An ambulance is made up of a driver and a medical attendant. The medical attendant could be a paramedic, Emergency Medical Technician (EMT), nurse or even a doctor.
To understand an ambulance may not have any doctor inside, it is crucial to appreciate the unique intent and purpose of emergency services.
First, ambulance services is classified as pre-hospital care. If there are different stages of healthcare, then you can consider ambulance work to be the step just before hospital care.
In this step, the ambulance steps in to initiate primary and the most basic level of care first.
Next, ambulance services is designed to provide quick lifesaving services to patients.
Unlike the purpose of hospitals to provide long term, continued and advanced care, ambulance paramedics aim to stabilise the medical condition. If possible, paramedics treat the presenting conditions such as terminating excessive blood loss.
Whereas at the hospital, tertiary investigations delve into CT scans to uncover the extent of damage. Doctors dig any discover possible implications and also the plausible causes of traumatic injury.
Therefore, ambulatory services ride on a single intention. To ensure that the medical condition of the patient is kept managed and preferably under control.
We, the emergency services, aim to transport the patient as fast as possible to the nearby medical facility. While managing the condition is primary inside the ambulance cabin, the extensive treatment will eventually be started at the hospital.
Concluding the the purpose of an ambulance, we can be sum it up as “immediate rescue”, “advanced first aid” and “transportation vehicle”.
If your medical situation does not fit the criteria of necessity, you may not even need an ambulance in the first place!
Bringing home the point that an ambulance may not contain a doctor, only staff with moderate medical knowledge and physical strength is needed for ambulance work. No need for an advanced Master’s Degree or Specialist Diploma.
These are the basic requirements of the staff in the vehicle van.
Thus, there plainly is little need for a doctor to be inside the ambulance.
Most ambulances in fact do not have a doctor. Doctors role can be replaced by a senior paramedic or nurse who is seasoned and with a wealth of experience.
Based on the functional and vocational training of the crew, the service standards delivered to the patient may vary.
If a doctor were to be onboard the ambulance rather than an EMT (basic medic), the doctor would be able to provide advanced life support to the patient. The EMT may not.
However, specific skillsets are commanded by certain paramedics that junior doctors will not have.
For example, interpreting a 12 lead ECG and intubation (inserting an airway tube through the mouth) are skills by an Advanced Care Paramedic.
Having underwent training in pre-hospital care, the paramedic will first stabilise the condition. This allows the emergency ambulance time to send the patient to a hospital with advanced facilities.
Instead of stabilising the condition, a doctor is more likely to “stay-and-treat”. Only 15 minutes into the work, the doctor may only realise that he cannot do much at a later stage. When the bulky equipment (MRI, CT scan, etc.) and sterile surgical environment he really needs is at the hospital, this doctor will be at a loss.
In fact, some hospital doctors have trouble adapting to become an ambulance doctor.
The physical restrictions of time, equipment and space are vastly different. Even though crew competency has a bearing on quality of service, experience matters more.
Often, a seasoned paramedic outperforms a hospital-trained doctor due to the quick adaptability and lightning thinking they have after years on the road.
|Role||Training & Experience|
|EMT||Basic – Works mostly in the ambulance environment. Junior & with most basic of training.|
|Paramedic||Advanced – Works mostly in the ambulance environment. Tertiary education with a build up of experience as an EMT in the past.|
|Nurse||Advanced – Works mostly in the hospital environment. Experience varies on job posting (e.g. Emergency Room, General Ward, etc.)|
Most commonly seen people inside ambulances are paramedics.
Paramedics can also be dual trained to drive or be a crew leader.
There are nurses who are interested in the adrenaline rush. This excitement of ambulance work brings them to jump into employment or contract roles in ambulance organisations.
However, during the initial months of employment, nurses tend to be slower and less responsive. This is due to the lack of urgency in their previous workplace (hospital) which can compromise patient safety at critical moments. As such, new nurses are paired with a senior paramedic who function as a mentor. Similarly, fresh out-of-school EMTs have to undergo a handholding period. Both EMTs and nurses are closely monitored during on the job training.
More than one paramedic can run a case. With two or three paramedics onboard an ambulance, a crew leader will take charge the ambulance functions. He also manages communication and coordinate medical treatment. Intervention will be initiated by the lead. The remaining paramedics will play a supporting role.
The driver will continue his function to drive, navigate and generally operate the vehicle.
There is no limit to the number of medical staff in the vehicle. All crew have the collective aim for the safe transportation of the injured.
This post was last modified on December 28, 2020 9:29 pm