inmotiontechnology.com/newsevents/roadsafety.html |title=Press Releases |url-status=dead |archive-url=https://web.archive.org/web/20110713035514/http://www.inmotiontechnology.com/newsevents/roadsafety.html |archive-date=13 July 2011}} [102] => [103] => ===Intermediate technology=== [104] => In parts of the world that 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 ambulance]]s) are also used, though they are subject to some of the same limitations as more traditional over-the-road ambulances. The level of care provided by these ambulances varies between merely providing transport to a medical clinic to providing on-scene and continuing care during transport. [105] => [106] => The design of intermediate technology ambulances must take into account not only the operation and maintenance of the ambulance, but its construction as well. The robustness of the design becomes more important, as does the nature of the skills required to properly operate the vehicle. Cost-effectiveness can be a high priority.{{cite journal | last1=Hofman | first1=Jan J. | last2=Dzimadzi | first2=Chris | last3=Lungu | first3=Kingsley | last4=Ratsma | first4=Esther Y. | last5=Hussein | first5=Julia | title=Motorcycle ambulances for referral of obstetric emergencies in rural Malawi: Do they reduce delay and what do they cost? | journal=International Journal of Gynecology & Obstetrics | publisher=Wiley | volume=102 | issue=2 | date=2008-06-16 | issn=0020-7292 | doi=10.1016/j.ijgo.2008.04.001 | pages=191–197| pmid=18555998 | s2cid=26227283 }} [107] => [108] => ==Appearance and markings== [109] => Emergency ambulances are highly likely to be involved in hazardous situations, including incidents such as a [[Car accident|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'),{{cite web|url=http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h08_e.htm#BK213|title=Ontario Highway Traffic Act|year=2009|pages=Section 144.20|access-date=19 November 2009| archive-url= https://web.archive.org/web/20091122043253/http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h08_e.htm| archive-date= 22 November 2009 | url-status= live}} or be permitted to break the speed limit.{{cite web|url=http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h08_e.htm#BK193|title=Ontario Highway Traffic Act|publisher=Province of Ontario|pages=Section 128.0.13|access-date=19 November 2009| archive-url= https://web.archive.org/web/20091122043253/http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h08_e.htm| archive-date= 22 November 2009 | url-status= live}} 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,{{cite web|url=http://www.caep.ca/template.asp?id=98758372CC0F45FB826FFF49812638DD#4%29%20TRIAGE%20&%20ACUITY%20SCALE%20CATEGORY%20DEFINITIONS |title=CTAS Category Definitions |work=Implementation Guidelines for the Canadian ED Triage & Acuity Scale (CTAS) |publisher=Canadian Association of Emergency Physician |access-date=19 November 2009 |url-status=dead |archive-url=https://web.archive.org/web/20100921192755/http://caep.ca/template.asp?id=98758372CC0F45FB826FFF49812638DD |archive-date=21 September 2010}} and because of this need, emergency ambulances are often fitted with passive and active visual and/or audible warnings to alert road users. [110] => [111] => ===Passive visual warnings=== [112] => {{multiple image|perrow = 3|total_width=420 [113] => | align = right [114] => | direction = horizontal [115] => | image1 = Star of life2.svg [116] => | image2 = Flag_of_the_Red_Cross.svg [117] => | image3 = Flag_of_the_Red_Crescent.svg [118] => | image5 = Maltese_cross.svg [119] => | image6 = Battenburg-ambulance.svg [120] => | footer = Various symbols for identifying ambulances:
'''Top:''' The [[Star of Life]], the [[International Red Cross and Red Crescent Movement|Red Cross]], the [[International Red Cross and Red Crescent Movement|Red Crescent]]
'''Bottom:''' The [[Maltese Cross]], [[Battenburg markings]] [121] => }} [122] => [123] => 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 [[Retroreflector|retro-reflective]] designs, which reflects light from car headlights or torches. Popular patterns include 'checker board' (alternate coloured squares, sometimes called '[[Battenburg markings|Battenburg]]', named after a [[Battenberg cake|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 [[Fluorescence|fluorescent]]) yellow or orange for maximum visual impact, though classic white or red are also common. Fire department-operated ambulances are often painted red to match the fire apparatuses.{{citation needed|date=April 2021}} [124] => [125] => 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 mirror]]s. Ambulances may display the name of their owner or operator, and an [[emergency telephone number]] for the ambulance service. [126] => [127] => [[File:NSW Ambulance Australia.png|thumb|An ambulance in [[New South Wales]], Australia with warped Battenburg markings, the Maltese Cross, and additional fluorescent reflective stripes to aid in visibility. Also visible are its emergency lights.]] [128] => 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 [[Emblems of the Red Cross|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.{{cite book |last1=Dromi |first1=Shai M. |title=Above the fray: The Red Cross and the making of the humanitarian NGO sector |date=2020 |publisher=Univ. of Chicago Press |location=Chicago |isbn=978-0226680101 |pages=55–56 |url=https://press.uchicago.edu/ucp/books/book/chicago/A/bo46479924.html}} 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.{{citation needed|date=April 2021}} [129] => [130] => The [[Star of Life]] is widely used, and was originally designed and governed by the U.S. [[National Highway Traffic Safety Administration]],{{cite web|url=http://www.ems.gov/vgn-ext-templating/ems/sol/pages/Contents.htm|title=Star of Life DOT HS 808 721|publisher=National Highway Safety Administration|access-date=19 November 2009}} because the Red Cross symbol is legally protected by both National{{cite web|url=http://www.redcross.ca/article.asp?id=000340&tid=019 |title=The Red Cross Emblem |publisher=The Canadian Red Cross |access-date=19 November 2009 |url-status=dead |archive-url=https://web.archive.org/web/20100111081703/http://www.redcross.ca/article.asp?id=000340&tid=019 |archive-date=11 January 2010}} and international{{cite web|title=The Emblems|date=28 December 2015|url=https://www.icrc.org/en/document/emblems|url-status=live|access-date=28 December 2015|publisher=International Committee of the Red Cross|archive-url=https://web.archive.org/web/20170701024007/https://www.icrc.org/en/document/emblems |archive-date=1 July 2017 }}{{cite web|url=http://www.icrc.org/Web/eng/siteeng0.nsf/htmlall/genevaconventions|title=The Geneva Convention of 1949|publisher=International Committee of the Red Cross|access-date=19 November 2009| archive-url= https://web.archive.org/web/20091122011212/http://www.icrc.org/Web/Eng/siteeng0.nsf/htmlall/genevaconventions| archive-date= 22 November 2009 | url-status= live}} law. [131] => [132] => Ambulance services with historical origins such as the [[Venerable Order of Saint John|Order of St John]], the [[Order of Malta Ambulance Corps]]{{Cite web|url=https://orderofmaltaireland.org/|title=Order of Malta Charity Ireland}} and [[Malteser International]] often use the [[Maltese cross]] to identify their ambulances. This is especially important in countries such as Australia, where [[St. John Ambulance]] operate one state and one territory ambulance service, and all of Australia's other ambulance services use variations on a red Maltese cross.{{cite web|url=http://www.ambulance.qld.gov.au/about/default.asp|title=About Queensland Ambulance Service|access-date=27 June 2007| archive-url= https://web.archive.org/web/20070706071845/http://www.ambulance.qld.gov.au/about/default.asp| archive-date= 6 July 2007 | url-status= live}}{{cite web|url=http://www.ambulance.act.gov.au/|title=ACT Ambulance Service|access-date=27 June 2007|archive-url=https://web.archive.org/web/20070630131352/http://www.ambulance.act.gov.au/|archive-date=30 June 2007|url-status=dead}}{{cite web|url=http://www.asnsw.health.nsw.gov.au/|title=Ambulance Service of New South Wales|access-date=27 June 2007 |archive-url = https://web.archive.org/web/20070607030731/http://www.asnsw.health.nsw.gov.au/index.html |archive-date = 7 June 2007}}{{cite web|url=http://www.saambulance.com.au/|title=South Australian Ambulance Service|access-date=27 June 2007|archive-url=https://web.archive.org/web/20070625084647/http://www.saambulance.com.au/|archive-date=25 June 2007|url-status=dead}} [133] => [134] => [[Fire service]] operated ambulances may display the Cross of [[Saint Florian|St. Florian]] (often incorrectly called a Maltese cross) as this cross is frequently used as a fire department logo (St. Florian being the patron saint of [[firefighter]]s).{{cite web|url=http://www.saintflorian.net/index.html|title=St. Florian – Patron Saint of Firefighters|access-date=3 June 2007|publisher=stflorian.net|archive-url=https://web.archive.org/web/20070927201655/http://www.saintflorian.net/index.html|archive-date=27 September 2007|url-status=dead}} [135] => [136] => ===Active visual warnings=== [137] => {{Main|Emergency vehicle lighting}} [138] => {{See also | Emergency vehicle equipment}} [139] => [140] => [[File:DNK ambulance A6.jpg|thumb|An ambulance in Denmark with roof-integrated LED lights, plus side-view mirror, grill and front fend-off lights, and fog lamps wig-wags]] [141] => The active visual warnings are usually in the form of flashing lights. These flash in order to attract the attention of other road users as the ambulance approaches, or to provide warning to motorists approaching a stopped ambulance in a dangerous position on the road. Common colours for ambulance warning beacons are blue, red, amber, and white (clear). However the colours may vary by country and sometimes by operator.{{citation needed|date=April 2021}} [142] => [143] => There are several technologies in use to achieve the flashing effect. These include flashing a [[Incandescent light bulb|light bulb]] or [[Light-emitting diode|LED]], flashing or rotating [[halogen light|halogen]], and [[strobe light]]s, 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.{{citation needed|date=April 2021}} [144] => [145] => 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. [[headlamp]]s, tail lamps) may be programmed to flash. Flashing headlights (typically the high beams, flashed alternately) are known as a [[wig-wag (automobile)|wig-wag]].{{citation needed|date=April 2021}} Additional white lights may be placed strategically around the vehicle to illuminate the area around it when it is dark, almost always at the rear for loading and unloading stretchers and often at the sides as well. In areas very far North or South where there are times of year with long periods of darkness, additional driving lights at the front are often fitted as well to increase visibility for the driver. [146] => [147] => 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 and rear 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.{{citation needed|date=April 2021}} [148] => [149] => ===Audible warnings=== [150] => {{Main|Emergency vehicle equipment#Audible Warning Devices (Sirens)|l1=Audible warning devices}} [151] => [152] => [[File:Whelen.ogg|thumb|right|A [[Whelen Engineering Company]] siren with ''wail'', ''yelp'' and ''phaser'' tones, commonly used by [[emergency vehicle]]s such as ambulances in several countries]] [153] => In addition to visual warnings, ambulances can be fitted with '''audible warnings''', sometimes known as [[siren (noisemaker)|siren]]s, which can alert people and vehicles to the presence of an ambulance before they can be seen. The first audible warnings were mechanical bells, mounted to either the front or roof of the ambulance. Most modern ambulances are now fitted with electronic sirens, producing a range of different noises which ambulance operators can use to attract more attention to themselves, particularly when proceeding through an intersection or in heavy traffic.{{cite book|others=The Canadian Red Cross|title=Emergency Care Manual|publisher=The StayWell Health Company|location=Guelph, ON|year=2008|page=359|chapter=23|isbn=978-1584804048}}. [154] => [[File:St John ambulance Dunedin.jpg|thumb|A [[St. John Ambulance in New Zealand|St. John Ambulance]] responding through traffic in New Zealand]] [155] => 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 air horns as their primary siren. [156] => [157] => A recent{{when|date=February 2024}} development is the use of the [[Radio Data System|RDS]] system of [[Car audio|car radios]]. The ambulance is fitted with a short range [[Frequency modulation|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).{{cite web|url=http://www.freepatentsonline.com/y2003/0164775.html|title=Emergency warning device – patent application|access-date=19 November 2009}} 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.{{cite book|last=Wright|first=Scott|title=The Broadcaster's Guide to RDS|publisher=Butterworth-Heineman|location=Woburn, MA|year=1997|page=73|isbn=0240802780|url=https://books.google.com/books?id=MX0nKoHTQ_4C&q=RDS%20Code%2031&pg=PA47}} [158] => [159] => ==Costs== [160] => [[File:American Medical Response AMR Ford Transit Ambulance (52794460376).jpg|thumb|A [[Ford Transit]] ambulance operated by [[American Medical Response]], a privately-funded service operating in parts of the United States]] [161] => [[File:Wellington Free Ambulance 430.jpg|thumb|A [[Mercedes-Benz Sprinter]] ambulance operated by [[Wellington Free Ambulance]], a charity-funded service in [[Wellington]], New Zealand]] [162] => The cost of an ambulance ride may be paid for from several sources, and this will depend on the local situation type of service being provided, by whom, and to whom. [163] => * '''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).{{cite web|url=http://www.health.gov.on.ca/english/public/pub/ohip/amb.html|title=OHIP:Ambulance Services Billing|publisher=Ontario Ministry of Health and Long-Term Care|access-date=19 November 2009}} [164] => * '''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.{{cite web|url=http://www.amr.net/Patients-and-Family-Members/Payment-Policy.aspx|title=Payment Policy|publisher=American Medical Response|access-date=19 November 2009|archive-date=5 July 2011|archive-url=https://web.archive.org/web/20110705060624/http://amr.net/Patients-and-Family-Members/Payment-Policy.aspx|url-status=dead}} [165] => * '''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.{{cite web|url=http://www.yorkshireairambulance.org.uk/|title=Yorkshire Air Ambulance Charity|access-date=19 November 2009| archive-url= https://web.archive.org/web/20091125202654/http://www.yorkshireairambulance.org.uk/| archive-date= 25 November 2009 | url-status= live}} [166] => * '''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).{{cite web|url=https://vic.pvhs.org/portal/page?_pageid=333,429645&_dad=portal&_schema=PORTAL&pagid=108|title=Ambulance Services|access-date=19 November 2009|url-status=dead|archive-url=https://web.archive.org/web/20071025072438/https://vic.pvhs.org/portal/page?_pageid=333%2C429645&_dad=portal&_schema=PORTAL&pagid=108|archive-date=25 October 2007}} [167] => [168] => ==Crewing== [169] => 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). 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 technician, or in countries like Australia advanced life support registered paramedics. [170] => [171] => Common ambulance crew qualifications are: [172] => * '''[[Certified first responder|First responder]]''' – A person who arrives first at the scene of an incident,{{cite web|url=http://www.resus.org.uk/pages/FirstRsp.htm|title=Role of the First Responder|access-date=2 June 2007|publisher=Resuscitation Council UK| archive-url= https://web.archive.org/web/20070529155100/http://www.resus.org.uk/pages/FirstRsp.htm| archive-date= 29 May 2007 | url-status= live}} 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. They may be on duty for another agency, or volunteers who are on-call during their free time. [173] => * '''Ambulance driver''' – Some services employ staff with no medical qualification (or just basic first aid training) whose job is to simply drive the vehicle. In some emergency ambulance contexts this term is a pejorative towards personnel with higher medical training, as it implies they perform no function other than driving, although it may be acceptable for patient transport or community operations. Ambulance drivers may also have training in using the radio and knowing where medical supplies are stored in the ambulance. [174] => * '''Non-emergency attendant''' – This role has different 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.{{cite web|url=http://www.nhscareers.nhs.uk/details/Default.aspx?Id=907|title=Ambulance Care Assistant Role|access-date=1 November 2009|publisher=nhs| archive-url= https://web.archive.org/web/20091125230105/http://www.nhscareers.nhs.uk/details/Default.aspx?Id=907| archive-date= 25 November 2009 | url-status= live}} 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. [175] => * '''[[Emergency care assistant]]''' – 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. [176] => * '''[[Emergency medical technician]]''' – 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 [[Emergency medical technician - basic|EMT-Basic]] and [[Emergency medical technician - intermediate|EMT-Intermediate]]).{{cite web|url=http://bhpr.hrsa.gov/kidscareers/emt.htm|title=US Government Careers advice on EMT|access-date=2 June 2007|archive-url=https://web.archive.org/web/20070607123558/http://bhpr.hrsa.gov/kidscareers/emt.htm|archive-date=7 June 2007|url-status=dead}} [177] => * '''[[Registered nurse]]''' – In some systems, nurses are the primary providers of advanced-level care on ambulances, often in place of paramedics. This includes [[Estonia]], the [[Netherlands]],{{cite journal |author=Wulterkens D |title=EMS in the Netherlands: A Dutch Treat? |journal=Journal of Emergency Medical Services |date=6 December 2005 |url=http://m.jems.com/article/operations-protcols/ems-netherlands-dutch-treat |access-date=30 September 2019 |archive-date=17 February 2015 |archive-url=https://web.archive.org/web/20150217201958/http://m.jems.com/article/operations-protcols/ems-netherlands-dutch-treat |url-status=dead }} [[Sweden]]{{cite journal |author=Suserud B |title=A new profession in the pre-hospital care field: the ambulance nurse |journal=Nursing in Critical Care |volume=10 |issue=6 |pages=269–271 |year=2005 |pmid= 16255333|doi=10.1111/j.1362-1017.2005.00129.x|doi-access=free }} and [[Spain]].{{cite journal |url=https://www.boe.es/buscar/doc.php?id=BOE-A-2012-7655 |title=Real Decreto 836/2012, de 25 de mayo, por el que se establecen las características técnicas, el equipamiento sanitario y la dotación de personal de los vehículos de transporte sanitario por carretera |trans-title=Royal Decree 836/2012, of 25 May, which establishes the technical characteristics, the sanitary equipment and the staffing of the vehicles of sanitary transport by road |language=es |journal=Boletín Oficial del Estado |volume=137 |date=8 June 2012 |pages=41589–41595 }} Nurses may also work on ambulances for critical care transport. [178] => * '''[[Paramedic]]''' – This is a high level of medical training and usually involves key skills not permissible for technicians, such as [[Intravenous therapy|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]].{{cite book|title=National Occupational Competency Profile|publisher=Paramedic Association of Canada|year=2001|pages=96–97|url=http://www.paramedic.ca/Content.aspx?ContentID=4&ContentTypeID=2|access-date=19 November 2009|archive-date=5 October 2011|archive-url=https://web.archive.org/web/20111005010014/http://www.paramedic.ca/Content.aspx?ContentID=4&ContentTypeID=2|url-status=dead}} Dependent on jurisdiction, the title "paramedic" can be a protected title, and use of it without the relevant qualification may result in criminal prosecution.{{cite web|url=http://www.hpc-uk.org/aboutregistration/protectedtitles/|title=UK Health Care Professionals Council advice on use of protected titles|access-date=2 June 2007|publisher=Health care Professionals council|archive-url=https://web.archive.org/web/20181107140106/http://www.hpc-uk.org/aboutregistration/protectedtitles/|archive-date=7 November 2018|url-status=dead}} [179] => * '''[[Emergency care practitioner]]''' – This position 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,{{cite web|url=http://www.swast.nhs.uk/careersandvac/careers.htm#ECP|title=Definition of an Emergency Care Practitioner|access-date=2 June 2007|publisher=South West Ambulance Service|archive-url=https://web.archive.org/web/20070517154015/http://www.swast.nhs.uk/careersandvac/careers.htm#ECP|archive-date=17 May 2007|url-status=dead}} and are trained to prescribe medicines for longer-term care, such as antibiotics, as well as being trained in a range of additional diagnostic techniques. [180] => * '''[[Physician assistant]]''' – Physician Assistants are found predominately in English-speaking countries and may also be known as physician associates in some countries. PA's mirror the practice of a physician and are capable of providing the range of medical skills a physician provides. They generally work in collaboration with a physician, although in an ambulance environment this may not be possible. Instead, advanced directives or electronic communication is available to PA's to consult with physicians when required. [181] => * '''[[Physician]]''' – In some systems such as the [[Emergency medical services in France|SAMU in France]], it is common for doctors to staff ambulances. On the other hand, this is rare in systems that rely heavily on paramedics or field nurses. In those cases, doctors may be present in specialist ambulance units – most notably the [[Air medical services|air ambulances]]. Alternatively, in some systems, such as Albuquerque, NM and Pittsburgh, PA, physicians are available to respond to serious cases via a fly car.{{cite web|url=https://hsc.unm.edu/medicine/departments/emergency-medicine/programs/prehospital-care/ems-consortium/pefr/|title=EMS Physician Scene Response Program|access-date=1 November 2020|publisher=UNM}}{{cite web|url=http://www.londonsairambulance.com/SecureStore/welcome.aspx?Q1788=30&J847=x30&A988=&NL477=&F=&G=&C=&SC=&S9=0&UT1=&R=1&S=&RE=www.londonsairambulance.com&D=32|title=London Air Ambulance Crew List|access-date=1 November 2009|publisher=London Air Ambulance|archive-url=https://web.archive.org/web/20091208044829/http://www.londonsairambulance.com/SecureStore/welcome.aspx?Q1788=30&J847=x30&A988=&NL477=&F=&G=&C=&SC=&S9=0&UT1=&R=1&S=&RE=www.londonsairambulance.com&D=32|archive-date=8 December 2009|url-status=dead}}{{cite web|url=http://www.surreyairambulance.co.uk/|title=Surrey Air Ambulance|access-date=1 November 2009|publisher=Surrey Air Ambulance| archive-url= https://web.archive.org/web/20091006000749/http://www.surreyairambulance.co.uk/| archive-date= 6 October 2009 | url-status= live}} [182] => [183] => ==Military use== [184] => [[File:Survivor ambulance.jpg|left|thumb|An [[RMMV Survivor R]] in ambulance configuration.]] [185] => [[File:VAMTAC ambulancia.JPG|thumb| 150px|An [[URO VAMTAC]] ambulance of the [[Spanish Army]] emblazoned with the [[Emblems of the Red Cross|Red Cross]]]] [186] => [[File:World War I ambulance Pittsburgh 20th Century Club.png|thumb|left|1917 Red Cross ambulance]] [187] => [188] => Military ambulances have historically included vehicles based on civilian designs and at times also included armored, but unarmed, vehicle ambulances based upon [[armoured personnel carrier]]s (APCs). In the [[World War II|Second World War]] vehicles such as the Hanomag [[Sd.Kfz. 251|Sd Kfz 251]] half-track were pressed into service as ad hoc ambulances{{citation needed|date=April 2021}}, 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 colors, depending on the operational requirements (i.e. camouflage for field use, white for [[United Nations peacekeeping]], etc.). For example, the British [[Royal Army Medical Corps]] has a fleet of white ambulances, based on production trucks.{{citation needed|date=April 2021}} Military helicopters have also served both as ad hoc and purpose-built air ambulances since they are extremely useful for [[MEDEVAC]].{{cite web|url=http://www.century-of-flight.freeola.com/Aviation%20history/helicopter%20history/M.A.S.H.%20Medevac%20Helicopters.htm|title=M.A.S.H. medevac helicopters|access-date=2 June 2007| archive-url= https://web.archive.org/web/20070617052953/http://www.century-of-flight.freeola.com/Aviation%20history/helicopter%20history/M.A.S.H.%20Medevac%20Helicopters.htm| archive-date= 17 June 2007 | url-status= live}} 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. [189] => [190] => Since [[laws of war]] demand ambulances be marked with one of the [[Emblems of the Red Cross]] not to mount offensive [[weapon]]s, military ambulances are often unarmed.{{cite web|url=http://www.icrc.org/ihl.nsf/CONVPRES?OpenView|title=International Committee of the Red Cross policy on usage|access-date=2 June 2007|publisher=International committee of the Red Cross| archive-url= https://web.archive.org/web/20070706014427/http://www.icrc.org/IHL.nsf/CONVPRES?OpenView| archive-date= 6 July 2007 | url-status= live}} It is a generally accepted practice in most countries to classify the personnel attached to military vehicles marked as ambulances as [[non-combatant]]s; however, this does not always exempt medical personnel from coming under fire{{snd}}accidental or deliberate. As a result, medics and other medical personnel attached to military ambulances are usually put through basic [[military training]],{{cite web|url=http://www.armyjobs.mod.uk/jobs/pages/JobExplorerResults.aspx?category=6|title=UK Army information on basic training for medical personnel|access-date=1 November 2009|publisher=British Army|archive-url=https://web.archive.org/web/20090917085424/http://www.armyjobs.mod.uk/jobs/pages/JobExplorerResults.aspx?category=6|archive-date=17 September 2009}} on the assumption that they may have to use a weapon. The laws of war do allow non-combatant military personnel to carry individual weapons for protecting themselves and casualties. However, not all militaries exercise this right to their personnel. [191] => [192] => [[File:USNS Mercy T-AH-19.jpg|[[USNS Mercy (T-AH-19)|USNS ''Mercy'']], a U.S. Navy hospital ship|thumb|left]] [193] => The [[Israel Defense Forces|Israeli Defense Forces]] modified a number of its [[Merkava]] [[main battle tank]]s with ambulance features in order to allow rescue operations to take place under heavy fire in [[urban warfare]].{{cite web|url=http://www.defense-update.com/products/m/merkava-lic.htm|title=LIC Modeled Merkava Mk-3 Baz / Mk 4|access-date=2 June 2007|publisher=Defense Update |date=July 27, 2006|archive-url=https://web.archive.org/web/20070627140305/http://www.defense-update.com/products/m/merkava-lic.htm|archive-date=27 June 2007|url-status=dead}} The modifications were made following a failed rescue attempt in which [[Palestinian people|Palestinian]] gunmen killed two soldiers who were providing aid for a Palestinian woman in [[Rafah]].{{cite news|url=http://news.bbc.co.uk/1/hi/world/middle_east/3713585.stm|title=Three dead in fresh Gaza clashes|access-date=2 June 2007|work=BBC News | date=14 May 2004}} Since [[M113 armored personnel carrier|M-113]] armored personnel carriers and regular up-armored ambulances are not sufficiently protected against [[anti-tank]] weapons and [[improvised explosive device]]s,{{cite web|url=http://www.inetres.com/gp/military/cv/inf/M113.html|title=Technical data on armament of M113 APC Ambulance|access-date=2 June 2007|publisher=Inetres}} it was decided to use the heavily [[Vehicle armour|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|date=February 2010}} For use as ground ambulances and treatment & evacuation vehicles, the [[United States military]] currently employs the M113, the [[M577]], the [[M1133]] [[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 Bradley Fighting Vehicle]] (formerly known as the ATTV).{{cite book |last1=Hurd |first1=William W. |last2=Jernigan |first2=John G. |title=Aeromedical Evacuation: Management of Acute and Stabilized Patients |date=18 April 2006 |publisher=Springer Science & Business Media |isbn=978-0-387-22699-6 |page=55 |url=https://books.google.com/books?id=7JYMBwAAQBAJ |language=en}}{{cite web|url=http://1-22infantry.org/history/forcexxiattv.htm|title=1-22 Infantry tests ATTV|website=1-22infantry.org}}{{Cite web |url=http://www.dodig.mil/audit/reports/fy01/01012sum.htm |title=Bradley AMEV |access-date=6 January 2012 |archive-url=https://web.archive.org/web/20120916215904/http://www.dodig.mil/Audit/reports/fy01/01012sum.htm |archive-date=16 September 2012 |url-status=dead}} [194] => [195] => Some navies operate ocean-going [[hospital ship]]s to lend medical assistance in high casualty situations such as wars or natural disasters.{{cite web|title=US Navy Military Sealift Command – Hospital Ships|url=http://www.msc.navy.mil/inventory/inventory.asp?var=Hospitalship|access-date=17 June 2007|publisher=US Navy Military Sealift Command| archive-url= https://web.archive.org/web/20070629172753/http://www.msc.navy.mil/inventory/inventory.asp?var=Hospitalship| archive-date= 29 June 2007 | url-status= live}} 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.{{cite web|title=The sinking of HMHS Llandovery Castle |date=30 October 2000 |orig-year=1920 |url=http://www.gwpda.org/naval/lcastl11.htm|publisher=World War One Document Archive|access-date=27 June 2007| archive-url= https://web.archive.org/web/20070714232216/http://www.gwpda.org/naval/lcastl11.htm| archive-date= 14 July 2007 | url-status= live}} [196] => [197] => ==Ambulette== [198] => Ambulettes provide [[patient transport]] service for non-emergency situations. Scheduling is a major factor in their effective use.{{cite news |newspaper=[[The New York Times]] |url=https://www.nytimes.com/1996/11/10/nyregion/medicaid-ride-program-for-disabled-is-criticized.html |title=Medicaid Ride Program For Disabled Is Criticized |author=Raymond Hernandez |date=10 November 1996}} [199] => [200] => ==Reuse of retired ambulances== [201] => [[File:DFVAC 1991 Princess Ex Ford LifeLine Ambulance Fire Rehab unit 08 August 2011.jpg|Retired ambulances may find reuse in less-demanding emergency services, such as this [[Ford E-Series]] former ambulance that has become a logistics unit.|thumb|right]] [202] => When an ambulance is retired, it may be donated or sold to another [[Emergency medical services|EMS]] provider.{{cite web |url=http://www.york.ca/Regional+Government/Agendas+Minutes+and+Reports/_2011/pdf+CHSC+6-2.htm |title=Report No. 6 of the Community and Health Services, §2: Donation of Decommissioned Ambulances for 2011 |access-date=4 February 2012 |url-status=dead |archive-url=https://web.archive.org/web/20130726050326/http://www.york.ca/Regional%2BGovernment/Agendas%2BMinutes%2Band%2BReports/_2011/pdf%2BCHSC%2B6-2.htm |archive-date=26 July 2013}} [http://www.york.ca/Regional+Government/Agendas+Minutes+and+Reports/_2011/CHSC+rpt+6.htm Full report] {{Webarchive|url=https://web.archive.org/web/20130726050330/http://www.york.ca/Regional+Government/Agendas+Minutes+and+Reports/_2011/CHSC+rpt+6.htm |date=26 July 2013 }}{{cite web |title=Media Release: York Region donates ambulance to Haitian recovery efforts |url=http://www.york.ca/Publications/News/2010/June+25%2c+2010+York+Region+donates+ambulance+to+Haitian+recovery+efforts.htm |url-status=dead |archive-url=https://web.archive.org/web/20130726040145/http://www.york.ca/Publications/News/2010/June%2B25%2C%2B2010%2BYork%2BRegion%2Bdonates%2Bambulance%2Bto%2BHaitian%2Brecovery%2Befforts.htm |archive-date=26 July 2013 |access-date=4 February 2012 |publisher=Community and Health Services, York Region}} [http://www.york.ca/NR/rdonlyres/2oh662sqs5hsdwikhm45umbhbqsyaks5thf4sjekdbyi3ginngge5ucpweymvgapsszni3fvbsthg5jnam4eu4hxbd/rpt+8+cls+3.pdf] {{Webarchive|url=https://web.archive.org/web/20120407121809/http://www.york.ca/NR/rdonlyres/2oh662sqs5hsdwikhm45umbhbqsyaks5thf4sjekdbyi3ginngge5ucpweymvgapsszni3fvbsthg5jnam4eu4hxbd/rpt+8+cls+3.pdf|date=7 April 2012}} 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.{{cite web|url=http://www.citizen.on.ca/news/2006-03-16/Local_news/046.html |archive-url=https://archive.today/20130101181358/http://www.citizen.on.ca/news/2006-03-16/Local_news/046.html |url-status=dead |archive-date=1 January 2013 |title=Orangeville Police inherit retired ambulance |access-date=7 July 2012 }} Others are refurbished and resold,[http://www.malleyindustries.com/reconditioned-ambulances/ "Reconditioned ambulances"]. Malleyindustries.com. or may just have their emergency equipment removed to be sold to private businesses or individuals, who then can use them as small [[recreational vehicle]]s. They may also have a perfectly serviceable body or vehicle (or both) separated from the other and reused. [203] => [204] => [[Toronto]] City Council operates a "Caravan of Hope" project to give retired Toronto ambulances a second life by donating them to the people of [[El Salvador]]. Since Ontario laws require ambulances to be retired after just four and a half years in service, the City of Toronto decommissions and auctions around 28 ambulances each year.{{cite web|url=http://www.sanlorenzo.ca/english/Supporting_Hope.html|title=Supporting hope|access-date=7 July 2012|archive-date=21 October 2018|archive-url=https://web.archive.org/web/20181021200005/http://www.sanlorenzo.ca/english/Supporting_Hope.html|url-status=dead}} [205] => {{clearleft}} [206] => [207] => ==See also== [208] => * [[Ambulance station]] [209] => * [[Combination car (ambulance)|Combination car]] [210] => * [[Emergency medical dispatcher]] [211] => * [[Khilkhilat]] [212] => * [[Rail ambulance]] [213] => [214] => ==References and notes== [215] => [216] => [217] => {{reflist}} [218] => [219] => ==External links== [220] => *{{Wikiquote-inline}} [221] => *{{Commons category-inline}} [222] => [223] => {{Emergency medical services}} [224] => {{Portal bar|Medicine}} [225] => {{Authority control}} [226] => [227] => [[Category:Ambulances|*]] [] => )
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Ambulance

An ambulance is a specialized vehicle used to transport people who require medical assistance to a healthcare facility, usually a hospital. The term "ambulance" comes from the Latin word "ambulare," which means "to walk" or "to move.

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The term "ambulance" comes from the Latin word "ambulare," which means "to walk" or "to move. " The concept of ambulances has evolved over centuries, with different forms of medical transportation being utilized in various cultures and time periods. Modern ambulances are equipped with a range of medical equipment and supplies to facilitate the treatment and stabilization of patients. These emergency vehicles typically feature sirens, flashing lights, and distinct markings to alert other road users and gain priority access to traffic. Paramedics, emergency medical technicians (EMTs), or other trained healthcare professionals provide medical care to patients during transport. The organization and provision of ambulance services vary by country and jurisdiction. Some countries have national ambulance services, while others have privatized companies or a combination of both. In many regions, ambulance services are part of the emergency medical services (EMS) system, which includes other emergency responses like fire departments and police. The history of ambulances dates back to ancient times when various methods were used to transport the wounded from the battlefield. From the horse-drawn carriages of the 18th century to the motorized vehicles of today, ambulances have continually evolved to meet the changing needs of medical transportation. Ambulance crews play a crucial role in emergency response, providing vital medical assistance at the scene of accidents or medical emergencies and ensuring the safe and efficient transport of patients to healthcare facilities. Advances in technology and medical knowledge continue to shape the design and capabilities of modern ambulances, improving patient outcomes and enhancing the overall efficiency of emergency medical services.

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