High Standards Required for Ambulance Service
Space in vehicle, equipment, sanitation must be considered; attendants should have training beyond advanced first aid
In too many communities, the ambulance is still looked on chiefly as a means of transportation. We should work toward the improvement of our ambulance personnel so that the medical profession will be glad to consider them a paramedical group, like our Xray and laboratory technicians.
A list of minimal surgical equipment for an ambulance was adopted in 1961 by the committee on trauma of the American College of Surgeons. No apparatus has any place in an ambulance unless the personnel on all shifts has been thoroughly trained in when and how to use it. Oxygen equipment seems to be more uniformly oarried than any other type. Attendants commonly have had no adequate training in its use. The health department should inspect and approve professional equipment, sanitation, etc.
To make resuscitation practical, ambulances need high ceilings, wide bodies, room to work about the patient’s head, a seat alongside the injured and seat belts.
Personnel is basically much more important than the machine or the equipment. In a large proportion of instances, its quality is entirely disregarded. An ambulance requires at least two people, a driver and an attendant. Both should have completed an American Red Cross advanced first aid course and a further course given by physicians, should carry a valid certificate and be licensed by some governmental authority (usually the health department). A certificate should not be issued for more than one to three years. It is inexcusable to have doctors on ambulances.
For years the committee on trauma advised the ARC standard and advanced first aid courses as a requirement for attendants and drivers. We know now that this is not enough. It does not include emergency childbirth, handling of emergency mental patients or external cardiac compression, for example.
Courses are starting up all over the country. In 1966 at least 63 communities offered them. They are given by medical schools, trauma committees, county medical societies, single doctors, trained nurses, policemen and fire fighters who are ARC instructors.
Training beyond the advanced first aid course should be given by physicians. Attendants, where paid, should receive a larger salary after training. We must find a way to increase the prestige of the position.
A model ordinance for ambulances has been prepared and is available from the National Safety Council for either legislative act or municipal ordinance. It covers standards for ambulance licensing, equipment, personnel, reports, etc., with penalties for infringement. The first state laws were enacted about 25 years ago. There are now seven statewide ambulance attendant laws. Municipal ordinances started a few years earlier and we know of-20 to 25 of these. Practioally all of both types have been notable for lack of enforcement.
Speed practically never saved a life and should be decried at every opportunity. The only excuse for speed is ignorance of the condition of the patient. When the ambulance is called, whoever acts as the dispatcher ought to be at least as well trained as was outlined above for the driver or attendant. He should learn whether there is an emergency and what kind before he lets the caller leave the telephone. This information should be passed on to the driver. The attendant should be trained to get an idea of the patient’s condition while at the scene. He should then know the probable gravity of the emergency.
In practically all instances, after immediate care has been rendered, the ambulance should then travel carefully and comfortably for the patient, without careening around corners, jamming on brakes, using the siren or going through red lights.
The uncertain period between sustaining a serious injury and arrival in a hospital deserves more thoughtful planning than it now receives. Daily, lives are being lost unnecessarily. Emergency cases are well cared for by laymen when they have been trained. We must do all we can to prevent accidents.
When they happen, we hope enough interest will have been shown previously so that trained laymen will produce an open airway, stop bleeding, splint fractures and, if the patient is pulseless or not breathing, will employ mouth to mouth breathing and external cardiac compression promptly and correctly. Unless they can do so, we must each feel that we might have done more for the good of our communities.
Paying for service
Some portion of the charge for ambulance service should undoubtedly be on your tax bill. It is unfair to expect funeral directors and other private owners to transport welfare patients, or those who do not pay, at their own expense. When fire or police departments handle the ambulance service, it is a question whether the taxpayers should ever be responsible for more than the true emergency— and then only if the patient is unable to pay.
A council to advise on immediate care and transportation of the injured was organized in Flint, Mich., about five years ago. It is under the leadership of the chairman of the local committee on trauma. It includes such persons as the director of safety services of the American Red Cross, chief training officer of the fire department, sheriff, state police sergeant, chief of police for suburban communities, local official of the National Safety Council, representative of the county medical society, representative of the American Association for Surgery of Trauma, and chairman of the county ambulance committee.
It meets quarterly to discuss suggestions, criticisms, etc. It has proved of considerable interest and value. Something of this type might well be adopted in communities of varying sizes to improve the quality of emergency care.
Editor s Note: This article is from a paper presented by Dr. Kennedy at the Home Safety Session of the National Safety Council at Chicago on October 27, 1966. Dr. Kennedy, of New York City, is director of the field program of the Committee on Trauma of the American College of Surgeons.