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An ambulance is a medically equipped
vehicle A vehicle (from la, vehiculum) is a machine that transports people or cargo. Vehicles include wagons, bicycles, motor vehicles (motorcycles, cars, trucks, buses, mobility scooters for disabled people), railed vehicles (trains, trams), ...
which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport. Ambulances are used to respond to medical emergencies by
emergency medical services Emergency medical services (EMS), also known as ambulance services or paramedic services, are emergency services that provide urgent pre-hospital treatment and stabilisation for serious illness and injuries and transport to definitive care. ...
(EMS). For this purpose, they are generally equipped with flashing warning lights and
sirens Siren or sirens may refer to: Common meanings * Siren (alarm), a loud acoustic alarm used to alert people to emergencies * Siren (mythology), an enchanting but dangerous monster in Greek mythology Places * Siren (town), Wisconsin * Siren, Wisco ...
. They can rapidly transport
paramedic A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research. Not all ambulance personnel are p ...
s and other first responders to the scene, carry equipment for administering
emergency care Emergency medicine is the medical speciality concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians (often called “ER doctors” in the United States) continuously learn to care for unsche ...
and transport patients to hospital or other definitive care. Most ambulances use a design based on vans or pickup trucks. Others take the form of
motorcycles A motorcycle (motorbike, bike, or trike (if three-wheeled)) is a two or three-wheeled motor vehicle steered by a handlebar. Motorcycle design varies greatly to suit a range of different purposes: long-distance travel, commuting, cruising ...
, buses,
limousine A limousine ( or ), or limo () for short, is a large, chauffeur-driven luxury vehicle with a partition between the driver compartment and the passenger compartment. A very long wheelbase luxury sedan (with more than four doors) driven by a pr ...
s,
aircraft An aircraft is a vehicle that is able to fly by gaining support from the air. It counters the force of gravity by using either static lift or by using the dynamic lift of an airfoil, or in a few cases the downward thrust from jet engines ...
and
boats A boat is a watercraft of a large range of types and sizes, but generally smaller than a ship, which is distinguished by its larger size, shape, cargo or passenger capacity, or its ability to carry boats. Small boats are typically found on inl ...
. Generally, vehicles count as an ambulance if they can transport patients. However, it varies by jurisdiction as to whether a non-emergency patient transport vehicle (also called an
ambulette An ambulance is a medically equipped vehicle which transports patients to treatment facilities, such as hospitals. Typically, out-of-hospital medical care is provided to the patient during the transport. Ambulances are used to respond to medi ...
) 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 emergency response vehicles that cannot transport patients. These are known by names such as nontransporting EMS vehicles, fly-cars or response vehicles. The term ''ambulance'' comes from the
Latin Latin (, or , ) is a classical language belonging to the Italic branch of the Indo-European languages. Latin was originally a dialect spoken in the lower Tiber area (then known as Latium) around present-day Rome, but through the power of the ...
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 The American Civil War (April 12, 1861 – May 26, 1865; also known by other names) was a civil war in the United States. It was fought between the Union ("the North") and the Confederacy ("the South"), the latter formed by states th ...
vehicles for conveying the wounded off the field of battle were called ambulance wagons.
Field hospital A field hospital is a temporary hospital or mobile medical unit that takes care of casualties on-site before they can be safely transported to more permanent facilities. This term was initially used in military medicine (such as the Mobile A ...
s were still called ambulances during the Franco-Prussian War of 1870 and in the Serbo-Turkish war of 1876 even though the wagons were first referred to as ambulances about 1854 during the
Crimean War The Crimean War, , was fought from October 1853 to February 1856 between Russia and an ultimately victorious alliance of the Ottoman Empire, France, the United Kingdom and Piedmont-Sardinia. Geopolitical causes of the war included the ...
.


History

The history of the ambulance begins in
ancient times Ancient history is a time period from the beginning of writing and recorded human history to as far as late antiquity. The span of recorded history is roughly 5,000 years, beginning with the Sumerian cuneiform script. Ancient history cov ...
, 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 self-powered ambulances.


Functional types

Ambulances can be grouped into types depending on whether or not they transport patients, and under what conditions. In some cases, ambulances may fulfill more than one function (such as combining emergency ambulance care with patient transport: * 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 Air medical services is a comprehensive term covering the use of air transportation, aeroplane or helicopter, to move patients to and from healthcare facilities and accident scenes. Personnel provide comprehensive prehospital and emergency and cri ...
s), or even converted vehicles such as
golf cart A golf cart (alternatively known as a golf buggy or golf car) is a small motorized vehicle designed originally to carry two golfers and their golf clubs around a golf course with less effort than walking. Over time, variants were introduced ...
s. *
Patient transport Patient transport is a service that transfers patients to and from medical facilities in non-emergency situations. In emergency situations, patients are transported by the emergency medical services. Non-emergency patient transport is sometimes ...
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. *
Ambulance bus An ambulance bus is a type of ambulance with the capacity to transport and treat multiple patients. An ambulance bus is used primarily for medical evacuation of mass casualty incidents and non-emergency medical transport of care-dependent patient ...
– A large ambulance, usually based upon a bus chassis, that can evacuate and transport a large number of patients. * 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. * Rapid organ recovery ambulance collects the
bodies Bodies may refer to: * The plural of body * ''Bodies'' (2004 TV series), BBC television programme * Bodies (upcoming TV series), an upcoming British crime thriller limited series * "Bodies" (''Law & Order''), 2003 episode of ''Law & Order'' * ...
of people who have died suddenly from
heart attacks A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may tr ...
, accidents and other
emergencies An emergency is an urgent, unexpected, and usually dangerous situation that poses an immediate risk to health, life, property, or environment and requires immediate action. Most emergencies require urgent intervention to prevent a worsening ...
and try to preserve their
organs In biology, an organ is a collection of tissues joined in a structural unit to serve a common function. In the hierarchy of life, an organ lies between tissue and an organ system. Tissues are formed from same type cells to act together in a f ...
."
New York City New York, often called New York City or NYC, is the List of United States cities by population, most populous city in the United States. With a 2020 population of 8,804,190 distributed over , New York City is also the L ...
is launching a
pilot program A pilot study, pilot project, pilot test, or pilot experiment is a small-scale preliminary study conducted to evaluate feasibility, duration, cost, adverse events, and improve upon the study design prior to performance of a full-scale research pr ...
deploying one such ambulance with a $1.5 million, three-year
grant Grant or Grants may refer to: Places *Grant County (disambiguation) Australia * Grant, Queensland, a locality in the Barcaldine Region, Queensland, Australia United Kingdom * Castle Grant United States * Grant, Alabama * Grant, Inyo County, ...
. * Psychiatric ambulance – Ambulance dedicated to treat psychiatric emergencies. "Psykebilen" ("The Psych ambo") in Bergen, Norway pioneered the idea in 2005. Other cities in Norway and Sweden followed suit when the evidence 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.


Vehicle types

In North America (US and Canada), 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 Truck classifications are typically based upon the maximum loaded weight of the truck, typically using the gross vehicle weight rating (GVWR) and sometimes also the gross trailer weight rating (GTWR), and can vary among jurisdictions. United ...
chassis-cab with a custom rear compartment that is often referred to as a "box" or "module." Type I ambulances are primarily used for Advanced Life Support (ALS), also referred to as Mobile Intensive Care Unit (MICU) in some jurisdictions, and rescue work. A Type II ambulance 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. These types of ambulances are primarily used for Basic Life Support (BLS) and transfer of patients but it is not uncommon to find them used for advanced life support and rescue. Type III is a van chassis-cab but with a custom-made rear compartment and has the same uses as Type I ambulances. Type IV is for smaller ad hoc patient transfer that use smaller utility vehicles in which passenger vehicles and trucks would have difficulty in traversing, such as large industrial complexes, commercial venues, and special events with large crowds; they generally do not fall under Federal Regulations. Ambulances can be based on many types of vehicle although emergency and
disaster A disaster is a serious problem occurring over a short or long period of time that causes widespread human, material, economic or environmental loss which exceeds the ability of the affected community or society to cope using its own resources ...
conditions may lead to other vehicles serving as makeshift ambulances: * 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. * Car – Used either as a
fly-car A nontransporting EMS vehicle, also known as a fly-car, response vehicle, quick response service (QRS) vehicle, or fast response vehicle, is a vehicle that responds to and provides emergency medical services (EMS) without the ability to transp ...
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 A stretcher, gurney, litter, or pram is an apparatus used for moving patients who require medical care. A basic type (cot or litter) must be carried by two or more people. A wheeled stretcher (known as a gurney, trolley, bed or cart) is often ...
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 A hearse is a large vehicle, originally a horse carriage but later with the introduction of motor vehicles, a car, used to carry the body of a deceased person in a coffin at a funeral, wake, or memorial service. They range from deliberately a ...
s, as these were some of the few vehicles able to accept a human body in a
supine position The supine position ( or ) means lying horizontally with the face and torso facing up, as opposed to the prone position, which is face down. When used in surgical procedures, it grants access to the peritoneal, thoracic and pericardium, pericardi ...
. Some operators use modular-body transport ambulances based on the chassis of a
minivan Minivan (sometimes called simply as van) is a North American car classification for vehicles designed to transport passengers in the rear seating row(s), with reconfigurable seats in two or three rows. The equivalent classification in Europe is ...
and
station wagon A station wagon ( US, also wagon) or estate car ( UK, also estate), is an automotive body-style variant of a sedan/saloon with its roof extended rearward over a shared passenger/cargo volume with access at the back via a third or fifth door ( ...
. * Motorcycle and motor scooter – In urban areas, these may be used for rapid response in an emergency as they can travel through heavy traffic much faster than a car or van. Trailers or
sidecar A sidecar is a one-wheeled device attached to the side of a motorcycle, scooter, or bicycle, making the whole a three-wheeled vehicle. A motorcycle with a sidecar is sometimes called a ''combination'', an ''outfit'', a ''rig'' or a ''hack''. ...
s can make these patient transporting units. See also
motorcycle ambulance Motorcycle ambulances are a type of emergency vehicle which either carries a solo paramedic or first responder to a patient; or is used with a trailer or sidecar for transporting patients. Because of its size and performance, a motorcycle ambul ...
. * 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
cycle responder A cycle responder is a medically trained responder, such as a paramedic or first aider that uses a bicycle to respond to a medical emergency. They are used by professional ambulance services to respond to emergency calls and also by private and vol ...
. *
All-terrain vehicle An all-terrain vehicle (ATV), also known as a light utility vehicle (LUV), a quad bike, or simply a quad, as defined by the American National Standards Institute (ANSI); is a vehicle that travels on low-pressure tires, with a seat that is stra ...
(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 Mountain rescue refers to search and rescue activities that occur in a mountainous environment, although the term is sometimes also used to apply to search and rescue in other wilderness environments. This tends to include mountains with tech ...
in inaccessible areas. *
Golf cart A golf cart (alternatively known as a golf buggy or golf car) is a small motorized vehicle designed originally to carry two golfers and their golf clubs around a golf course with less effort than walking. Over time, variants were introduced ...
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 A helicopter is a type of rotorcraft in which lift and thrust are supplied by horizontally spinning rotors. This allows the helicopter to take off and land vertically, to hover, and to fly forward, backward and laterally. These attributes ...
– Usually used for emergency care, either in places inaccessible by road, or in areas where speed is of the essence, as they are able to travel significantly faster than a road ambulance. Helicopter and fixed-wing ambulances are discussed in greater detail at
air ambulance Air medical services is a comprehensive term covering the use of air transportation, aeroplane or helicopter, to move patients to and from healthcare facilities and accident scenes. Personnel provide comprehensive prehospital and emergency and cri ...
. *
Fixed-wing aircraft A fixed-wing aircraft is a heavier-than-air flying machine, such as an airplane, which is capable of flight using wings that generate lift caused by the aircraft's forward airspeed and the shape of the wings. Fixed-wing aircraft are distinc ...
– 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 ambulance Air medical services is a comprehensive term covering the use of air transportation, aeroplane or helicopter, to move patients to and from healthcare facilities and accident scenes. Personnel provide comprehensive prehospital and emergency and cri ...
. * 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 ambulance The water ambulance is a boat used for emergency medical care in island areas such as the city of Venice, Italy, the Isles of Scilly, UK or the Norway fjords. Dubai Dubai Ambulance Foundation has launched the "maritime ambulance project" in ...
s. Some
lifeboat Lifeboat may refer to: Rescue vessels * Lifeboat (shipboard), a small craft aboard a ship to allow for emergency escape * Lifeboat (rescue), a boat designed for sea rescues * Airborne lifeboat, an air-dropped boat used to save downed airmen ...
s or lifeguard vessels may fit the description of an ambulance as they are used to transport a casualty. * 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 bus An ambulance bus is a type of ambulance with the capacity to transport and treat multiple patients. An ambulance bus is used primarily for medical evacuation of mass casualty incidents and non-emergency medical transport of care-dependent patient ...
es 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. *
Fire engine A fire engine (also known in some places as a fire truck or fire lorry) is a road vehicle (usually a truck) that functions as a firefighting apparatus. The primary purposes of a fire engine include transporting firefighters and water to an ...
– 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.


Vehicle type gallery

File:Rettungswagen schutzundrettung zuerich.jpg, Ambulance in
Switzerland ). Swiss law does not designate a ''capital'' as such, but the federal parliament and government are installed in Bern, while other federal institutions, such as the federal courts, are in other cities (Bellinzona, Lausanne, Luzern, Neuchâtel ...
File:New York Fire Department Ambulance.jpg,
New York City New York, often called New York City or NYC, is the List of United States cities by population, most populous city in the United States. With a 2020 population of 8,804,190 distributed over , New York City is also the L ...
Fire Department File:ToyotaHiaceKKM.jpg, Toyota HiAce Commuter ambulance in
Malaysia Malaysia ( ; ) is a country in Southeast Asia. The federation, federal constitutional monarchy consists of States and federal territories of Malaysia, thirteen states and three federal territories, separated by the South China Sea into two r ...
File:Ambulance in Abu Dhabi 04.JPG, A van bodied ambulance built for the
Abu Dhabi Abu Dhabi (, ; ar, أَبُو ظَبْيٍ ' ) is the capital and second-most populous city (after Dubai) of the United Arab Emirates. It is also the capital of the Emirate of Abu Dhabi and the centre of the Abu Dhabi Metropolitan Area. ...
National Ambulance File:Amberg - Notarzt-PKW (Audi Avant, AM-RK70.jpg, Audi A4 Avant fly-car in
Germany Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwe ...
File:Ambulance Motorbike (29274193644).jpg, A paramedic bike in London File:NHS bicycle.jpg, In large, congested cities, paramedics may travel by bicycle, such as this one of the
London Ambulance Service The London Ambulance Service NHS Trust (LAS) is an NHS trust responsible for operating ambulances and answering and responding to urgent and emergency medical situations within the London region of England. The service responds to 999 phone cal ...
File:C12 air ambulance.jpg, An
air ambulance Air medical services is a comprehensive term covering the use of air transportation, aeroplane or helicopter, to move patients to and from healthcare facilities and accident scenes. Personnel provide comprehensive prehospital and emergency and cri ...
in Austria File:Royal Flying Doctor Service of Australia Central Operations (VH-FGS) Pilatus PC-12-45 at Wagga Wagga Airport.jpg, An
air ambulance Air medical services is a comprehensive term covering the use of air transportation, aeroplane or helicopter, to move patients to and from healthcare facilities and accident scenes. Personnel provide comprehensive prehospital and emergency and cri ...
in Australia File:Scilly Isles Ambulance Service alongside Tresco quay.jpg, A
water ambulance The water ambulance is a boat used for emergency medical care in island areas such as the city of Venice, Italy, the Isles of Scilly, UK or the Norway fjords. Dubai Dubai Ambulance Foundation has launched the "maritime ambulance project" in ...
in the
Scilly Isles The Isles of Scilly (; kw, Syllan, ', or ) is an archipelago off the southwestern tip of Cornwall, England. One of the islands, St Agnes, is the most southerly point in Britain, being over further south than the most southerly point of the ...
File:Eyr Ytterholmen.jpg,
Norwegian Norwegian, Norwayan, or Norsk may refer to: *Something of, from, or related to Norway, a country in northwestern Europe * Norwegians, both a nation and an ethnic group native to Norway * Demographics of Norway *The Norwegian language, including ...
boat ambulance operating on the coast of Helgeland. File:Surgeon Nikolay Pirogov 9.jpg, A Russian
hospital train A hospital train is a railway train with carriages equipped for the provision of healthcare. Historically this has ranged from trains equipped to transport wounded soldiers, with basic nursing and first aid facilities on board, to fully equipped ...
File:SUV "Shaman" (medical edition) during the "Armiya 2020" exhibition (front view).jpg, An
Avtoros Shaman The Avtoros Shaman is a four cylinder diesel engine 8x8 all-terrain vehicle, built by Russian company ''Avtoros''. The vehicle's design includes the ability to carry eight passengers, the use of low pressure tyres, an optional extra that can allo ...
ATV Russian military ambulance File:G-KTW BF Frankfurt.JPG, Ambulance bus File:Nd-574.jpg, A typical American ambulance, operated by the
Longboat Key A longboat is a type of ship's boat that was in use from ''circa'' 1500 or before. Though the Royal Navy replaced longboats with launches from 1780, examples can be found in merchant ships after that date. The longboat was usually the largest boat ...
fire department.


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 Four-wheel drive, also called 4×4 ("four by four") or 4WD, refers to a two-axled vehicle drivetrain capable of providing torque to all of its wheels simultaneously. It may be full-time or on-demand, and is typically linked via a transfer case ...
or all-terrain vehicles can be used. Fuel must be available and service facilities are necessary to maintain the vehicle. Methods of summoning (e.g. telephone) and
dispatching Dispatch is a procedure for assigning employees (workers) or vehicles to customers. Industries that dispatch include taxicabs, couriers, emergency services, as well as home and commercial services such as maid services, plumbing, HVAC, pest contro ...
ambulances usually rely on
electronic Electronic may refer to: *Electronics, the science of how to control electric energy in semiconductor * ''Electronics'' (magazine), a defunct American trade journal *Electronic storage, the storage of data using an electronic device *Electronic co ...
equipment, which itself often relies on an intact
power grid An electrical grid is an interconnected network for electricity delivery from producers to consumers. Electrical grids vary in size and can cover whole countries or continents. It consists of:Kaplan, S. M. (2009). Smart Grid. Electrical Power ...
. Similarly, modern ambulances are equipped with
two-way radio A two-way radio is a radio that can both transmit and receive radio waves (a transceiver), unlike a broadcast receiver which only receives content. It is an audio (sound) transceiver, a transmitter and receiver in one unit, used for bidirecti ...
s or
cellular telephones A mobile phone, cellular phone, cell phone, cellphone, handphone, hand phone or pocket phone, sometimes shortened to simply mobile, cell, or just phone, is a portable telephone that can make and receive calls over a radio frequency link whil ...
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. 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 Mercedes-Benz (), commonly referred to as Mercedes and sometimes as Benz, is a German luxury and commercial vehicle automotive brand established in 1926. Mercedes-Benz AG (a Mercedes-Benz Group subsidiary established in 2019) is headquartere ...
,
Nissan , trade name, trading as Nissan Motor Corporation and often shortened to Nissan, is a Japanese multinational corporation, multinational Automotive industry, automobile manufacturer headquartered in Nishi-ku, Yokohama, Japan. The company sells ...
,
Toyota is a Japanese multinational automotive manufacturer headquartered in Toyota City, Aichi, Japan. It was founded by Kiichiro Toyoda and incorporated on . Toyota is one of the largest automobile manufacturers in the world, producing about 10 ...
, or
Ford Ford commonly refers to: * Ford Motor Company, an automobile manufacturer founded by Henry Ford * Ford (crossing), a shallow crossing on a river Ford may also refer to: Ford Motor Company * Henry Ford, founder of the Ford Motor Company * Ford F ...
. The second manufacturer (known as
second stage manufacturer A second stage manufacturer, known in the industry as "bodybuilder," builds such products as bus and truck bodies, ambulances, motor homes, and other specialized vehicles. Neither their product, nor the first stage portion, called an ''incomp ...
) modifies 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 Emergency vehicle equipment is any equipment fitted to, or carried by, an emergency vehicle, other than the equipment that a standard non-emergency vehicle is fitted with (such as headlights, steering wheels, and windshield/windscreens). Visu ...
, and interior fittings. This is done by one of two methods – either
coachbuilding A coachbuilder or body-maker is someone who manufactures bodies for passenger-carrying vehicles.Construction has always been a skilled trade requiring a relatively lightweight product with sufficient strength. The manufacture of necessarily ...
, 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 A chassis (, ; plural ''chassis'' from French châssis ) is the load-bearing framework of an artificial object, which structurally supports the object in its construction and function. An example of a chassis is a vehicle frame, the underpart ...
of the ambulance, and then finished off. Modern ambulances are typically powered by
internal combustion engine An internal combustion engine (ICE or IC engine) is a heat engine in which the combustion of a fuel occurs with an oxidizer (usually air) in a combustion chamber that is an integral part of the working fluid flow circuit. In an internal combus ...
s, which can be powered by any conventional fuel, including
diesel Diesel may refer to: * Diesel engine, an internal combustion engine where ignition is caused by compression * Diesel fuel, a liquid fuel used in diesel engines * Diesel locomotive, a railway locomotive in which the prime mover is a diesel engin ...
, gasoline or
liquefied petroleum gas Liquefied petroleum gas (LPG or LP gas) is a fuel gas which contains a flammable mixture of hydrocarbon gases, specifically propane, propylene, butylene, isobutane and n-butane. LPG is used as a fuel gas in heating appliances, cooking e ...
, 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 in comparison to diesel fuel. The type of engine may be determined by the manufacturer: in the past two decades,
Ford Ford commonly refers to: * Ford Motor Company, an automobile manufacturer founded by Henry Ford * Ford (crossing), a shallow crossing on a river Ford may also refer to: Ford Motor Company * Henry Ford, founder of the Ford Motor Company * Ford F ...
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.


Standards

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 The European Committee for Standardization (CEN, french: Comité Européen de Normalisation) is a public standards organization whose mission is to foster the economy of the European Single Market and the wider European continent in global tr ...
publishes the standard
CEN 1789 CEN 1789:2020 is the European Union standard for ambulances and medical transportation vehicles. This European standard specifies requirements for the design, testing, performance and equipping of road ambulances used for the transport and care of ...
, 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 The General Services Administration (GSA) is an independent agency of the United States government established in 1949 to help manage and support the basic functioning of federal agencies. GSA supplies products and communications for U.S. gover ...
and known as KKK-A-1822. 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 The National Fire Protection Association (NFPA) is an international nonprofit organization devoted to eliminating death, injury, property and economic loss due to fire, electrical and related hazards. As of 2018, the NFPA claims to have 50,000 mem ...
has also published a design standard,
NFPA 1917 NFPA may refer to: * National Fire Protection Association ** NFPA 704, National Fire Protection Association Fire Diamond * National Food Processors Association * National Fluid Power Association * Non-Fossil Purchasing Agency *Non-functioning pitu ...
, which offers an alternative to KKK-A-1822F. 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. 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.


Safety

Ambulances, like other
emergency vehicles An emergency vehicle is a vehicle used by emergency services. Emergency vehicles typically have specialized emergency lighting and vehicle equipment that allow emergency services to reach calls for service in a timely manner, transport equipment a ...
, are required 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 belts. Research has shown that ambulances are more likely to be involved in motor vehicle collisions resulting in injury or death than either
fire truck A fire engine (also known in some places as a fire truck or fire lorry) is a road vehicle (usually a truck) that functions as a firefighting apparatus. The primary purposes of a fire engine include transporting firefighters and water to an i ...
s 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 in the United States 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.


Equipment

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: * 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 ASHICE is one of several mnemonic acronyms used by emergency medical services in the United Kingdom and the Republic of Ireland to pass summarised advance details of a patient to the next group of persons or organisation dealing with them, otherwis ...
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 The Global System for Mobile Communications (GSM) is a standard developed by the European Telecommunications Standards Institute (ETSI) to describe the protocols for second-generation ( 2G) digital cellular networks used by mobile devices such ...
system, such as
TETRA Terrestrial Trunked Radio (TETRA; formerly known as Trans-European Trunked Radio), a European standard for a trunked radio system, is a professional mobile radio and two-way transceiver specification. TETRA was specifically designed for use by ...
. *
Mobile data terminal A mobile data terminal (MDT) or mobile digital computer (MDC) is a computerized device used in emergency services, public transport, taxicabs, package delivery, roadside assistance, and logistics, among other fields, to communicate with a cent ...
– Some ambulances are fitted with
mobile data terminal A mobile data terminal (MDT) or mobile digital computer (MDC) is a computerized device used in emergency services, public transport, taxicabs, package delivery, roadside assistance, and logistics, among other fields, to communicate with a cent ...
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. * Evidence gathering
CCTV Closed-circuit television (CCTV), also known as video surveillance, is the use of video cameras to transmit a signal to a specific place, on a limited set of monitors. It differs from broadcast television in that the signal is not openly t ...
– 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 the crew stands accused of
malpractice In the law of torts, malpractice, also known as professional negligence, is an "instance of negligence or incompetence on the part of a professional".Malpractice definition, Professionals who may become the subject of malpractice actions inc ...
. *
Tail lift A tail lift (term used in the UK, also called a "liftgate" in North America) is a mechanical device permanently installed on the rear of a work truck, van, or lorry, and is designed to facilitate the handling of goods from ground level or a load ...
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 Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...
or specialty care transports that require large, bulky equipment such as a
neonatal incubator A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit (ICU) specializing in the care of ill or premature newborn infants. Neonatal refers to the first 28 days of life. Neonatal care, as kn ...
or
hospital bed A hospital bed or hospital cot is a bed specially designed for hospitalized patients or others in need of some form of health care. These beds have special features both for the comfort and well-being of the patient and for the convenience of he ...
s. There may also be equipment linked to this such as
winch A winch is a mechanical device that is used to pull in (wind up) or let out (wind out) or otherwise adjust the tension of a rope or wire rope (also called "cable" or "wire cable"). In its simplest form, it consists of a spool (or drum) attache ...
es 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 Photosensitivity is the amount to which an object reacts upon receiving photons, especially visible light. In medicine, the term is principally used for abnormal reactions of the skin, and two types are distinguished, photoallergy and phototoxicit ...
. *
Air conditioning Air conditioning, often abbreviated as A/C or AC, is the process of removing heat from an enclosed space to achieve a more comfortable interior environment (sometimes referred to as 'comfort cooling') and in some cases also strictly controlling ...
– 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 Filter, filtering or filters may refer to: Science and technology Computing * Filter (higher-order function), in functional programming * Filter (software), a computer program to process a data stream * Filter (video), a software component tha ...
ing against airborne pathogens. * Data recorders – These are often placed in ambulances to record such information as speed, braking power and time, activation of active emergency warnings such as lights and sirens, as well as seat belt usage. These are often used in coordination with
GPS The Global Positioning System (GPS), originally Navstar GPS, is a satellite-based radionavigation system owned by the United States government and operated by the United States Space Force. It is one of the global navigation satellite sy ...
units.


Intermediate technology

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 A sidecar is a one-wheeled device attached to the side of a motorcycle, scooter, or bicycle, making the whole a three-wheeled vehicle. A motorcycle with a sidecar is sometimes called a ''combination'', an ''outfit'', a ''rig'' or a ''hack''. ...
(or
motorcycle ambulance Motorcycle ambulances are a type of emergency vehicle which either carries a solo paramedic or first responder to a patient; or is used with a trailer or sidecar for transporting patients. Because of its size and performance, a motorcycle ambul ...
s) are also used, though they are subject to some of the same limitations as more traditional over-the-road ambulances. The level of care provided by these ambulances varies between merely providing transport to a medical clinic to providing on-scene and continuing care during transport. The design of intermediate technology ambulances must take into account not only the operation and maintenance of the ambulance, but its construction as well. The robustness of the design becomes more important, as does the nature of the skills required to properly operate the vehicle. Cost-effectiveness can be a high priority.


Appearance and markings

Emergency ambulances are highly likely to be involved in hazardous situations, including incidents such as a road traffic 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 Traffic lights, traffic signals, or stoplights – known also as robots in South Africa are signalling devices positioned at intersection (road), road intersections, pedestrian crossings, and other locations in order to control flows of traf ...
or stop sign as a
yield sign In road transport, a yield or give way sign indicates that merging drivers must prepare to stop if necessary to let a driver on another approach proceed. A driver who stops or slows down to let another vehicle through has yielded the right of w ...
('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 In medicine, triage () is a practice invoked when acute care cannot be provided for lack of resources. The process rations care towards those who are most in need of immediate care, and who benefit most from it. More generally it refers to prio ...
) 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

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 A developing country is a sovereign state with a lesser developed industrial base and a lower Human Development Index (HDI) relative to other countries. However, this definition is not universally agreed upon. There is also no clear agreem ...
) 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 Fluorescence is the emission of light by a substance that has absorbed light or other electromagnetic radiation. It is a form of luminescence. In most cases, the emitted light has a longer wavelength, and therefore a lower photon energy, ...
) 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. 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 Most public switched telephone networks have a single emergency telephone number (sometimes known as the universal emergency telephone number or the emergency services number) that allows a caller to contact local emergency services for assis ...
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 upright=1.15, Original document in single pages, 1864 The Geneva Conventions are four treaties, and three additional protocols, that establish international legal standards for humanitarian treatment in war. The singular term ''Geneva Conve ...
, and all countries signatory to it agree to restrict their use to either (1) Military Ambulances or (2) the national
Red Cross The International Red Cross and Red Crescent Movement is a Humanitarianism, humanitarian movement with approximately 97 million Volunteering, volunteers, members and staff worldwide. It was founded to protect human life and health, to ensure re ...
or
Red Crescent The International Red Cross and Red Crescent Movement is a Humanitarianism, humanitarian movement with approximately 97 million Volunteering, volunteers, members and staff worldwide. It was founded to protect human life and health, to ensure re ...
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 Magen David Adom ( he, מגן דוד אדום, abbr. MDA, pronounced ''MAH-dah'' per its Hebrew acronym, ) is Israel's national emergency medical, disaster, ambulance and blood bank service. The name means "Red Shield" or "Red Star of Davi ...
, the Red Cross member organization use a red
Star of David The Star of David (). is a generally recognized symbol of both Jewish identity and Judaism. Its shape is that of a hexagram: the compound of two equilateral triangles. A derivation of the ''seal of Solomon'', which was used for decorative ...
, but this does not have recognition beyond Israeli borders, where they must use the Red Crystal. The
Star of Life The Star of Life is a symbol used to identify emergency medical services. It features a blue six-pointed star outlined by a white border. The middle contains a Rod of Asclepius – an ancient symbol of medicine. The Star of Life can be found on a ...
is widely used, and was originally designed and governed by the U.S.
National Highway Traffic Safety Administration The National Highway Traffic Safety Administration (NHTSA ) is an agency of the U.S. federal government, part of the Department of Transportation. It describes its mission as "Save lives, prevent injuries, reduce vehicle-related crashes" rel ...
, because the Red Cross symbol is legally protected by both National and international law. Ambulance services with historical origins such as the Order of St John, the
Order of Malta Ambulance Corps The Order of Malta Ireland – Ambulance Corps is a voluntary ambulance and first aid organisation operating in Ireland in affiliation with the Sovereign Military Order of Malta, founded in 1938. Its purposes include teaching first aid, prov ...
and
Malteser International Malteser International is an international non-governmental aid agency for humanitarian aid of the Sovereign Military Order of Malta. Developed in 2005 from the foreign aid service of Malteser Germany (founded 1953), and having the status of an ind ...
often use the Maltese cross to identify their ambulances. This is especially important in countries such as Australia, where St. John Ambulance operate one state and one territory ambulance service, and all of Australia's other ambulance services use variations on a red Maltese cross.
Fire service A fire department (American English) or fire brigade (Commonwealth English), also known as a fire authority, fire district, fire and rescue, or fire service in some areas, is an organization that provides fire prevention and fire suppression se ...
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 firefighters).


Active visual warnings

The active visual warnings are usually in the form of flashing lights. These flash in order to attract the attention of other road users as the ambulance approaches, or to provide warning to motorists approaching a stopped ambulance in a dangerous position on the road. Common colours for ambulance warning beacons are blue, red, amber, and white (clear). However the colours may vary by country and sometimes by operator. There are several technologies in use to achieve the flashing effect. These include flashing a light bulb or
LED A light-emitting diode (LED) is a semiconductor Electronics, device that Light#Light sources, emits light when Electric current, current flows through it. Electrons in the semiconductor recombine with electron holes, releasing energy i ...
, flashing or rotating
halogen The halogens () are a group in the periodic table consisting of five or six chemically related elements: fluorine (F), chlorine (Cl), bromine (Br), iodine (I), astatine (At), and tennessine (Ts). In the modern IUPAC nomenclature, this group is ...
, and
strobe light A strobe light or stroboscopic lamp, commonly called a strobe, is a device used to produce regular flashes of light. It is one of a number of devices that can be used as a stroboscope. The word originated from the Ancient Greek ('), meaning ...
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. Emergency lights may simply be mounted directly on the body, or may be housed in special fittings, such as in a
lightbar Emergency vehicle lighting, also known as simply emergency lighting or emergency lights, is a type of vehicle lighting used to visually announce a vehicle's presence to other road users. A sub-type of emergency vehicle equipment, emergency veh ...
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 A headlamp is a lamp attached to the front of a vehicle to illuminate the road ahead. Headlamps are also often called headlights, but in the most precise usage, ''headlamp'' is the term for the device itself and ''headlight'' is the term for ...
) 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 A headlamp is a lamp attached to the front of a vehicle to illuminate the road ahead. Headlamps are also often called headlights, but in the most precise usage, ''headlamp'' is the term for the device itself and ''headlight'' is the term for ...
s, tail lamps) may be programmed to flash. Flashing headlights (typically the high beams, flashed alternately) are known as a wig-wag. 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. 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. See also
Emergency vehicle equipment Emergency vehicle equipment is any equipment fitted to, or carried by, an emergency vehicle, other than the equipment that a standard non-emergency vehicle is fitted with (such as headlights, steering wheels, and windshield/windscreens). Visu ...
.


Audible warnings

In addition to visual warnings, ambulances can be fitted with audible warnings, sometimes known as
siren Siren or sirens may refer to: Common meanings * Siren (alarm), a loud acoustic alarm used to alert people to emergencies * Siren (mythology), an enchanting but dangerous monster in Greek mythology Places * Siren (town), Wisconsin * Siren, Wisc ...
s, which can alert people and vehicles to the presence of an ambulance before they can be seen. The first audible warnings were mechanical bells, mounted to either the front or roof of the ambulance. Most modern ambulances are now fitted with electronic sirens, producing a range of different noises which ambulance operators can use to attract more attention to themselves, particularly when proceeding through an intersection or in heavy traffic. The speakers for modern sirens can be integral to the lightbar, or they may be hidden in or flush to the grill to reduce noise inside the ambulance that may interfere with patient care and radio communications. Ambulances can additionally be fitted with airhorn audible warnings to augment the effectiveness of the siren system, or may be fitted with extremely loud two-tone air horns as their primary siren. 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.


Costs

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. * 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).


Crewing

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 Advanced Life Support (ALS) is a set of life saving protocols and skills that extend basic life support to further support the circulation and provide an open airway and adequate ventilation (breathing). Components These include: * Tracheal in ...
ambulance may be crewed by one paramedic and one technician, or in countries like Australia advanced life support registered paramedics. 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 Cardiopulmonary resuscitation (CPR) is an emergency procedure consisting of chest compressions often combined with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spont ...
(CPR) or using an
automated external defibrillator An automated external defibrillator (AED) is a portable electronic device that automatically diagnoses the life-threatening cardiac arrhythmias of ventricular fibrillation (VF) and pulseless ventricular tachycardia, and is able to treat them thro ...
(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. * 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. * Non-emergency driver/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 A wheelchair is a chair with wheels, used when walking is difficult or impossible due to illness, injury, problems related to old age, or disability. These can include spinal cord injuries ( paraplegia, hemiplegia, and quadriplegia), cerebr ...
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 worker (ECA/ECSW) – 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 An emergency medical technician (EMT), also known as an ambulance technician, is a health professional that provides emergency medical services. EMTs are most commonly found working in ambulances. In English-speaking countries, paramedics are ...
(EMT) – Also known as an Ambulance Technician. Technicians are usually able to perform a wide range of emergency care skills, such as
defibrillation Defibrillation is a treatment for life-threatening cardiac arrhythmias, specifically ventricular fibrillation (V-Fib) and non-perfusing ventricular tachycardia (V-Tach). A defibrillator delivers a dose of electric current (often called a ''cou ...
, 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 EMT-Intermediate). * Registered nurse (RN) – In some systems, nurses are the primary providers of advanced-level care on ambulances, often in place of paramedics. This includes
Estonia Estonia, formally the Republic of Estonia, is a country by the Baltic Sea in Northern Europe. It is bordered to the north by the Gulf of Finland across from Finland, to the west by the sea across from Sweden, to the south by Latvia, a ...
, the
Netherlands ) , anthem = ( en, "William of Nassau") , image_map = , map_caption = , subdivision_type = Sovereign state , subdivision_name = Kingdom of the Netherlands , established_title = Before independence , established_date = Spanish Netherl ...
,
Sweden Sweden, formally the Kingdom of Sweden,The United Nations Group of Experts on Geographical Names states that the country's formal name is the Kingdom of SwedenUNGEGN World Geographical Names, Sweden./ref> is a Nordic country located on ...
and
Spain , image_flag = Bandera de España.svg , image_coat = Escudo de España (mazonado).svg , national_motto = ''Plus ultra'' (Latin)(English: "Further Beyond") , national_anthem = (English: "Royal March") , i ...
. Nurses may also work on ambulances for critical care transport. *
Paramedic A paramedic is a registered healthcare professional who works autonomously across a range of health and care settings and may specialise in clinical practice, as well as in education, leadership, and research. Not all ambulance personnel are p ...
– This is a high level of medical training and usually involves key skills not permissible for technicians, such as
cannulation A cannula (; Latin meaning 'little reed'; plural or ) is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of samples. In simple terms, a cannula can surround the inner or outer surfaces ...
(and with it the ability to administer a range of drugs such as
morphine Morphine is a strong opiate that is found naturally in opium, a dark brown resin in poppies (''Papaver somniferum''). It is mainly used as a analgesic, pain medication, and is also commonly used recreational drug, recreationally, or to make ...
),
tracheal intubation Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequentl ...
and other skills such as performing a
cricothyrotomy A cricothyrotomy (also called cricothyroidotomy) is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, o ...
. 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 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 diagnostic techniques. * 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. *
Physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
– In some systems such as the 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 ambulances Air medical services is a comprehensive term covering the use of air transportation, aeroplane or helicopter, to move patients to and from healthcare facilities and accident scenes. Personnel provide comprehensive prehospital and emergency and cri ...
. Alternatively, in some systems, such as Albuquerque, NM and Pittsburgh, PA, physicians are available to respond to serious cases via a fly car.


Military use

Military ambulances have historically included vehicles based on civilian designs and at times also included armored, but unarmed, vehicle ambulances based upon armoured personnel carriers (APCs). In the
Second World War World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposin ...
vehicles such as the Hanomag Sd Kfz 251 half-track 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 The Medical Evacuation Vehicle (MEV) are assigned from the Battalion Aid Station for Battalion-sized units, and dedicated to each of the company-sized elements of the unit and provide treatment for serious injury and advanced trauma cases. Models ...
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 Peacekeeping by the United Nations is a role held by the Department of Peace Operations as an "instrument developed by the organization as a way to help countries torn by conflict to create the conditions for lasting peace". It is distinguished ...
, etc.). For example, the British
Royal Army Medical Corps The Royal Army Medical Corps (RAMC) is a specialist corps in the British Army which provides medical services to all Army personnel and their families, in war and in peace. The RAMC, the Royal Army Veterinary Corps, the Royal Army Dental Corps a ...
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 Medical evacuation, often shortened to medevac or medivac, is the timely and efficient movement and en route care provided by medical personnel to wounded being evacuated from a battlefield, to injured patients being evacuated from the scene of a ...
. 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 The law of war is the component of international law that regulates the conditions for initiating war (''jus ad bellum'') and the conduct of warring parties (''jus in bello''). Laws of war define sovereignty and nationhood, states and territor ...
demand ambulances be marked with one of the
Emblems of the Red Cross The emblems of the International Red Cross and Red Crescent Movement, under the Geneva Conventions, are to be placed on humanitarian and medical vehicles and buildings, and to be worn by medical personnel and others carrying out humanitarian ...
not to mount offensive
weapon A weapon, arm or armament is any implement or device that can be used to deter, threaten, inflict physical damage, harm, or kill. Weapons are used to increase the efficacy and efficiency of activities such as hunting, crime, law enforcement, s ...
s, 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-combatant Non-combatant is a term of art in the law of war and international humanitarian law to refer to civilians who are not taking a direct part in hostilities; persons, such as combat medics and military chaplains, who are members of the belligerent ...
s; however, this does not always exempt medical personnel from coming under fireaccidental or deliberate. As a result, medics and other medical personnel attached to military ambulances are usually put through basic military training, on the assumption that they may have to use a weapon. The laws of war do allow non-combatant military personnel to carry individual weapons for protecting themselves and casualties. However, not all militaries exercise this right to their personnel. Recently, the
Israeli Defense Forces Israeli may refer to: * Something of, from, or related to the State of Israel * Israelis, citizens or permanent residents of the State of Israel * Modern Hebrew, a language * ''Israeli'' (newspaper), published from 2006 to 2008 * Guni Israeli ...
has modified a number of its
Merkava The Merkava ( he, מרכבה, , "chariot") is a series of main battle tanks used by the Israel Defense Forces and the backbone of the IDF's armored corps. The tank began development in 1970, and its first generation, the Merkava mark 1, entere ...
main battle
tank A tank is an armoured fighting vehicle intended as a primary offensive weapon in front-line ground combat. Tank designs are a balance of heavy firepower, strong armour, and good battlefield mobility provided by tracks and a powerful engin ...
s with ambulance features in order to allow rescue operations to take place under heavy fire in
urban warfare Urban warfare is combat conducted in urban areas such as towns and cities. Urban combat differs from combat in the open at both the operational and the tactical levels. Complicating factors in urban warfare include the presence of civilians a ...
. The modifications were made following a failed rescue attempt in which
Palestinian Palestinians ( ar, الفلسطينيون, ; he, פָלַסְטִינִים, ) or Palestinian people ( ar, الشعب الفلسطيني, label=none, ), also referred to as Palestinian Arabs ( ar, الفلسطينيين العرب, label=non ...
gunmen killed two soldiers who were providing aid for a Palestinian woman in
Rafah Rafah ( ar, رفح, Rafaḥ) is a Palestinian city in the southern Gaza Strip. It is the district capital of the Rafah Governorate, located south of Gaza City. Rafah's population of 152,950 (2014) is overwhelmingly made up of former Palestini ...
. Since M-113 armored personnel carriers and regular up-armored ambulances are not sufficiently protected against anti-tank weapons and
improvised explosive device An improvised explosive device (IED) is a bomb constructed and deployed in ways other than in conventional military action. It may be constructed of conventional military explosives, such as an artillery shell, attached to a detonating mecha ...
s, it was decided to use the heavily
armor Armour (British English) or armor (American English; see spelling differences) is a covering used to protect an object, individual, or vehicle from physical injury or damage, especially direct contact weapons or projectiles during combat, or f ...
ed
Merkava The Merkava ( he, מרכבה, , "chariot") is a series of main battle tanks used by the Israel Defense Forces and the backbone of the IDF's armored corps. The tank began development in 1970, and its first generation, the Merkava mark 1, entere ...
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. For use as ground ambulances and treatment & evacuation vehicles, the
United States military The United States Armed Forces are the military forces of the United States. The armed forces consists of six service branches: the Army, Marine Corps, Navy, Air Force, Space Force, and Coast Guard. The president of the United States is the ...
currently employs the M113, the M577, the M1133
Stryker The Stryker is a family of eight-wheeled armored fighting vehicles derived from the Canadian LAV III. Stryker vehicles are produced by General Dynamics Land Systems-Canada (GDLS-C) for the United States Army in a plant in London, Ontario. It ...
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). Some navies operate ocean-going
hospital ship A hospital ship is a ship designated for primary function as a floating medical treatment facility or hospital. Most are operated by the military forces (mostly navies) of various countries, as they are intended to be used in or near war zones. I ...
s to lend medical assistance in high casualty situations like wars or natural disasters. These hospital ships fulfill the criteria of an ambulance (transporting the sick or injured), although the capabilities of a hospital ship are more on par with a Mobile Army Surgical Hospital. In line with the
laws of war The law of war is the component of international law that regulates the conditions for initiating war (''jus ad bellum'') and the conduct of warring parties (''jus in bello''). Laws of war define sovereignty and nationhood, states and territor ...
, these ships can display a prominent Red Cross or Red Crescent to confer protection under the appropriate
Geneva Convention upright=1.15, Original document in single pages, 1864 The Geneva Conventions are four treaties, and three additional protocols, that establish international legal standards for humanitarian treatment in war. The singular term ''Geneva Conve ...
. However, this designation has not always protected hospital ships from enemy fire.


Ambulette

Ambulettes provide
patient transport Patient transport is a service that transfers patients to and from medical facilities in non-emergency situations. In emergency situations, patients are transported by the emergency medical services. Non-emergency patient transport is sometimes ...
service for non-emergency situations. Scheduling is a major factor in their effective use.


Reuse of retired ambulances

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 vehicle A recreational vehicle, often abbreviated as RV, is a motor vehicle or trailer that includes living quarters designed for accommodation. Types of RVs include motorhomes, campervans, coaches, caravans (also known as travel trailers and camper ...
s. They may also have a perfectly serviceable body or vehicle (or both) separated from the other and reused.
Toronto Toronto ( ; or ) is the capital city of the Canadian province of Ontario. With a recorded population of 2,794,356 in 2021, it is the most populous city in Canada and the fourth most populous city in North America. The city is the ancho ...
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 El Salvador (; , meaning " The Saviour"), officially the Republic of El Salvador ( es, República de El Salvador), is a country in Central America. It is bordered on the northeast by Honduras, on the northwest by Guatemala, and on the south b ...
. 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.


See also


References and notes


External links

* * {{Portal bar, Medicine *