Ambulance
An ambulance is a vehicle used to transport sick or injured people, to, from or between places of treatment.
The term ambulance is generally used to designate a vehicle used to provide medical care to patients who are far from a hospital or to transport the patient to a medical center where their progress can be closely monitored and treatment performed. more medical tests. In some cases, the purpose of the ambulance is only to attend the patient on site (such as in emergency cases that give pre-hospital medicine paramedical treatments), but it does not have the purpose of taking him to a health center. In these situations, The patient who requires a transfer to a hospital will need an ambulance dedicated exclusively to the transfer of patients.
The term "ambulance" comes from the Latin verb ambulare, whose meaning is to walk. This term refers to the first war medical services, where patients They were moved on wheeled or manual stretchers. The original meaning of the word was that of "hospital that follows an army in its campaigns". During the American Civil War, vehicles used to remove the wounded from the battlefield were called & #34;ambulance wagons". Later, during the Franco-Prussian War at the end of the 19th century, historical references already speak of ambulances to refer interchangeably to the medical aid that evacuated the wounded from the front and to field hospitals.
The word is commonly associated with emergency-ready vehicles, which provide urgent care to sick or injured people. The vehicles that serve as ambulances usually have warning lights and sirens, which facilitate their movement and allow their identification. It is these ambulances that often carry the Star of Life, which represents the six stages of pre-hospital medical care.
There are other types of ambulances, of which the most common are ambulances dedicated to transporting patients. These vehicles are often not equipped with patient life support systems, and their personnel are often less well trained than those of emergency ambulances. Their purpose is simply to transport patients, so in many countries, these vehicles do not have special lights or sirens.
Other vehicles that are often used as ambulances are trucks, vans, buses, helicopters, planes, ships, and even hospital ships.
In any case, for the use of these vehicles to have optimal results, it is necessary for those who manage them to adequately equip these ambulances, which, although they are used for emergency care or only to transport patients, their use is official and requires of an enormous responsibility, even for this vehicle to be optimized, trained personnel and first aid kits or basic tools should first be available, even in the most basic ambulances.
Types of ambulances
Ambulances can be classified into certain types, depending on whether or not they transport patients, and under what conditions. In some cases, ambulances may perform more than one role, such as emergency transportation and patient care.
- Emergency ambulance: the most common of all ambulances, which provides emergency care to sick or injured patients. They can be vans, boats, helicopters, airplanes or any other means of reconverted transport. They provide emergency medical facilities and personnel to care for the patient at the site of the incident and during the transfer to a medical facility. They are known as AEB (Basic Equipment Ambulance) or AEA (Advanced Equipment Ambulance), depending on your available settings and medical equipment can be classified into:
- Basic life support ambulances (SVBs). Typical 2 technicians in Sanitary Emergencies. (You can add a general physician and a general nurse in exceptional situations).
- Sanitarized ambulances. Usual docking of a Specialist Nurse and 2 technicians in Sanitary Emergencies. (You can add a general physician in exceptional situations).
- Medical Ambulances / UVI-Móvil or advanced life support ambulance (SVA). Usual training of a Specialist Doctor, a specialist nurse and 2 technicians in Sanitary emergencies.
- Ambulance for patient transport: an ambulance that has the mission to transport patients to a medical center, but not for urgent care. Vehicles such as vans or buses can be used for this task. They are also called ATS (Simple Transfer Ambulances).
- It can be simple transport, intended for the transport of patients on a stretcher (when the patient needs an interhospital transfer and presents gravity, they can be medicalized).
- Or it can be of collective transport, conditioned for the joint transport of patients whose transfer does not review a character of urgency, nor are they suffering from infectious-contagious diseases.
- Response unit: used to reach a patient who needs very fast care and providing care at the place where the patient is. However, you can't take him from the place. They receive various names such as Fast Intervention Vehicle (VIR) or Fast Intervention Vehicle (FIV), First Medical Emergency Vehicle, etc. For this reason, they often have a support unit, i.e. an emergency ambulance that comes at once or shortly after the same incident.
- Ambulance of charity: provides special attention with the aim of caring for sick children or adults who are away from hospitals or places to receive health care for travel or holidays. Buses are used for this service.
Types of vehicles
Many types of vehicles can be used as ambulances, although in emergencies or disasters, any vehicle could serve as an ambulance.
Terrestrial media
- Furgoneta: a typical ambulance is the one installed in a van, with a standard chassis and usually with a maximum weight of between 3.5 and 7.5 tons.
- Car/SUV: used for a quick response or for patients who can sit down. These are normal cars that have been adapted to the conditions of the ambulance service. Some cars are able to widen the seat for a patient lying down, but this often requires the withdrawal of the passenger front seat, or the use of a particularly long car. This function used to be present in the first ambulances, which many times were the transformation of a funeral car, as they were of the few cars able to take a man lying in a supine position.
- Motorcycle: in developed areas, they are used to respond urgently to an emergency, as they can travel faster than a car or van in circumstances of a lot of traffic. In developed countries, trailers and sidecars have been adapted to be able to transport the patient using the motorcycle, but this transformation obviously prevents assistance during transport.
- Bike: The use of a bicycle as an ambulance is often done in areas where larger vehicles have access problems. Like the motorcycle, it can be hooked to a trailer to transport the patient.
- Quads: used to intervene outside the road. They can be modified to transport a patient, to rescue tasks in mountains or unavailable areas.
- Buggys: used in sporting events or shows. Its functions are similar to those of the quads, but with less responsiveness in non-alphalt terrain, although making less noise.
- Buses: used for the care of patients accidents of multiple victims as well as in different sports events or shows in a preventive way.
Air means
- Helicopters: They are usually used to care for patients in inaccessible places by road or in places where speed is essential, as they are able to move much faster than a road ambulance.
- Fixed-wing aircraft: used to assist in an emergency in remote areas (the most notable example is Flying Doctors, in Australia) or to move a patient in large distances (usually for repatriation for disease abroad).
Aquatic environments
- Botes: boats or boats can be used to serve as ambulances, especially in islands or in areas with a large number of channels, such as the Venetian ambulance service.
- Boats: ships can be used as hospital ships, especially in military operations, although some of them are owned by charitable organizations. Although they will never be ambulance ships in the strict sense of the word (since they are hospital facilities), being in fact a means of maritime transport, they also serve for the transfer of the patient along with his treatment. They usually go to areas that have suffered disasters or wars to alleviate the needs arising after such events. Other times, the civil merchant marine of certain states makes available to their merchant or fishing vessels some hospital boat that have the means to be able to attend to any emergency of the civil fleet in their area of intervention. Many times they have a heliport on board, which makes it easier for them to refer patients to distances greater than their own journey.
History
First patient transports
There is evidence of forced transport of mentally ill and leprosy patients in ancient times. The first evidence of an ambulance dates from the 10th century and was built by the Anglo-Saxons. This consisted of a stretcher placed on a horse-drawn cart.
During the Crusades of the 11th century, the Order of Malta established hospitals to care for the wounded from battles in the Holy Land, although there is no clear evidence as to how the wounded reached the hospitals.
Horse-carried stretchers were later used by the Normans to carry the sick. The horse-powered ambulance service continued with some variations until the 20th century.
First treatments on the battlefields
The first recorded ambulances used in emergencies were those used during the reign of Isabella I of Castile, in the year 1487. The Castilian army of the time was treated excellently and attracted volunteers from all over Europe, to which the first military hospitals (or "ambulantis") contributed, although the wounded soldiers were not picked up until the end of the battle, causing a higher number of deaths in fields.
The main change in the use of ambulances during battles came with the flying ambulances designed by Dominique-Jean Larrey, physician to Napoleon Bonaparte. Larrey was present at the Battle of Spiers, between France and Prussia, saddened by the fact that the wounded soldiers were not picked up by the numerous ambulances, which Napoleon ordered located just over 3 kilometers from the battle site, until the hostilities ended. They did not stop, so he thought of developing a new system. He decided to use the method used by the Normans, of stretchers and horses, deciding that two or four-wheeled carts, drawn by horses, would carry the wounded from the battlefield, after they had received palliative care on the scene itself. These flying ambulances were first used by Napoleon's Army of the Rhine in 1793. Larrey later developed similar services for the rest of Napoleon's troops, adapting his ambulances to different conditions, including stretchers that could be carried by camels, for the campaigns of Egypt.
Development for civilian use
The main advance in ambulances for civilian use came with the introduction of cholera transport in London in 1832. The Times newspaper stated: "The healing process begins at the very moment in which the patient is carried in the carriage; being the time saved spent in caring for the patient and also, they can drive the patient to the hospital so quickly, that the hospitals can be less numerous and can be located at greater distances between them."
Advances During the American Civil War
The American Civil War saw further advances in medical care for the military. Union military doctors Joseph Barnes and Jonathan Letterman reviewed Larrey's progress and designed a system of pre-hospital care for the soldiers, including new techniques and methods of transportation. They made sure that each regiment had at least one ambulance, with a cart designed to carry two or three patients at a time. Unfortunately, these ambulances proved too light for the task, and were replaced by the 'Rucker' ambulance, named after Major General Rucker, which had four wheels and visible markings for wartime battles.. Other vehicles were used for this service during the Civil War, including steamboats, which served as mobile hospitals for the troops. It was in this period that the transport by rail of wounded soldiers to their place of treatment began.
Start of hospital-based service
The first known hospital-based ambulance service is that of the Commercial Hospital (now Cincinnati General), in Cincinnati, Ohio, United States, in 1865. Later, other hospitals offered this service, notably Bellevue New York Hospital.
Edward Dalton, a former Federal Army surgeon, was commissioned to create a hospital near New York. He started an ambulance service to get patients to the hospital as quickly as possible and in greater comfort. Said service began in 1869. He claimed that his service was the first of his kind. His ambulances had medical equipment, splints, stomach pumps, morphine and brandy, a true reflection of contemporary medicine. Dalton believed that speed was the main thing, so his horses were almost always ready at any moment. He affirmed that, after a call, he left after 30 seconds. The service became very popular and grew rapidly. Thus, in 1870, the service handled 1,401 emergency calls, and twenty years later, it was more than triple, a total of 4,392. At the beginning of the century XX, interim doctors accompanied New York ambulances, providing care to patients at the scene of the call and often dropping them off at home.
In 1867, the Metropolitan Asylums Board of London, in the United Kingdom, received six horse-drawn ambulances for the purpose of transporting patients with smallpox and fever from their homes to the hospital. These ambulances were designed to look like private carriages, but were equipped with rollers on the floor and large reversible doors to make transporting the patient to the stretcher easier. There was enough space for an attendant next to the patient, plus the patient area was designed to be easily cleaned and decontaminated. Anyone willing to pay the cost of renting the horse could call the ambulance by telegram or in person.
Start of exclusive service
In June 1887, the Saint John Ambulance Brigade was formed to provide emergency aid and ambulance service at public events in London. It was regulated as a military-style commando. The Saint John Ambulance Association had already been teaching first aid to the public for 10 years prior to this.
Massive use to provide urgent medical care
At the end of the XIX century several American cities, including Salvador de Bahía, in Brazil and Saint Louis, Missouri, United States, began to use their streetcars as ambulances, to transport the sick and wounded. The Salvador de Bahía tram included a fumigation compartment and a stretcher with two nurses. The design of the St. Louis streetcar network allowed the streetcar ambulance, introduced in 1894, to reach the city's 16 infirmaries.
In Germany, in 1902, a civilian ambulance train was introduced (based on the use of trains during military conflicts) for use in railway accidents. It housed a mobile operating room and eight stretchers. The employed surgeons lived near the railway station where the ambulance train was parked, and from where they were summoned in case of an emergency. The train had priority over the tracks, so the rest of the trains were obliged to give way to it.
Early Motorized Vehicles
At the end of the XIX century, the automobile was in the development phase, so models of automobile ambulances alongside horse-drawn ones. In the early 20th century, ambulances were powered by steam, gasoline, and electricity.
However, the first engine present in an ambulance was presented in 1899, at the Michael Reese Hospital in Chicago, in the United States, making it the first automobile converted into an ambulance. This had been paid for by 500 businessmen from the city, in February of that year. Later, the same was done in 1900, in New York, where its greater speed, safety for the patient, its speed to stop and its speed were praised. comfort. These first two automobile ambulances were electric, with two horsepower (1.5 kW) in the rear axle motors.
The first gasoline-powered ambulance was the Palliser Ambulance, introduced in 1905 and named after Captain John Palliser of the Canadian Militia. This vehicle consisted of three wheels, one in the front and two in the rear, having been designed to be used in battlefields under enemy fire. It was a heavy tractor, with a bulletproof sheet metal. Said plate had a small external opening of 2.7 meters wide by 2.1 m high, with the aim that the ambulance personnel could go outside.
The British Army lagged behind the Canadian Army in introducing a small number of automobile ambulances. In 1905, the Royal Army Medical Corps ordered a series of van-based ambulances from the Straker-Squire firm of Bristol. They were based on a double-decker bus made by the same company, albeit with a shorter wheelbase. Several of these were based in Oxfordshire, serving several of the major camps in the area.
The first mass-produced car-based ambulances were produced in the United States by the James Cunningham, Son & Company of Rochester, New York, a manufacturer of carriages and hearses, in 1909. The ambulance featured a 32 horsepower (24 kW) 4-cylinder internal combustion engine. The chassis was mounted on tires, while the body had an electric light, suspension on the stretcher, two seats next to the stretcher, and a gong on one side.
During World War I
During World War I, the Red Cross carried out early battlefield relief efforts with motorized rather than horse-drawn ambulances, with subsequent success. This led to the progressive elimination of horse-drawn ambulances. In civilian emergency care, ambulance services were often managed or dispatched from individual hospitals, although in some areas telegraph and telephone enabled police departments to handle ambulance dispatch.
The equipment in charge of the ambulance changed rapidly at that time. Splints were introduced during World War I, having a positive effect on the morbidity and mortality of patients with leg fractures. Also, two-way radios were introduced shortly after World War I, allowing more efficient dispatch of radio-called ambulances. Shortly before World War II, a modern ambulance carried advanced medical equipment, a medic, and was dispatched by radio. Ambulances were often hearses - the only available vehicle that could carry a reclining patient - and therefore were often run by undertakers.
Air Ambulances
During World War I, aviation experienced strong growth, becoming a powerful military force, and after the war, with a surplus of aircraft in circulation, new uses for aircraft were sought.
During World War I, aviation moved into testing a powerful military force, and after the war, with a surplus of aircraft in circulation, new uses were found for the aircraft. This included the conversion of aircraft from around the world into ambulance aircraft. Although in 1917 Lieutenant Clifford Peel, a medical student, outlined a system of aircraft and ground facilities to provide medical services in the Australian Outback, the first air ambulance did not see the light of day until 1920. This project became a reality. under the direction of John Flynn in 1928, when the Australian Inland Mission established the Air Medical Service, a year-long experimental programme. The doctors in this program had several responsibilities, among which were flying to the patient, treating him, and if it was convenient because the doctor could not carry out any treatment in situ, taking him to a hospital. This experiment later became the Royal Flying Doctor Service of Australia.
During World War II
In most of the world, the quality of ambulances declined sharply during World War II, as medics, needed in the armed forces, were brought into the war, and thus abandoned ambulances. In England, during the Battle of Britain, the need for ambulances was so great that vans were requisitioned and pressured by demand, often carrying multiple victims at once. After the war, doctors would still go in ambulances in some countries, but not in others. Other vehicles, including regular cars and police cars, were used to transport patients, due to a shortage of dedicated ambulances. Military ambulances such as the Austin K2 were used in both combat and civilian areas.
During the Korean War
During the Korean War, the newly created United States Air Force established a number of air ambulance units for employment in various operations, using helicopters for rapid evacuation of patients. The Bell H-13 helicopter, known from the film and television versions of M*A*S*H, transported 18,000 wounded soldiers during the conflict. The work of the Air Medical Evacuation Squads was a success and was repeated. by US forces in Vietnam. The use of helicopters for emergency medical evacuations was extended to civilian use.
Ambulances for medical care, not just transportation
After the Harrow & Wealdston, the ambulances were restructured to become 'a mobile hospital', although they only transported patients, thus laying the foundation for modern ambulances. Cardiopulmonary resuscitation was developed and accepted as the standard of care for cardiorespiratory arrest far from a hospital; defibrillation was imposed, understood as an increase in cardiac arrhythmias, in addition to new pharmaceutical products to be used in situations of cardiorespiratory arrest. In Ireland, an ambulance specialized in coronary patients managed to revive them thanks to these techniques, demonstrating the need to review ambulance services. This meant increased demand on governments to improve care and emergency care, including care provided by an ambulance. The result was the creation of a series of standards in the construction of ambulances, related to the height of the area where care was provided to the patient (allowing having an assistant to continue caring for the patient during transport) and in the equipment (thus controlling the weight) that an ambulance should carry. Few, if any, ambulances of the time could meet those standards.
Most of the ambulances of that time were mounted on the chassis of a car (often hearses), which could not support the weight and other demands of the new regulations; van chassis (and later, small trucks) began to be used to mount ambulances.
The design of ambulances underwent its main changes in the 1970s. The first ambulances established in vans were very similar to the rest of the vans used by civilians, since they had medical equipment and very reduced light and acoustic signals, the most notable medical equipment accessory being the stretcher.
Over time, ambulances improved their performance, gaining the capacity to carry additional equipment (both portable and permanent), becoming part of the doctors' arsenal.
Modern Vehicles
Modern ambulances are often custom built, as well as specialized medical equipment, installed directly on the ambulances. Vehicle design has been improved, including improvements in visual and acoustic alerts, as well as other more general ones such as ABS, which is particularly necessary in ambulances, due to the speed at which they travel and what they carry inside. There have also been changes to improve the well-being of the ambulance medical team, such as the addition of a stretcher lift, ramps and winches, in order to reduce the manual task to be carried out by the medical team.
Ambulance design continues to evolve, largely due to new developments and the role of paramedics and other ambulance equipment, which requires specialized equipment. Other improvements are intended to protect the driver and the team in the event of an accident, whether they are mere traffic collisions or more catastrophic ones, such as terrorist attacks.
Design and construction
The design of an ambulance must take into account local infrastructure conditions. Road maintenance is necessary so that ambulances can arrive on the scene and then transport the patient to a hospital, although the four-wheel drive available in off-road vehicles can be used. The fuel must always be available and there must be facilities in the maintenance of the vehicle.
The methods of calling and dispatching ambulances (for example, the telephone) generally depend on electronic systems, which also depend on the electricity transmission network. Likewise, most modern ambulances are equipped with two-way radios or mobile phones to enable them to contact hospitals, notify the appropriate hospital of the arrival of the ambulance, or, in cases where doctors are not part of the ambulance team, talk to one about treatment or symptoms.
Security
Like any vehicle, ambulances can be involved in accidents. These, like any other emergency vehicle, need to be operational under any conditions, including when civilian drivers decide not to leave the road. Also, the responsibility of the ambulance crew to care for their patient often precludes the use of safety devices such as seat belts. Research has shown that ambulances have a higher chance of their occupants being killed or injured in a collision, this is higher than that of fire and police cars. The occupants who are most at risk are those who are in charge of patient care. One study compared the results between accidents involving ambulances and family-size vehicles, concluding that accidents involving ambulances tend to involve more people. An eleven-year retrospective study completed in 2001 found that although the worst ambulance accidents occurred during emergency runs, they tended to occur on straight, dry roads in clear weather. Safety thus becomes a concern of special interest to design the ambulance
Equipment
In addition to equipment used directly for the treatment of patients, ambulances can house a range of additional equipment used to facilitate patient care. This may include:
- Bidirectional radio: one of the most important elements of the equipment, since it allows the ambulance to receive orders and can allow the equipment to contact the hospital, either to inform of their arrival or the state of the patient. More recently many services around the world have changed from traditional UHF/VHF, which can be spyed on by others, to safer systems, such as those working on a GSM system, such as TETRA.
- Global Positioning System: At present, much of the ambulances are being equipped with GPS equipment, thus allowing to obtain information on alternative pathways or more quickly to reach the place where the patient is located and the hospital. In addition, it is very useful for the dispatcher of the emergency service to assign to a given emergency, the nearest unit.
- Mobile terminal: some ambulances carry mobile terminals (or MDTS), which are wirelessly connected to a central computer, usually in the control center. These terminals can work by receiving or sending radio signals and can be used to send medical details to the team, record the time the team attends the patient, which it took to get to the place, to leave it and to get to the hospital.
- Closed circuit television: Some newly manufactured ambulances have video cameras (CCTV) that record the activity inside or outside the vehicle. They are used as a protection tool for possible violent attacks against the ambulance, or in some cases, as evidence against a medical negligence case.
- Rampa: They usually carry a ramp or lift in the back to facilitate the patient's load. It is often important when the ambulance has to treat or carry obese or handicapped patients.
- Special lighting: in cases of patients with photosensitivity, there are ambulances that have special lighting (in blue or green colors).
- Air conditioning: The air-conditioned ambulances have two separate parts: one for the driver's area and the other for the treatment area. In this way, an ideal temperature is obtained for the patient and the air is filtered, thus eliminating pathogens from the air.
Intermediate technology
In parts of the world that lack a high level of infrastructure, ambulances are designed based on local conditions, built based on the technologies used. Ambulances can also be trailers, which are pulled by bicycles, motorcycles, tractors, or animals. Animal-drawn ambulances can be useful in regions that experience flooding. Three-wheeled motorcycles are also used, although they have some of the limitations that more traditional ambulances have on roads. The level of care provided by these ambulances varies between providing transportation to a medical clinic and providing on-scene medical care and continuing care during transport.
The design of intermediate technology ambulances must take into account the maintenance and construction of the ambulance. The robustness of the design becomes more important, due to the needs of the vehicle. Profitability can be a high priority.
Appearance
Emergency ambulances are often found in risky situations, including incidents such as traffic accidents, where their intervention is required. Ambulances need to arrive as quickly as possible, and in many countries, they may break traffic laws, such as running stop lights, or exceeding the speed limit.
For these reasons, emergency ambulances use audible and visual warnings to alert other drivers. Visual warnings can be of two types: active or passive.
Passive visual prompts
Passive visual cues are part of vehicle design, and involve the use of a wide range of contrasts. Older ambulances (from developing countries) have the signs painted on the sheet metal, while modern ambulances usually have retroreflectors that reflect light from cars. For this reason, they usually wear bright striped or checkerboard-shaped colors. In addition to retroreflectors, some ambulances are painted in bright colors, such as orange or yellow, to attract the attention of motorists. Another form of passive warning is the word «ambulance» reflected on the hood of the vehicle, in order to be seen from the rear-view mirrors.
Ambulances may display the name of their owner or operator, and a phone number that can be used to call the ambulance, such as 911 (USA), 112 (Europe) or 107 (Argentina).
They may also carry an emblem (as part of passive signs), such as a Red Cross, Red Crescent or Red Crystal. These symbols were agreed upon at the Geneva Conventions, and all signatory countries pledged to restrict their use to military ambulances and the national Red Cross or Red Crescent society only. Employment by any other person, organization or agency is a violation of international law. The protective symbols were designed to indicate, especially to combatants in case of war, that the vehicle is neutral and should not be attacked, thus giving protection to doctors and victims, despite the fact that on many occasions, this code is violated.. In Israel, Magen David Adom, a member organization of the Red Cross, uses a red Star of David as its identifying emblem, although beyond the Israeli borders, to be recognized, they must use the Red Crystal.
Also widely used is the Star of Life, originally designed and used by the US NHTSA after legal action was taken by the Red Cross over misuse of its symbol (a bright orange cross was used, very similar to the Star of Life). symbol of the Red Cross.This star, with its six points, indicates the care that the occupants of the vehicle can provide.It is usually blue.
Ambulance services that have their origins in the Order of Saint John usually use the red Maltese cross to identify their vehicles. This occurs mainly in Australia.
Active visual warnings
Active visual warnings are usually colored flashing lights (beacons and strobes). Its flashing seeks to attract the attention of other drivers, so that they move away or to warn that an ambulance is in a dangerous place on the road. Common colors in this type of light signals are red and blue, although green, orange and yellow are sometimes used, depending on the country and the ambulance operator.
There are several different technologies used to achieve the flashing effect. The original method was to place a mirror next to the rotary bulb. More modern methods include the use of strobe lights, which are usually very bright and can be programmed to signal in a certain way. Currently the most widespread use of flashing lights are those with a low profile and low energy consumption, under LED technology. More information on emergency vehicle equipment.
To increase safety, it is best that the lights have 360º coverage, improving the possibility of the vehicle being seen from any position. In some countries, such as the United States, it is mandatory.
Audible warnings
In addition to visual warnings, ambulances often have audible warnings, commonly known as sirens, which alert vehicles to the presence of an ambulance in their vicinity. The first acoustic signals used were simple bells, installed on top of the ambulance. The most modern ambulances carry electronic sirens, which can produce different sounds.
Ambulance services have their drivers use different types of sirens depending on the driving situation. For example, on an empty road the sound 'moaning' is used, which gives a long, steady high tone followed by a lower tone. At busy intersections, a "howl" can be employed, which delivers a faster signal. "The Dual Tone" and "phaser" they are also found in more modern sirens. The change in speed and warning tone intensifies the alert towards drivers in the path of the ambulance.
Electric vehicles
Manufacturers of electric ambulances and services that use them begin to appear.
Service providers
Some countries closely regulate ambulance service, while others allow for fairly wide differences between types of ambulance service operator. In countries like the United States, the service is often provided by the city's Fire Department. In other countries, this is done by the Red Cross or by the same medical centers (SAMU). It is also possible to observe the existence of private operators, who provide their services for specific situations (sports activities, concerts, massive events) or companies with which they have agreements (hotels, ski resorts, gyms).
Team
It is worth distinguishing, within the medical team, the human and the material:
- Human equipment: it relates to the specialized persons who are part of the usual crew of the ambulance. They are usually three people: a doctor and two Healthy Emergency Technicians (one of whom leads), or a Healthy Emergency Technician (which leads) and two doctors, or a Healthy Emergency Technician, a nurse and a doctor. However, in some countries they do not use doctors for this service because of an alleged higher cost of trained personnel.
The technical-professional training of ambulance operating personnel varies greatly from country to country depending on their customs and legislation. In the US these are typically two-year professional courses comprising a broad curriculum ranging from anatomy and physiology to dynamic cardiology and some may go as far as a Ph.D. in emergency medicine, these personnel are generally referred to as as emergency medical technical personnel (Basic or Paramedical) and within their functions they have many to perform similar, equal or superior to those of nurses in an emergency room, among these procedures may be mechanical ventilation, establishing intravenous access, airway access and administer emergency medication and treatment among others. In the continental US most EMTs-Basic or Paramedics are registered and competitively evaluated by the NREMT (National Registry of Emergency Medical Technician.) www.NREMT.org
- Material equipment: Within this concept, we find the instruments, utensils and means necessary to give attention. Depending on the level of complexity, it will be possible to find equipment for trauma management, oxygen units and resuscitation, elements for wound treatment, defibrillators, among others.
Military use
Military ambulances include designs based on civilian ambulances and military ambulances, but unarmed. They are based on armored personnel carriers. Military ambulances are usually painted olive, white, or any other type of color, depending on the role. Military helicopters are often used as air ambulances as they are really useful for MEDEVAC.
Regulations
Spain
Ambulances are regulated in Spain by Royal Decree 836/2012, of May 25, which establishes the technical characteristics, medical equipment and staffing of road medical transport vehicles.