1. Introduction to Ambulances – Different Types of Ambulances
Different Types of Ambulances; Ambulances are vehicles that accompany people who are in need of immediate health care. The purpose of ambulances is to transfer patients from their present location to the place where they can receive the required medical attention, which is generally a hospital. The medical staff inside the ambulance will provide life support to the patient in transit. Over the years, ambulance services have evolved from being vehicles that carried loads of stretcher cases to one where speedy attendance ensured life-saving support and early moving out to the hospital where appropriate treatment could be given to stabilize the patient thereafter. There has been a sea change in the care provided to the patients during transportation. Ambulances are generally equipped with an array of devices to offer life-saving emergency care en route to the hospital, and patients can be observed and monitored even on board the ambulance. Under law, ambulances are emergency vehicles. Many people use them during severe medical conditions. It is the right of a patient to avail themselves of an ambulance facility, especially during emergencies.
Emergencies are generally due to accidents, heart attacks, industrial catastrophes, earthquakes, or fires. Ambulance types, design, and equipment coverage vary greatly according to local legislation, custom, and practice. Ambulances can be seen in many sizes and various designs; some can carry one person, while others can carry as many as 8 to 10 people. The structure can be either a van or a unique vehicle with a raised roof or each of three compartments. For over 100 years, emergency medical services have been an essential part of public health. Today, both public and private ambulance providers offer millions of patients who are in critical condition quick access to emergency care services. As a result, the emergency medical service system has become an integral part of the health care system in many nations. Every country regulates the operation of ambulances differently, and each country or special use region has its own set of laws, registration and licensing specifications, and operational standards.
2. Basic Ambulance Types – Different Types of Ambulances
In addition to being private or government-owned, ambulances can be divided into two basic types. These include: 1) Emergency Ambulances: These are designed to cater to unanticipated emergency situations. They are fully equipped to provide life-saving medical care and support to severely ill, injured, or in some cases, dying individuals right on the spot of the incident. Some examples of equipment found in them are oxygen cylinders, ventilators, IV fluids, medications, and a defibrillator. Emergency ambulances are staffed with a doctor, paramedics, or emergency medical technicians who have their respective specialized training. They rush to the spot of an incident as soon as the emergency call is received and stabilize the victims on the spot before transporting them to the nearest hospital. 2) Non-Emergency Ambulances: These cater to patients who do not need any critical emergency care or are not in any life-threatening situations. Instead, they might need transporting for planned or non-urgent situations. A dialysis, chemotherapy, radiotherapy, or physiotherapy session can be some of the instances when an emergency ambulance may be used for a hospital visit and back. The staffing could include anyone from a nurse to a family member, depending on the condition of the patient. This way, quality medical assistance can be given to patients that need it, without their presence causing any disturbance in the workings of hospital staff and facilities.
2.1. Emergency Ambulances – Different Types of Ambulances
Ambulances are vehicles used for emergency medical services and to transport individuals to healthcare facilities, most commonly a hospital. The modern ambulance began with the horse-drawn ambulances that emerged in the second half of the 19th century. The methods have evolved over time. Today, there are many different types of ambulances to serve various needs. Perhaps the most common type of ambulance known to the public is the emergency ambulance. There are more than one type of emergency ambulance out there, though. Depending on what is needed for the individual, their situation, and how they are going to be transported, a different type of ambulance may be deployed for transportation.
Emergency ambulances are there to attend to urgent cases. Trained personnel are able to administer medical care to people while they are being transported to a hospital. An emergency vehicle comes fully equipped with supplies and can offer more than just in-motion hospital transport. Firstly, emergency ambulances are fully equipped with basic supplies. They are kitted with automated external defibrillators for those that could be in need of a shock to restore normal heart function, a full supply of oxygen, and various other tools and devices. There are advanced heart monitoring machines in an emergency ambulance that can tell a great deal about the condition of the patient. Typically, emergency ambulances are all staffed by paramedics. In some cases, a team of two paramedics will be present. Other times, a paramedic will work in tandem with an emergency medical technician. Entering an emergency transport vehicle, you are in good hands. Protocol varies slightly, but you can guarantee that a team is going to be with you every step of the way. Different emergency departments and organizations have their models and specifications, but the fundamentals will be consistent. There is a distinction between ambulances for adults and children, the latter being more specialized. Challenges: With an increasing population, emergency services are facing greater demands. Waiting times for ambulances have expanded, and this has led to a greater burden on the emergency care sector. The number of calls across Europe has, at the same time, risen. Public health systems are estimated to be under-resourced. It is predicted that the state of the healthcare industry will only deteriorate.
2.2. Non-Emergency Ambulances – Different Types of Ambulances
Tony Eason’s Non-Emergency Transport service has a van going to Baptist Hospital several times a day to bring patients here for procedures. There are also vans in service every day in our area that transport patients to various dialysis clinics passing St. Clare Health and Rehabilitation on Highway 51 South. The newer vans employed in this service are equipped with electric wheelchair lifts and have spacious interiors to transport large bariatric patients or those who may be accompanied by several family members. Currently, the NOPH transports 80-100 patients per month using this van service and is currently the only rural facility using it in the Jackson area. Some patients use the service only once, while others require transportation several times a week. The non-emergent ambulance serves a population of consumers needing a safe, comfortable transport for various reasons, such as outpatient surgery, transfusion or hemotherapy appointments, or for return home after a hospital stay. Transports are also made to every nursing home and extended care facility in the area, and those patients typically have been discharged from Baptist Memorial or Jackson Madison County General Hospital. All are in need of a safe, comfortable transport. These patients are usually ambulatory, but medical supplies including oxygen are readily available to ensure their safety and comfort if needed. The ambulance is the largest and most visible division, yet only a third of the companies’ business.
3. Specialized Ambulance Types – Different Types of Ambulances
Some ambulances are designed to undertake specific types of patients. It is important because these demographics have distinct patient care and mobility needs. An adult patient may have vastly different clinical problems from a child. Some of them are specifically designed and used for neonates. These types include, but are not limited to, mobile intensive care unit ambulances and neonatal ambulances.
Mobile intensive care unit ambulances are designed to move critically ill patients from hospital to hospital or transportation from scene to hospital in situations that require advanced monitoring and/or treatment modalities not available in most ambulances. For a transferred patient, often being in a tertiary care hospital, it may be necessary to have a “physician on wheels” to prevent the deterioration of critical patient status during transport. The neonatal ambulance is specifically designed for the transport of newborns. Premature babies have unique problems; vital signs and their medication treatment are very different compared to adults and older children. They need the additional capability of being kept in shelters that simulate their mother’s womb with controllable light, temperature, humidity, and noise. The core neonatal ambulance should be designed differently to accommodate neonates and multiple associated caregivers. Keeping this in mind, the design of the neonatal ambulance should be very different from other types. The neonatal ambulance should have oxygen, compressed air, and vacuum flush. It should be pre-equipped with an infant warmer. It should have a provision for the installation of a transport incubator. It should also have a break in the circuit in the pipeline for the use of a nebulizer. It should have facilities for the installation of monitors like pulse oximeter, capnometer, and cardiac monitor. It should have facilities for a nurse-cum-paramedic with expertise in neonatal transport and any other medical doctor transportation. The connector for the oxygen, air, and vacuum in the neonatal ambulance should be of standard international type so that they easily fit any of our transport infant incubators, monitors, ventilators, and pulse oximeters. When the neonatal ambulance is not carrying an incubator, it should have a baggage system with lashing devices for the stabilization of baggage during transportation.
3.1. Mobile Intensive Care Unit (MICU) Ambulances – Different Types of Ambulances
Some of the ambulances you may have seen are described as Mobile Intensive Care Unit (MICU) ambulances. These ambulances are designed for critically ill patients who will require extensive medical care while they are being transported. As such, they are equipped with state-of-the-art medical technology that you might find in a hospital to manage these critically ill patients. These usually come in the form of mechanical ventilation and monitoring devices. However, some may have extras including arterial blood gas or point-of-care tests. The intended outcome of ambulance-based care should be that the patient is stable enough to be given in-hospital care at a hospital such as a rural base hospital or could be admitted directly to a ward in a larger facility. MICUs provide a highly specialized resource, and their staff are highly skilled. The staff that work in these ambulances may also be qualified in areas such as critical care, emergency, or intensive care nursing. Some services also have critical care trained doctors that work on these ambulances as well. Expertise in ICU or advanced life support settings is a must-have for both doctors and nurses’ further training. The purpose of an MICU is to provide mobile, hospital-equivalent care for patients from injury events or who present illnesses of varying severity. They function apart from and above low and moderate acuity emergency ambulances to connect patients to definitive levels of care or the next stage in their care pathway. The ideal design of an MICU ambulance is one that is operationally and technically safe and user-friendly and enables the medical and nursing staff to normalize patients’ physiological data prior to arrival at an intensive care facility. In essence, the ideal design supplies everything necessary to keep a patient stable in place of a standard emergency department, bypassing a lower acuity hospital. It is then used for the ongoing management of the patient by clinical staff prior to termination of transport to a required facility, and it transports the patient in a comfortable, timely, and cost-effective manner rather than relying on regionalized retrieval services for transport. Regulatory requirements for ambulance services adhere to the relevant government regulated bodies for all healthcare. Regulatory and accreditation requirements may differ among countries. Regulatory requirements also set out any additional requirements in different geographic areas that may vary in the level of care provided by different services. Although by nature ambulance services operate MICUs on urban and rural transfer routes, the allocation of resources and decision to operate MICUs depends on the relative number of critical care admissions to the hospital. It goes without saying that equivalent care is provided if a hospital MICU is not desirable. In general, rural MICUs have greater operational capability to provide stabilization and support of deteriorating rural populations for longer periods of time. For services that do have MICUs, the organization values and wishes these services to provide a unique patient experience in both not for profit and for profit health models.
3.2. Neonatal Ambulances – Different Types of Ambulances
Neonatal ambulances are specially equipped for critically ill babies. They are fitted with neonatal incubators, which maintain a controlled environment around the baby throughout transport. The incubator contains life-support equipment including breathing and heart monitors, feeding pumps, intravenous equipment for drug delivery, and connections providing ventilator support, all within easy reach. All of the healthcare professionals in the ambulance are specially trained in caring for babies. The basic team will include a driver and a trained neonatal nurse. The specialist team also includes a neonatal doctor, who has special expertise and training in dealing with the peculiarities of newborn and premature baby care. The support pediatric junior doctors will also help in transferring sick infants from one hospital to another.
Because of this delicate balancing act, it’s essential that we start neonatal transfers with a thorough assessment of the infant’s clinical status to predict any potential clinical events. Modern technology can generate alarms, warning that there may be a problem about to happen. The Newborn Intensive Care Unit does not just come with four, six, eight, or ten wheels – it’s a highly technical mobile unit able to supply the same quality of care given on the units where the babies are admitted. This also places special demands on the members of the team looking after the baby, who have to have particular skills to care for sick infants, which may be very premature indeed. These individuals must be specially chosen and given appropriate training to a standard focused on ‘safety first, last, and always.’ Because of the highly specialized nature of the care and the skills required and the expertise of the team involved, the service cannot be as widely available as is safe in adult intensive care. However, the new transport service now brings our expertise directly to the babies and families who need it most. All of this is done in direct partnership with the District General Hospitals, where most mothers give birth and from where the service makes pediatric intensive care and neonatal intensive care accessible.
4. Air Ambulances
Air ambulances are either helicopters or fixed-wing airplanes. They transport patients long distances to a receiving facility. They are typically used to transport patients over 750 miles, where the terrain or population makes fixed-wing travel more feasible. Transport by aircraft can usually get a patient from the most remote areas and still have them at the hospital within an hour. An air ambulance is staffed by two crewmembers, typically a nurse and a paramedic. Equipment and medications are similar for an MICU ambulance, with a few differences. The amount of medical equipment and the medications carried on ACU aircraft are tailored to the type of patients commonly transported.
There are “high-time” jets that are faster and can fly higher and safer. Air ambulance crew members are either critical care nurses or paramedics. They are certified as nationally registered EMT-paramedics and have a minimum of two years of experience working as a licensed paramedic. They have also completed advanced medical training in pre-hospital critical care. In all cases, none of the personnel on board are patient care nurses and are commonly mislabeled if that is stated. Air ambulances are always secured by a safety belt and are trackable throughout the state and even outside of the country on the FAA flight plan system. Air ambulances fly in a straight line from the sending hospital to the receiving hospital and follow pre-determined airways set up by the FAA. Air ambulances do not fly in a zigzag pattern; the shortest route to the hospital of the patient’s choice is always taken.
5. Future Trends in Ambulance Technology – Different Types of Ambulances
Instead of just transporting patients to a hospital, the future of ambulances is centered on adding value to the patient handover process and treatment before patients are handed over to hospital staff. For example, technology provides superior mobile and wireless communication than previously seen; as a result, telemedicine capabilities are being introduced to create an always-connected wireless ambulance environment. In this scenario, while en route to the hospital in an ambulance, lower acuity patient vitals, images, ECGs, or the patient themselves are connected, communicated, and presented to a doctor in a hospital for ‘just in case’ system triage if necessary, and a bed or emergency room can be allocated at the hospital when the ambulance arrives.
Artificial intelligence is likely to play a significant role in ensuring the efficient processing and analysis of the large amount of data generated, and this technology is also expected to be used to help develop more efficient operational and patient care strategies. Drones could be utilized to deliver medical supplies to an emergency scene and then facilitate patient transfers to a hospital quickly as required. Perhaps because the ambulance is more involved in patient treatment en route, the long ambulance vehicles of the future will be turned into a ‘care pod’ environment with patient comfort and safety in mind. For example, passengers no longer have to be strapped onto a traditional gurney; they can be treated while they are strapped into an ambulance’s seats in a single-room or double-room compartment. Such future ambulance care pods might come with soundproof, therapeutic bedrooms, soothing color schemes, scent diffusers, and adjustable partitions. The control center-based technician could then put the bed down and operate the mini-ambulance’s propulsion. With this vision of the future, extensive hospital-based training may need to be given to student paramedics. Additionally, regulators would have to adapt to new categories of ambulance and approved compressing chairs, while cities and towns would have to rebuild parking spaces and erect overnight charging stations. Finally, universities and colleges might have to change their courses to teach highly skilled ambulance medical electric vehicle engineers to build, service, and repair a new generation of bespoke electric vehicles.
