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Ambulance

An ambulance is a vehicle designated for the transport of sick or injured people. The first ambulances called by that name were horse ambulances used in the American Civil War. The first practical ambulances were created by Dominique Larrey, a French surgeon (1766-1842), for use in the Napoleonic Wars. Modern-day ambulances are typically large automobiles on a van or light truck chassis.

The first civilian ambulance is said to have been set up in Brisbane, Queensland, Australia, in September 1892, following a fall at the Brisbane Exhibition on August 7, 1892, which was witnessed by Seymour Warrian who went on to become the founder of the Alexander Graham Bell is also said to have played a part in spreading the news of this civilian ambulance service around the world as he travelled promoting his invention the telephone.

However, an ambulance can be any vehicle, including a bus, helicopter, or even a hospital ship. Ambulances models are known as Type One (box-type without entry into the front cab, Type Two (van style), and Type Three (box with walk-through to the cab area). Civilian ambulances use the symbol referred to as the "Star of Life," a blue six point star, originally designed and governed by the NHTSB. Any unit displaying this star is said to be qualified to render its specific level of emergency care.

Under the laws of war an ambulance marked by a red cross is not to be fired on and is to be permitted to carry out its duties in spite of the fighting. An ambulance may not mount weapons, although the Israelis have produced a "tankbulance" that combines a Merkava main battle tank with ambulance features.

Ambulances in France

In France, the most general term is "vehicle adapted to patient transport", the term "ambulance" only applies for some categories of patient transport vehicles.

The word "ambulance" is reserved to transportation on medical prescription, including oral prescription in case of emergency. It does not apply to first responders vehicles (most of times firefighters), although they also transport casualties; their vehicles are called VSAV–véhicule de secours et d'assistance aux victimes (rescue and assistance to casualties vehicle), or VPS–véhicules de premiers secours (first responders vehicles) in case of volunteers from associations. The VSAV and VPS are considered as vectors that bring rescue workers and devices onsite, the evacuation being only the logical following of this intervention but not their main duty.

There are therefore two kinds of ambulance providers: hospitals and private companies.

The reglementation classifies the patient transport vehicles in four types:

• A-type : ambulance for rescue and emergency care (ambulance de secours et de soins d'urgence–Assu) : in these ambulances, the personnel can stand; only these vehicles can be used for emergency (sanitary duty and H-MICU, see below) ;
• B-type : rescue and assistance to casualty vehicles (VSAV), i.e. first responders vehicles, very close to the A-type ;
• C-type : ambulance : the personnel cannot stand, it only allows the transport of a lying patient and of a sitting ambulance technician besides ; due to the lack of room, cares cannot be performed during the transport (these vehicles tend to disappear) ;
• D -type: light vehicle (véhicule sanitaire léger–VSL) : normal car without any specific equipment, for patient who can sit.

The A, B and C-types are called "specialy equiped" vehicles, and must follow the NF EN 1789 standard (december 1999).

First responders vehicles

A VSAV has three professional¹ CFR onboard, a VPS has five volunteer CFR.

The first responders of the VSAV and VPS are called secouristes and have 60 hours of initial education (plus additional continuous education) and perform non-medical, non-invasive acts. They use splints (including cervical collars, long spine boards and vacuum mattresses), oxygen first aid, and make the casualty lifting.

Note

1. some firefighters are not full-time professionals; they are called "pompiers volontaires", but they are paid for their work, whereas the volunteers from CFR associations (secouristes bénévoles) are not paid.

Hospital ambulances

There are two kind of hospital ambulances:

• internal ambulances, which drive the patients from a building to the other; these are sometimes simple vehicles without any medical equipment when the transport do not require any care (these are always very short transportations).
• the UMH–unité mobile hospitalière (H-MICU–hospital medical intensive care unit) from the Smur–service mobile d'urgence et de réanimation (mobile emergency resuscitation service) : an ambulance with an MD, a nurse and an ambulance technician that do pre-hospital intervention and interhospital transportation under intensive care.

The H-MICU is often a light rapid-intervention vehicle, i.e. a car carrying the personnal and the material to the casualty; the transport itself is made with a VSAV or a private ambulance equiped with the medical unit.

Private ambulance companies

Private ambulance companies perform non-urgent transportation from home to hospital and back (e.g. regular dialysis, programmed surgical operation, this could be described as a "white taxi") or between hospitals. They also participate to the sanitary duty: they make interventions at home for relative emergencies (their response time is not compatible with "real" emergencies); the crew of a private ambulance is made of an ambulance driver and an ambulance technician.

The ambulance drivers do not legally need to have any first aid education, however, the boss usually demands at least the basic first aid training (10h, called AFPS–attestation de formation aux premiers secours). The ambulance technicians (ambulanciers) have an education level a bit higher than first responders (160h including deinfection of the vehicle and legislation of patient transport, and 25 days of practical training); the diploma is called CCA–certificat de capacité d'ambulance (certificate of ability for ambulance). For the sanitary duty, the most serious bosses provide an ambulance technician as a driver (there are thus two ambulance technicians).

For simple transport (no care required), private companies also provide light vehicles (cars) called VSL–véhicule sanitaire léger, for seated transport. The crew has only one the ambulance driver. In this case, the driver must have the basic first aid diploma.

Neither the secouristes nor the ambulanciers can apply medical protocols. Medical acts are performed either by a Smur physician (specialised in emergency medicine), or by a firefighter nurse (ISP–infirmier sapeur-pompier): there are no specific profession such as paramedic in France.

See also

• emergency medical service
• MEDEVAC
• paramedic
• stretcher