Editing Ambulance (section)

==Appearance and markings==
Emergency ambulances are highly likely to be involved in hazardous situations, including incidents such as a [[Car accident|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'),<ref>{{cite web|url=http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h08_e.htm#BK213|title=Ontario Highway Traffic Act|year=2009|pages=Section 144.20|access-date=19 November 2009| archive-url= https://web.archive.org/web/20091122043253/http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h08_e.htm| archive-date= 22 November 2009 | url-status= live}}</ref> or be permitted to break the speed limit.<ref>{{cite web|url=http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h08_e.htm#BK193|title=Ontario Highway Traffic Act|publisher=Province of Ontario|pages=Section 128.0.13|access-date=19 November 2009| archive-url= https://web.archive.org/web/20091122043253/http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h08_e.htm| archive-date= 22 November 2009 | url-status= live}}</ref> 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,<ref>{{cite web|url=http://www.caep.ca/template.asp?id=98758372CC0F45FB826FFF49812638DD#4%29%20TRIAGE%20&%20ACUITY%20SCALE%20CATEGORY%20DEFINITIONS |title=CTAS Category Definitions |work=Implementation Guidelines for the Canadian ED Triage & Acuity Scale (CTAS) |publisher=Canadian Association of Emergency Physician |access-date=19 November 2009 |url-status=dead |archive-url=https://web.archive.org/web/20100921192755/http://caep.ca/template.asp?id=98758372CC0F45FB826FFF49812638DD |archive-date=21 September 2010}}</ref> and because of this need, emergency ambulances are often fitted with passive and active visual and/or audible warnings to alert road users.

===Passive visual warnings===
{{multiple image|perrow = 3|total_width=420
| align     = right
| direction = horizontal
| image1    = Star of life2.svg
| image2    = Flag_of_the_Red_Cross.svg
| image3    = Flag_of_the_Red_Crescent.svg
| image5    = Maltese_cross.svg
| image6    = Battenburg-ambulance.svg
| footer    = Various symbols for identifying ambulances:<br />'''Top:''' The [[Star of Life]], the [[International Red Cross and Red Crescent Movement|Red Cross]], the [[International Red Cross and Red Crescent Movement|Red Crescent]]<br />'''Bottom:''' The [[Maltese Cross]], [[Battenburg markings]]
}}

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 [[Retroreflector|retro-reflective]] designs, which reflects light from car headlights or torches. Popular patterns include 'checker board' (alternate coloured squares, sometimes called '[[Battenburg markings|Battenburg]]', named after a [[Battenberg cake|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 [[Fluorescence|fluorescent]]) yellow or orange for maximum visual impact, though classic white or red are also common. Fire department-operated ambulances are often painted red to match the fire apparatuses.{{citation needed|date=April 2021}}

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 mirror]]s. Ambulances may display the name of their owner or operator, and an [[emergency telephone number]] for the ambulance service.

[[File:NSW Ambulance Australia.png|thumb|An ambulance in [[New South Wales]], Australia with warped Battenburg markings, the Maltese Cross, and additional fluorescent reflective stripes to aid in visibility. Also visible are its emergency lights.]]
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 [[Emblems of the Red Cross|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.<ref>{{cite book |last1=Dromi |first1=Shai M. |title=Above the fray: The Red Cross and the making of the humanitarian NGO sector |date=2020 |publisher=Univ. of Chicago Press |location=Chicago |isbn=978-0226680101 |pages=55–56 |url=https://press.uchicago.edu/ucp/books/book/chicago/A/bo46479924.html}}</ref> 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.{{citation needed|date=April 2021}}

The [[Star of Life]] is widely used, and was originally designed and governed by the U.S. [[National Highway Traffic Safety Administration]],<ref>{{cite web|url=http://www.ems.gov/vgn-ext-templating/ems/sol/pages/Contents.htm|title=Star of Life DOT HS 808 721|publisher=National Highway Safety Administration|access-date=19 November 2009}}</ref> because the Red Cross symbol is legally protected by both National<ref>{{cite web|url=http://www.redcross.ca/article.asp?id=000340&tid=019 |title=The Red Cross Emblem |publisher=The Canadian Red Cross |access-date=19 November 2009 |url-status=dead |archive-url=https://web.archive.org/web/20100111081703/http://www.redcross.ca/article.asp?id=000340&tid=019 |archive-date=11 January 2010}}</ref> and international<ref>{{cite web|title=The Emblems|date=28 December 2015|url=https://www.icrc.org/en/document/emblems|url-status=live|access-date=28 December 2015|publisher=International Committee of the Red Cross|archive-url=https://web.archive.org/web/20170701024007/https://www.icrc.org/en/document/emblems |archive-date=1 July 2017 }}</ref><ref>{{cite web|url=http://www.icrc.org/Web/eng/siteeng0.nsf/htmlall/genevaconventions|title=The Geneva Convention of 1949|publisher=International Committee of the Red Cross|access-date=19 November 2009| archive-url= https://web.archive.org/web/20091122011212/http://www.icrc.org/Web/Eng/siteeng0.nsf/htmlall/genevaconventions| archive-date= 22 November 2009 | url-status= live}}</ref> law.

Ambulance services with historical origins such as the [[Venerable Order of Saint John|Order of St John]], the [[Order of Malta Ambulance Corps]]<ref>{{Cite web|url=https://orderofmaltaireland.org/|title=Order of Malta Charity Ireland}}</ref> 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.<ref>{{cite web|url=http://www.ambulance.qld.gov.au/about/default.asp|title=About Queensland Ambulance Service|access-date=27 June 2007| archive-url= https://web.archive.org/web/20070706071845/http://www.ambulance.qld.gov.au/about/default.asp| archive-date= 6 July 2007 | url-status= live}}</ref><ref>{{cite web|url=http://www.ambulance.act.gov.au/|title=ACT Ambulance Service|access-date=27 June 2007|archive-url=https://web.archive.org/web/20070630131352/http://www.ambulance.act.gov.au/|archive-date=30 June 2007|url-status=dead}}</ref><ref>{{cite web|url=http://www.asnsw.health.nsw.gov.au/|title=Ambulance Service of New South Wales|access-date=27 June 2007 |archive-url = https://web.archive.org/web/20070607030731/http://www.asnsw.health.nsw.gov.au/index.html |archive-date = 7 June 2007}}</ref><ref>{{cite web|url=http://www.saambulance.com.au/|title=South Australian Ambulance Service|access-date=27 June 2007|archive-url=https://web.archive.org/web/20070625084647/http://www.saambulance.com.au/|archive-date=25 June 2007|url-status=dead}}</ref>

[[Fire service]] operated ambulances may display the Cross of [[Saint Florian|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 [[firefighter]]s).<ref>{{cite web|url=http://www.saintflorian.net/index.html|title=St. Florian – Patron Saint of Firefighters|access-date=3 June 2007|publisher=stflorian.net|archive-url=https://web.archive.org/web/20070927201655/http://www.saintflorian.net/index.html|archive-date=27 September 2007|url-status=dead}}</ref>

===Active visual warnings===
{{Main|Emergency vehicle lighting}}
{{See also | Emergency vehicle equipment}}

[[File:DNK ambulance A6 b.jpg|thumb|An ambulance in Denmark with roof-integrated LED lights, plus side-view mirror, grill and front fend-off lights, and fog lamps wig-wags]]
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.{{citation needed|date=April 2021}}

There are several technologies in use to achieve the flashing effect. These include flashing a [[Incandescent light bulb|light bulb]] or [[Light-emitting diode|LED]], flashing or rotating [[halogen light|halogen]], and [[strobe light]]s, 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.{{citation needed|date=April 2021}}

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. [[headlamp]]s, tail lamps) may be programmed to flash. Flashing headlights (typically the high beams, flashed alternately) are known as a [[wig-wag (automobile)|wig-wag]].{{citation needed|date=April 2021}} Additional white lights may be placed strategically around the vehicle to illuminate the area around it when it is dark, almost always at the rear for loading and unloading stretchers and often at the sides as well. In areas very far North or South where there are times of year with long periods of darkness, additional driving lights at the front are often fitted as well to increase visibility for the driver.

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 and rear 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.{{citation needed|date=April 2021}}

===Audible warnings===
{{Main|Emergency vehicle equipment#Audible Warning Devices (Sirens)|l1=Audible warning devices}}

[[File:Whelen.ogg|thumb|right|A [[Whelen Engineering Company]] siren with ''wail'', ''yelp'' and ''phaser'' tones, commonly used by [[emergency vehicle]]s such as ambulances in several countries]]
In addition to visual warnings, ambulances can be fitted with '''audible warnings''', sometimes known as [[siren (noisemaker)|siren]]s, 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.<ref>{{cite book|others=The Canadian Red Cross|title=Emergency Care Manual|publisher=The StayWell Health Company|location=Guelph, ON|year=2008|page=359|chapter=23|isbn=978-1584804048}}.</ref>
[[File:St John ambulance Dunedin.jpg|thumb|A [[Hato Hone St John]] responding through traffic in [[New Zealand]]]]
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 air horns as their primary siren.

A recent{{when|date=February 2024}} development is the use of the [[Radio Data System|RDS]] system of [[Car audio|car radios]]. The ambulance is fitted with a short range [[Frequency modulation|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).<ref>{{cite web|url=http://www.freepatentsonline.com/y2003/0164775.html|title=Emergency warning device – patent application|access-date=19 November 2009}}</ref> 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.<ref>{{cite book|last=Wright|first=Scott|title=The Broadcaster's Guide to RDS|publisher=Butterworth-Heineman|location=Woburn, MA|year=1997|page=73|isbn=0240802780|url=https://books.google.com/books?id=MX0nKoHTQ_4C&q=RDS%20Code%2031&pg=PA47}}</ref>