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Ambulance
An ambulance is a vehicle for transportation of sick or injured people to, from or between places of treatment for an illness or injury, and in some instances will also provide out of hospital medical care to the patient. The word is often associated with road going emergency ambulances which form part of an emergency medical service, administering emergency care to those with acute medical problems.
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The term ambulance does however extend to a wider range of vehicles other than those with flashing warning lights and sirens, including a large number of non-urgent ambulances which are for transport of patients without an urgent acute condition and a wide range of vehicles including trucks, vans, bicycles, motorbikes, station wagons, buses, helicopters, fixed-wing aircraft, boats, and even hospital ships.

The term ambulance comes from the Latin word ambulare, 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. 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.

There are other types of ambulance, with the most common being the patient transport 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. Their purpose is simply to transport patients to, from or between places of treatment. In most countries, these are not equipped with flashing lights or sirens. In some jurisdictions there is a modified form of the ambulance used, that only carries one member of ambulance crew to the scene to provide care, but is not used to transport the patient. Such vehicles are called fly-cars. In these cases a patient who requires transportation to hospital will require a patient-carrying ambulance to attend in addition to the fast responder.


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 fulfil more than one function (such as combining emergency ambulance care with patient transport).
  1. Emergency ambulance - The most common type of ambulance, which provide care to patients with an acute illness or injury. These can be road-going vans, boats, helicopters, fixed-wing aircrafts (known as air ambulances) or even converted vehicles such as golf carts.

  2. Patient transport 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.

  3. Response unit - Also known as a fly-car, which is a vehicle which is used to reach an acutely ill patient quickly, and provide on scene care, but lacks the capacity to transport the patient from the scene. Response units may be backed up by an emergency ambulance which can transport the patient, or may deal with the problem on scene, with no requirement for a transport ambulance. These can be a wide variety of vehicles, from standard cars, to modified vans, motorcycles, pedal cycles, quad bikes or horses. These units can function as a vehicle for officers or supervisors (similar to a fire chief's vehicle, but for ambulance services).

  4. 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.
Safety
Ambulances, like other emergency vehicles, are required to operate in all 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 trucks 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 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 have died during ambulance trips in the US since 1991.

Equipment
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Modern ambulance equipment

Interior of a mobile intensive care unit (MICU) ambulance





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Four stages of deployment on an ambulance tail lift
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:
  1. Two-way radio - One of the most important pieces of equipment in modern emergency medical services as it allows for the issuing of jobs to the ambulance, and can allow the crew to pass information back to control or to the hospital (for example a priority ASHICE message to alert the hospital of the impending arrival of a critical patient.) More recently many services world wide have moved from traditional UHF/VHF sets, which can be monitored externally, to more secure systems, such as those working on a GSM system, such as TETRA.

  2. Mobile data terminal - Some ambulances are fitted with Mobile data terminals (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 scene, or fulfill any other computer based function.

  3. Evidence gathering CCTV - Some ambulances are now being fitted with video cameras used to record activity either inside or outside the vehicle. They may also be fitted with sound recording facilities. This can be used as a form of protection from violence against ambulance crews, or in some cases (dependent on local laws) to prove or disprove cases where a member of crew stands accused of malpractice.

  4. Tail lift or ramp – Ambulances can be fitted with a tail lift or ramp in order to facilitate loading a patient without having to undertake any lifting. This is especially important where the patient is obese or specialty care transports that require large, bulky equipment such as a neonatal incubator or hospital beds. There may also be equipment linked to this such as winches which are designed to pull heavy patients in to the vehicle.

  5. 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.

  6. Air conditioning– Ambulances are often fitted with a separate air conditioning system to serve the working area from that which serves the cab. This helps to maintain an appropriate temperature for any patients being treated, but may also feature additional features such as filtering against airborne pathogens.

  7. Data Recorders – These are often placed in ambulances to record such information as speed, braking power and time, activation of active emergency warnings such as lights and sirens, as well as seat belt usage. These are often used in coordination with GPS units.
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