How to Call for an Ambulance during an Emergency

What to Expect from Ambulance and its Staff

Understand what to expect from ambulance staff, including their training and protocols, and how to communicate effectively with them.

Alexander Mitchell
Alexander Mitchell

New York, United States

Ambulance Equipment, Staff Training and Certification

Ambulances are like A&E hospital emergency rooms on wheels. They are usually reconfigured vans with retrofitted cupboards to store equipment and mounted stretchers.

Essential equipment onboard:

  1. Cardiac monitor: Allows paramedic to take a 3, 4, or 12 lead ECG (or EKG) to detect the electrical rhythm of the patient's heart.
  2. Manual defibrillator or AED: Physical paddles or sticky AED pads are accessories that accompany the defib. This equipment discharges electrical current into the patient to restart the heart or "reset the heart rhythm / pacing".
  3. Stretcher bed: To transport the patient in a supine (head facing vertically to the sky) or a seated position.
  4. Ambulance blinker lights: Visually alerts the traffic to the presence of an emergency vehicle.
  5. Ambulance siren: The sound emitted alerts other drivers even if the ambulance itself is blocked by taller buses, trucks or oversized motor vehicles.
Ambulances do not have surgical equipment to fix a broken bone or repair an organ. Not only is the ambulance less sanitary compared to the operating theatre, it is not easy to make incisions (cuts) on a moving vehicle. Plus, most paramedics are Level 2 or 3 trained (maximum is Level 4. They do not have the required training to perform surgery. Thus, the medics tend to do first aid and calm the patient - the main repair work will be done by doctors in the hospital.

The medical team in an ambulance will almost always include one paramedic (in the back) and one driver (in the front).

Essential ambulance crew onboard:

  • Front: The driver controls the vehicle and ensures the ambulance reaches its destination.
  • Back: The ambulance paramedic manages the condition of the patient to reduce the worsening of the situation. Also he or she renders lifesaving procedures such as CPR (for cardiac arrests), intubation (for compromised airway), intravenous injection (for hypertensive or hypotensive crisis - sudden blood pressure rise or drop)
Ambulances do not have a doctor onboard most of the time. It is too resource intensive as the doctor can only be attending to one patient, whereas in the hospital, his expertise can be used to benefit many.
Ambulance paramedics are trained to various levels 1, 2, 3 or 4. Most of them are Level 3, which is broadly equivalent to the Canadian Primary Care Paramedic or the North American Advanced EMT level.
Ambulance drivers need to hold a valid driving license and of the valid class-type. As the emergency vehicles are non-standard, drivers also attend defensive driving courses to ensure they understand how to drive in an emergency, have good reaction time and are able to perform evasive manoeuvres.

Infection Control Measures

Personal protective equipment (PPE) - Types

There are different types of PPE used by ambulance staff, such as:

  • gloves,
  • face masks / face shields, and
  • gowns

Use of sterile medical PPE creates a physical barrier between the medic and the surface in contact. This prevents any direct interaction which can cause transmission of viruses or diseases, thus reducing overall risk.

Viral transmission happens bi-directionally.

  • From a sick patient or environment to the medic
  • From a sick medic to the patient

Personal protective equipment (PPE) - Disposal

Proper disposal of PPE is important because surfaces can be contaminated with infectious material, such as blood, bodily fluids, or other potentially harmful substances. If not properly disposed of, contaminated PPE can spread infectious diseases to other patients, ambulance staff, and the general public.

Proper disposal of PPE involves placing used PPE in designated waste containers or biohazard bags (yellow bags) that are clearly labeled as   waste. This waste is then disposed of according to regulations and protocols, which may involve incineration or other approved methods of disposal. Ambulance staff are responsible for following established protocols to minimise the risk of infection.

Hand Hygiene

Hand hygiene includes regular hand washing before and after cases. It also means that during cases, medics should use hand sanitisers to maintain cleanliness. Sanitiser gels or sprays should be used especially after handling bodily fluids (before or after an IV injection, inserting a nasal cannula or feeding tube).

Surface Hygiene - Disinfection and Sterilisation

Ambulance crew typically use a medical disinfectant such as precept tablets or an alcohol based spray to kill germs.

It is a norm for ambulance medics to perform a wipedown after a case has ended (i.e. patient has been handed over to the nurse at the hospital) of high contact surfaces in the ambulance.

High contact surfaces include:

  • door handles,
  • stretcher beds,
  • seats,
  • clipboard or tablet (used to record patient notes),
  • ECG electrode wires,
  • oximeter finger probe, and
  • Blood pressure cuff and its velcro

In cases where a deeper sterilisation is deemed necessary after handling patients with infectious diseases, ambulance crew may use one or a combination of the following:

  1. Particulate mister: Sprays fine disinfectant into the air and onto surfaces
  2. Ultraviolet (UV) light: To sterilise the air and also surfaces

However, there is a downtime pegged to the vehicle after the "deep clean". This means that the ambulance is out of commission for a period of time - anywhere from 1 hour to 1 day. Ambulance crew may be made to take similar isolation precautions.

Patient Confidentiality

Why Patient Info Is Collected

Identification numbers are required for the medical team to establish the identity and legality of the injured person.

Medical history is required to find out if the patient has underlying, previously diagnosed or known occurrence of one or more condition. The medical history has bearing on what kind of treatment paramedics can use - for example, if the patient cannot be pricked due to low white blood cell count, IV route of administration will be avoided and oral medication (GTN tablet) may be given instead.

Where Patient Info Is Stored

Most ambulances adopt a form of Electronic Health Records (EHRs) which serves as a digital record of the case, response information, particulars, identifiers and history of events.

Complications from Being Aware of Sensitive Info

In the course of medical work, the ambulance crew will unavoidably come across such personal and private information. Steps has to be taken to adhere to the legal and ethical considerations of patient privacy and confidentiality.

Laws and regulations govern patient confidentiality. This includes the Health Insurance Portability and Accountability Act (HIPAA) in the United States, Personal Data Protection Act (PDPA) in Singapore and other relevant legislation in different countries.

The protocols for release of information of the patient are multivariate.

Consent can be obtained by the ambulance crew by:

  1. Getting explicit consent from the patient: Verbal or written. Crew may carry bodyworn cameras; video and audio will be recorded. Documented proof via a signature digitally on a tablet or with regular pen and paper.
  2. Getting explicit consent from the patient's next-of-kin (family): Requested by ambulance medics if the patient is non-verbal or unconscious. Medically, the crew may use the AVPU scale (alert, verbal, pain-responsive, unconscious) to gauge the alertness of the patient.
  3. Implicit consent: If patient is alone or with bystanders only, ambulance crew may intervene in emergencies. The medic may treat the unconscious / helpless person and obtain patient particulars from his wallet, access pass or otherwise without obtaining consent based on the Good Samaritans Law and Principle. The principle generally absolves rescuers from liability as long as the rescuer can show that he intends to help.