EMS has seen rapid advancements in pre-hospital care since the 1970's, but advancement of the basic ambulance has seen few changes. The ambulance remains a truck or van with a patient compartment behind the operator. Cabinets were added to store bandaging materials and other basic medical supplies. The main purpose of the ambulance remains transporting vital equipment and crew to the patient, attempt to stabilize the patient prior to departure and continuing patient care during transport to the medical facility. Most sick patients prefer and most trauma patients require that they be transported semi-fowlers or supine.   In years past, funeral homes used their hearses to transport severely injured patients to the hospital as they were well equipped to transport supine patients, though it allowed for little, if any, room to tend to the patient.

        What is the one piece of EMS equipment used the most and usually trained on the least? Could it be the blood pressure cuff, stethoscope or maybe something simple like a pair of trauma shears? Actually it is the ambulance. The ambulance is used for every emergency run, whether it be a cancelled call, a multiple vehicle crash or the proverbial stubbed toe. Yet, how often do we refresh our vehicle knowledge and  skills?

     The ambulance remains the "office" for the EMS professional. Their "tools of the trade" are usually within their arms reach. The crew, with their extensive medical training, can now treat a patient with advanced life support that only a few years ago were performed by skilled doctors in the emergency room. Basic life support has also advanced with enhanced training and the use of more and more advanced airway management techniques, AED's, Epi-pens and Combitubes (just to name a few).

        The onset of this advanced knowledge, training and skills drastically reduced the necessity for the ambulance to "race" back to the hospital. Highly skilled care can now be rendered immediately upon the crews' arrival at the patients' side and remain uninterrupted until arrival at the emergency department. The days of needing to travel 80-100 mph to "save" the patient are now gone, at least it should be. Studies time and time again confirm that CPR is best performed in the ambulance at speeds of 25 mph or less. While we are on the issue of CPR, statistics have shown that survival rates (patient walks out of the hospital) for "out-of-hospital" CPR is less than 2%. There are very, very few instances now when CPR should be performed in a speeding ambulance. Prolonged CPR in an ambulance is CONTRAINDICATED (should NOT be performed), due to the risks involved for the crew. An older, very wise ER doctor once told me, "Tom, dead is dead", and I can't argue that point.

        If you have "gotten into" EMS for the adrenaline rush or the lights and sirens, I am truly sorry for you and any patients you care for. True pre-hospital medicine is all about patient care and comfort. Think about exchanging places with your next few patients and treat them (physically and emotionally) as you would like to be treated.

    I personally have been in EMS since 1980 (26+ years), and I have yet to see a patient "saved" by the ambulance going 80+ mph. If you arrive 10 minutes longer due to driving slower and safer and the patient dies, the patient didn't have 10 minutes to live anyway. If you had crashed; what damages and injuries may have occurred? Who could have died? Not to mention your patient died in the crash anyway.

Oftentimes we are compared to firefighters or law enforcement officers when it comes to emergency vehicle driving. Firefighters haul vital equipment and water, law enforcement officers are trained in high speed pursuit techniques, but the ambulance is transporting a sick or injured family member that may need continuous care and treatment. I haven't seen a lot of fire trucks or police cars transporting a paralyzed trauma patient on a back board with an IV running. We are twice as likely as law enforcement officers and three times more likely than firefighters to be killed in our vehicle at work. The most dangerous part of our job is responding to and returning from a call.

        If you haven't been convinced yet, stay tuned for upcoming articles on varying facets of emergency vehicle safety. Operating an ambulance involves specific knowledge, skills and attitudes that are unique to EMS and the ambulance.

        Increasing traffic and road speeds coupled with poor or obsolete emergency vehicle training add up to increased damages, injuries and deaths from ambulance crashes. Nationally there are over 6,500 reported emergency vehicle (ambulance) crashes every year (18/day), injuring 10/day and killing over 36/year. When will we get serious about comprehensive and on-going emergency vehicle safety? Again, I apologize for repeating myself, but CPR survival rates are extremely low, yet we train and refresh on a regular basis. (By no means am I slamming or discounting CPR!) What will it take? How many more people have to get severely injured or die? I hope you will join me in this passionate crusade of "Emergency Vehicle Safety in the 21st Century".

        Till next time, "Keep both hands on the wheel and both eyes on the road".