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[[File:
[[File:NHS_ambulance_rushing_London_SW10.jpg|thumb|An NHS ambulance in south-west London]]
An '''ambulance''' is a [[Medical device|medically equipped]] [[vehicle]]
Ambulances are generally considered [[emergency vehicle]]s authorized to be [[Emergency vehicle equipment|equipped]] with [[emergency vehicle lighting|emergency lights]] and [[Siren (alarm)|sirens]]. Generally, vehicles count as an ambulance if they can transport patients. However, it varies by jurisdiction as to whether a [[Patient transport|non-emergency patient transport]] vehicle (also called an [[#Ambulette|ambulette]]) is counted as an ambulance. 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. Conversely, EMS agencies may also have [[nontransporting EMS vehicle]]s that cannot transport patients.<ref name="essexcar">{{cite web|url=http://www.carpages.co.uk/honda/honda_essex_ambulance_chooses_honda_power_24_07_04.asp|title=Essex Ambulance Response Cars|publisher=Car Pages|date=24 July 2004|access-date=27 June 2007}}</ref>
The term ''ambulance'' comes from the [[Latin]] word "''[[wikt:ambulare|ambulare]]''" as meaning "to walk or move about"<ref>{{cite web|url=http://science.enotes.com/how-products-encyclopedia/ambulance|title=How Products Are Made: Ambulance|publisher=How products are made|access-date=2 June 2007|url-status=dead|archive-url=https://web.archive.org/web/20070325025913/http://science.enotes.com/how-products-encyclopedia/ambulance|archive-date=25 March 2007}}</ref> 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.<ref>''Oxford English Dictionary'' ambulance definition 1</ref> Ambulances (''ambulancias'' in Spanish) were first used for emergency transport in 1487 by the Spanish forces during the [[Siege of Málaga (1487)|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.<ref>{{cite web|url=http://www.civilwarhome.com/ambulancewagons.htm|title=Civil War Ambulance Wagons|website=civilwarhome.com|access-date=25 March 2008|archive-date=17 July 2017|archive-url=https://web.archive.org/web/20170717144400/http://www.civilwarhome.com/ambulancewagons.htm|url-status=dead}}</ref> [[Field hospital]]s were still called ambulances during the [[Franco-Prussian War]]<ref>The memoirs of Charles E. Ryan ''With An Ambulance Personal Experiences And Adventures With Both Armies 1870–1871'' [http://www.ourstory.info/library/1-roots/Ryan/ambTC.html#TC] {{Webarchive|url=https://web.archive.org/web/20160401155426/http://www.ourstory.info/library/1-roots/Ryan/ambTC.html#TC|date=1 April 2016}} and of {{cite web |last1=Pearson |first1=Emma Maria |author-link1=Emma Maria Pearson |last2=McLaughlin |first2=Louisa |author-link2=Louisa McLaughlin |others=Annotated by McLaughlin, G. Harry. |title=Our Adventures During the War of 1870 |url=http://www.ukchnm.org/uploads/file/ouradventures.pdf |url-status=dead |archive-url=https://web.archive.org/web/20080410103613/http://www.ukchnm.org/uploads/file/ouradventures.pdf |archive-date=10 April 2008 |access-date=2008-03-25}}</ref> of 1870 and in the Serbo-Turkish war of 1876<ref>[[Emma Maria Pearson]] and [[Louisa McLaughlin]] ''Service in Servia Under the Red Cross'' {{cite web |url=http://www.ukchnm.org/uploads/file/serviceinservia.pdf |title=Archived copy |access-date=2016-02-07 |url-status=dead |archive-url=https://web.archive.org/web/20080709041433/http://www.ukchnm.org/uploads/file/serviceinservia.pdf |archive-date=9 July 2008}}</ref> even though the wagons were first referred to as ambulances about 1854 during the [[Crimean War]].<ref>''Oxford English Dictionary'' ambulance definition 2a</ref>
==History==
[[File:DFVAC 1948 Cadillac Miller Meteor front passenger quarter.jpg|thumb|Early car-based ambulances,
{{Main|History of the ambulance}}[[File:Hrh Princess Elizabeth in the Auxiliary Territorial Service, April 1945 TR2832.jpg|thumb|[[Elizabeth II]] (then Princess) next to a [[British Army]] ambulance in 1945]]The history of the ambulance begins in [[Ancient history|ancient times]], with the use of [[cart]]s 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.<ref name=Ambulance>{{cite book | author=Katherine T. Barkley | year=1990 | title=The Ambulance | publisher=Exposition Press}}</ref> Advances in technology throughout the 19th and 20th centuries led to modern self-powered ambulances.
==Functional types==
[[File:FDNY ambulance, 1949.jpg|thumb|A [[New York City Fire Department]] [[ambulance bus]] in 1949]]
Ambulances can be grouped into types depending on whether or not they transport patients, and under what conditions. In some cases, ambulances may fulfill more than one function (such as combining emergency ambulance care with patient transport:
* '''Emergency ambulance''' – The most common type of ambulance, which provides care to patients with an acute illness or injury. These can be road-going vans, boats, helicopters, fixed-wing aircraft (known as [[air ambulance]]s), or even converted vehicles such as [[golf cart]]s.
* '''[[Patient transport]] ambulance''' – A vehicle, which has the job of transporting patients to, from or between places of medical treatment, such as hospital or [[Kidney dialysis|dialysis]] center, for non-urgent care. These can be vans, buses, or other vehicles.
* '''[[Ambulance bus]]''' – A large ambulance, usually based
* '''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
* '''[[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.
* '''Rapid organ recovery ambulance''' – A special ambulance used to collect the bodies of people who have died to preserve their [[Organ (biology)|organs]].<ref name=Stein>{{cite news |url=https://www.washingtonpost.com/wp-dyn/content/article/2008/05/23/AR2008052303006.html |title=N.Y. Planning Special Ambulance To Recover Organs |first=Rob |last=Stein |newspaper=[[The Washington Post]]|date=2008-05-24}}</ref><ref>{{cite web |url=http://www.slate.com/blogs/blogs/humannature/archive/2008/05/27/meat-wagons.aspx |title=Meat Wagons |first=William |last=Saletan |author-link=William Saletan |work=Slate |date=2008-03-27 |access-date=25 July 2019 |archive-date=23 January 2011 |archive-url=https://web.archive.org/web/20110123175914/http://www.slate.com/blogs/blogs/humannature/archive/2008/05/27/meat-wagons.aspx |url-status=dead }}</ref> In 2008, [[New York City]] launched a [[Pilot experiment|pilot program]] deploying one such ambulance with a $1.5 million three-year [[Grant (money)|grant]].<ref name=Stein/>
* '''Psychiatric ambulance''' – A special ambulance dedicated to treat [[Emergency psychiatry|psychiatric emergencies]]. The idea was first tested as "Psykebilen" ("The Psych ambo") in [[Bergen]], [[Norway]] in 2005, and was soon adopted by other cities in Norway and [[Sweden]]. Tests from the time showed that an ambulance service with personnel specially trained in psychiatric treatment was highly effective, and reduced the use of force when treating patients in psychiatric crises.<ref>{{Cite web|url=https://www.napha.no/content/14442/psykiatrisk-ambulansetjeneste-i-bergen|title = Psykiatrisk Ambulansetjeneste i Bergen}}</ref><ref>{{Cite web|url=https://www.politiforum.no/helse-psykiatri-psykiatriambulanse/tilpassede-biler-og-ansatte-med-spesiell-kompetanse-slik-har-egne-ambulanser-for-psykisk-syke-blitt-en-suksess-i-bergen-og-stavanger/143916|title=Tilpassede biler og ansatte med spesiell kompetanse: Slik har egne ambulanser for psykisk syke blitt en suksess i Bergen og Stavanger|date=20 March 2018}}</ref>
==Vehicle types==
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 general-purpose ambulance is based on either the chassis of a van ("vanbulance") or a light-duty truck. This chassis is then modified to the designs and specifications of the purchaser. Vans may either retain their original body and be upfitted inside, or may be based on a chassis without the original body with a modular box body fitted instead. Those based on pickup trucks almost always have modular bodies. Those vehicles intended for especially [[Intensive care medicine|intensive care]] or require a large amount of equipment to be carried may be based on medium-duty trucks.
* '''Car''' – Used either as a [[fly-car]] for rapid response<ref name=essexcar/> or to transport 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) [[hearse]]s, as these were some of the few vehicles able to accept a human body in a [[supine position]]. Some operators use modular-body transport ambulances based on the chassis of a [[minivan]] or [[station wagon]].
* '''Motorcycle and motor scooter''' – In urban areas, these may be used for rapid response in an emergency<ref>{{cite web|url=http://www.southcentralambulance.nhs.uk/dynamicpage.php?pagerec=60 |title=South Central Ambulance Service NHS Trust – About Us |access-date=18 October 2009 |publisher=South Central Ambulance Service NHS Trust |url-status=dead |archive-url=https://web.archive.org/web/20090303174744/http://www.southcentralambulance.nhs.uk/dynamicpage.php?pagerec=60 |archive-date=3 March 2009}}</ref> as they can travel through heavy traffic much faster than a car or van. [[Trailer (vehicle)|Trailer]]s or [[sidecar]]s can make these patient transporting units.<ref name=motor1>{{cite web|url=http://www.tnn.co.uk/WorldwideNews/plonearticle.2006-07-04.2967165399 |title=News Reference to Motorcycle Trailer Ambulance |access-date=2 June 2007 |publisher=TNN |url-status=dead |archive-url=https://web.archive.org/web/20070927160815/http://www.tnn.co.uk/WorldwideNews/plonearticle.2006-07-04.2967165399 |archive-date=27 September 2007}}</ref><ref name=motor2>{{cite web|url=http://www.ittransport.co.uk/documents/Bicycleambulance.pdf|title=Motorcycle Trailer-Ambulance Brochure|publisher=IT Transport LTD|access-date=2 June 2007|archive-url=https://web.archive.org/web/20070614021104/http://www.ittransport.co.uk/documents/Bicycleambulance.pdf|archive-date=14 June 2007|url-status=dead}}</ref>
* '''Bicycle''' – Used for response, but usually in pedestrian-only areas where large vehicles find access difficult.<ref>{{cite web|url=http://www.londonambulance.nhs.uk/news/news_releases_and_statements/two-wheeled_medics_cover_more.aspx |title=Two-wheeled medics cover more ground in the capital |access-date=18 October 2009 |url-status=dead |archive-url=https://web.archive.org/web/20110427033036/http://www.londonambulance.nhs.uk/news/news_releases_and_statements/two-wheeled_medics_cover_more.aspx |archive-date=27 April 2011}}</ref><ref>{{cite web|url=http://www.londonambulance.nhs.uk/news/news_releases_and_statements/square_mile_cycle-paramedics_b.aspx |title=Square-Mile cycle paramedics become the new City-Slickers |access-date=18 October 2009 |url-status=dead |archive-url=https://web.archive.org/web/20110427033022/http://www.londonambulance.nhs.uk/news/news_releases_and_statements/square_mile_cycle-paramedics_b.aspx |archive-date=27 April 2011}}</ref> Like the motorcycle ambulance, a bicycle may be connected to a trailer for patient transport, most often in the developing world.<ref>{{cite web|url=http://www.designfordevelopment.org/activities/bike_ambulance.html|title=Bike Ambulance Project|publisher=Design for Development|date=20 July 2005|access-date=14 July 2007|archive-url=https://web.archive.org/web/20070928191033/http://www.designfordevelopment.org/activities/bike_ambulance.html|archive-date=28 September 2007|url-status=dead}}</ref>
* '''[[All-terrain vehicle]]''' – Used for response off-road,<ref>{{cite web|url=http://www.quadtech.co.uk/index.php?section_id=100|title=Information on Quadtech EMS quad|access-date=2 June 2007|publisher=Quadtech}}</ref> especially at events or in remote areas. ATVs can be modified to carry a stretcher, and are used for tasks such as [[mountain rescue]] in inaccessible areas.
* '''[[Golf cart]]''' or '''[[Neighborhood Electric Vehicle]]''' – Used for rapid response at events<ref>{{cite web|url=http://www.diversifiedgolfcars.com/standardambulance.htm|title=EMS golf cart brochure|access-date=2 June 2007|publisher=Diversified Golf Cars |archive-url = https://web.archive.org/web/20070405122944/http://www.diversifiedgolfcars.com/standardambulance.htm |archive-date = 5 April 2007}}</ref> or on campuses. These function similarly to ATVs, with less rough terrain capability and less noise.
* '''Bus''' – In some cases, buses can be used to transport multiple casualties, either for the purposes of taking patients on journeys,<ref name="jumbulance" /> in the context of [[Disaster response|major incidents]], or to deal with specific problems such as drunken patients in town centers.<ref>{{cite web |date=18 December 2008 |title=Ambulance crews prepare for party night pressure |url=http://www.londonambulance.nhs.uk/news/news_releases_and_statements/ambulance_crews_prepare_for_p.aspx |url-status=dead |archive-url=https://web.archive.org/web/20160303202825/http://www.londonambulance.nhs.uk/news/news_releases_and_statements/ambulance_crews_prepare_for_p.aspx |archive-date=3 March 2016 |publisher=London Ambulance Service}}</ref><ref>{{cite news |date=17 December 2007 |title=Aboard the 'Booze Bus' |url=http://news.bbc.co.uk/1/hi/magazine/7147646.stm |access-date=1 January 2010 |work=BBC News}}</ref> They are sometimes referred to as [[ambulance bus]]es.
* '''[[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.<ref>{{cite web|url=http://www.highways.gov.uk/business/15658.aspx |title=Highways Agency – Air Ambulance |access-date=18 October 2009 |url-status=dead |archive-url=https://web.archive.org/web/20090603213633/http://www.highways.gov.uk/business/15658.aspx |archive-date=3 June 2009}}</ref> 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 '[[Royal Flying Doctor Service of Australia|Flying Doctors]]'<ref name=Flying>{{cite web|url=http://www.flyingdoctor.net/|title=Royal Flying Doctor Service of Australia|access-date=2 June 2007|publisher=Royal Flying Doctor Service of Australia|archive-url=https://web.archive.org/web/20070612073357/http://www.flyingdoctor.net/|archive-date=12 June 2007|url-status=dead}}</ref>), for patient transport over long distances (e.g. a re-patriation following an illness or injury in a foreign country<ref>{{cite web|url=http://www.heathrowairambulance.com/repatriation.html|title=Heathrow Air Ambulance Service|access-date=2 June 2007|publisher=Heathrow air ambulance|archive-url=https://web.archive.org/web/20070617031304/http://heathrowairambulance.com/repatriation.html|archive-date=17 June 2007|url-status=dead}}</ref>), 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
* '''Train''' – In remote or hard-to-reach areas that are accessed primarily by [[railway]] connections, [[train]]s may be used to provide medical care as a mobile treatment facility or transport patients to better care in more accessible areas. These are generally called [[hospital train]]s.
* '''Trailer''' – In some instances, a [[Trailer (vehicle)|trailer]], which can be towed behind a self-propelled vehicle, can be used as an ambulance. This permits flexibility in areas with minimal access to vehicles, such as on small islands.<ref>{{cite web
* '''Horse and cart''' –
* '''[[Fire engine]]''' – Fire services (especially in North America) often train firefighters to respond to medical emergencies and most apparatuses carry at least basic medical supplies. By design, most apparatuses cannot transport patients unless they can sit in the cab. However, some fire trucks may be designed to have a large ambulance compartment behind the front of the cab, where the driver and officer's seats are located.
=== Vehicle type gallery ===
<gallery>
File:Washington DC Fire Department Ambulance 1.jpg|A [[Navistar]] truck ambulance operated by the [[District of Columbia Fire and Emergency Medical Services Department]]
File:ToyotaHiaceKKM.jpg|A [[Toyota HiAce]] van ambulance operated by the [[Malaysia]] [[Ministry of Health (Malaysia)|Ministry of Health]]
File:Notarzt Lübeck.jpg|An [[Volkswagen Transporter (T6)]] [[nontransporting EMS vehicle]] carrying an [[Emergency physician]]
File:Ambulance
File:NHS bicycle.jpg|A [[Cycle responder|paramedic bicycle]] operated by the London Ambulance Service
File:2009-08 Przystanek Woodstock 3.jpg|An [[all-terrain vehicle]] ambulance with a [[Trailer (vehicle)|trailer]] operated by the [[Pol'and'Rock Festival]]'s Medical Patrol
File:GRTW BFHB.JPG|A [[MAN Lion's City]] operated by the [[Bremen]] [[Feuerwehr]]
File:Zepper-BK 117-C2-(EC145)-SchweizerischeRettungsflugwacht.jpg|A [[Eurocopter EC145]] helicopter [[air ambulance]] operated by [[Rega (air rescue)|Rega]]
File:Royal Flying Doctor Service of Australia Central Operations (VH-FGS) Pilatus PC-12-45 at Wagga Wagga Airport.jpg|
File:
File:Surgeon Nikolay Pirogov 9.jpg|The "Surgeon [[Nikolay Pirogov]]" [[hospital train]] operated by [[Russian Railways]]
</gallery>
==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>
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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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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.
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>
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===Equipment===
[[File:Ambulance Interior Details.jpg|thumb|right|Interior of a mobile intensive care unit (MICU) ambulance from [[
[[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:
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| 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]]
}}
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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]],
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}}
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===Active visual warnings===
{{Main|Emergency vehicle lighting}}
{{See also | Emergency vehicle equipment}}
[[File:DNK ambulance A6.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}}
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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
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 [[St. John Ambulance in New Zealand|St. John Ambulance]] 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>
==Costs==
[[File:
[[File:
In the United States, the cost of an ambulance ride may be paid for from several sources, and this will depend on the local situation type of service being provided, by whom, and to whom.
* '''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).<ref>{{cite web|url=http://www.health.gov.on.ca/english/public/pub/ohip/amb.html|title=OHIP:Ambulance Services Billing|publisher=Ontario Ministry of Health and Long-Term Care|access-date=19 November 2009}}</ref>
* '''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.<ref>{{cite web|url=http://www.amr.net/Patients-and-Family-Members/Payment-Policy.aspx|title=Payment Policy|publisher=American Medical Response|access-date=19 November 2009|archive-date=5 July 2011|archive-url=https://web.archive.org/web/20110705060624/http://amr.net/Patients-and-Family-Members/Payment-Policy.aspx|url-status=dead}}</ref>
* '''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.<ref>{{cite web|url=http://www.yorkshireairambulance.org.uk/|title=Yorkshire Air Ambulance Charity|access-date=19 November 2009| archive-url= https://web.archive.org/web/20091125202654/http://www.yorkshireairambulance.org.uk/| archive-date= 25 November 2009 | url-status= live}}</ref>
* '''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).<ref>{{cite web|url=https://vic.pvhs.org/portal/page?_pageid=333,429645&_dad=portal&_schema=PORTAL&pagid=108|title=Ambulance Services|access-date=19 November 2009|url-status=dead|archive-url=https://web.archive.org/web/20071025072438/https://vic.pvhs.org/portal/page?_pageid=333%2C429645&_dad=portal&_schema=PORTAL&pagid=108|archive-date=25 October 2007}}</ref>
==Crewing==
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). 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 technician, or in countries like Australia advanced life support registered paramedics.
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[[File:World War I ambulance Pittsburgh 20th Century Club.png|thumb|left|1917 Red Cross ambulance]]
Military ambulances have historically included vehicles based on civilian designs and at times also included armored, but unarmed, vehicle ambulances based upon [[armoured personnel carrier]]s (APCs). In the [[World War II|Second World War]] vehicles such as the Hanomag [[Sd.Kfz. 251|Sd Kfz 251]] half-track were pressed into service as ad hoc ambulances{{citation needed|date=April 2021}}, and in more recent times purpose-built AFVs such as the U.S. [[M1133
Since [[laws of war]] demand ambulances be marked with one of the [[Emblems of the Red Cross]] not to mount offensive [[weapon]]s, military ambulances are often unarmed.<ref>{{cite web|url=http://www.icrc.org/ihl.nsf/CONVPRES?OpenView|title=International Committee of the Red Cross policy on usage|access-date=2 June 2007|publisher=International committee of the Red Cross| archive-url= https://web.archive.org/web/20070706014427/http://www.icrc.org/IHL.nsf/CONVPRES?OpenView| archive-date= 6 July 2007 | url-status= live}}</ref> It is a generally accepted practice in most countries to classify the personnel attached to military vehicles marked as ambulances as [[non-combatant]]s; however, this does not always exempt medical personnel from coming under fire{{snd}}accidental or deliberate. As a result, medics and other medical personnel attached to military ambulances are usually put through basic [[military training]],<ref>{{cite web|url=http://www.armyjobs.mod.uk/jobs/pages/JobExplorerResults.aspx?category=6|title=UK Army information on basic training for medical personnel|access-date=1 November 2009|publisher=British Army|archive-url=https://web.archive.org/web/20090917085424/http://www.armyjobs.mod.uk/jobs/pages/JobExplorerResults.aspx?category=6|archive-date=17 September 2009}}</ref> 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.
[[File:USNS Mercy T-AH-19.jpg|[[USNS Mercy (T-AH-19)|USNS ''Mercy'']], a U.S. Navy hospital ship|thumb|left]]
Some navies operate ocean-going [[hospital ship]]s to lend medical assistance in high casualty situations
==Ambulette==
Ambulettes provide [[patient transport]] service for non-emergency situations. Scheduling is a major factor in their effective use.<ref>{{cite news
==Reuse of retired ambulances==
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[[Toronto]] City Council operates a "Caravan of Hope" project to give retired Toronto ambulances a second life by donating them to the people of [[El Salvador]]. Since Ontario laws require ambulances to be retired after just four and a half years in service, the City of Toronto decommissions and auctions around 28 ambulances each year.<ref>{{cite web|url=http://www.sanlorenzo.ca/english/Supporting_Hope.html|title=Supporting hope|access-date=7 July 2012|archive-date=21 October 2018|archive-url=https://web.archive.org/web/20181021200005/http://www.sanlorenzo.ca/english/Supporting_Hope.html|url-status=dead}}</ref>
{{
==See also==
* [[Ambulance station]]
* [[Combination car (ambulance)|Combination car]]
* [[Emergency medical dispatcher]]
* [[Khilkhilat]]
* [[Rail ambulance]]
==References and notes==
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==External links==
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