Ambulance

An **ambulance** is a vehicle that is made to take people who are sick or injured to a hospital or other medical facility. Ambulances help people who are involved in life-threatening emergency situations. These include motor vehicle accidents, heart attacks, strokes, seizures and other emergency situations. Ambulances and other medical vehicles have specialized equipment that helps in these emergencies.

The first ambulances were used on battlefields. They were carts pulled by horses that were used to take wounded soldiers to field hospitals. Horse-drawn ambulances were common in Europe and North America in the 19th century. Automobiles replaced horses in the early 1900s. The chief physician of Napoleon Bonapart, Dominique Jean Larrey invented a concept of a dedicated vehicle which is reserve to carry patients to the hospital. Nowadays, these can provide first aid or other emergency care. Ambulances and other medical vehicles have specialized emergency lights, sirens and horns that they use to warn people that they are coming down the road. Ambulances normally have emergency medical technicians (EMTs) or paramedics working in them. Ambulances may be used by a Rescue Squad, a separate Emergency Medical Services Agency or a fire department.

Ambulances are normally called by dialing a special emergency number. This number is different for each country. In the United Kingdom, the number is 999. In the United States, the number is 911; In Europe, the number is 112. A call to any of these numbers connects the caller to a specialized Emergency Telephone Operator or Dispatcher who works at an Emergency Dispatch or Control Facility. Once information from the calling person or persons have been given, the Emergency Telephone Operator or Dispatcher sends an ambulance or other Medical vehicles to the incident.

## 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** – Used either as a fly-car for rapid response or to transport patients who can sit, these are standard car models adapted to the requirements of the service using them. Some cars are capable of taking a stretcher with a recumbent patient, but this often requires the removal of the front passenger seat, or the use of a particularly long car. This was often the case with early ambulances, which were converted (or even serving) 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** – 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. 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 truck** – Fire services (especially in North America) often train firefighters to respond to medical emergencies and most apparatuses carry at least basic medical supplies. By design, most apparatuses cannot transport patients unless they can sit in the cab. However, some fire trucks may be designed to have a large ambulance compartment behind the front of the cab, where the driver and officer's seats are located.

## 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. 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

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 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: An electric 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.
- Nitrous oxide: Also known as "laughing gas". This gas is used to reduce pain.
- Heart monitor: This machine 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

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.