Editing Ambulance (section)

==Design and construction==
[[File:Ambulance - Tokyo area - 2016-9-10.webm|thumb|left|An ambulance responding in [[Tokyo]], Japan]]
[[File:MICU UZA Nationaal Defilé 2018.jpg|thumb|right|Truck-based ambulance in [[Antwerp]], Belgium]]
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 [[Auto mechanic|maintain the vehicle]].

Methods of summoning (e.g. telephone) and [[Dispatch (logistics)|dispatching]] ambulances usually rely on [[Electronics|electronic]] equipment, which itself often relies on an intact [[power grid]]. Similarly, modern ambulances are equipped with [[two-way radio]]s<ref name=radio1>{{cite web|url=http://www.emergencyambulance.com/news-handheldradios.html |title=Handheld radios for Emergency Ambulance Service |date=16 January 2003 |access-date=28 June 2007 |publisher=Emergency Ambulance.com |url-status=dead |archive-url=https://web.archive.org/web/20070927020619/http://www.emergencyambulance.com/news-handheldradios.html |archive-date=27 September 2007}}</ref> or [[Mobile phone|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.<ref name=radio2>{{cite news|url=http://www.cnn.com/TECH/computing/9904/07/lifelink.idg/index.html|title=New technology closes gap between accident victims and ER|publisher=CNN News|date=7 April 1999|access-date=27 June 2007}}</ref>

Ambulances often have two stages of manufacturing. The first is frequently the manufacture of light or medium truck chassis-cabs or full-size vans (or in some places, cars) such as [[Mercedes-Benz]], [[Nissan]], [[Toyota]], or [[Ford Motor Company|Ford]].<ref>{{cite web|url=http://www.demers-ambulances.com/index.php?productId=50§ionId=95|archive-url=https://archive.today/20070619170810/http://www.demers-ambulances.com/index.php?productId=50§ionId=95|url-status=dead|archive-date=19 June 2007|title=Mystere – Chassis|publisher=Demers Ambulances|access-date=18 October 2009}}</ref> The second manufacturer (known as [[second stage manufacturer]]) modifies the vehicle (which is sometimes purchased [[Cutaway van chassis|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 engine]]s, which can be powered by any conventional fuel, including [[Diesel fuel|diesel]], gasoline or [[liquefied petroleum gas]],<ref>{{cite web|title=The Royal Air Force Motor Sports Association utilizes an LPG-powered ambulance|url=http://www.rafmsa.raf.mod.uk/rafmsa-text/rescue/rescue-front.htm|date=24 November 2005|access-date=2 June 2007|publisher=RAFMSA|archive-url=https://web.archive.org/web/20070701142554/http://www.rafmsa.raf.mod.uk/rafmsa-text/rescue/rescue-front.htm|archive-date=1 July 2007|url-status=dead}}</ref><ref>{{cite web|title=The United States Air Force lists an LPG-powered ambulance on a 2001 vehicle roster|url=https://www.denix.osd.mil/denix/Public/Library/AFV/Reports/af_afv_report01.doc|date=13 November 2001|access-date=2 June 2007|format=DOC|archive-url=https://web.archive.org/web/20070614021105/https://www.denix.osd.mil/denix/Public/Library/AFV/Reports/af_afv_report01.doc|archive-date=14 June 2007|url-status=dead}}</ref> 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 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 (chemistry)|volatility]] in comparison to diesel fuel.<ref>{{cite web|title=National Highway Traffic Safety Administration, see campaign ID #s 87V111000 & 87V113000|url=http://www.nhtsa.dot.gov/|access-date=2 June 2007|publisher=NHTSA| archive-url= https://web.archive.org/web/20070530213217/http://www.nhtsa.dot.gov/| archive-date= 30 May 2007 | url-status= live}}</ref><ref>{{cite web|title=Ford Ambulance/Van Fuel-Fed Fires|date=9 November 2002|url=http://www.autosafety.org/ford-ambulancevan-fuel-fed-fires|access-date=13 February 2010|publisher=Center for Auto Safety}}</ref> The type of engine may be determined by the manufacturer: in the past two decades, [[Ford Motor Company|Ford]]<ref>{{cite web|url=https://www.fleet.ford.com/showroom/specialty_vehicles/Ambulance_DisplayContent-Specs.asp?VehicleID=3|title=2006 Ford E-Series Cutaway Chassis: Specifications|access-date=2 June 2007|publisher=Ford|archive-date=21 November 2018|archive-url=https://web.archive.org/web/20181121021803/https://www.fleet.ford.com/showroom/specialty_vehicles/Ambulance_DisplayContent-Specs.asp?VehicleID=3|url-status=dead}}</ref><ref>{{cite web|url=https://www.fleet.ford.com/showroom/specialty_vehicles/Ambulance_DisplayContent-Specs.asp?VehicleID=1|title=2006 Ford F-Series Super Duty Chassis Cab Ambulance: Specifications|access-date=2 June 2007|publisher=Ford|archive-date=20 November 2018|archive-url=https://web.archive.org/web/20181120221014/https://www.fleet.ford.com/showroom/specialty_vehicles/Ambulance_DisplayContent-Specs.asp?VehicleID=1|url-status=dead}}</ref><ref>{{cite web|url=https://www.fleet.ford.com/showroom/specialty_vehicles/Ambulance_DisplayContent-Specs.asp?VehicleID=2|title=2006 Ford E-Series Van Ambulance: Specifications|access-date=2 June 2007|publisher=Ford|archive-date=21 November 2018|archive-url=https://web.archive.org/web/20181121021905/https://www.fleet.ford.com/showroom/specialty_vehicles/Ambulance_DisplayContent-Specs.asp?VehicleID=2|url-status=dead}}</ref> 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.<ref>{{cite web|url=http://www.jems.com/news_and_articles/articles/ford_to_offer_gasoline_ambulances_in_2010.html|title=Ford to Offer Gasoline Ambulances in 2010|author=James Philips|access-date=10 July 2009|archive-date=16 April 2009|archive-url=https://web.archive.org/web/20090416073953/http://www.jems.com/news_and_articles/articles/ford_to_offer_gasoline_ambulances_in_2010.html?|url-status=dead}}</ref>

In the United Kingdom, the National Health Service has set a target for all ambulances to be fully electric as part of the Net Zero campaign by 2045.<ref>{{Cite news |last=Searles |first=Michael |last2=Donnelly |first2=Laura |date=2024-03-15 |title=Net zero ambulances could cost NHS half a billion pounds |url=https://www.telegraph.co.uk/news/2024/03/15/nhs-net-zero-ambulance-plans-cost-halfabillionpounds/ |access-date=2024-04-21 |work=The Telegraph |language=en-GB |issn=0307-1235}}</ref>
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===Standards===
[[File:Ambulance lane.jpg|thumb|upright|An ambulance [[lane]] in [[Warsaw]], Poland]]
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-A-1822.<ref>{{cite journal |author =Vogt F |title=Equipment: Federal Specification, Ambulance KKK-A-1822 |journal=Emerg Med Serv |volume=5 |issue=3 |pages=58, 60–64 |year=1976 |pmid=1028572 }}</ref> This standard has been revised several times, and is currently in version 'F' change notice #13, known as KKK-A-1822F. The [[National Fire Protection Association]] has also published a design standard, [[NFPA 1917]], which offers an alternative to KKK-A-1822F.<ref name="NebraskaEMSLetter">{{cite web|first=Dean|last=Cole|publisher=Nebraska EMS/Trauma Program|access-date=24 May 2013|url=http://dhhs.ne.gov/publichealth/NebraskaEMS/Documents/Ambulance%20Vehicle%20Design%20Specifications%20Revision.pdf|year=2013|title=Ambulance Vehicle Design Specifications Revision|archive-url=https://web.archive.org/web/20150430113312/http://dhhs.ne.gov/publichealth/NebraskaEMS/Documents/Ambulance%20Vehicle%20Design%20Specifications%20Revision.pdf|archive-date=30 April 2015|url-status=dead}}</ref> The Commission on Accreditation of Ambulance Services (CAAS) has published its Ground Vehicle Standard for Ambulances v2.0, effective July 2019. This standard is similar to the KKK-A-1822F and NFPA 1917–2019 specifications. The decision on which of the current (3) standards to require is left up to each individual state legislature or EMS director. Some states have no specific requirement, while others specify which standard is acceptable. Others, yet, allow the end user to decide which standard to comply to.

In the United States and Canada, there are four types of ambulances: Type I, Type II, Type III, and Type IV. Type I is based on a [[heavy truck]] chassis-cab with a custom rear compartment that is often referred to as a "box" or "module", primarily used for Advanced Life Support (ALS) or Mobile Intensive Care Unit (MICU), as well as rescue work. Type II is based on a commercial heavy-duty van with few modifications except for a raised roof and a secondary air conditioning unit for the rear of the vehicle, primarily used for Basic Life Support (BLS) and transfer of patients, though they are occasionally also used for ALS and rescue. Type III is a van chassis-cab with a custom-made rear compartment, used for ALS and rescue. Type IV is for ''ad hoc'' patient transfer using smaller utility vehicles selected for maneuverability in special environments such as dense crowds at events; these are uncommon and are not subject to federal regulations in the United States.<ref>{{cite web |title=Index of Federal Specifications, Standards, and Commercial Item Descriptions |url=https://www.gsa.gov/buying-selling/purchasing-programs/requisition-programs/gsa-global-supply/supply-standards/index-of-federal-specifications-standards-and-commercial-item-descriptions |website=gsa.gov}}</ref><ref>{{cite web |title=Ambulances – Type I, Type II, Type III and Type IV Ambulances |url=http://metronixinc.com/site/ambulances.html |website=metronixinc.com}}</ref><ref>{{cite web |title=Untitled Page |url=https://ntea.com/WorkArea/DownloadAsset.aspx?id%3D1342 |url-status=dead |archive-url=https://web.archive.org/web/20141104202923/https://ntea.com/WorkArea/DownloadAsset.aspx?id=1342 |archive-date=4 November 2014 |access-date=2013-12-17}}</ref>

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.<ref>{{cite news|work=The Statesman|url=http://www.thestatesman.net/index.php?option=com_content&view=article&id=459973&catid=36|archive-url=https://archive.today/20130620012756/http://www.thestatesman.net/index.php?option=com_content&view=article&id=459973&catid=36|url-status=dead|archive-date=20 June 2013|title=Ministry gives its nod to national ambulance code|date=7 June 2013}}</ref>

===Safety===
[[File:Crash Testing an Ambulance.webm|thumb|A video on ambulance crash testing]]
Ambulances, like other [[emergency vehicles]], are required{{citation needed|date=October 2018}} to operate in most 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 belt]]s. Research has shown that ambulances are more likely to be involved in [[Car accident|motor vehicle collisions]] resulting in injury or death than either [[fire truck]]s or [[police car]]s. Unrestrained occupants, particularly those riding in the patient-care compartment, are particularly vulnerable.<ref name="pmid12971929">{{cite journal |vauthors=Becker LR, Zaloshnja E, Levick N, Li G, Miller TR |title=Relative risk of injury and death in ambulances and other emergency vehicles |journal=Accid Anal Prev |volume=35 |issue=6 |pages=941–948 |date=November 2003 |pmid=12971929 |doi=10.1016/S0001-4575(02)00102-1}}</ref> 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.<ref name="pmid16263674">{{cite journal |vauthors=Ray AF, Kupas DF |s2cid=22922599 |title=Comparison of crashes involving ambulances with those of similar-sized vehicles |journal=Prehosp Emerg Care |volume=9 |issue=4 |pages=412–415 |date=October–December 2005 |pmid=16263674 |doi=10.1080/10903120500253813}}</ref> An 11-year retrospective study concluded in 2001 found that although most fatal ambulance crashes in the United States occurred during emergency runs, they typically occurred on improved, straight, dry roads, during clear weather.<ref name="pmid11446540">{{cite journal |vauthors=Kahn CA, Pirrallo RG, Kuhn EM |s2cid=24097668 |title=Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective analysis |journal=Prehosp Emerg Care |volume=5 |issue=3 |pages=261–269 |date=July 2001 |pmid=11446540|doi=10.1080/10903120190939751}}</ref> 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.<ref>{{cite web|url=http://www.dexigner.com/news/7262|title=New Ambulance Design Protects Paramedics|access-date=17 October 2009|publisher=WESH News|archive-url=https://web.archive.org/web/20131114043358/http://www.dexigner.com/news/7262|archive-date=14 November 2013|url-status=dead}}</ref>

===Equipment===
[[File:Ambulance Interior Details.jpg|thumb|right|Interior of a mobile intensive care unit (MICU) ambulance from [[Graz]], Austria]]
[[File:Tail lift deploy.png|Four stages of deployment on an inboard ambulance [[tail lift]]|thumb|right]]
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.)<ref name=radio1/><ref name=radio2/> 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]].<ref>{{cite web |url=https://www.motorola.com/staticfiles/Business/_Documents/Case%20studies/_Static%20files/case%20study%20ireland%20nationwide.pdf?localeId=252 |title=Motorola and Tetra Ireland Consortium Deliver National Public Safety Network |publisher=Motorola |access-date=19 October 2009}}{{dead link|date=April 2025|bot=medic}}{{cbignore|bot=medic}}</ref>
* '''[[Mobile data terminal]]''' – Some ambulances are fitted with [[mobile data terminal]]s (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 the scene, or fulfill any other computer-based function.<ref>{{cite web|url=http://www.microbus.com/Mobile_Data/Market/Public_Safety.aspx |title=MDT Market Sectors |publisher=Microbus |access-date=13 June 2007 |url-status=dead |archive-url=https://web.archive.org/web/20100327104206/http://microbus.com/Mobile_Data/Market/Public_Safety.aspx |archive-date=27 March 2010}}</ref>
* '''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,<ref>{{cite news|url=http://news.bbc.co.uk/1/hi/england/merseyside/3925661.stm|title=CCTV to protect ambulance staff|date=26 July 2004|access-date=13 June 2007|work=BBC News}}</ref> or in some cases (dependent on local laws) to prove or disprove cases where a member of the 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 bed]]s. There may also be equipment linked to this such as [[winch]]es which are designed to pull heavy patients into the vehicle.<ref name=tail>{{cite web|url=http://www.rossandbonnyman.co.uk/specialist-lifts.html#aa|title=Ambulance Lifts|publisher=Ross and Bonnyman|access-date=27 June 2007|archive-url=https://web.archive.org/web/20070701055836/http://www.rossandbonnyman.co.uk/specialist-lifts.html#aa|archive-date=1 July 2007|url-status=dead}}</ref>
* '''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 [[photosensitivity|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 [[filter (air)|filter]]ing 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.<ref>{{cite web|url=http://www.inmotiontechnology.com/newsevents/roadsafety.html |title=Press Releases |url-status=dead |archive-url=https://web.archive.org/web/20110713035514/http://www.inmotiontechnology.com/newsevents/roadsafety.html |archive-date=13 July 2011}}</ref>

In 2021 ''[[The New England Journal of Medicine]]'' published a ''Prospective, Multicenter, Controlled Trial of Mobile Stroke Units'', related to healthcare effectiveness of ambulances "equipped with a [[CT scanner]], [[point-of-care]] laboratory testing, and personnel trained to diagnose and treat patients with [[stroke]] in the ambulance, including administration of [[tissue plasminogen activator|t-PA]] and [[triage]] for [[endovascular thrombectomy|EVT]]."<ref>{{Cite journal|author=Grotta, James C.|author2=Yamal, Jose-Miguel|author3=Parker, Stephanie A.|date=2021-09-08|title=Prospective, Multicenter, Controlled Trial of Mobile Stroke Units|journal=New England Journal of Medicine|volume=385|issue=11|pages=971–981|access-date=2025-04-09|doi=10.1056/NEJMoa2103879|OCLC=9239893712|PMID=34496173|url=https://www.nejm.org/doi/full/10.1056/NEJMoa2103879}}</ref> As 2025, some Europena Uniion countries (e.g. [[Italy]]) are evaluating their adoption.<ref>{{Cite web|language=it|author=Giacomo Sebastiano Canova|url=https://www.nurse24.it/dossier/unita-mobili-dedicate-migliorano-esiti-pazienti-trattati.html|title=Unità mobili per ictus migliorano gli esiti dei pazienti trattati|website=Nurse24.it|date=2021-09-18|access-date=2025-04-09|archive-url=https://web.archive.org/web/20241203164519/https://www.nurse24.it/dossier/unita-mobili-dedicate-migliorano-esiti-pazienti-trattati.html|archive-date=December 3, 2024|url-status=live}}</ref>

===Intermediate technology===
In parts of the world that 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 ambulance]]s) 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.<ref name=motor1/>

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.<ref name=motor2/><ref name="Hofman Dzimadzi Lungu Ratsma pp. 191–197">{{cite journal | last1=Hofman | first1=Jan J. | last2=Dzimadzi | first2=Chris | last3=Lungu | first3=Kingsley | last4=Ratsma | first4=Esther Y. | last5=Hussein | first5=Julia | title=Motorcycle ambulances for referral of obstetric emergencies in rural Malawi: Do they reduce delay and what do they cost? | journal=International Journal of Gynecology & Obstetrics | publisher=Wiley | volume=102 | issue=2 | date=2008-06-16 | issn=0020-7292 | doi=10.1016/j.ijgo.2008.04.001 | pages=191–197| pmid=18555998 | s2cid=26227283 }}</ref>