Ambulance

A Mercedes-Benz Sprinter ambulance in London.

A Fiat Ducato ambulance in Rome, Italy

An ambulance is a medically equipped vehicle used to transport 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 (EMS), and can rapidly transport paramedics and other first responders, carry equipment for administering emergency care, and transport patients to hospital or other definitive care. Most ambulances use a design based on vans or pickup trucks, though others take the form of motorcycles, buses, hearses, aircraft and boats.

Ambulances are generally considered emergency vehicles authorized to be equipped with emergency lights and sirens. 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) 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 vehicles that cannot transport patients.

The term ambulance comes from the Latin word ambulare as meaning 'to walk or move about' which is a reference to early medical care where patients were moved by lifting or wheeling. The word originally meant a moving hospital, which follows an army in its movements. Ambulances (ambulancias in Spanish) were first used for emergency transport in 1487 by the Spanish forces during the siege of Málaga by the Catholic Monarchs against the Emirate of Granada. During the American Civil War vehicles for conveying the wounded off the field of battle were called ambulance wagons. Field hospitals were still called ambulances during the Franco-Prussian War of 1870 and in the Serbo-Turkish war of 1876 even though the wagons were first referred to as ambulances about 1854 during the Crimean War.

Vehicle types

Ambulances can be based on many types of vehicle, although emergency and disaster 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–Some Emergency Medical Services Agencies have vehicles that can be Used either as a fly-car for rapid response or to transport patients who can sit.There are standard car models that are adapted to the requirements of the service using them. Some cars are capable of taking a stretcher with a recumbent patient, but this often requires the removal of the front passenger seat, or the use of a particularly long car. This was often the case with early ambulances, which were converted (or even serving) hearses, as these were some of the few vehicles able to accept a human body in a supine position. Some operators use modular-body transport ambulances based on the chassis of a minivan or station wagon.
• 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 sidecars can make these patient transporting units.
• 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.
• All-terrain vehicle – All Terrain Vehicles are Used for response off-road, 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.
• Golf cart or Neighborhood Electric Vehicle – Used for rapid response at events or on campuses.These function similarly to ATVs, with less rough terrain capability and less noise.
• Bus – In some cases, buses can be used to transport multiple casualties, either for the purposes of taking patients on journeys than a car or van, in the context of major incidents, or to deal with specific problems such as drunken patients in town centers. They are sometimes referred to as ambulance buses.
• 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. Helicopter and fixed-wing ambulances are discussed in greater detail at air ambulance.
• Fixed-wing aircraft – These can be used for either acute emergency care in remote areas (such as in Australia, with the 'Flying Doctors'), for patient transport over long distances (e.g. a re-patriation following an illness or injury in a foreign country), or transportation between distant hospitals than a hospital ship and hospital train. Helicopter and fixed-wing ambulances are discussed in greater detail at air ambulance.
• Boat – Boats can be used to serve as water ambulances, especially in island areas or in areas with a large number of canals. Some lifeboats or lifeguard vessels may fit the description of an ambulance as they are used to transport a casualty.
• Train – In remote or hard-to-reach areas that are accessed primarily by railway connections, trains 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 trains.
• Trailer – In some instances, a 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.
• Horse and cart – More traditional form of transport, mostly seen in developing economies.
• Fire engine or Fire truck – Fire services (especially in North America) often train firefighters to respond to medical emergencies and most apparatus carry at least basic medical supplies. By design, most apparatus 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.Some Fire Engines or Fire Trucks have cabinets or doors located in the cab or outside of the cab that contain medical equipment.

Vehicle type gallery

• 
  A Navistar truck ambulance operated by the District of Columbia Fire and Emergency Medical Services Department
• 
  A Toyota HiAce van ambulance operated by the Malaysia Ministry of Health
• 
  An Volkswagen Transporter (T6) nontransporting EMS vehicle carrying an Emergency physician
• 
  A Honda ST series motorcycle ambulance operated by the London Ambulance Service
• 
  A paramedic bicycle operated by the London Ambulance Service
• 
  An all-terrain vehicle ambulance with a trailer operated by the Pol'and'Rock Festival's Medical Patrol
• 
  A MAN Lion's City operated by the Bremen Feuerwehr
• 
  A Eurocopter EC145 helicopter air ambulance operated by Rega
• 
  A Pilatus PC-12 plane air ambulance operated by the Royal Flying Doctor Service
• 
  A water ambulance operated by the Norwegian Society for Sea Rescue
• 
  The "Surgeon Nikolay Pirogov" hospital train operated by Russian Railways

Crew

An ambulance usually has two or more crew members. One person drives while the other looks after the patient in the back. A paramedic will have at least a year of medical training. They can do fairly advanced treatment. However, not all ambulances have paramedics on them. In the United States, some may have emergency medical technicians (EMTs). Emergency care assistants (ECAs) can be found in the United Kingdom. In some countries such as France, Germany, the Netherlands and Sweden, ambulances may have doctors or nurses on board.

Equipment

Big military ambulance for when many people are hurt

In the past, ambulances only gave patients a ride to hospital. They only carried a small amount of first aid equipment. This is still true in some parts of the world. Most modern ambulances will have more equipment and medicine. In some countries, an ambulance is like a mobile doctor's clinic.

Ambulances or other medical vehicles have some or all of the following equipment on board:

• Collar:A special collar is used to hold a person so they can not move their neck.This is used if it is thought that they may have damaged their backbone.
• Defibrillator:This is a machine that delivers electricity and restarts a heart that has stopped beating normally.Some defibrillators are connected to a heart monitor and use Manual Paddles whereas an Automated Defibrillator has voice commands and tells the emergency workers and bystanders to stand back so that a shock can be delivered.Defibrillators treat certain Heart Arrhythmias such as Ventricular Fibrillation (V-Fib),Ventricular Tachycardia (V-Tach) and some other Arrhythmias.However,Asystole (Flatline),Cannot be treated by a Defibrillator.
• Nitrous oxide:This is Also known as "laughing gas". This gas is used to reduce pain.
• Heart monitor:This is a machine that shows how well a heart is beating.As explained above,a Heart Monitor can have a Defibrillator connected to it.
• Oxygen cylinders:If a person is having trouble breathing, it often helps to give them oxygen from a cylinder.
• Splints: These hold an arm or leg in place if a bone is broken. They stop the broken bone from moving and getting worse.
• Stretcher: A stretcher is used to carry the patient in and out of the ambulance.
• Wheelchair: A chair with wheels used to carry a patient.
• Medications: Medications are found on Ambulances and other medical vehicles. Medications include cardiac (heart) drugs, anti seizure medications and others.

Air ambulance

A UK helicopter ambulance

Air ambulances became more common in the late 20th century. They are helicopters that carry much of the same equipment as a normal ambulance. In the United States, the Coast Guard runs a public air ambulance service using helicopters. These are often needed when emergencies happen at sea. There are also privately owned air ambulance services that provide for a wider range of needs, including international transport. Air ambulances are very useful when an emergency happens in a place that is hard to get to quickly by ground travel.

Air ambulances are very important in countries with low population density (few people, living in a vast area). Examples of these areas are Canada, Russia, Sweden or Finland. They can often save the life of a patient who would otherwise die because they could not get to a hospital quickly by other means.