Dacia 1300 Ambulance DACIA Logans, Dusters, Dokker + 13(20)
1950 DAF A10 Ambulance
Dacia 1300 Ambulance DACIA Logans, Dusters, Dokker + 13(20)
1950 DAF A10 Ambulance
An ambulance is a vehicle for transportation, from or between places of treatment, 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.
The term ambulance does, however, extend to a wider range of vehicles other than those with flashing warning lights and sirens. The term also includes a large number of non-urgent ambulances which are for transport of patients without an urgent acute condition (see below: Functional types) and a wide range of urgent and non-urgent vehicles including trucks, vans, bicycles, motorbikes, station wagons, buses, helicopters, fixed-wing aircraft, boats, and even hospital ships (see below: Vehicle types).
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.
There are other types of ambulance, with the most common being the patient transport ambulance (sometimes called an ambulette). 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 first responder.
The history of the ambulance begins in ancient times, 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.
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
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 aircraft (known as air ambulances) or even converted vehicles such as golf carts.
Patient transport ambulance – A vehicle, which has the job of transporting patients to, from or between places of medical treatment, such as hospital or dialysiscenter, for non-urgent care. These can be vans, buses or other vehicles.
Response unit – Also known as a fly-car or a [Quick Response Vehicle], 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). Fire & Rescue services in North America often staff EMTs or Paramedics to their apparatuses to provide medical care without the need to wait for an ambulance.
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.
In the US, 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 chassis and is used primarily for Advanced Life Support and rescue work. Type II is a van based ambulance with little modifications except for a raised roof. Its use is for basic life support and transfer of patients. The Type III is a van chassis but with a custom made rear compartment and has the same use as Type I ambulances. Type IV’s are nomenclature for smaller ad hoc patient transfer using smaller utility vehicles where passenger vehicles and trucks would have difficulty in traversing, such as large industrial complexes, commercial venues, and special events with large crowds. These do not, generally, fall under Federal Regulations.
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 ambulance is based on either the chassis of a van (vanbulance) or pickup truck. This chassis is then modified to the designs and specifications of the purchaser.
Car/SUV – Used either as a fly-car for rapid response or for 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.
Motorcycle – In developed areas, these are 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. See also motorcycle ambulance.
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.
All-terrain vehicle (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 in inaccessible areas.
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 ambulances, especially in island areas or in areas with a large number of canals, such as the Venetianwater ambulances. Some lifeboats or lifeguard vessels may fit the description of an ambulance as they are used to transport a casualty.
Ship – Ships can be used as hospital ships, mostly operated by national military services, although some ships are operated by charities. They can meet the definition of ambulances as they provide transport to the sick and wounded (along with treatment). They are often sent to disaster or war zones to provide care for the casualties of these events.
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 busses 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.
Hospital train – Early hospital trains functioned to carry large numbers of wounded soldiers. Similar to other ambulance types, as Western medicine developed, hospital trains gained the ability to provide treatment. In some rural locations, hospital trains now function as mobile hospitals, traveling by rail from one location to the next, then parking on a siding to provide hospital services to the local population. Hospital trains also find use in disaster response
Fire Engine – Fire services (especially in North America) often train Firefighters in emergency medicine and most apparatuses carry at least basic medical supplies. By design, apparatuses cannot transport patients.
A paramedic’s scooter in Israel
In large, congested cities, paramedics may travel by bicycle, such as this one of the London Ambulance Service
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 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 ambulances usually rely on electronic equipment, which itself often relies on an intact power grid. Similarly, modern ambulances are equipped with two-way radios or cellular telephones 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 manufacturers. The first is frequently a manufacturer of light trucks or full-size vans (or previously, cars) such as Mercedes-Benz, Nissan, Toyota, or Ford. The second manufacturer (known as second stage manufacturer) purchases 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, and interior fittings. This is done by one of two methods – either coachbuilding, 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 of the ambulance, and then finished off.
Modern ambulances are typically powered by internal combustion engines, which can be powered by any conventional fuel, including diesel, gasoline or liquefied petroleum gas, 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 thought to be 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 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.
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 publishes the standard CEN 1789, 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 and known as KKK-1822-A. This standard has been revised several times, and is currently in version ‘F’ change #10, known as KKK-A-1822F, although not all states have adopted this version. The National Fire Protection Association has also published a design standard, NFPA 1917, which some administrations are considering switching to if KKK-A-1822F is withdrawn. The Commission on Accreditation of Ambulance Services (CAAS) has published its Ground Vehicle Standard for Ambulances effective July 2016. This standard is similar to the KKK-A-1822F and NFPA 1917-2016 specifications.
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.
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 died during ambulance trips in the US between 1991 and 2006.
Interior of a mobile intensive care unit (MICU) ambulance from Graz, Austria
Four stages of deployment on an inboard 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:
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 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 system, such as TETRA.
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.
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.
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 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.
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.
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.
In parts of the world which 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 (or motorcycle ambulances) 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.
An ambulance on an oncoming lane in Moscow
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 or stop sign as a yield sign (‘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) 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.
The 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) 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) yellow or orange for maximum visual impact, though classic white or red are also common. Fire Department-operated Ambulances are often painted similarly to their apparatuses for ease of identification and the fact that bright red is a very striking color appropriate for this type of vehicle.
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 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, and all countries signatory to it agree to restrict their use to either (1) Military Ambulances or (2) the national Red Cross or Red Crescent 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 Red Cross member organization use a red Star of David, but this does not have recognition beyond Israeli borders, where they must use the Red Crystal.
The Star of Life is widely used, and was originally designed and governed by the U.S. National Highway Traffic Safety Administration, because the Red Cross symbol is legally protected by both National and international law. It indicates that the vehicle’s operators can render their given level of care represented on the six pointed star.
Ambulance services that have historical origins such as the Order of St John, the Order of Malta Ambulance Corps and Malteser International 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 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).
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, flashing or rotating halogen, and strobe lights, 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 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) 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. headlamps, tail lamps) may be programmed to flash. Flashing headlights (typically the high beams, flashed alternately) are known as a wig-wag.
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 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.
In addition to visual warnings, ambulances can be fitted with audible warnings, sometimes known as sirens, 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 airhorns 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.
A volunteer ambulance crew in Modena, Italy
A city fire service ambulance from the Tokyo Fire Department.
Some countries closely regulate the industry (and may require anyone working on an ambulance to be qualified to a set level), whereas others allow quite wide differences between types of operator.
Government Ambulance Service – Operating separately from (although alongside) the fire and police service of the area, these ambulances are funded by local or national government. In some countries, these only tend to be found in big cities, whereas in countries such as the United Kingdom almost all emergency ambulances are part of a nationwide system under the National Health Service. In Canada ambulance services are normally operated by local municipalities or provincial health agencies as a separate entity from fire or police services.
Fire or Police Linked Service – In countries such as the United States, Japan, Hong Kong and France ambulances can be operated by the local fire or police service, more commonly the fire service due to overlapping calls. This is particularly common in rural areas, where maintaining a separate service is not necessarily cost effective, or by service preference such as in Los Angeles where the Los Angeles Fire Department prefers to handle all parts of emergency medicine in-house. In some cases this can lead to an illness or injury being attended by a vehicle other than an ambulance, such as a fire truck, and firefighters must maintain higher standards of medical capability.
Volunteer Ambulance Service – Charities or non-profit companies operate ambulances, both in an emergency and patient transport function. This may be along similar lines to volunteer fire companies, providing the main service for an area, and either community or privately owned. They may be linked to a voluntary fire department, with volunteers providing both services. There are charities who focus on providing ambulances for the community, or for cover at private events (sports etc.). The Red Cross provides this service across the world on a volunteer basis. (and in others as a Private Ambulance Service), as do other organisations such as St John Ambulance and the Order of Malta Ambulance Corps. These volunteer ambulances may be seen providing support to the full-time ambulance crews during times of emergency. In some cases the volunteer charity may employ paid members of staff alongside volunteers to operate a full-time ambulance service, such in some parts of Australia and in Ireland and New Zealand.
Private Ambulance Service – Normal commercial companies with paid employees, but often on contract to the local or national government. Private companies may provide only the patient transport elements of ambulance care (i.e. nonurgent or ambulatory transport), but in some places, they are contracted to provide emergency care, or to form a ‘second tier’ response. In many areas private services cover all emergency transport functions and government agencies do not provide this service. Companies such as Falck, Acadian Ambulance, and American Medical Response are some of the larger companies that provide such services. These organisations may also provide services known as ‘Stand-by’ cover at industrial sites or at special events. From April 2011 all private ambulance services in the UK must be Care Quality Commission (CQC) registered. Private services in Canada operate non-emergency patient transfers or for private functions only.
Combined Emergency Service – these are full service emergency service agencies, which may be found in places such as airports or large colleges and universities. Their key feature is that all personnel are trained not only in ambulance (EMT) care, but as a firefighter and a peace officer (police function). They may be found in smaller towns and cities, where size or budget does not warrant separate services. This multi-functionality allows to make the most of limited resource or budget, but having a single team respond to any emergency.
Hospital Based Service – Hospitals may provide their own ambulance service as a service to the community, or where ambulance care is unreliable or chargeable. Their use would be dependent on using the services of the providing hospital.
Charity Ambulance – This special type of 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 UK’s ‘Jumbulance’ project.
Company Ambulance – Many large factories and other industrial centres, such as chemical plants, oil refineries, breweries and distilleries, have ambulance services provided by employers as a means of protecting their interests and the welfare of their staff. These are often used as first response vehicles in the event of a fire or explosion.
The cost of an ambulance ride may be paid for from several sources, and this will depend on the type of service being provided, by whom, and possibly who to.
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).
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), although response cars may have a sole crew member, possibly backed up by another double-crewed ambulance. 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 ambulance may be crewed by one paramedic and one EMT-Basic.
Common ambulance crew qualifications are:
Military ambulances have historically included vehicles based on civilian designs and at times also included armored, but unarmed, vehicles ambulances based upon armoured personnel carriers (APCs). In the Second World War vehicles such as the Hanomag Sd Kfz 251 halftrack 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 serve the exclusive purpose of armored medical vehicles. Civilian based designs may be painted in appropriate colours, depending on the operational requirements (i.e. camouflage for field use, white for United Nations peacekeeping, etc.). For example, the British Royal Army Medical Corps 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. 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 demand ambulances be marked with one of the Emblems of the Red Cross not to mount offensive weapons, 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-combatants; however, this application does not always exempt medical personnel from catching enemy fire—accidental 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.
USNS Mercy, a U.S. Navy hospital ship
Recently, the Israeli Defense Forces has modified a number of its Merkava main battle tanks with ambulance features in order to allow rescue operations to take place under heavy fire in urban warfare. The modifications were made following a failed rescue attempt in which Palestinian gunmen killed two soldiers who were providing aid for a Palestinian woman in Rafah. Since M-113 armored personnel carriers and regular up-armored ambulances are not sufficiently protected against anti-tankweapons and improvised explosive devices, it was decided to use the heavily armored Merkava 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 currently employs the M113, the M577, the M1133Stryker 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 ships 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, these ships can display a prominent Red Cross or Red Crescent to confer protection under the appropriate Geneva convention. However, this designation has not always protected hospital ships from enemy fire.
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 vehicles.
Toronto‘s City Council has begun a “Caravan of Hope” project to provide retired Toronto ambulances a second life by donating them to the people of El Salvador. Since the Province of Ontario requires that ambulances be retired after just four and a half years in service in Ontario, the City of Toronto decommissions and auctions 28 ambulances each year.
1905 Belgische Germain 24 H.P
1905-30 Mobil Ambulance Dinas Kesehatan Gemeente Batavia
1909 spyker ambulance van het rode kruis rode kruisziekenhuis den haag
1909 spyker rodekruis
1909 ziekenauto is een Fiat
1909 ziekenauto red cross
1909 fiat kroeskop meppel
1912 Spijker 16pk, de ziekenauto in die tijd in Rheden
1912-14 Adler betreft met zeer waarschijnlijk een carroserie v d N.V. Fabriek voor luxe rijtuigen en automobielen vh gebroeders H & F Kimman De nieuwe Haarlemsche ziekenauto zijingang
1912-14 Adler betreft met zeer waarschijnlijk een carroserie v d N.V. Fabriek voor luxe rijtuigen en automobielen vh gebroeders H & F Kimman De nieuwe Haarlemsche ziekenauto zijingang
1912-1913 Fiat of Opel Ambulance Groningen-bakker-emmamij-1913-2
1915 Leeuwarder ziekenauto (spyker)
1917 Ford Model T Army ambulance
1918 FIAT de eerste ziekenauto van Kroeskop in Meppel
1920 Dodge Brothers model 30 Ambulance Zuid Holland Wateringen H-31364
1920 Dodge Brothers model 30 Ambulance Zuid Holland Wateringen H-31364
1920 Oudkerkhof Utrecht. De ziekenauto van de GGD rukt uit (HUA)
1920 Spyker and Maybach
1920-25 Gemeentelijke Geneeskundige Dienst bij een drenkeling langs het Merwedekanaal te Utrecht
1926 Ziekenauto Vlaardingen
1927 Gemeentelijke Gezonheidsdienst Ziekenauto te Batavia
1927 ziekenauto gebaseerd op een T Ford vracht auto chassis
1928 Dodge brothers ziekenauto NL
1928 Morris Commercial T Type Tonner
1928 Studebaker type D5521 carr Jan Karsijns NL
1929 Cadillac serie 353 Kijlstra Drachten NL
1929 Eerste ziekenauto Hilversum 3 nov 1929
1930 Burgemeester Troost Waddinxveen met ziekenauto in 1930 met chauffeur v.Gelder NL
1930 Cadillac Ambulance v Leersum NL
1931 Cadillac B21473 de Vrij Leeuwarden Serie 341B NL
1934 Ambulance Adler Standard 8 B-20341 NL
1934 Lincoln type KB B-21473 W de Vrij Leeuwarden NL
1936 Cadillac series Rust Groningen de Vrij Leeuwarden NL
1936 Chevrolet Matane 1940, première ambulance Leon Sihors NL
1937 Hudson ambulance NL
1938 Het Sint Jozefziekenhuis beschikt over een Vauxhall ambulance NL
1938 Mercedes-Benz L1500E NL ?
1941 1e-ambulance-peugeot-d4b-carr-visser NL
1942 Austin K2HZ77982 Visser de Vries Assen NL
1942 chevrolet-ambulance de Vries Assen NL
1943 Amerikaanse Dodge WC54 Ambulance 2nd WW NL
1944 Cadillac multifunctionele zieken, doden, brandweer en taxiauto Ommen NL
1945 Austin K2 NL
1945 Chevrolet ziekenauto GG&GD Amsterdam NL collectie Jan Korte
1947 Cadillac Fleetwood kent Compaan Poepe Assen Holten Reinders Roden NL
1948 Ford ambulance-ziekenauto, die bemand werd door de verpleger-chauffeur Bolks NL
1948 Ford ? Ziekenauto Drachten NL
1949 Chevrolet GK2100 TG3225 De Boer Co Assen De Vries Assen NL
1949 gezondheidsdienst. G.G.D. boot in het water en de ziekenauto op de kant. Het was een repetitie in 1949
1950 Packard de luxe supereight ambulance NL
1950 Packard de luxe supereight ambulance carr. de Vrij Leeuwarden NL
1950 van links naar rechts de Packard DeLuxe Super Eight uit 1950, de Buick Roadmaster uit 1955 en de Buick Super Series 50-70
1953 Mercedes-Benz ambulance NT-72-51 NL
1955 Ford Type 79B Country Sedan SP8342 Compaan Poepe Assen De Vries Assen NL
1956 Buick Roadmaster de Vrij Leeuwarden NL
1958 Buick Limited Series 700 met kenteken ZD-57-31 NL
1958 Cadillac Ambulance de Vrij Leeuwarden NL
1959 Verschillende Ambulances NL
1960 Cadillac type BT6246 DT2956 Smit Joure de Vrij Leeuwarden NL
1964 Chevrolet Ziekenauto van de GG en GD Voorburg
1964 Ford Transit FK1000 UN5697 carr St Pancras KW1
1965 Mercedes-Benz 190 Ambulance NL
1965 Mercedes Benz LP 1213 truck from the steered front axle series, medium-duty class1965 Peugeot 403 Pickup D4B Bus Ambulance Brochure
1966 Ford Transit 8999 BV Ambulance carrosserie de Vries Assen NL
1966 Mercedes Benz Ambulance NL
1967 Mercedes 230 Ambulance
1967 Opel Admiraal ziekenauto Geleen opel kapitein NL
1967-76 Mercedes-Benz W114-115 84-83-UL Visser Leeuwarden NL
1969 Peugeot-J7-Ambulance NL
1971 Mercedes W114 Ambulance NL
1971 Mercedes-Benz W122 5735RR Visser de Vries Assen NL
1971 peugeot-j7-ambulance-carrosserie-visser-standplaats-schiphol NL 1972 Mercedes W114 230 Visser Ambulance NL
1975 Dodge B200 56GF46 Visser de Vries Assen NL
1975 Mercedes-Benz Ambulance Wagenpark Eindhovense GG
1977 Dodge B200 64RE70 Wayne De Vries Assen
1977 Volvo 245 53RT52 De Vries Assen TT Assen NL
1978 Chevrolet Chevy Van 27UP55 WHC De Vries Assen
1978 Peugeot 504 Ambulance NL
1979 GMC Van FF71RZ WHC De Vries Assen NL
1979 Mercedes Benz W123 250 automatic Binz Ambulance NL
1981 Volvo 245 HD18GP De Vries Assen ANWB Alarmcentrale NL
1984 Mercedes-Benz Bremer LK93FP WHC De Vries Assen NL
1988 Chevrolet Vanguard met zwaailichten aan NL
1994 German Army ambulance version of Mercedes Benz G250 ook gebruikt in Nederlands leger.
1996 Volvo 960 NVJH33 RAV Drenthe.941.co NL
2001 Nederlandse Volvo S80 ambulance met Nilson carrosserie NL 2013 Mercedes-Benz Ambulance 08116 uit veiligheidsregio Gelderland Zuid NL
References and notes
|Fate||merged into Chrysler Europe, subsequently into PSA|
|Successor||Talbot, a brand of PSA Peugeot Citroën|
|Founder||Henri Théodore Pigozzi|
|Defunct||1970 taken over by Chrysler,
1979 by PSA
|Headquarters||Nanterre, France (1935–1961)
Poissy, France (1954–1970)
|Products||Simca Aronde, Simca Ariane, Simca Vedette, Simca 1000, Simca 1100, Simca 1300/1500, Simca 1307|
Simca 1000 GL (1974)
Simca (Société Industrielle de Mécanique et Carrosserie Automobile, Mechanical and Automotive Body Manufacturing Company) was a French automaker, founded in November 1934 by Fiat and directed from July 1935 to May 1963 by Italian Henri Théodore Pigozzi (born Enrico Teodoro Pigozzi, 1898–1964). Simca was affiliated with Fiat and then, after Simca bought Ford‘s French activities, became increasingly controlled by the Chrysler Group. In 1970, Simca became a subsidiary and brand of Chrysler Europe, ending its period as an independent company. Simca disappeared in 1978, when Chrysler divested its European operations to another French automaker, PSA Peugeot Citroën. PSA replaced the Simca brand with Talbot after a short period when some models were badged as Simca-Talbots.
During most of its post-war activity, Simca was one of the biggest automobile manufacturers in France. The Simca 1100 was for some time the best-selling car in France, while the Simca 1307 and Simca Horizon won the coveted European Car of the Year title in 1976 and 1978, respectively—these models were badge engineered as products of other marques in some countries. For instance the Simca 1307 was sold in Britain as the Chrysler Alpine, and the Horizon was also sold under the Chrysler brand.
Simca vehicles were also manufactured by Simca do Brasil in São Bernardo do Campo, Brazil, and Barreiros (another Chrysler subsidiary) in Spain. They were also assembled in Australia, Chile, Colombia and the Netherlands during the Chrysler era.
Henri Théodore Pigozzi was active in the automotive business in the early 1920s when he met Fiat founder, Giovanni Agnelli. They began business together in 1922 with Pigozzi acting as a scrap merchant, buying old automobile bodies and sending them to Fiat for recycling. Two years later Pigozzi became Fiat’s General Agent in France, and in 1926 SAFAF (Société Anonyme Française des Automobiles Fiat) was founded. In 1928, SAFAF started the assembly of Fiat cars in Suresnes near Paris, and licensed the production of some parts to local suppliers. By 1934, as many as 30,000 Fiat cars were sold by SAFAF.
The first cars produced were Fiat 508 Balillas and Fiat 518 Arditas, but with Simca-Fiat 6CV and 11CV badges. They were followed during 1936 by the Simca Cinq or 5CV, a version of the Fiat Topolino announced in the Spring, but only available for sale from October 1936. The Huit, an 8CV version of the Fiat 508C-1100, appeared in 1937. Production of the 6CV and 11CV stopped in 1937, leaving the 5CV and the 8CV in production until the outbreak of World War II. The firm nevertheless remained closely connected with Fiat, and it was not until 1938 that the shortened name “Simca” replaced “Simca-Fiat”.
Of the businesses that emerged as France’s big four auto-makers after the war, Simca was unique in not suffering serious bomb damage to its plant. There were persistent suggestions that Henri Pigozzi‘s close personal relationship with the Agnelli family (which owned Fiat) and Fiat’s powerful political influence with the Mussolini government in Italy secured relatively favourable treatment for Simca during the years when France fell under the control of Italy’s powerful ally, Germany. Despite France being occupied, Simca cars continued to be produced in small numbers throughout the war.
Following the 1944 liberation, the company’s close association with Italy became an obvious liability in the feverish atmosphere of recrimination and new beginnings that swept France following four years of German occupation. Nevertheless, shortly after the liberation the Nanterre plant’s financial sustainability received a boost when Simca won a contract from the American army to repair large numbers of Jeep engines.
On 3 January 1946 the new government’s five-year plan for the automobile industry (remembered, without affection, as the Pons Plan) came into force. Government plans for Simca involved pushing it into a merger with various smaller companies such as Delahaye-Delage, Bernard, Laffly and Unic so as to create an automobile manufacturing combine to be called “Générale française automobile” (GFA). With half an eye on the Volkswagen project across the Rhine, the authorities determined that GFA should produce the two door version of the “AFG”, a small family car that had been developed during the war by the influential automobile engineer, Jean-Albert Grégoire. Grégoire owed his influence to a powerfully persuasive personality and a considerable engineering talent. Regarding the future of the French automobile industry, Grégoire held strong opinions, two of which favoured front-wheel drive and aluminium as a material for car bodies. A few weeks after the liberation Grégoire joined the Simca board as General Technical Director, in order to prepare for the production of the AFG at the company’s Nanterre factory.
For Simca, faced with a determinedly dirigiste left-wing French government, the prospect of nationalisation seemed very real. (Renault had already been confiscated and nationalised by the government at the start of 1945.) Simca’s long standing (but Italian born) Director General, Henri Pigozzi, was obliged to deploy his very considerable reserves of guile and charm in order to retain his own position within the company, and it appears that in the end Pigozzi owed his very survival at Simca to the intervention with the national politicians of his new board room colleague, Jean-Albert Grégoire. In return, Grégoire obtained the personal commitment of the surviving Director General to the production at Nanterre of his two-door AFG.
It is very easy to see how the two-door AFG looked, because its four-door equivalent went into production, little changed from Grégoire’s prototype, as the Panhard Dyna X. It was a car designed by an engineer, and Pigozzi thought it ugly. In trying to make it more appealing to the style conscious car buyers who, it was hoped, would appear in Simca showrooms once the economy picked up and government restrictions on car ownership began to be relaxed, Simca designers took the underpinnings of the Grégoire prototype and clothed it with various more conventionally modern bodies, the last of which looked uncannily similar to a shortened Peugeot 203. This “Simca-Grégoire” performed satisfactorily in road tests in France and around Turin (home town of Fiat who still owned Simca), and by September 1946 the car was deemed ready for production. But Pigozzi was still cautious. He had little enthusiasm for the gratuitously unfathomable complexities involved in producing a mass-market front-wheel drive car. The experience of the Citroën Traction Avant, which had bankrupted its manufacturer in the mid-1930s, was not encouraging. Pigozzi therefore applied to the (at this stage still strongly interventionist) government for a far higher level of government subsidy than the government could contemplate. Both the “Simca-Grégoire” project and the government’s own enthusiasm for micro-managing the French automobile industry were by now running out of momentum. Sensing that there was no prospect of putting the “Simca-Grégoire” into production any time soon, General Technical Director Grégoire resigned from the company early in 1947.
Meanwhile, at the first Paris Motor Show since the end of the war, in October 1946, two models were on display on the Simca stand, being the Simca 5 and the Simca 8, at this stage barely distinguishable from their pre-war equivalents. A new car arrived in 1948 with the Simca 6, a development of the Simca 5 which it would eventually replace, and featuring an overhead valve 570 cc engine: the Simca 6 was launched ahead of the introduction of the equivalent Fiat.
The French economy in this period was in a precarious condition and government pressure was applied on the auto-makers to maximize export sales. During the first eight months of 1947, Simca exported 70% of cars produced, placing it behind Citroen (92% exported), Renault (90% exported), Peugeot (87% exported) and Ford France (83% exported). In the struggle to maximize exports, Simca was handicapped by the fact that it could not compete with its principal Italian shareholder, Fiat.
Simca Aronde (1956)
The Simca Aronde, launched in 1951, was the first Simca model not based on a Fiat design. It had a 1200 cc engine and its production reached 100,000 units yearly. Following this success, Simca took over the French truck manufacturers Unic in 1951, Saurer in 1956, and the Poissy plant of Ford SAF in 1954. The Poissy plant had ample room for expansion, enabling Simca to consolidate French production in a single plant and, in 1961, to sell the old Nanterre plant.
The 1950s was a decade of growth for Simca, and by 1959 the combined output of the plants at Nanterre and at Poissy had exceeded 225,000 cars, placing the manufacturer in second place among French automakers in volume terms, ahead of Peugeot and Citroën, though still far behind market leader Renault.
The Ford purchase also added the V-8 powered Ford Vedette range to the Simca stable. This model continued to be produced and progressively upgraded until 1962 in France and 1967 in Brazil, but with various names under the Simca badge. An Aronde-powered version was also made in 1957 and called the Ariane which, because it was economical and had a large body, was popular as a taxi.
In 1958 Simca bought Talbot-Lago.
The Simca plant received a visit by Juscelino Kubitschek before his inauguration in 1956, organized by a Brazilian General who had a family member employed there. He jokingly invited Simca to build a plant in Minas Gerais, his home state. Simca followed through and sent a letter of intent to this effect. In the interim, Brazil had formed an Executive Group for the Automotive Industry (GEIA), which had established a set of requirements for any producer wishing to establish a plant in Brazil. Simca claimed that their proposal and arrangement with Kubitschek pre-dated these rules and lobbied for exceptions. Simca also lobbied directly in Minas, but in the end were forced to present their own proposal, which was accepted with a number of conditions. The delays in passing the GEIA rules meant that Simca, which established its first plant in São Paulo, was unable to access hard currency and suffered severe parts shortages as a result. Simca quickly developed a reputation for low quality which it was unable to shake.
Simca do Brasil was originally 50% Brazilian-owned, but after Chrysler took over Simca France in 1966 they also obtained control of the Brazilian arm. Simca remained based in São Paulo for the entire time they were active in Brazil and never moved to Minas, as originally promised. Their range was built around the 2.4 liter V8-engined Simca Vedette, which entered production in Brazil in March 1959. It was built under a variety of names and in a number of different bodystyles, until the Simca badge was retired there in 1969. Later models were redesigned completely, and were sold as the Simca Esplanada.
The Simca Fulgur was a concept car designed in 1958 by Robert Opron for Simca and first displayed at the 1959 Geneva Auto Show. It was also displayed at the New York Auto Show, and the 1961 Chicago Auto Show. The concept car was intended to show what cars in the year 2000 would look like. It was to be atomic powered, voice controlled, guided by radar, and use only two wheels balanced by gyroscopes when driven at over 150 kph. Fulgur is Latin for flash or lightning. Another translation is lensman.
In 1958, the American car manufacturer Chrysler Corporation, which wanted to enter the European car market, bought 15% of the Simca stocks from Ford in a deal which Henry Ford II was later reported as having publicly regretted. At this stage, however, the dominant shareholder remained Fiat, and their influence is apparent in the engineering and design of Simcas of that period such as the 1000 and 1300 models introduced respectively in 1961 and 1963. However, in 1963 Chrysler increased their stake to a controlling 64% by purchasing stock from Fiat, and they subsequently extended that holding further to 77%. Even in 1971 Fiat retained a 19% holding, but by now they had long ceased to play an active role in the business.
Also, in 1964 Chrysler bought the British manufacturer Rootes thus putting together the basis of Chrysler Europe. All the Simca models manufactured after 1967 had the Chrysler pentastar logo as well as Simca badging. In 1961 Simca started to manufacture all of its models in the ex-Ford SAF factory in Poissy and sold the factory at Nanterre to Citroën. The rear-engined Simca 1000 was introduced in 1961 with its sporting offspring, the Simca-Abarth in 1963. The 1000 also served as the platform for the 1000 Coupe, a sports coupe sporting a Bertone-designed body by Giorgetto Giugiaro and 4-wheel disc brakes. It debuted in 1963 and was described by Car Magazine as “the world’s neatest small coupe”. 1967 saw the more powerful 1200S Bertone Coupe that, with a horsepower upgrade in 1970, could reach the dizzying speed of almost 112 mph (180 km/h), making it the fastest standard production Simca ever built. In 1967 a much more up to date car, the 1100, appeared with front wheel drive and independent suspension all round, and continued in production until 1979. On 1 July 1970 the company title was formally changed to Chrysler France.
The most successful pre-Chrysler Simca models were the Aronde, the Simca 1000 and the front-engined 1100 compact. During the 1970s Chrysler era, Simca produced the new Chrysler 160/180/2 litre saloon, 1307 range (Chrysler Alpine in the UK) and later theHorizon, (Dodge Omni and Plymouth Horizon in the USA). The 1307 and Horizon were both named European Car of the Year at launch. However, Chrysler’s forced marriage of Simca and Rootes was not a happy one: Chrysler Europe collapsed in 1977 and the remains were sold to Peugeot the following year. The Rootes models were quickly killed off, and the Simca-based Alpine/1307 and Horizon soldiered on through the first half of the 1980s using the resurrected Talbot badge. The last car to carry the Simca badge was the 1980 Solara, a 1307 with a boot, but by 1981 this had become a Talbot, thus ending the Simca marque entirely.
Peugeot eventually abandoned the Talbot brand, and the last Simca design was launched as Peugeot 309 (instead of Talbot Arizona as had been originally planned). The Peugeot 309 used Simca engines until October 1991 (some 18 months before the end of production) when they were replaced by PSA’s own TU and XU series of engines. The 309 was produced at the former Rootes factory in Ryton-on-Dunsmore, UK, as well as in the Poissy plant.
Simcas were also manufactured in Brazil, Colombia, Spain and Finland. The last Simca-based car produced was the Horizon-based Dodge Omni, which was built in the USA until 1990. The European equivalent had already been axed three years earlier when use of the Talbot name on passenger cars was finally discontinued.
Simca Jangada (Brazilian model)
1966-69 Simca Esplanada Brazil
Simca GTX (Brazilian model)