Types of Ambulance Services

Introduction

Ambulances come in different kinds because the configuration of medical staff and medical equipment affects the kind of emergency treatment the ambulance service can provide.

There 2 main types are Basic Life Support (BLS) and Advanced Life Support (ALS) Ambulances.

• BLS, or basic ambulances, are barebone. Very few pieces of equipment. Lowly skilled staff.
• ALS, or advanced ambulances, have more features. Not just in increased comfort, but the equipment and crew are better. May not always translate to better patient outcomes and survival rates, but few people may deny that these are not correlated.

Basic Life Support (BLS) Ambulances

BLS ambulances are staffed by emergency medical technicians (EMTs) or Standard First Aid trained medics with a driver. They have minimal equipment and the crew are typically equipped to handle basic medical emergencies such as heart attacks, strokes, or injuries.

Common features of a BLS ambulance:

• Oxygen tank
• Foldable stretcher with regular car seat belts
• AED

Advanced Life Support (ALS) Ambulances

An overview of ALS ambulances, which are staffed by paramedics instead of an EMT or a medic. ALS ambulance services are equipped to provide more advanced medical care, such as administering medications, advanced airway management, and cardiac monitoring.

Some potential differences between ALS and BLS ambulances:

• Treatment for chest pain and agina: ALS carries GTN tablets which can provide ready relief, whereas an EMT medic on a BLS ambulance may calm the patient down and provide a blanket. If the patient's chest pain worsens, the EMT is prepared to apply the AED.
• Oxygen devices: ALS ambulances may carry a host of airway devices such as oxygen face mask (regular kind that covers over nose and mouth), nasal cannula (goes directly into the nostril) and a re-breathable mask (used to dispense Salbutamol / Ventolin to relive an obstructed airway. BLS ambulances are equipped with only the first item.
• Oxygen devices: With higher qualifed paramedics, ALS may carry an oxygen concentrator (non-invasive) or transport ventilator (minimally invasive) which gives more treatment options. BLS ambulances usually carry portable oxygen tanks, which will be rather small since the ambulances itself are usually smaller too. This means there is limited supply of medical oxygen and it would not be advisable to use a BLS service for long-distance transportation.
• Cardiac monitoring: ALS ambulances are likely equipped with a defibrillator with heart monitoring features such as ECG, pacing and shock paddles. Common brands of such machines are Zoll, Laerdal and CardiacSense. BLS medics, even if they had a defibrillator, would not know how to use them. They are unlikely able to distinguish a Normal Sinus Rhythm from Vfib, Vtach or SVT, as the medics are not trained.

Purpose-Built Ambulance Services

Certain ambulances are configured for specific purpose.

Examples of purpose-built ambulances:

• Military ambulances (able to go off-road),

• Wheelchair ambulance (a normal collapsible stretcher is not installed, but a motorised wheelchair lift is mounted in its place)
• Long-distance, cross-border ambulances (features a larger engine capacity, ability to hold more diesel, a heavier vehicular chassis for enhanced stability on the expressway and equipped with extra batteries that hold a longer charge for these extended journeys)

Specialised Ambulance Services

Specialised ambulance services are extremely rare globally as it is extremely challenging to maintain a team with the required skills.

Examples of specialised ambulances are:

• neonatal (ambulance for very young babies)
• or bariatric units (ambulance for obese people)

These ambulance services are designed to meet the unique needs of specific patient populations.

Child & neonatal medical equipment

For neonatal ambulances, the equipment prepared would be for babies.

This means:

• child AED pads,
• neonatal bag valve mask (BVM) as an assisted ventilation device instead of mouth-to-mouth,
• smaller oxygen masks, and
• endotracheal tube (ETT) and laryngeal mask airway (LMA) used for intubation.

The medics themselves would have more experience with handling neonatal resuscitation (bluish babies are extremely common) and familiar with the APGAR score (used to describe a neonate's cardiorespiratory and neurologic condition).

Choosing the Right Ambulance Service

With the description and general comparison of the different kinds of ambulances, it is prudent that the patient and/or the family picks the right type of ambulance service for a specific medical emergency.

It is important to identify the patient's needs and make an informed decision so that the patient receives optimal prehospital care.