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Emergency medical technician
Emergency medical technician
Emergency Medical Technician (EMT) or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services. Common terms, obsolete in some cases, include ambulance driver, ambulance orderly, ambulance attendant and ambulanceman or woman. The precise meaning of the term varies by jurisdiction, but in many countries EMTs respond to emergency calls, perform certain medical procedures and transport patients to hospital in accordance with protocols and guidelines established by physician medical directors. They may work in an ambulance service (paid or voluntary), as a member of technical rescue teams/squads, or as part of an allied service such as a fire or police department. EMTs are trained to assess a patient's condition, and to perform such emergency medical procedures as are needed to maintain a patent airway with adequate breathing and cardiovascular circulation until the patient can be transferred to an appropriate destination for advanced medical care. Interventions include cardiopulmonary resuscitation, defibrillation, controlling severe external bleeding, preventing shock, body immobilization to prevent spinal damage, and splinting of bone fractures.
The Star of Life, a global symbol of emergency medical service
Paramedics in Canada
In Canada the scope of practice of Paramedics is described by the National Occupational Competency Profile (NOCP) for Paramedics document developed by the Paramedic Association of Canada. Most EMTs loading an injured skier into an ambulance providers that work in ambulances will be identified as 'Paramedics'. However, in many cases, the most prevalent level of emergency prehospital care is that which is provided by the Emergency Medical Responder (EMR). This is a level of practice recognized under the National Occupational Competency Profile, although unlike the next three successive levels of practice, the EMR is not specifically considered a Paramedic, per se. The high number of EMRs across Canada cannot be ignored as contributing a critical role in the chain of survival, although it is a level of practice that is least comprehensive (clinically speaking), and is also generally not consistent with any medical acts beyond advanced first-aid, with the exception of automated external defibrillation (which is still considered a regulated medical act in most provinces in Canada). Of considerable relevance to understanding the nature of Canadian Paramedic practice, the reader must appreciate the considerable degree of inter-provincial variation. Although a national consensus (by way of the National Occupational Competency Profile) identifies certain knowledge, skills, and abilities as being most synonymous with a given level of Paramedic practice, each province retains ultimate authority in legislating the actual administration and delivery of emergency medical services within its own borders. For this reason, any discussion of Paramedic Practice in Canada is necessarily broad, and general. Specific regulatory frameworks and questions related to Paramedic practice can only definitively be answered by consulting relevant provincial legislation, although provincial Paramedic Associations may often offer a simpler overview of this topic when it is restricted to a province-by-province basis.
and other fundamental basic medical care. the nature of training and how it is regulated. This is regulated both provincially (by statute) and locally (by the medical director). EMTs are authorised to work on non-emergency ambulances only as the standard for emergency (999) calls is a minimum of a two-paramedic crew. Nevertheless. ASA (aspirin) and nitroglycerine).Emergency medical technician Regulatory frameworks vary from province to province. Emergency Medical Technician is the entry-level standard of practitioner for employment within the ambulance service. performing trauma immobilization (including cervical immobilization). and include direct government regulation (such as Ontario's method of credentialing its practitioners with the title of A-EMCA. . varies from province to province. such as 50% Dextrose. or initiate intravenous therapy to deliver a few additional medications. the province of Alberta uses the title "Emergency Medical Technician". Currently. respiratory therapists. In this manner. for example. Primary Care Paramedics may also receive additional training in order to perform certain skills that are normally in the scope of practice of Advanced Care Paramedics. regardless of how titles are specifically regulated within their own provincial systems. This is often referred to as Medical Control. or Advanced Emergency Medical Care Assistant) to professional self-regulating bodies. epinephrine. the Primary Care Paramedic training may be six months (British Columbia) to three years (Quebec) in length. EMTs are a vital part of the voluntary and auxiliary services where a practitioner must be on board any ambulance in the process of transporting a patient to hospital. equal in importance to nurses. in the province of Ontario many paramedic services allow Primary Care Paramedics to perform 12-lead ECG interpretation. cardiac perfusionists and others.but almost all provinces are gradually moving to adopting the new titles. or 'EMT' for the Primary Care Paramedic and 'Paramedic' only for those qualified as Advanced Care Paramedics Advanced Life Support (ALS) providers . and ordinarily entails an aspect of medical oversight by a specific body or group of physicians. administration of Symptom Relief Medications for a variety of emergency medical conditions (these include oxygen. or a role played by a base hospital. glucagon. Training varies regionally. the confusing myriad of titles and occupational descriptions can at least be discussed using a common language for comparison sake. For example. or have at least recognized the NOCP document as a benchmarking document to permit inter-provincial labour mobility of practitioners. Training Paramedic training in Canada is intense. The scope of practice includes performing semi-automated external defibrillation. Though the title of Paramedic is a generic description of a category of practitioners. interpretation of 4-lead or 12 lead ECG's depending on the area. 2 Primary care paramedics Primary care paramedics (PCP) are the entry-level of paramedic practice in Canadian provinces. salbutamol. Ireland Emergency Medical Technician is a legally defined title in the Republic of Ireland based on the standard set down by the Pre-Hospital Emergency Care Council (PHECC). For example. as paramedics are seen as health professionals. like actual paramedic practice. such as the Alberta College of Paramedics. provincial variability in regulatory methods accounts for ongoing differences in actual titles that are ascribed to different levels of practitioners.
John McDade. along with four associate physicians. Physicians in training (interns and residents). United States History EMT program in the United States began as part of the "Alexandria Plan" in the early 70's. a wide range of Medications. It was not until the establishment of American College of Emergency Physicians (ACEP). the recognition of emergency medicine training programs by the AMA and the AOA. Dr. advanced Airway management etc. internists. Prior to the 1960s and 70s.3 or 4 based on their level of experience. tracheal intubation.Emergency medical technician 3 PHECC Responder Levels Responder Title CARDIAC FIRST RESPONDER OCCUPATIONAL FIRST AIDER EMERGENCY FIRST RESPONDER Abbr Level of Care CFR Trained in BLS with emphasis on CPR and the Automated External Defibrillator OFA Trained as CFR with additional training in management of bleeding. Anatomy/Physiology. providing a similar level of care to the EMT with Emergency Care Assistants employed in some areas as support. Chalmers A. among them general surgeons. The first of such groups was headed by Dr. and in 1979 a historical vote by the American Board of Medical Specialties that EM became a recognized medical specialty. groups of physicians began to emerge who had left their respective practices in order to devote their work completely to the ED. hospital emergency departments were generally staffed by physicians on staff at the hospital on a rotating basis. Pharmacology. Pathophysiology. Trained to Paramedic level plus IV & IO access. William Weaver. Trained in BLS. foreign medical graduates and sometimes nurses also staffed the Emergency Department (ED). fractures etc. Dr. AP United Kingdom Emergency Medical Technician is a term that has only recently been introduced into the ambulance service in the United Kingdom. The nations first EMT's were from the .2. IHCD Ambulance Technicians and Assistant Ambulance Practitioners still exist within other UK ambulance services. particularly in the workplace EFR Extensive first aid and BLS training with introduction to Oxygen therapy and assisting practitioners with care PHECC Practitioner Levels Practitioner Title EMERGENCY MEDICAL TECHNICIAN PARAMEDIC ADVANCED PARAMEDIC Abbr Level of Care EMT Entry-level EMS Healthcare professional. During this period. in addition to a growing issue with injuries associated with car accidents. EM was born as a specialty in order to fill the time commitment required by physicians on staff to work in the increasingly chaotic emergency departments (EDs) of the time. Steven Bednar at Alexandria Hospital. and dermatologists. VA established 24/7 year round emergency care which became known as the "Alexandria Plan". psychiatrists. A number of National Health Service ambulance services are running EMT conversion courses for staff who were trained by the Institute of Healthcare Development (IHCD) as Ambulance Technicians and Assistant Ambulance Practitioners. Ambulance trusts such as the London Ambulance Service and the North West Ambulance Service are in the process of converting existing Ambulance Technicians into new roles as Emergency Medical Technician 1. and Dr. Manual Defib etc. Emergency medicine (EM) as a medical specialty is relatively young. Dr. Loughridge. James DeWitt Mills who. ECG Monitoring and Spinal Immobilization P Emergency Ambulance Practitioner. Trained in advanced Pharmacology.
supplemental oxygen administration.Emergency medical technician Alexandria plan working as Emergency Care Technicians serving in the Alexandria Hospital Emergency Room. In attendance were three of the nations first ECTs/EMTs: David Stover. emergency medical technician (replacing EMT-Basic). advanced emergency medical technician (replacing EMT-Intermediate 1985). In addition. these "new" levels will replace the fragmented system found around the United States. On June 24. Wilderness Paramedic and Flight Paramedic. NREMT exams are used by 46 states as the sole basis for certification at one or more EMT certification levels. Transition to new levels In 2009. Levels The NHTSA recognizes four levels of EMTs: • • • • EMT-B (Basic) EMT-I/85 (Intermediate) EMT-I/99 (Intermediate or Advanced) EMT-P (Paramedic) Some states also recognize the Advanced Practice Paramedic or Critical Care Paramedic level as a state-specific licensure above that of the paramedic. EMTs are certified according to their level of training. positive pressure ventilation with a bag valve mask. Individual states set their own standards of certification (or licensure. Currently. EMTs can seek out specialty certifications such as Wilderness EMT. EMTs tend to a spiral fracture at a roller derby bout.and Kenneth Weaver. nasopharyngeal airway. The procedures and skills allowed at this level are generally non-invasive such as bleeding control. and paramedic (replacing EMT-Intermediate 1999 and EMT-Paramedic). 2011. The Alexandria Hospital Celebrated the 50th Anniversary of the Alexandria Plan. the NREMT posted information about a transition to a new system of levels for emergency care providers developed by the NHTSA with the National Scope of Practice project. Training requirements and treatment protocols vary from area to  area. The new classification will include emergency medical responder (replacing first responder). and splinting (including full spinal immobilization). The training for these technicians was modeled after the established "Physician Assistant" training program and later restructured to meet the basic needs for emergency pre-hospital care. oropharyngeal airway. Intermediate levels of EMT . The National Registry of Emergency Medical Technicians (NREMT) is a private organization which offers certification exams based on NHTSA education guidelines. 4 Certification In the United States. in some cases) and all EMT training must meet the minimum requirements as set by the National Highway Traffic Safety Administration's (NHTSA) standards for curriculum. By 2014. Larry Jackson. EMT-B EMT-Basic is the entry level of EMS.
often reaching or exceeding 120 hours. and provides for enhanced assessment skills.g. and an ambulance with paramedics is dubbed an advanced life support (ALS) unit. EMT-Bs must obtain at least 48 hours of additional education and either complete a 24 hour refresher course or complete an additional 24 hours of CEs that would  Recertification for other levels cover. obtaining IV access. some states have instituted their own intermediate EMT levels using a variety of names (e. a basic and a paramedic or an intermediate and a paramedic) to staff ambulances and operate at the level of the highest trained provider. EMT-Bs receive at least 110 hours of classroom training. Advanced EMT in California or the levels of Advanced EMT-Intermediate and Advanced EMT-Critical Care in New York). The standard curriculum for EMT-I from 1998 is defined by the NHTSA.000 hours or more. For example. instead focusing on maintaining the current lists of intermediates they have. on an hour by hour basis. Many states have stopped issuing new Intermediate licensure. Paramedics perform a variety of medical procedures such as fluid resuscitation. provided that each course at least meets local and national requirements. including IV therapy. EMT-P EMT-Paramedics. cardiac monitoring (continuous and 12-lead). but each state may not have implemented or approved this program. then it is acceptable to have two paramedics and a basic). Outside of the NHTSA framework. represents the highest level of EMT. and EMT-Ps are trained for 1. In addition to each level's didactic education. Similar in a sense to medical school clinical rotations. an ambulance utilizing EMT-Is is dubbed an intermediate life support (ILS) unit. EMT-I/85 EMT-I/85 is a level of training that will typically allow several more invasive procedures than are allowed at the basic level. the use of multi-lumen airway devices (even endotracheal intubation in some states). There are two intermediate levels that are tested for by the NREMT. fast track programs are available for EMT-Bs that are completed in two weeks by holding class for 8 to 12 hours a day for at least two weeks. clinical rotations may also be required (especially for levels above EMT-Basic). though some areas utilize physicians as providers on air ambulances or as a ground provider. and other advanced procedures and assessments. to maintain NREMT certification. There is nothing stopping supplemental crew members to be of a certain certification. EMT training programs vary greatly in calendar length (number of days or months). Some states allow ambulance crews to contain a mix of crews levels (i. For example. the highest level of prehospital medical provider. or up to 2 years for paramedics in an associates degree program. EMT-Is generally have 200–400 hours of training. and in general.Emergency medical technician EMT-Intermediates are the levels of training between basic (EMT-B) and paramedic (EMT-P). Other training programs are months long. if an ALS ambulance is required to have two paramedics. who are commonly referred to as simply "paramedics". though (e. with the 1999 level being the more advanced of the two. In the United States. In addition. Staffing levels An ambulance with only EMT-Bs is considered a basic life support (BLS) unit.e. as well as additional training time. such as cardiac monitoring and the administration of additional pharmaceutical interventions. pharmaceutical administration. EMT-I/99 The EMT-I/99 represents a higher level than the EMT-I/85 with an expanded scope of practice. the EMT-I/85 and the EMT-I/99. a minimum number of continuing education (CE) hours are required to maintain certification. and encouraging the Basic to Paramedic program philosophy. 5 Education and training EMT training programs for certification vary greatly from course to course.g. follows a similar pattern. the same topics as the refresher course would. EMT students are required to spend a .
Every state in the United States has an EMS lead agency or state office of emergency medical services that regulates and accredits EMT training programs. the level the student is obtaining. These volunteers have the same state certification as their paid counterparts. New York State has similar procedures. emergency medical services are provided by volunteer agencies. In this environment.g. Most of these offices have web sites to provide information to the public and individuals who are interested in becoming an EMT. AEMT-Critical Care and EMT-Paramedics in New York). or “third-party”.g. and the amount of time it takes the student to show competency. The NHTSA curriculum is the foundation Standard of Care for EMS providers in the US. community colleges. EMT training programs take place at numerous locations. it is not uncommon for the primary employer of EMTs (both EMT-Ps and EMT-Bs) to be the fire department. psychiatry) in order to complete a course and become eligible for the certification exam. a procedure can be both an on-line and a standing order depending on the level of the provider. The development of these policies are guided by a physician medical director. systems also have policies in place to handle medical direction when communication failures happen or in disaster situations. such as universities. Treatments and procedures administered by paramedics fall under one of two categories. In addition. but many ambulance services operate both non-emergency and emergency care. In many places across the United States. levels of training and clinical experiences. an EMT's actions in the field are governed by state regulations. On-line medical orders refers to procedures that must be explicitly approved by a base hospital physician or registered nurse through voice communication (generally by phone or radio) and are generally rare or high risk procedures (e. In other locations. emergency medicine. and by the policies of their EMS organization. The number of clinical hours for both time in an ambulance and time in the hour vary depending on local requirements.g. when multiple levels can perform the same procedure (e. such as Boston. hospitals or EMS academies. These procedures often vary from county to county based on local needs. 6 Medical direction In the United States. . Employment EMTs are employed in varied settings ranging from industrial and entertainment first aid positions to hospital and health care settings. local regulations. many systems work with protocols as guidelines and not "cook book" treatment plans. government agency. surgery. off-line medical orders (standing orders) or on-line medical orders.Emergency medical technician required amount of time in an ambulance and on a variety of hospital services (e. hospital discharges) and emergency (9-1-1 calls) services. under the supervision of the California Emergency Medical Services Authority. In still other locations. Massachusetts. for example. rapid sequence induction or cricothyrotomy). often with the advice of a medical advisory committee. Finally. In NJ (and other states). emergency medical services are provided by a separate. each county's Local Emergency Medical Service Agency (LEMSA) issues a list of standard operating procedures or protocols.g. technical schools. whereas a regional medical-advisory council ("REMAC") determines protocols for one or more counties in a geographical section of the state. and the prehospital environment. obstetrics. many EMS agencies are run by Independent Non-Profit Volunteer First Aid Squads that are their own corporations set up as separate entities from fire departments. College and university campuses may provide emergency medical responses on their own campus using students. In California. with the fire department providing the primary emergency medical system response. volunteers are "hired" to fill certain blocks of time to cover emergency calls. Since no set of protocols can cover every patient situation. The prehospital environment is loosely divided into non-emergency (e.
 "Tennessee Critical Care Paramedic" (http:/ / www. emsa. September 2006. asp) on 2007-10-28. aarems. New York State Department of Health. South Carolina Department of Health and Environmental Control. .  "Emergency Medical Technician-Intermediate: National Standard Curriculum" (http:/ / www. asp). healthsystem. Retrieved 2008-03-10.  "Advanced Practice Paramedic" (http:/ / www. org/ EMTServices/ emt_cand_state_offices. Retrieved 2011-09-18. htm). com/ medical/ ems/ procedures. ca. asp) on 2007-10-26. 6–7. Retrieved 2008-03-10. state. bls. pp. Retrieved 2008-03-11. asp). T. . Retrieved 2008-03-10.  "AAREMS 2007 Regional ALS Treatment Protocols" (http:/ / www. edu/ internet/ emergency/ education/ paramedicprogram/ paramedic. . . .  "Paramedic Education: Paramedic Associate Degree Program" (http:/ / www. gov/ aboutemsa/ mandate. ca. Archived from the original (http:/ / nremt. nhtsa. org/ EMTServices/ rr_basic_history. MAXIMIZE/ menuitem. Retrieved 2011-09-18. nremt. gov/ people/ injury/ ems/ pub/ emtbnsc. org/ web/ 20071027161221/ http:/ / www. emsa. gov/ portal/ site/ nhtsa/ template. org/ web/ 20071026051111/ http:/ / www. Retrieved 2008-03-10. asp). org/ about/ Legal_Opinion. morristownresidency.  "National Standard Curriculum" (http:/ / www. Retrieved 2008-03-10. portlet.  "What is the Bureau of Emergency Medical Services" (http:/ / www. dot. Retrieved 2008-03-11. gov/ personnel/ EMT. nremt. Bureau of Labor Statistics. ca/ Content. . National Registry of Emergency Medical Technicians. pdf) (PDF). . . Retrieved 2008-03-10. org/ EMTServices/ rr_basic_history. archive.  "EMS Fellowship Overview" (http:/ / em. ny. asp#EMTonlyCLASSESFOR19992000). org/ about/ about_exams. NHTSA. Retrieved 2008-03-10. Retrieved 2008-03-10. Adirondack . . nhtsa. Retrieved 2008-03-10. California EMSA. 11–23. asp).  "EMT-I (1) Regulations" (http:/ / www. html). cfm).  "Emergency Medical Services Program" (http:/ / www. California Emergency Medical Services Authority. . Retrieved 2008-03-10. org/ about/ about_exams. Retrieved 2011-09-18. Archived from the original (http:/ / nremt. archive. 2a0771e91315babbbf30811060008a0c/ ?javax. php). htm). scdhec. asp) on 2007-10-27. Archived from the original (http:/ / nremt. drexel. gov/ people/ injury/ ems/ EMT-I/ index. . pdf) (PDF). . pdf) (PDF). Retrieved 2008-03-11.  "1998 Emergency Medical Technician .  "BLS/ALS Procedures" (http:/ / ochealthinfo. National Highway Transportation Safety Administration. . pdf) (PDF). archive. asp). tpst=4670b93a0b088a006bc1d6b760008a0c_ws_MX& javax. org/ EMTServices/ emt_cand_state_offices.  "NREMT "EMT-Basic Recertification" (http:/ / web.  "Emergency Medical Services (EMS) Certification and Education Information" (http:/ / www. prp_4670b93a0b088a006bc1d6b760008a0c_viewID=detail_view& itemID=1822abcc80c81010VgnVCM1000002c567798RCRD& overrideViewName=Article). gov/ oco/ ocos101.Intermediate: National Standard Curriculum" (http:/ / www.  "EMT Information" (http:/ / www. archive. Licensure" (http:/ / web. org/ web/ 20071027161226/ http:/ / www. org/ regionalALS. . aspx?ContentID=4& ContentTypeID=2). com/ medical/ ems/ guidelines/ ). California Emergency Medical Services Authority.  "SC EMT-Basic Skills" (http:/ / www. University of Virginia Health System. state.  "2008 EMT-Basic Course Schedule" (http:/ / www. US Department of Labor. . . Link 2 Life. dot. National Highway Transportation Safety Administration. Retrieved 2008-03-15. New York State Department of Health. ochealthinfo. National Registry of Emergency Medicial Technicians. org/ pricing. gov/ people/ injury/ ems/ EMT-I/ ). Retrieved 2011-18-09. National Highway Transportation Safety Administration. gov/ health/ ems/ cskills. Orange County EMS Agency.  "About us" (http:/ / www. Retrieved 2008-03-10. Orange County EMS Agency. org/ Fellowships/ EMS Fellowship Overview. asp) on 2007-10-27. dot. gov/ legislation/ FinalApprovedChapter3242007. . nasemso. tn. .  "EMS Authority's Mandates Summary" (http:/ / www.  "State Office Information" (http:/ / web. Archived from the original (http:/ / www. Retrieved 2008-10-05. pdf). org/ about/ Legal_Opinion. Retrieved 2011-09-18. Retrieved 2011-09-18.Appalachian Regional Emergency Medical Services Council. nhtsa. com/ medical/ ems/ ).  "Treatment Guidelines" (http:/ / www. nremt. Retrieved 2008-03-10. National Registry of Emergency Medical Technicians. Retrieved 2008-06-12. wakegov. "Legal Opinion: Certification v. htm). Morristown Memorial Hospital Emergency Medicine Residency. National Registry of Emergency Medical Technicians.  "About NREMT Examinations" (http:/ / web.  "National Occupational Competency Profile" (http:/ / www. . virginia. nremt. ca.  "Emergency Medical Technician-Basic National Standard Curriculum" (http:/ / www. . ochealthinfo. Retrieved 2008-03-10. Drexel University. .  Abram. National Highway Transportation Safety Administration. . nhtsa. emsa.  "National EMS Scope of Practice Model" (http:/ / www. . Orange County EMS Agency. htm). . edu/ catalog/ ABOUT/ ems. us/ nysdoh/ ems/ educ. portlet. . org/ web/ 20071028093612/ http:/ / nremt. state. us/ sos/ rules/ 1200/ 1200-12/ 1200-12-05. org/ documents/ FINALEMSSept2006_PMS314. com/ ems/ staff/ app. Retrieved 2008-03-10. . us/ nysdoh/ ems/ about. Retrieved 2011-09-18. asp). health. link2life.Emergency medical technician 7 References and notes  "Emergency Medical Technicians and Paramedics" (http:/ / www. . paramedic. health. dot. htm). htm). . htm). ny.
Orange County Emergency Medical Services Agency. An ALS Rescue Unit of Palm Beach County Fire-Rescue used for EMS in Palm Beach County. ncemsf. aspx). Six Flags Magic Mountain. 1. us/ fire/ emergency_medical.org) Advanced life support Advanced Life Support (ALS) is a set of life-saving protocols and skills that extend Basic Life Support to further support the circulation and provide an open airway and adequate ventilation (breathing). . . Retrieved 2008-03-13. Retrieved 2008-03-13. . Retrieved 2008-03-11.  "National Collegiate Emergency Medical Services Foundation" (http:/ / www. rivcoems. Riverside County Emergency Medical Services Agency.  "Advanced Life Support Treatment In Communication Failure or Without Base Hospital contact" (http:/ / www. 8 External links • National Highway Traffic Safety Agency. . NJ State First Aid Council. Retrieved 2010-05-21. ci.  "NJ State First Aid Council" (http:/ / www. City of Santa Ana. bostonems. ems?category=999). njsfac. asp). Retrieved 2008-03-11. . Office of Emergency Medical Services (http://www. org/ downloads/ downloads_documents/ Protocol102904/ 7000.nremt. . com/ docs/ medical/ ems/ P& P/ 330.Emergency medical technician  "Patient Care Policy (ALS)" (http:/ / www. .  "Boston EMS" (http:/ / www. org/ index. Florida. pdf) (PDF). Retrieved 2008-03-13. org/ resources/ links/ showlinks.  "Emergency Medical Services" (http:/ / www. pdf) (PDF). p.nhtsa. sixflags. shtml). santa-ana.  "Job Openings" (http:/ / www.dot. com/ magicMountain/ jobs/ JobListings. Retrieved 2008-03-13. com/ ).2a0771e91315babbbf30811060008a0c/) • United States National Registry of Emergency Medical Technicians (http://www. 15. ca. ochealthinfo.gov/ portal/site/nhtsa/menuitem. .
at Aviva Stadium. Oxygen is administered and endotracheal intubation may be attempted to secure the airway. Basic Trauma Life Support (BTLS) or International Trauma Life Support (ITLS) A HSE advanced paramedic vehicle. At regular intervals. as agreed in Europe by the European Resuscitation Council. Depending on the type of cardiac arrhythmia. defibrillation is applied. Medication that may be administered may include adrenaline (epinephrine). .. ET.Advanced life support 9 Components of ALS These include: • Tracheal intubation • Rapid sequence intubation • Cardiac monitoring • Cardiac defibrillation • Transcutaneous pacing • Intravenous cannulation (IV) • Intraosseous (IO) access and intraosseous infusion • Surgical cricothyrotomy • Needle cricothyrotomy • Needle decompression of tension pneumothorax • Advanced medication administration through parenteral and enteral routes (IV. relies on the monitoring of the electrical activity of the heart on a cardiac monitor. Saline or colloids may be administered to increase the circulating volume. The main algorithm of ALS. 2010 revisions include: • • • • • • greater emphasis on continuous (uninterrupted) chest compression less emphasis on airway and breathing promotion of the intraosseous infusion of drugs and fluids if IV access not readily available further demotion of the precordial thump ongoing simplification expanded role for post-arrest hypothermia and emphasis on post-arrest normo-glycaemial.. Ireland 2010 changes ALS is a treatment consensus for cardiopulmonary resuscitation in cardiac arrest and related medical problems. topical. and transdermal) • Advanced Cardiac Life Support (ACLS) • Pediatric Advanced Life Support (PALS) or Pediatric Emergencies for Pre-Hospital Providers (PEPP) • Pre-Hospital Trauma Life Support (PHTLS). is assessed. as well as the presence of cardiac output. potassium and magnesium. the effect of the treatment on the heart rhythm. bicarbonate.. and medication is administered. PO. amiodarone. IO. SL. Dublin. ALS algorithms ALS assumes that basic life support (bag-mask administration of oxygen and chest compressions) are administered. PR. most recently in 2010. atropine. which is invoked when actual cardiac arrest has been established.. calcium.
to produce higher coronary and cerebral perfusion pressures. apart from the truly surgical emergencies (which are covered by Advanced Trauma Life Support). The ratio of compressions to ventilation's is now recommended as 30:2 for adults. whether medication or poisoning Thromboembolism and related mechanical obstruction (blockage of the blood vessels to the lungs or the heart by a blood clot or other material) As of December 2005. commonly abbreviated as "6Hs & 5Ts" according to 2005/2010 AHA Advanced Cardiac Life Support (ACLS). leading to decreased venous return to the heart Tamponade: fluid or blood in the pericardium. In out-of-hospital settings trained emergency medical technicians. Note these reversible causes are usually taught and remembered as 4Hs and 4Ts—including hypoglycaemia and acidosis with hyper/hypokalaemia and 'metabolic causes' and omitting trauma from the T's as this is redundant with hypovolaemia—this simplification aids recall during resuscitation. each followed immediately by two minutes of CPR before rhythm is re-assessed (five cycles of CPR). Paramedic level services are referred to as Advanced Life Support (ALS). compressing the heart Toxic and/or therapeutic: chemicals. poisoning and effectively all conditions that may lead to cardiac arrest if untreated. and related disturbances of calcium or magnesium levels. In the Republic of Ireland. • Hypothermia/Hyperthermia: body temperature not maintained • Hydrogen ions (Acidosis) • Hypoglycemia: Low blood glucose levels Ts • • • • Tension pneumothorax: increased pressure in the thoracic cavity. In the United States. ventricular tachycardia). Who performs ALS Many healthcare providers are trained to administer some form of ALS. Services staffed by basic EMTs are referred to as Basic Life Support (BLS). as those staffed by EMT-Intermediates are called Intermediate Life Support (ILS).Advanced life support While CPR is given (either manually. Canadian paramedics may be certified in either ALS (Advance Care Paramedic-ACP) or in Basic Life Support (Primary Care Paramedic-PCP) (see paramedics in Canada). members of the team consider eight forms of potentially reversible causes for cardiac arrest. Advanced Life Support guidelines have changed significantly. or through automated equipment such as AutoPulse). although they may employ slightly modified version of the Medical algorithm. paramedics or medics typically provide this level of care. Advanced Life Support (ALS) is provided by an Advanced paramedic. the Irish regulatory body for pre-hospital care and ambulance services. Advanced Paramedic (AP) is the highest clinical level (level 6) in pre-hospital care in the Republic of Ireland based on the standards set down by PHECC. See Advanced Cardiac Life Support Other conditions ALS also covers various conditions related to cardiac arrest. 10 Hs and Ts Hs • Hypoxia: low oxygen levels in the blood • Hypovolemia: low amount of circulating blood. This . either absolutely due to blood loss or relatively due to vasodilation • Hyperkalemia or hypokalemia: disturbances in the level of potassium in the blood. Emergency medical technicians (EMTs) are often skilled in ALS. A major new worldwide consensus has been sought based upon the best available scientific evidence. Defibrillation is now administered as a single shock. such as cardiac arrhythmias (atrial fibrillation.
112: IV-58 – IV-66.htm) . 11 References  Part 7. pdf) External links • UK Resuscitation Council ALS page (http://www. org. Dallas: American Heart Association.htm) • About First Aid ALS Definition (http://firstaid. ISBN 0-87493-341-2.Advanced life support terminology extends beyond emergency cardiac care to describe all capabilities of the providers. general or internal medicine. 71–87. 3-5. ahajournals.resus.com/od/glossary/g/07_als. org/ cgi/ content/ full/ 112/ 24_suppl/ IV-58)  ACLS: Principles and Practice. uk/ pages/ alsalgo.2: Management of Cardiac Arrest .112 (24 Supplement): IV-58 .  ACLS for Experienced Providers. or "Code Teams". p. Dallas: American Heart Association." Circulation 2005. p. anesthetics. 2003. Cardiac arrest teams. resus. 2003.uk/pages/mediMain.2: Management of Cardiac Arrest. ALS is usually given by a team of physicians (DOs and MDs) and nurses (RNs).org.  Resuscitation Council UK adult ALS algorithm 2005 (http:/ / www.  "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care .about. In hospitals.Circulation (http:/ / circ. ISBN 0-87493-424-9. generally include junior doctors or senior nurses and technicians from various specialties such as emergency medicine.Part 7. with some clinical paramedics practicing in certain systems.
Air ambulance 12 Air ambulance Air ambulance A Eurocopter EC 145 of Switzerland's Rega air rescue service. The French used light helicopters in the First Indochina War. It carried a single stretcher under a fairing behind the pilot. the British.S. and the first dedicated use of helicopters by U. Aircraft were still primitive at the time. has been definitively dis proven. and the American Army and Navy used them regularly for crash rescue within the United States. Like ground ambulances. used a Airco DH. forces occurred during the Korean War. however. in Vietnam. By 1969. and France and the United Kingdom used fully organized air ambulance services during the African and Middle Eastern Colonial Wars of the 1920s. CPR equipment. various military organizations tested air ambulances. While popularly depicted as simply removing casualties from the battlefield (which they did). between 1950 and 1953. By 1936. researchers to determine that . During the First World War. The French evacuated over 7. History Military As with many Emergency Medical Service (EMS) innovations. Exploration of the idea continued. Knowledge and expertise of use of air ambulances evolved parallel to the aircraft themselves. In 1920.9A fitted out as an air ambulance. treating patients in flight originated in the military. These and related operations are called aeromedical. The concept of using aircraft as ambulances is almost as old as powered flight itself. the same aircraft may be used to search for missing or wanted people. with limited capabilities. and the effort received mixed reviews. helicopters in the Korean War also moved critical patients to hospital ships after initial emergency treatment in field hospitals. an organized military air ambulance service evacuated wounded from the Spanish Civil War for medical treatment in Nazi Germany. ECGs and monitoring units. Post-World War I. air ambulances are equipped with medical equipment vital to monitoring and treating injured or ill patients. however. An air ambulance is a specially outfitted aircraft that transports injured or sick people in an medical emergency or over distances or terrain impractical for a conventional ground ambulance. and stretchers.000 casualties during that period. The first use of helicopters to evacuate combat casualties was by the United States Army in Burma during WW2. Common equipment for air ambulances includes medications. A medically staffed and equipped air ambulance provides medical care in flight—while a non-medically equipped and staffed aircraft simply transports patients without care in flight. In some circumstances. Some sources identify the first air medical transport as an operation during the 1870 Siege of Paris when 160 wounded French soldiers were transported by hot-air balloon. the use of specially trained medical corpsmen and helicopter air ambulances led U. ventilators. while suppressing the "Mad Mullah" in Somalialand.S. several Dehavilland DH-4 were converted to air ambulances for the US Army and Navy. This. though not in combat. Military organizations and NATO refer to the former as Medical Evacuation (MEDEVAC) and to the latter as Casualty Evacuation (CASEVAC).
 In 1936. many of these communities began to rely on civilian "bush" pilots. and visiting doctors or nurses. The use of military aircraft as battlefield ambulances continues to grow and develop today in a variety of countries.Air ambulance servicemen wounded in battle had better rates of survival than motorists injured on California freeways.3117 in Somaliland 1920 Older version of a Danish air ambulance Light helicopters like this Bell 47 Sioux removed the wounded from the battlefield (Korea) Civilian The first civilian uses of aircraft as ambulances were probably incidental. full-time air ambulance service was established in the Australian outback. or even year round. in Morocco. including repatriation of the wounded. Early in aviation history. albeit on an ad hoc basis—but clearly. Currently. 13 Early air ambulance efforts DH. Australia. Bush pilots probably performed the first civilian air ambulance trips. a need for these services existed. Sweden established a standing air ambulance system. In 1934.9A D. particularly in Norway. air ambulance services were established as part of the Highlands and Islands Medical Service to serve more remote areas of Highland Scotland. The US military recently employed UH-60 Black Hawk helicopters to provide air ambulance service during the Iraq War to military personnel and civilians. the primary means of transportation between communities is by boat. In 1928 the first formal. This organization became the Royal Flying Doctor Service and still operates. who fly small aircraft and transport supplies. and in Scandinavian countries. sparsely populated settlements are often inaccessible by road for months at a time. as did Siam (Thailand). remote. Australia's Royal Flying Doctor Service King Air Pilatus PC 12/45 . a NATO working group is investigating unpiloted aerial vehicles (UAVs) for casualty evacuation. as does the use of fixed-wing aircraft for long-distance travel. In the early 1920s. Marie Marvingt established the first civil air ambulance service in Africa. This inspired the first experiments with the use of civilian paramedics in the world. mail. In northern Canada. In some places in Scandinavia.
After World War II. air ambulances primarily provided medical transportation. These programs were highly successful at establishing the need for such services. Canada.S. The Schaefer Air Service. established the first civilian air ambulance in North America. Eventually. Saskatchewan. and departments of the civilian governments began to operate aircraft for other purposes. the Military Assistance to Safety and Traffic (MAST) system. but also in other countries. Today in the U. to assess the impact of medical helicopters on mortality and morbidity in the civilian arena. in Los Angeles. Walter Schaefer founded the first air ambulance service in the U. the Saskatchewan government in Regina. Project CARESOM was established in Mississippi in 1969.Air ambulance Air ambulances quickly established their usefulness in remote locations. the program was considered a success and each of the three communities was given the opportunity to continue the helicopter operation. When the Saskatchewan and Schaefer services began. The Saskatchewan government had to consider remote communities and great distances in providing health care to its citizens. and persists today. A great deal of the early use of aircraft as ambulances in civilian life. particularly helicopters. involved the improvised use of aircraft that belonged to the military. Schaefer Air Service was also the first FAA-certified air ambulance service in the United States. in 1947. central. helicopters and airplanes carry out approximately a half million transports per year.S. . operated as part of Schaefer Ambulance Service. and southern areas of the state. The Saskatchewan Air Ambulance service continues to be active as of 2011. Only the one located in Hattiesburg. J. this became more organized. Mississippi did so. paramedicine was still decades away.S. In many cases. and it was therefore established as the first civilian air medical program in the United States. was established in Fort Sam Houston in San Antonio in 1969. The remaining challenge was in how such services could be operated most cost-effectively. as agencies. This occurred not only in the United States. Upon termination of the grant.. and unless a physician or nurse accompanied the patient. branches. 14 Military aircraft supporting civilian air ambulance Swedish search and rescue Israeli military helicopter as air ambulance Polish navy helicopter W-3 as air ambulance. these aircraft were frequently pressed into service to provide cost-effective air support to the evolving Emergency Medical Services. search and rescue Two research programs were implemented in the U. The second program. This was an experiment by the Department of Transportation to study the feasibility of using military helicopters to augment existing civilian emergency medical services. but their role in developed areas developed more slowly. Three helicopters were purchased through a federal grant and located strategically in the north.
Munich. Germany. Christoph Brandenburg or Christoph Murnau am Staffelsee. began with a single rotor-wing aircraft based in Toronto.England STARS .000 admissions are dispatched annually. the air ambulance program began in 1977. based at St. entered service at the Hospital of Harlaching. and is seen as a much-needed support for ground-based EMS systems. Over 17. Flight For Life Colorado began with a single Alouette III helicopter. An important difference in the Ontario program involved the emphasis of service. The system. the first permanent civil air ambulance helicopter. making Ornge North America's largest operator in the field of transport medicine. across the world. dedicated civilian air ambulances began to appear. Christoph 1. 1970. Today. Christoph 20 in 1981. the presence of civilian air ambulances has become commonplace. Modern civilian air ambulances London Air Ambulance . there are about 80 helicopters named after Saint Christopher. Colorado. the system operates 33 aircraft stationed at 26 bases across the province. and Christoph 51 in 1989.Air ambulance 15 Government Agency Aircraft Performing Double Duty Hong Kong Government Flying Service German 'Christoph' Air Ambulance of the Federal Ministry of the Interior Italian Dauphin of the Autonomous Province of Trento also used in mountain rescue missions As the concept was proven. although less commonly. Austria adopted the German system in 1983 when Christophorus 1 entered service at Innsbruck. As of 2007. "On scene" calls were taken. operated by the Ontario Ministry of Health. and featured a paramedic-based system of care. The first civilian. performing both interfacility transfers and on-scene responses in support of ground-based EMS. hospital-based medical helicopter program in the United States began operation in 1972. and a great deal of the initial emphasis of the program was on the interfacility transfer of critical care patients. In Ontario. Ornge operates the largest and most sophisticated program of aeromedical transport in North America. Canada. like Christoph Europa 5 (also serving Denmark). On November 1. Canada SAMU . with the presence of physicians or nurses being relatively unusual. Anthony Central Hospital in Denver.Alberta. with Christoph 10 entering service in 1975. Operating today through a private contractor (ORNGE). The apparent success of Christoph 1 led to a quick expansion of the concept across Germany.France .
sometimes called Aeromedical Evacuation or simply Medevac. The military role in civilian air ambulance operations is described in the History section. fee-for-service. However. These include military/civilian models and services that are government-funded. There are 5 helicopters for North East Ohio and. Ornge . including Cleveland. including rotary-wing. either directly or via a negotiated contract with a commercial service provider. is provided by a variety of different sources in different places in the world. it is reasonable to differentiate by the type of aircraft used. support ground-based EMS on scenes. There are a number of reasonable methods of differentiating types of air ambulance services.The UK's only Government funded air ambulance service. In North East Ohio. Scottish Ambulance Service . Metro Life Flight has one fixed-wing aircraft. private aircraft charter companies provide non-emergency air ambulance service on a fee-for-service basis. Each of the remaining models is explored separately. It may also be reasonable to differentiate between dedicated aircraft and those with multiple purposes and roles. there is no independent HEMS operator in Poland. the government almost always takes a 'hands-off' approach to actual running of the system. the Cuyahoga County-owned MetroHealth Medical Center uses its Metro Life Flight to transport patients to Metro's level I trauma and burn unit. It should also be noted that this information applies to air ambulance systems performing emergency service. or funded by public donations. in addition. In almost all jurisdictions.Air ambulance 16 Mobiel Medisch Team . or very large aircraft.Ontario's Air ambulance service helicopter . The Polish LPR is a national system covering the entire country and funded by the government through the Ministry of Health but run independently. USA Swedish King Air Organization Air ambulance service.Netherlands Memorial Hermann Life Flight Texas. relying instead on local managers with subject matter (physicians and aviation executives) expertise. Ontario's ORNGE program and the Polish Lotnicze Pogotowie Ratunkowe (LPR) are examples of this type of operating system. Such services may focus on critical care patient transport. or may perform a combination of these roles. such as an aircraft charter company. the government provides guidelines to hospitals and EMS systems to control operating costs—and may specify operating procedures in some level of detail to limit potential liability. In almost all cases. donated by a business enterprise. fixed-wing. Government operated In some cases. governments provide air ambulance services. Finally.
Organizations such as service aircraft charter companies. Rega of Switzerland is an example of such a service. local EMS provides the flight paramedic to the aircraft operator as-needed. Australia. where in London the Virgin Corporation funds the Helicopter Emergency Medical Service. In most cases. However. In these cases. for example. and some private-for-profit EMS systems generally charge for service. but may have to meet government licensing requirements. the operation may vary. Within the European Union. but has a dual function. the cost of providing air ambulance services is considerable and many. Fee-for-service In many cases. These represent the UK's only government-funded air ambulance service. the paramedic staffs the aircraft full-time. and the presence of dedicated air ambulances is simply not practical. Donated by business In some cases. and New Zealand. charge for service. except for systems that operate by private Switzerland REGA Fee-for-service subscription. almost all air ambulance service is on a fee-for-service basis. the flight paramedic is a serving State Trooper whose job is to act as the Observer Officer on a police helicopter when not required for medical emergencies. many air ambulance helicopter operations are sponsored by the Westpac Bank. local jurisdictions do not charge for air ambulance service. the Scottish Ambulance Service operates two helicopters and two fixed-wing aircraft twenty-four hours per day. cost is a major consideration. In some cases. hospitals. relying instead on subject matter .Air ambulance In the United Kingdom. with the Queensland Ambulance Service or New South Wales Ambulance Service providing paramedics. the helicopter that responds as an air ambulance is actually operated by the local hydroelectric utility. a local business or even a multi-national company may choose to fund local air ambulance service as a goodwill or public relations gesture. Many jurisdictions have a mix of operation types. and the donor. hospitals. including government-run operations. EMS. In the case of the Maryland State Police. while the sponsor receives advertising exposure in exchange for funding. the aircraft may be operated by another government or quasi-government agency and made available to EMS for air ambulance service when required. and in Germany and the Netherlands a large number of the 'Christoph' air ambulance operations are actually  In Australia funded by ADAC. 17 Multiple purpose In some jurisdictions. particularly for emergency calls. but is the result of a carefully negotiated agreement between German Auto Club government. Fee-for-service operators are generally responsible for their own organization. Examples of this are common in the European Union. they take a 'hands off' approach to daily operations. Snowy Hydro SouthCare Bell 412 helicopter in Australia In other cases. as required. Germany's largest automobile club. In these cases. In southern Queensland.
They have commissioned research (March 2010) and expect that in future. or to repatriate individuals. nurses. although the service to London receives most of its funding through the National Health Service. Each operates aircraft staffed by physicians. Recently retired USAF C-9 Nightingale air ambulance. This has necessitated some charities buying expensive clinical governance services from independent "for profit" companies. However. ADAC. Some countries. and each can providing long distance transport with full medical support to dozens of patients simultaneously. and Mercy Jets. which requires them to support overseas combat operations. however. such as the U. and the British Royal Air Force. Public donations supported Great strides were made in the UK between 2005 and 2008. the German automobile club.. in recent years. the German Luftwaffe.Air ambulance specialists. In recent years. NHS partners joined the association. In the past. generally fixed-wing air ambulances. This organization is widely credited for having created the political climate that made the helicopter industry and National Health Service recognise the enormous contribution charities make to trauma care in the United Kingdom. and it renamed itself the Association of Air Ambulances. clinical governance will be provided either free or on a not-for-profit basis.K. the infrequency of civilian demand for such a service confined such operations to the military. and corpsmen/technicians. 18 Public donations In some cases. as opposed to government funding. through the Scottish Ambulance Service In England and Wales. exceptions to the "military-only" rule have grown with the need to quickly transport patients to facilities that provide higher levels of care. the service has moved towards the physician-paramedic model of care. The industry is currently divided over whether it is ethically acceptable that income derived through philanthropy and altruism should be spent on buying this essential governance from profit-driven entrepreneurs. "Heavy-lift" A final area of distinction is the operation of large. when independent charities formed the National Association of Air Ambulance Charities (AAAC). use both large and small fixed wing aircraft configured to provide levels of care that can be found in Trauma centers for individuals who subscribe to their own health insurance or affiliated travel insurance and protection plans. the parliament has voted to fund air ambulance service directly. use a mix of such systems. In Scotland. In 2008. the service is funded on a charitable basis via a number of local charities for each region covered. Military organizations capable of this type of specialized operation include the United States Air Force. air ambulance services may be provided by means of voluntary charitable fundraising. . or they may receive limited government subsidy to supplement local donations.
and aircraft meet much higher standards than previously required. instead charter aircraft based on the mission-specific requirements. While in principle providing medical increasing trend as services flights. New Jersey. which has adopted CAMTS' Accreditation Standards (Sixth Edition. air ambulance pilots must have a great deal of experience in piloting their aircraft because the conditions of air ambulance flights are often more challenging than regular non-emergency flight services. the U. After a spike in air ambulance crashes in the United States in the 1990s. which applies only in the United States. New Mexico. such as Rhode Island. and Texas. Utah. The accreditation is done by professionals who are qualified to determine air ambulance safety. with considerable input from all disciplines of the medical profession.S. According to the rationale used to justify the state of Washington's adoption of the accreditation requirements. realizing it is virtually impossible to have the correct medicalized aircraft for every mission. an operator not wishing to become CAMTS accredited must submit to an equivalent survey by state auditors who are . This is an state health services agencies address the issues surrounding the safety of emergency medical Some examples are the states of Colorado. a number of government jurisdictions require companies transportation services to have CAMTS accreditation to be licensed to operate. compliance with accreditation standards is checked on a continual basis by the accrediting organization. government and the Commission on Air Medical Transportation Systems (CAMTS) stepped up the accreditation and air ambulance flight requirements. includes the requirement for an air ambulance company to own and operate its own aircraft. changing environment of medical transport. personnel. In addition. and Washington. requiring accreditation of air ambulance services provides assurance that the service meets national public safety standards. Some air ambulance companies. In Texas.S. October 2004) as its own. The resulting CAMTS accreditation. states require either CAMTS accreditation or a demonstrated equivalent. ensuring that all pilots.Air ambulance 19 Heavy lift capability German Luftwaffe A310 German Auto Club Dornier 328JET USAF C-17 Globemaster Gulfstream used by Mercy Jets Standards Aircraft and flight crews In most jurisdictions. CAMTS accreditation is voluntary. Other U. Accreditation standards are periodically revised to reflect the dynamic.
while in flight. Services that focus primarily on critical care transport are more likely to be staffed by physicians and nurses. including three in Canada and one in South Africa. Assessment skills tend to be considerably higher. EC130. In services operating under the Anglo-American model of service delivery. Equipment and interiors Most aircraft used as air ambulances. not the helicopter. the physician is almost always physically present. area. others have medical directors who are only available by pager. and the Agusta Westland 109 & . such as chest auscultation. using protocols for almost all procedures and only resorting to on-line medical control when protocols have been exhausted. There are a large variety of helicopter makes that are used for the civilian HEMS models. or in some cases. In some types of aircraft. Additional issues occur with respect to pressurization of the aircraft. and issuing contingency orders in case they are required during flight. While the original intent of CAMTS was to provide an American standard.Air ambulance CAMTS-trained. and. it may not be possible perform some assessment procedures. EC145. consultation with supervising physicians. the aircraft is much more likely to be used to deliver high level support to ground-based EMS. including changes in physiology and the behaviour of gases. occasionally even performing emergency surgical procedures in the field. have voluntarily submitted themselves to CAMTS accreditation. permit inclusion of functions such as reading x-rays and interpretation of lab results. Medical control The nature of the air operation frequently determines the type of medical control required.000 feet above sea level. accompanied by a specially trained advance care paramedic or nurse. are equipped for advanced life support and have interiors that reflect this. and the crew may consist of Emergency Medical Technicians. EC135. While equipment tends to be high-level and very conveniently grouped. on site medical directors with pertinent backgrounds (e. Eurocopter AS350. anesthetist. 20 Medical staffing The makeup of the medical crew staffing an air ambulance varies depending on country. with the exception of charter aircraft and some military aircraft. The challenges in most air ambulance operations. an air ambulance staffer is considerably more skilled than a typical paramedic. Some air ambulance operations have full-time. These pressure changes require advanced knowledge by flight staff with respect to the specifics of aviation medicine.. For those systems operating on the Franco-German model. Paramedics. the object is the rapid delivery of definitive care. flight nurses. are the high ambient noise levels and limited amounts of working space. In the Japanese Physician Delivery Helicopter Franco-German model. BK117.g. and medical control is not an issue. In these cases. often a surgeon. particularly on inter-facility transfers. the crew generally consists of a physician. particularly those involving helicopters. emergency medicine). trauma specialist or similar specialty. Not all aircraft used as air ambulances in all jurisdictions have pressurized cabins. Virginia and Oklahoma have also adopted CAMTS accreditation standards as their state licensing standards. This allows for planning. Some systems operate almost entirely off-line. service provider. 407. both of which create significant issues for the provision of ongoing care. the aircraft's design means that the entire patient is not physically accessible in flight. so medical control permits them to exercise more medical decision-making latitude . and 429. the helicopter is most likely to be used to transport patients. a Respiratory Therapist. and those that do typically tend to be pressurized to only 10. The commonly used types are the Bell 206. In most cases. air ambulance services in a number of other countries. In these cases. a physician. and type of air ambulance. with the eventual transport of the patient being accomplished by ground ambulance.
2010." (http:/ / www. Retrieved: December 4. 4(4): 477-494." National Academy of Sciences (White Paper)." (http:/ / www. Wings of Life and Hope: A History of Aeromedical Evacuation. com/ pdfarchive/ view/ 1956/ 1956 . 1870. Additionally. 21 Equipment and interiors Typical helicopter interior Typical helicopter interior Fixed-wing interior Challenges Beginning in the 1990s. 2007. mil/ -news/ 2007/ 02/ 09/ 1784-medevac-unit-stays-on-alert-to-save-injured-comrades/ ) US Military News via army. November 1929. google. & Environmental Medicine. Due to the configuration of the medical crew and patient compartments. monash. flyingdoctor. "MEDEVAC Unit Stays on Alert to Save Injured Comrades. October 1988. "Marie Marvingt "La Fiancée du Danger" (1875-1963). p.au. References  Lam DM. 2010. Space. Cost-effectiveness Whilst some air ambulances do have effective methods of funding.  "Lam. this number had reached a record high. Russell. as it was understood that the very nature of air ambulance operations meant that.0424. 13 April 1956. 1966. February 9. these aircraft are normally configured to only transport one patient but some can be configured to transport two patients if so needed. because a life was at stake. As a result. com/ books?id=0N8DAAAAMBAJ& pg=PA765& dq=Junkers+ stratosphere& hl=en& ei=9voOTe-zH8qUnQeRrdHyDQ& sa=X& oi=book_result& ct=result& resnum=5& ved=0CDYQ6AEwBDgK#v=onepage& q=Junkers stratosphere& f=true) Popular Mechanics. 2010. au/ About-Us/ Our-History/ ) flyingdoctor. 2010. eventually leading to the improvement of government standards and CAMTS accreditation. au/ hargrave/ marvingt.000 feet above sea level. began to climb. nearly fifty percent of all EMS personnel deaths in the United States occur in air ambulance crashes. they remain almost entirely charity funded. By 2005. DM. Retrieved: December 4." Aviation. "To Pop A Balloon: Air Evacuation During The Siege of Paris.  "Help From The Skies. for example from London's Helicopter Emergency Medical Service." (http:/ / www. the number of air ambulance crashes in the United States. in the UK. helicopters have stricter weather minimums that they can operate in and commonly do not fly at altitudes over 10.Air ambulance 149. html) monash. remain largely the same for both air and ground based services. mostly involving helicopters. In 2006.  Bearl. org. Retrieved: December 4. flightglobal.edu. Daniel. Crash rates from 2000–2005 more than doubled the previous five year's rates. html)Flight. ctie." Problems in Critical Care. To some extent.  "Accidental Death and Disability: The Neglected Disease of Modern Society.mil/-news. December 1990. going on missions in conditions where no other civilian pilot would fly. these numbers had been deemed acceptable.  Naughton." (http:/ / books.net. . army. 424. air ambulances would often operate on the very edge of their safety envelopes. Spc. 59(10): 988-991. edu. Health outcomes.  "Royal Flying Doctor Service. as improved cost-benefit ratios are generally achieved with land based attendance and transfers.  (http:/ / www. the United States National Transportation Safety Board (NTSB) concluded that many air ambulances crashes were avoidable.
Retrieved: December 4. fresno." (http:/ / www.Air ambulance  "[[Saskatchewan Air Ambulance (http:/ / www. utah. ca/ saskatchewan-air-ambulance)]. Retrieved: December 4. tx. 2007. Retrieved: December 4. 2006. pdf) dshs. com/ news/ nation/ 2006-01-25-air-ambulances_x." (http:/ / www. Retrieved: December 4.Celebrating 37 Years of Air Medical Transport!" (http:/ / www. Retrieved: December 4. asp?ComponentID=30621& SourcePageID=193391) adac.  "Rega Switzerland. mercyjets. rega. ca/ ) ornge. 2007. 2010.  Levin. co. state. 2004." (http:/ / www. nm. htm) State of Utah." (http:/ / www. 3786. htm) New Mexico Register. Retrieved: December 4. wa. 2005. us/ rules/ released/ pdf/ DOH/ DOH_2053_._Kings_and_Madera_Counties/ 001_-_099/ 021. ri.  "Colorado House Bill 07-1259. Retrieved: December 4. (http:/ / www. 2010." (http:/ / public. us/ emstraumasystems/ Minutes-final-05-26-05 _2_. com/ news/ nation/ 2005-07-17-air-ambulance-crashes_x. October 24. 2010.  "Our History: Forest General Hospital. aspx) rega." (http:/ / www. July 17." (http:/ / search.  "ADAC. Retrieved: December 4." (http:/ / www. com/ blog/ 2011/ 10/ the-history-of-the-air-ambulance-â-medflight911âs-current-and-future-role/ ) Retrieved: November 15. October 20. 2010. state. org/ frames.  "Air Ambulance. state. 2010. pdf) State of New Jersey.  "Draft of proposed changes to Texas Department of State Health Services rule 157. 2010. archive. 2010. ornge. J. flightforlifecolorado._Procedures_and_Memos/ content/ Fresno. Retrieved: December 4." (http:/ / www.org. usatoday. com/ medical-flight/ air-ambulance-aircraft. christoph-1. July 18.  "Official NTSB report on an air ambulance [[Learjet (http:/ / www. ch/ en/ start_en. 2005. "Reconsidering air ambulance usage" (http:/ / www. Retrieved: November 12. usatoday. 5new. 27. af. 22 . 2011. gov/ wslwac/ WAC 246 TITLE/ WAC 246 -976 CHAPTER/ WAC 246 -976 -320. Retrieved: December 4. pdf)  "Department of Community Health Policies and Procedures. 2010. Volume XVI. 2010. org/ web/ 20080617154133/ http:/ / www." (http:/ / web.  "State of New Jersey Assembly Act No. us/ gov_dir/ leg_dir/ olls/ sl2007a/ sl_96. Retrieved: December 4. Retrieved: December 4. 2007. Alan and Robert Davis.mil. pdf) Rhode Island Department of Health."] Government of Saskatchewan. California that killed everyone on board." (http:/ / www. adac. com/ news/ nation/ 2005-07-18-air-ambulance_x. htm)] crash in San Diego. htm) USA Today. "Surge in crashes scars air ambulance industry.state. 2011."] State of Texas.  "USAF 357: Medical Airlift Group. 2006.  "Rules and Regulations Relating to Emergency Medical Services.de. amounting to five deaths. sk. metrohealth.de.12.  "Utah Rule R426-2.  Levin. "The cost and effectiveness of the London Helicopter Emergency Medical Service. htm) USA Today. 2010. us/ nmregister/ xvi/ xvi24/ 7. forrestgeneral. state. co.af. Retrieved: December 4." (http:/ / www. org/ docs/ njdraft. php) forrestgeneral. schaeferamb.com.scott. gov/ publictn/ 2006/ AAB0605.com. 2010. January 25. Retrieved: December 4. mil/ library/ factsheets/ factsheet. nmcpr. dshs. org/ ) Flight for Life. 2010." (http:/ / www.amc."] NTSB Publication." J Health Serv Res Policy. 2010. Retrieved August 26.  "The History of the Air Ambulance" (http:/ / www. htm) State of Colorado. gov/ publicat/ code/ r426/ r426-002. flightparamedic. com/ story/ history.  Brazier. Number 24. rules.  "Governor O'Malley Announces New Additions to Maryland's World-Class Emergency Response." (http:/ / www. 2005.  "Texas DSHS committee minutes (http:/ / www. us/ uploadedFiles/ Departments/ Public_Health/ Divisions/ EMS/ content/ Policies." (http:/ / www. Retrieved: December 4. Alan. rules. 01-OCT-1996.ca.  "History. health." (http:/ / www. ntsb.  Davis. tx. 1(4): 232-7. dshs. 2010. pdf) EMS. gov. 2010. asp) Maryland State Police Aviation Command via mspaviation. us/ emstraumasystems/ 157_12Draft101252006. usatoday.  "Schaefer Ambulance Service. Retrieved: November 12. Retrieved: November 12. Retrieved: December 4. 2007.tx. amc.com.  "First in the Nation . com/ ) schaeferamb. mspaviation." (http:/ / www. scott. 2010. Retrieved: November 12. medflight911. asp?id=12759) public. "NTSB: Air ambulance crashes avoidable." (http:/ / www.  "Metro Life Flight. January 25. org/ body. htm) Washington: DC.  Washington State rule WAC 246-976-320. de/ ) christoph-1. December 30. htm) USA Today. 2010.ch/en. Retrieved: December 4." (http:/ / www. de/ mitgliedschaft_leistungen/ mitgliedschaftstarife/ membership/ default. leg. ca. 2010. state. cfm?id=1106) The MetroHealth System.  "Emergency Air Ambulance Services. Retrieved: December 4. Robert. html) mercyjets. 2006.us. 2010.  "Cristoph1" (in German).
which follows an army in its movements. and even hospital ships (see vehicle types. Field hospitals were still called ambulances during the Franco-Prussian War of 1870 and in the Serbo-Turkish war of 1876 even though the wagons were first referred to as ambulances about 1854 during the Crimean War. buses.state. from or between places of treatment for an illness or injury. Such vehicles are called fly-cars.org) • UK Air Ambulance Information & Operational Info + Gallery (http://www.S. however. The term ambulance does. These vehicles are not usually (although there are exceptions) equipped with life-support equipment. There are other types of ambulance. administering emergency care to those with acute medical problems.  The term ambulance comes from the Latin word ambulare. that only carries one member of ambulance crew to the scene to provide care. In some jurisdictions there is a modified form of the ambulance used. station wagons. bicycles. In these cases a patient who requires transportation to hospital will require a patient-carrying ambulance to attend in addition to the fast responder. gov/travel/cis_pa_tw/cis/cis_1470. motorbikes.uk) • U.co. In most countries.Air ambulance 23 External links • Association of Air Medical Services (http://www.html) • "Lifeguard" flight tracker (http://flightaware. Their purpose is simply to transport patients to.alecbuck. from or between places of treatment. below) and a wide range of urgent and non-urgent vehicles including trucks. State Department information on U. The word originally meant a moving hospital. and in some instances will also provide out of hospital medical care to the patient. boats.com/live/special/lifeguard/) • HEMS Pictures by State (http://www. meaning to walk or move about which is a reference to early medical care where patients were moved by lifting or wheeling. these are not equipped with flashing lights or sirens. with the most common being the patient transport ambulance (sometimes called an ambulette ).aams. but is not used to transport the patient.S. also below). vans. extend to a wider range of vehicles other than those with flashing warning lights and sirens. and are usually crewed by staff with fewer qualifications than the crew of emergency ambulances. fixed-wing aircraft.com/mediagallery/index.php) Ambulance An ambulance is a vehicle for transportation of sick or injured people to. The word is often associated with road going emergency ambulances which form part of an emergency medical service. The A modern van-based Volkswagen Crafter ambulance of the South Bohemian term also includes a large number of Ambulance Service in the Czech Republic non-urgent ambulances which are for transport of patients without an urgent acute condition (see functional types. . helicopters. During the American Civil War vehicles for conveying the wounded off the field of battle were called ambulance wagons.ukemergencyaviation. based air ambulance and medevac companies (http://travel.
Functional types Ambulances can be grouped into types depending on whether or not they transport patients. Response units may be backed up by an emergency ambulance which can transport the patient. and civilian variants were put into operation during the 1830s. helicopters. from or between places of medical treatment. These can be a wide variety of vehicles. with the use of carts to transport incurable patients by force. although emergency and disaster conditions may lead to other vehicles serving as makeshift ambulances: • Van or pickup truck – A typical ambulance is based on either the chassis of a van (vanbulance) or pickup truck. These are usually based on a bus. motorcycles. • Response unit – Also known as a fly-car. • Emergency ambulance – The most common type of ambulance. but this often requires the removal of the front passenger seat. which has the job of transporting patients to. • Car/SUV – Used either as a fly-car for rapid response or for patients who can sit. This was often the case with early ambulances. quad bikes or horses. for non-urgent care.Ambulance 24 History The history of the ambulance begins in ancient times. . These can be vans. and provide on scene care. or may deal with the problem on scene. These can be road-going vans. and under what conditions. these are standard car models adapted to the requirements of the service using them. as these were some of the few vehicles able to accept a human body in a supine position). Vehicle types Ambulances can be based on many types of vehicle. In some cases. Early car-based ambulances like this 1948 Cadillac Meteor were sometimes also used as hearses. hospices or care homes where they are in long term care. or the use of a particularly long car. pedal cycles. Some cars are capable of taking a stretcher with a recumbent patient. but for ambulance services). which were converted (or even serving) hearses. but lacks the capacity to transport the patient from the scene. ambulances may fulfil more than one function (such as combining emergency ambulance care with patient transport). boats. with no requirement for a transport ambulance. These units can function as a vehicle for officers or supervisors (similar to a fire chief's vehicle. • Charity ambulance – A special type of patient transport ambulance is provided by a charity for the purpose of taking sick children or adults on trips or vacations away from hospitals. such as hospital or dialysis center. which provide care to patients with an acute illness or injury. from standard cars. • Patient transport ambulance – A vehicle. fixed-wing aircraft (known as air ambulances) or even converted vehicles such as golf carts. which is a vehicle which is used to reach an acutely ill patient quickly. to modified vans. Examples include the United Kingdom's 'Jumbulance' project. Advances in technology throughout the 19th and 20th centuries led to the modern self-powered ambulances. Ambulances were first used for emergency transport in 1487 by the Spanish. This chassis is then modified to the designs and specifications of the purchaser. • Bariatric ambulance – A special type of patient transport ambulance designed for extremely obese patients equipped with the appropriate tools to move and manage these patients. buses or other vehicles.
with less rough terrain capability. and are used for tasks such as mountain rescue in inaccessible areas. mostly operated by national military services. or transportation between distant hospitals. buses can be used for multiple casualty transport. Similar to other ambulance types. . these are used for rapid response in an emergency as they can travel through heavy traffic much faster than a car or van. a re-patriation following an illness or • Boat – Boats can be used to serve as ambulances. They are often sent to disaster or war zones to provide care for the casualties of these events. Ambulance busses are discussed at greater length in their own article. as they are able to travel significantly faster than a road ambulance. This permits flexibility in areas with minimal access to vehicles. or in areas where speed is of the essence. Some lifeboats or lifeguard vessels may fit the description of an ambulance as they are used to transport a casualty. but with less noise. See also cycle responder. but usually in pedestrian-only areas  Like the where large vehicles find access difficult. ATVs can be modified to carry a stretcher. 25 Italian ambulance's Red Cross Mercedes-Benz Sprinter ambulance typically used in England. Trailers or sidecars can make these patient transporting units. hospital trains gained the ability to provide treatment. most often in the developing world. either for the purposes of taking patients on journeys. which can be towed behind a self-propelled vehicle can be used. in the context of major incidents. Helicopter and fixed-wing ambulances are discussed in greater detail at air ambulance. They can meet the definition of ambulances as they provide transport to the sick and wounded (along with treatment). • All-terrain vehicle (ATV) – for example quad bikes. such as on small islands. more traditional methods of transport include transport such as horse and cart.Ambulance • Motorcycle – In developed areas. as Western medicine developed. In some rural locations. especially in island areas or in areas with a large number of canals. then parking on a siding to provide hospital services to the local population. • Bus – In some cases. traveling by rail from one location to the next. these are used for response off road. • Trailer – In some instances a trailer. or to deal with specific problems such as drunken patients in town centres. Helicopter and fixed-wing ambulances are discussed in greater detail at air ambulance. See also motorcycle ambulance. These function similarly to response at events ATVs. such as the Venetian water ambulances. for patient transport over long distances (e. • Golf cart or Neighborhood Electric Vehicle – Used for rapid  or on campuses. • Helicopter – Usually used for emergency care. • Ship – Ships can be used as hospital ships. • Hospital train – Early hospital trains functioned to carry large numbers of wounded soldiers. especially at events. Wales and Northern Ireland • Fixed-wing aircraft – These can be used for either acute emergency care in remote areas (such as in Australia. used in much the same way as motorcycle or bicycle stretcher units to transport to a local clinic. although some ships are operated by charities. Hospital trains also find use in disaster response injury in a foreign country). either in places inaccessible by road. • Horse and cart – Especially in developing world areas. motorcycle ambulance. a bicycle may be connected to a trailer for patient transport. hospital trains now function as mobile hospitals. with the 'Flying Doctors').g. • Bicycle – Used for response.
congested cities. paramedics may travel by bicycle. either to notify the appropriate hospital of the ambulance's pending arrival. and then finished off. or. Toyota. having no body or interior behind the driver's seat) and turns it into an ambulance by adding bodywork. Ambulances often have two manufacturers. though in rugged areas four-wheel drive or all-terrain vehicles can be used. The second manufacturer (known as second stage manufacturer) purchases the vehicle (which is sometimes purchased incomplete. or using a modular system. modern ambulances are equipped with two-way radios or cellular telephones to enable them to contact hospitals. This is done by one of two methods – either coachbuilding. The first is frequently a manufacturer of light trucks or full-size vans (or previously. Similarly. emergency vehicle equipment. Maintained roads are necessary for road going ambulances to arrive on scene and then transport the patient to a hospital. Fuel must be available and service facilities are necessary to maintain the vehicle. to confer with a physician for medical oversight. Methods of summoning (e.Ambulance 26 Vehicle type gallery A paramedic's scooter in Israel In large. which itself often relies on an intact power grid. and interior fittings. telephone) and dispatching ambulances usually rely on electronic equipment. where a pre-built 'box' is put on to the empty chassis of the ambulance. where the modifications are started from scratch and built on to the vehicle. or Ford. cars) such Car-based ambulance in Sweden as Mercedes-Benz. such as this one of the London Ambulance Service An air ambulance in Austria A water ambulance in the Scilly Isles A Russian hospital train Soviet-made ambulance Type RAF-2203 "Latvija" as used in Bulgaria until the end of the 1990s Design and construction Ambulance design must take into account local conditions and infrastructure. in cases where physicians do not form part of the ambulance's crew.g. Nissan. .
and can allow the crew to pass information back to control or to the hospital (for example a priority ASHICE message to alert the hospital of the impending arrival of a critical patient. The type of engine may be determined by the manufacturer: in the past two decades. Also. Truck based ambulance in the United States using These fires were ultimately attributed in part to gasoline's higher a pre-built box system volatility in comparison to diesel fuel. including those during which civilian drivers often elect to stay off the road. one study found that on a per-accident basis. This could include: • Two-way radio – One of the most important pieces of equipment in modern emergency medical services as it allows for the issuing of jobs to the ambulance. Unrestrained occupants. and result in more injuries. as 27 paramedics have died during ambulance trips in the US since 1991. paramedics are also at risk in ambulances while helping patients. Diesel power is sometimes chosen due to safety concerns. Equipment In addition to the equipment directly used for the treatment of patients. An 11-year retrospective study concluded in 2001 found that although most fatal ambulance crashes occurred during emergency runs. Research has shown that ambulances are more likely to be involved in motor vehicle collisions resulting in injury or death than either fire trucks or police cars. particularly those riding in the patient-care compartment. after a series of fires involving gasoline powered ambulances during the 1980s. ambulance collisions tend to involve more people. Austria • Mobile data terminal – Some ambulances are fitted with Mobile data terminals (or MDTs). dry roads. Furthermore. When compared to civilian vehicles of similar size. such as those working on a GSM system. including diesel. 27 Safety Ambulances. are particularly vulnerable. are required to operate in all weather conditions. straight. during clear weather. which can be monitored externally. Interior of a mobile intensive care unit (MICU) ambulance from Graz. Colder regions often use gasoline powered engines. Beginning in 2010.  Ford would only sell vehicles for ambulance conversion if they are diesel powered. These terminals can function instead of or alongside the two-way radio and can be used . such as TETRA. as they are thought to be more efficient and more durable. to more secure digital systems.) More recently many services world wide have moved from traditional analog UHF/VHF sets. they typically occurred on improved. like other emergency vehicles. usually at the control center. Warmer regions may favor diesel engines. which can be powered by any conventional fuel.Ambulance Modern ambulances are typically powered by internal combustion engines. which are connected wirelessly to a central computer. Ford will sell its ambulance chassis with a gasoline engine in order to meet emissions requirements. ambulances may be fitted with a range of additional equipment which is used in order to facilitate patient care. the ambulance crew's responsibilities to their patient often preclude their use of safety devices such as seat belts. depending on the preference of the operator and the availability of different options. gasoline or liquefied petroleum gas. as diesels can be difficult to start when they are cold.
For instance. Generally. or be permitted to break the speed limit. This is especially important where the patient is obese or specialty care transports that require large. The level of care provided by these ambulances varies between merely providing transport to a medical clinic to providing on-scene and continuing care during transport. These are often used in coordination with GPS units. being built using intermediate technology. • Evidence gathering CCTV – Some ambulances are now being fitted with video cameras used to record activity either inside or outside the vehicle. • Air conditioning – Ambulances are often fitted with a separate air conditioning system to serve the working area from that which serves the cab. motorcycles. and in many countries. This can be used as a form of protection from violence against ambulance crews. activation of active emergency warnings such as lights and sirens. braking power and time. ambulances are designed to meet local conditions. or in some cases (dependent on local laws) to prove or disprove cases where a member of crew stands accused of malpractice. or animals. which are pulled by bicycles. ambulances can be fitted with special lighting (often blue or red) which is used when the patient becomes photosensitive. as well as seat belt usage. Motorcycles fitted with sidecars (or motorcycle ambulances) are also used. They may also be fitted with sound recording facilities. and can log the time the crew was mobile to a patient. Ambulances can also be trailers. This helps to maintain an appropriate temperature for any patients being treated. There may also be equipment linked to this such as winches which are designed to pull heavy patients in to the vehicle. Intermediate technology In parts of the world which lack a high level of infrastructure. • Data Recorders – These are often placed in ambulances to record such information as speed.Ambulance to pass details of jobs to the crew. as these emergencies create people who are likely to be in need of treatment. The design of intermediate technology ambulances must take into account not only the operation and maintenance of the ambulance. arrived. the priority of the response to the call will be assigned by the dispatcher. Animal-powered ambulances can be particularly useful in regions that are subject to flooding. including incidents such as a road traffic collision. as does the nature of the skills required to properly operate the vehicle. • Tail lift or ramp – Ambulances can be fitted with a tail lift or ramp in order to facilitate loading a patient without having to undertake any lifting. but may also feature additional features such as filtering against airborne pathogens. tractors. or fulfill any other computer based function. The robustness of the design becomes more important. but the priority of the return will be decided by the ambulance crew based on the severity of the patient's . They are required to gain access to patients as quickly as possible. though they are subject to some of the same limitations as more traditional over-the-road ambulances. but its construction as well. 28 Four stages of deployment on an ambulance tail lift • Trauma lighting – In addition to normal working lighting. Appearance and markings Emergency ambulances are highly likely to be involved in hazardous situations. Cost-effectiveness can be a high priority. and left scene. are given dispensation from obeying certain traffic laws. bulky equipment such as a neonatal incubator or hospital beds. they may be able to treat a red traffic light or stop sign as a yield sign ('give way').
The Star of Life is widely used. Older ambulances (and those in developing countries) are more likely to have their pattern painted on. although this has not always been adhered to. 29 Passive visual warnings The passive visual warnings are usually part of the design of the vehicle. and was originally designed and governed by the U. These are symbols laid down by the Geneva Convention.Ambulance illness or injury. John Ambulance operate one state and one territory ambulance service. Popular patterns include 'checker board' (alternate coloured displays reversed wording and the Star of Life. Magen David Adom. named after a type of cake). where St. the Order of Malta Ambulance Corps and Malteser International often use the Maltese cross to identify their ambulances. which reflects light from car headlights or A North West Ambulance Service ambulance torches. organization or agency is in breach of international law. Florian (often incorrectly called a Maltese cross) as this cross is frequently used as a fire department logo (St. and all of Australia's other ambulance services use variations on a red Maltese cross. squares. Ambulances may also carry an emblem (either as part of the passive warning markings or not). National Highway Traffic Safety Administration. Another passive marking form is the word ambulance (or local language variant) spelled out in reverse on the front of the vehicle. Fire service operated ambulances may display the Cross of St. sometimes called 'Battenburg'. and an emergency telephone number for the ambulance service. In addition to retro-reflective markings. This is especially important in countries such as Australia. The protective symbols are designed to indicate to all people (especially combatants in the case of war) that the vehicle is neutral and is not to be fired upon. Use by any other person. In Israel. the Red Cross member organization use a red Star of David. and because of this need. This enables drivers of other vehicles to more easily identify an approaching ambulance in their rear view mirrors. and involve the use of high contrast patterns. It indicates that the vehicle's operators can render their given level of care represented on the six pointed star. because the Red Cross symbol is legally protected by both National and international law. only came in tape form). Florian being the patron saint of firefighters). as the original reflective material. . Patients in significant danger to life and limb (as determined by triage) require urgent treatment by advanced medical personnel. Ambulances may display the name of their owner or operator. some services now have the vehicles painted in a bright (sometimes fluorescent) yellow or orange for maximum visual impact.S. emergency ambulances are often fitted with passive and active visual and/or audible warnings to alert road users. and all countries signatory to it agree to restrict their use to either (1) Military Ambulances or (2) the national Red Cross or Red Crescent society. invented by 3M. whereas modern ambulances generally carry retro-reflective designs. Ambulance services that have historical origins such as the Order of St John. where they must use the Red Crystal. hence giving protection to the medics and their casualties. with flashing blue grille lights and wig-wagging chevrons (arrowheads – often pointed towards the front of the vehicle headlamps if on the side. Red Crescent or Red Crystal (collective known as the Protective Symbols). such as a Red Cross. but this does not have recognition beyond Israeli borders. or pointing vertically upwards on the rear) or stripes along the side (these were the first type of retro-reflective device introduced.
but in such a way that the user of the receiving radio is unable to opt out of the message (as with traffic broadcasts). These flash in order to attract the attention of other road users as the ambulance approaches. producing a range of different noises which ambulance operators can use to attract more attention to themselves. Flashing headlights (typically the high beams. which are usually brighter than incandescent lights. this may be mandatory. which interrupts the radio of all cars within range. Common colours for ambulance warning beacons are blue. red. indicating to other road users that they should move to the right (away from the ambulance). In order to increase safety. and strobe lights. such as the United States. some of the standard lights fitted to an ambulance (e. grill and front fend-off lights.Ambulance 30 Active visual warnings The active visual warnings are usually in the form of flashing lights. There are several technologies in use to achieve the flashing effect. ambulances can be fitted with audible warnings. or may be hidden in a host light (such as a headlamp) by drilling a hole in the host light's reflector and inserting the emergency light. particularly when proceeding through an intersection or in heavy traffic. These hidden lights may not be apparent until they are activated. however. See also Emergency vehicle equipment. amber. improving the chance of the vehicle being seen from all sides. These include flashing a light bulb or LED. It is. those not using a compatible radio or even have it turned off. An ambulance in Denmark with roof-integrated LED lights. plus side-view mirror. The ambulance is fitted with a short range FM transmitter. which can alert people and vehicles to the presence of an ambulance before they can be seen. it is best practice to have 360° coverage with the active warnings. flashed alternately) are known as a wig-wag. Additionally. sometimes known as sirens. The speakers for modern sirens can be integral to the lightbar. set to RDS code 31. Most modern ambulances are now fitted with electronic sirens. A recent development is the use of the RDS system of car radios. Incandescent and LED lights may also be programmed to burn steadily. Each of these can be programmed to flash singly or in groups. as it is unable to alert pedestrians. This feature is built in to every RDS radio for use in national emergency broadcast systems. without flashing. . However the colours may vary by country and sometimes by operator. and can be programmed to flash in patterns (such as a left -> right pattern for use when the ambulance is parked on the left hand side of the road. or they may be hidden in or flush to the grill to reduce noise inside the ambulance that may interfere with patient care and radio communications. The first audible warnings were mechanical bells. Audible warnings In addition to visual warnings. headlamps. or to provide warning to motorists approaching a stopped ambulance in a dangerous position on the road. mounted to either the front or roof of the ambulance. tail lamps) may be programmed to flash. In some countries. Ambulances can additionally be fitted with airhorn audible warnings to augment the effectiveness of the siren system. but short range units on emergency vehicles can prove an effective means of alerting traffic to their presence. in the manner of a traffic broadcast.g. unlikely that this system could replace audible warnings. and fog lamps wig-wags Emergency lights may be housed in special fittings. such as in a lightbar. and white (clear).
Ambulance 31 Service providers Some countries closely regulate the industry (and may require anyone working on an ambulance to be qualified to a set level). In some countries. but in some places. Hong Kong and France ambulances can be operated by the local fire or police service. Ecuador. • Private Ambulance Service – Normal commercial companies with paid employees. where maintaining a separate service is not necessarily cost effective. or for cover at private events (sports etc. such in some parts of Australia and in Ireland. providing the main service for an area. In Canada ambulance services are normally operated by local municipalities or provincial health agencies as a separate entity from fire or police services. whereas others allow quite wide differences between types of operator. In some cases the volunteer charity may employ paid members of staff alongside volunteers to operate a full-time ambulance service. or to form a 'second tier' response. • Government Ambulance Service – Operating separately from (although alongside) the fire and police service of the area. emergency. This is particularly common in rural areas. as do other smaller organisations such as St John Ambulance and the Order of Malta Ambulance Corps. In some cases this can lead to an illness or injury being attended by a vehicle other than an ambulance. with volunteers providing both services. In many areas private services cover all emergency transport functions and government agencies do not provide this service. such as a fire truck. whereas in countries such as Great Britain almost all emergency ambulances are part of a nationwide system under the National Health Service. they are contracted to provide emergency care. both in an emergency and patient transport function. This may be along similar lines to volunteer fire companies. The Red Cross provides this service across the world on a volunteer basis. Japan. These volunteer ambulances may be seen providing A city fire service ambulance from the Tokyo support to the full-time ambulance crews during times of Fire Department. Private Ambulance Service). nonurgent or ambulatory transport).e. and either community or privately owned. Italy An ambulance from the Ecuadorian Red Cross in Cuenca. Companies such .). • Fire or Police Linked Service – In countries such as the United States. • Volunteer Ambulance Service – Charities or non-profit companies operate ambulances. these ambulances are funded by local or national government. these only tend to be found in big cities. (and in others as a A volunteer ambulance crew in Modena. Private companies may provide only the patient transport elements of ambulance care (i. There are charities who focus on providing ambulances for the community. They may be linked to a voluntary fire department. but often on contract to the local or national government.
where size or budget does not warrant separate services. Private services in Canada operate non-emergency patient transfers or for private functions only. This multi-functionality allows to make the most of limited resource or budget. but having a single team respond to any emergency. Acadian Ambulance. hospices or care homes where they are in long term care. Their use would be dependent on using the services of the providing hospital.e.Ambulance as Falck. From April 2011 all private ambulance services in the UK must be Care Quality Commission (CQC) registered. • Government funded service – The full or the majority of the cost of transport by ambulance is borne by the local. Examples include the UK's 'Jumbulance' project. have ambulance services provided by employers as a means of protecting their interests and the welfare of their staff. Costs The cost of an ambulance ride may be paid for from several sources. although donations may be sought for services received. and possibly who to. • Charity funded service – Transport by ambulance may be provided free of charge to patients by a charity. although this may be an issue with critically injured patients. on the condition that patients use the hospital's services (which they may have to pay for). payment or guarantee must be made before treatment or transport). and American Medical Response are some of the larger companies that provide such services. personnel are trained not only in ambulance (EMT) care. or through their insurance company. by whom. This may be at the point of care (i. Their key feature is that all Zealand. oil refineries. such as chemical plants. and this will depend on the type of service being provided. These are often used as first response vehicles in the event of a fire or explosion. regional. but as a firefighter and a peace officer (police function). which may be found in places such as airports or Non-acute patient transport ambulance from New large colleges and universities. • Charity Ambulance – This special type of ambulance is provided by a charity for the purpose of taking sick children or adults on trips or vacations away from hospitals. or where ambulance care is unreliable or chargeable. These organisations may also provide services known as 'Stand-by' cover at industrial sites or at special events . 32 • Company Ambulance – Many large factories and other industrial centres. • Hospital funded service – Hospitals may provide the ambulance transport free of charge. . or via a system of billing later on. breweries and distilleries. They may be found in smaller towns and cities. • Combined Emergency Service – these are full service emergency service agencies. • Privately funded service – Transport by ambulance is paid for by the patient themselves. or national government (through their normal taxation). • Hospital Based Service – Hospitals may provide their own ambulance service as a service to the community. unable to provide such details.
Registered nurse (RN) – Nurses can be involved in ambulance work. Ambulance Care Assistant – Have varying levels of training across the world. 3. and use of it without the relevant qualification may result in criminal prosecution.Ambulance 33 Crewing There are differing levels of qualification that the ambulance crew may hold. such as defibrillation. rather than acute care. Ambulance Driver – Some services employ staff with no medical qualification (or just a first aid certificate) whose job is to simply drive the patients from place to place. They may bring extra skills to the care of the patient. cardiac. In some emergency ambulance contexts this term is a pejorative toward qualified providers implying that they perform no function but driving. as some road routes may be blocked. 7. and one to attend the patient). Common ambulance crew qualifications are: Various ambulance crews help to load a patient into an air ambulance in Pretoria  and whose job is to provide early 1. Dependent on provider. assisting the patient with certain medications. from holding no formal qualification to having a fully qualified doctor on board. and the driver must know another route to the patient or to the hospital. although it may be acceptable for patient transport or community operations. Paramedic – This is a high level of medical training and usually involves key skills not permissible for technicians. Emergency medical technician – Also known as Ambulance Technician. In some locations. It may be the case that only the attendant need be qualified. doing basic observations or performing 12 lead ECG assessments. the title "paramedic" can be a protected title. First responders may be dispatched by the ambulance service. There role is to assist the clinician that they are working with either a Technician or Paramedic in there duties whether that be drawing up drugs. these drivers would survey and study the local network of routes for better performance of service. They may also have training in using the radio and knowing where medical supplies are stored in the ambulance. and the driver might have no medical training. and as with doctors. Dependent on jurisdiction. oxygen therapy and other lifesaving or palliative skills. or may be dispatched to the scene from other agencies. this is mostly as air-medical rescuers or critical care transport providers. 5. In some areas. 4. They may provide emergency cover when other units are not available. Emergency Care Assistant/Emergency Care Support Workers – Also known as ECA/ECSW are members of a frontline ambulance that drive the vehicles under both emergency and non-emergency conditions to incidents. often in conjunction with a technician or paramedic. such as the police or fire departments. tracheal intubation and other skills such as performing a cricothyrotomy. critical care such as cardiopulmonary resuscitation (CPR) or using an automated external defibrillator (AED). where there is EMT-Basic and EMT-Intermediate). spinal immobilization. and oxygen therapy. an advanced life support ambulance may be crewed by one paramedic and one EMT-Basic. especially those who may be critically ill or injured in locations that do not enjoy close proximity to a high level of definitive care such as trauma. 6. such as cannulation (and with it the ability to administer a range of drugs such as morphine). First responder – A person who arrives first at the scene of an incident. setting up fluids (but not attaching). bleeding control. Some countries split this term in to levels (such as in the US. Most ambulance services require at least two crew members to be on every ambulance (one to drive. The driver would gather the local weather and traffic status reports before and in-between emergencies. splinting of suspected fractures. they may be trained in first aid or extended skills such as use of an AED. possibly backed up by another double-crewed ambulance. Technicians are usually able to perform a wide range of emergency care skills. 2. or when accompanied by a fully qualified technician or paramedic. although response cars may have a sole crew member. may be passers-by. but these staff are usually only required to perform patient transport duties (which can include stretcher or wheelchair cases). or stroke .
Civilian based designs may be painted in olive. this application does not always exempt medical personnel from catching enemy fire —accidental or deliberate. regular up-armored ambulances are not sufficiently protected against anti-tank weapons and improvised explosive devices. 9. white or other colours. medics and other medical personnel attached to military ambulances are usually put through basic military training.Ambulance centers. and are trained to prescribe medicines (from a limited list) for longer term care. The modifications were made following a failed rescue attempt in which Palestinian gunmen killed two soldiers who were providing aid for a Palestinian  Since M-113 armored personnel carriers and woman in Rafah. Due to the inherently hazardous situation of a battle ground. on the assumption that they may have to use a weapon. an ambulance AFV is often unarmed. claiming that weapons were more effective protection than emblems since Palestinian militants would disregard any symbols of protection and fire at ambulances anyway. is designed to bridge the link between ambulance care and the care of a general practitioner. depending on the operational requirements – the British Royal Army Medical Corps has a fleet of white ambulances.S.S. the United States military currently employs the M113. and the RG-33 Heavily Armored Ground Ambulance (HAGA) as treatment and evacuation vehicles. Israel has modified a number of its Merkava main battle tanks with ambulance features in order to allow rescue operations to take place under heavy fire in urban warfare. Israel did not remove the Merkava's weaponry. as well as being trained in a range of additional diagnostic techniques. Military helicopters often function as air ambulances. Emergency Care Practitioner – This position. such as antibiotics. not all militaries exercise this right to their personnel. For use as ground ambulances and treatment & evacuation vehicles. The laws of war do allow non-combatant military personnel to carry individual weapons for protecting themselves and casualties. Its rear door enables the USNS Mercy. sometimes called 'Super Paramedic' in the media. 34 Military use Military ambulances include both ambulances based on civilian designs and armored. Doctor – Doctors are present on some ambulances – most notably air ambulances – will employ physicians to attend on the ambulances. Navy hospital ship evacuation of critically wounded soldiers. 8. the M1133 Stryker Medical Evacuation Vehicle (MEV). since they are extremely useful for MEDEVAC. Since laws of war demand ambulances marked with one of the Emblems of the Red Cross not to mount offensive weapons. however. the M577. ECPs are already qualified paramedics who have undergone further training. military An URO VAMTAC ambulance of the Spanish ambulances are often armored. but unarmed ambulances based upon armoured personnel carriers (APCs) such as the British FV104 Samaritan and the U. However. a U. bringing a full range of additional skills such as use of prescription medicines. or based upon armored fighting Army emblazoned with the Red Cross vehicles (AFV). with contracts to incorporate . it was decided to use the heavily armored Merkava tank. based on production trucks. M1133 Medical Evacuation Vehicle. It is a generally accepted practice in most countries to classify the personnel attached to military vehicles marked as ambulances as non-combatants. As a result. Recently.
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htm)  "Media Release: York Region donates ambulance to Haitian recovery efforts" (http:/ / www. gwpda. globalsecurity. medic-car.Ambulance  "Technical data on armament of M113 APC Ambulance" (http:/ / www. quick response service (QRS). paramedic chase car. Retrieved 2 June 2007. dodig. Retrieved 27 June 2007. org/ military/ systems/ ground/ amev. . org/ history/ forcexxiattv. ca/ NR/ rdonlyres/ 2oh662sqs5hsdwikhm45umbhbqsyaks5thf4sjekdbyi3ginngge5ucpweymvgapsszni3fvbsthg5jnam4eu4hxbd/ rpt+ 8+ cls+ 3. Full report at (http:/ / www. 39 Ambulance emergency response vehicle An ambulance emergency response vehicle is a vehicle operated by an emergency medical service to respond to medical emergencies either in addition to. M2A0 Armored Medical Evacuation Vehicle (http:/ / www. Retrieved 4 February 2012. an ambulance capable of transporting patients. They can also be known as a fly car. (http:/ / www. emergency response unit (ERU). 6 of the Community and Health Services. Community and Health Services. htm)  M2A0 AMEV (http:/ / 1-22infantry. org/ web/ 20070714232216/ http:/ / www. fast response unit (FRU). ca/ Regional+ Government/ Agendas+ Minutes+ and+ Reports/ _2011/ CHSC+ rpt+ 6. or travel at greater speed. or in place of.  U. although it is likely to be limited in its capacity to transport patients. htm)  "Report on the sinking of the HMHS Llandovery Castle" (http:/ / www.  "Report No. htm). ca/ english/ Supporting_Hope. . ca/ Publications/ News/ 2010/ June+ 25. org/ naval/ lcastl11. . html). com/ gp/ military/ cv/ inf/ M113. to bring additional or more skilled resource to a scene. echo unit. mil/ audit/ reports/ fy01/ 01012sum. york. Retrieved 4 February 2012. The vehicle may be a production car (often a station wagon or SUV as they have greater carrying capacity) which is provided and manned by an emergency medical service organization in order to provide transport to their staff. §2: Donation of Decommissioned Ambulances for 2011" (http:/ / www. gwpda. york. ca/ Regional+ Government/ Agendas+ Minutes+ and+ Reports/ _2011/ pdf+ CHSC+ 6-2. rapid response vehicle (RRV). and may carry most of the same equipment as a full size ambulance. . htm). malleyindustries. Retrieved 7 July 2012. Ambulance emergency response car. archive. tango unit or simply an ambulance car (PRU) Paramedic Response Unit. .S. york. or to simply to avoid sending too much resource to medical problems that do not require it. World War One Document Archive. Archived (http:/ / web. org/ naval/ lcastl11. on.+ 2010+ York+ Region+ donates+ ambulance+ to+ Haitian+ recovery+ efforts. ca/ news/ 2006-03-16/ Local_news/ 046. . html). as they may be able to move through traffic with greater ease. citizen. . htm)  Bradley AMEV (http:/ / www. htm) from the original on 14 July 2007. quick response vehicle (QRV). built on a Volvo V70 in Sweden Emergency response vehicles can be used to reach a scene more quickly than a standard ambulance. htm). York Region. The fly-car enables the crew (often a lone responder) to bring their equipment quickly to the scene of an emergency.  http:/ / www. inetres. com/ ambulances/ reconditioned-ambulances/  "Supporting hope" (http:/ / www. html). york. pdf)  "Orangeville Police inherit retired ambulance" (http:/ / www. Inetres. sanlorenzo. Retrieved 7 July 2012.
there are Emergency Physician Rapid Response Cars (in German called NEF from NotarztEinsatzFahrzeug—Notarzt = Emergency Physician. Examples Several European countries. with physician-led emergency services. built in a Renault Scenic. air ambulance(s) and other emergency services. and can be treated at the scene by the crew on site (such as cuts and bruises to non-dangerous body areas). such as Germany and Austria. such as emergency medical technicians on an ambulance. in Portugal. Einsatz = Mission. meaning fewer people at the higher qualification level are required. However. This especially applies in areas such as busy roads. Fly-cars can be staffed around the clock or during the busiest hours of the day and week in order to augment the capacity of the prehospital care provider and can respond both independently and in conjunction with one or more ambulances. A well-known example of a fly-car in the United States is Squad 51 from the 1970s era television series. This principle especially applies where the fly-car is crewed by a paramedic. with most fly-cars costing much less than full size ambulances. Trisha Ecklund writes that the QRV is smaller than an ambulance so it can maneuver to places at a quicker pace. a fly-car (akutbil) can be equipped with a nurse specialized in anesthesia who is specialized in pain management. paired together with a paramedic. As a result of new legislation requiring all ambulances to be equipped with at least one trained nurse. any level of emergency medical provider from first responder to doctor can be found on fly-cars. . Some fly-cars may also have off-road capabilities. Such vehicles can also provide first aid assistance for patients who do not require hospital treatment. fly-cars have become less common. dependent on the jurisdiction and needs of the individual service. staffed with at least an emergency physician and a paramedic. sending this smaller vehicle to the scene of an emergency call. Fly-cars can also be used to improve response times. and because they can often be staffed by a single person (ambulances require a minimum of two crew members: a driver and an attendant). Other uses for fly cars include work as a "supervisor" vehicle where an officer or supervisor responds to various calls but does not ride on the ambulance to the hospital. Emergency!. more urgent jobs. giving them access to areas that traditional ambulances cannot reach. where the smaller vehicles are able to move through traffic faster than a full size ambulance. where they can assess an incident's severity (especially where there is reason to suspect the injury or illness is not serious) and call in additional help if required. In the Swedish medical system. which saves conventional ambulances for other. Emergency medical vehicle. who can assist lower qualified staff.Ambulance emergency response vehicle 40 Purpose An emergency response vehicle can help emergency medical organizations use their resources more efficiently. Fahrzeug = Vehicle). This can represent a resource saving on several levels.
Switzerland. ambulansforum. Norway Prehospital motorcycle from Oslo. shtml (Swedish)  http:/ / www. php?p=1138& sid=b4fd069447d4ac233cec8f50157cdb35 (Swedish) . A Subaru Outback used as SMU-car outside of Lausanne. Norway Physician-car of the Italian EMS—Lombardia A London Ambulance Service Zafira RRV (April 2008) A Northern Dutchess Paramedics flycar in Beekman. Austria A Swedish akutbil in Stockholm. Toronto EMS Emergency Response Unit (ERU) Footnotes  http:/ / www. se/ PAM/ artiklar/ 99/ akutbilsthlm. se/ forum/ viewtopic. SsangYong Rexton first responder vehicle from Bergen.Ambulance emergency response vehicle 41 Emergency physician rapid response car in Graz. Austria. Emergency physicians car (Notarzt) together with ambulances at Graz. New York. blaljus. Sweden Squad 51 1972 Dodge D-300 from Emergency! German emergency physician car (Notarzteinsatzfahrzeug) and an ambulance (Rettungswagen). Physician Response Vehicle from Fire Department Frankfurt.
and the use of AEDs is taught in many first aid. through a combination of CPR and cardiac stimulant drugs. irreversible brain/tissue damage may begin to occur. . preventing the ventricle from effectively pumping blood. In ventricular tachycardia. allowing the heart to reestablish an effective rhythm.Automated external defibrillator 42 Automated external defibrillator An automated external defibrillator (AED) is a portable electronic device that automatically diagnoses the potentially life threatening cardiac arrhythmias of ventricular fibrillation and ventricular tachycardia in a patient. Ventricular fibrillation (shortened to VF or V-Fib) In each of these two types of shockable cardiac arrhythmia. The rhythms that the device will treat are usually limited to: 1.  Effect of delayed treatment Uncorrected. like all defibrillators. open and ready for pads to be attached Usage Conditions that the device treats An automated external defibrillator is used in cases of life threatening cardiac arrhythmias which lead to cardiac arrest. which makes it imperative for CPR to be carried out prior to the arrival of a defibrillator. dysfunctional pattern. and will eventually reach asystole. first responder. the chance of survival decreases by 7 percent per minute in the first 3 minutes. and basic life support (BLS) level CPR classes. AEDs. The asystolic patient only has a chance of survival if. Ultimately. the heart beats too fast to effectively pump blood. are not designed to shock asystole ('flat line' patterns) as this will not have a positive clinical outcome. asystole) rapidly lead to irreversible brain damage and death. ventricular tachycardia leads to ventricular fibrillation. the electrical activity of the heart becomes chaotic. and is able to treat them through defibrillation. AEDs are designed to be simple to use for the layman. and decreases by 10 percent per minute as time advances beyond ~3 minutes. one of the shockable rhythms can be established. these cardiac conditions (ventricular tachycardia. The fibrillation in the heart decreases over time. In ventricular fibrillation. For every minute that a person in cardiac arrest goes without being successfully treated (by defibrillation). the heart is active. An automated external defibrillator. but in a life-threatening. With simple audio and visual commands. Pulseless Ventricular tachycardia (shortened to VT or V-Tach) 2. ventricular fibrillation. the application of electrical therapy which stops the arrhythmia. After approximately three to five minutes.
In September 2008. 11 survived. emergency vehicles are likely to carry AEDs. restaurants. airports.Automated external defibrillator 43 Requirements for use AEDs are designed to be used by laypersons who ideally should have received AED training. Placement and availability Automated external defibrillators are generally either held by trained personnel who will attend events or are public access units which can be found in places including corporate and government offices. When these protective cases are opened or the defibrillator is removed. airplanes. In order to make them highly visible. trained AED operators should know to phone for an ambulance when sending for or using an AED. AEDs are also increasingly common on commercial airliners. It has been suggested that AEDs carried on elevators could save critical minutes for cardiac arrest victims. cruise ships. the International Liaison Committee on Resuscitation issued a 'universal AED sign' to be adopted throughout the world to indicate the presence of an AED. This is in contrast to more sophisticated manual and semi-automatic defibrillators used by health professionals. Maimonides Medical Center in Borough Park. Of these 11 patients. and other transportation facilities. regardless of age or activity. public access AEDs are often brightly colored. sports stadiums. 6 were treated by good Samaritan bystanders with absolutely no previous  training in AED use. some will sound a buzzer to alert nearby staff to their removal. Of these 18. though this does not necessarily summon emergency services. health clubs. schools and universities. who are volunteers tasked with keeping an AED and taking it to any victims in their area. . with some ambulances carrying an AED in addition to manual defibrillators. workplaces and any other location where people may congregate. Children as well as adults may fall victim to sudden cardiac arrest (SCA) In many areas. but are more difficult to access emergency crews facing heavy traffic and security barriers. Brooklyn was the first hospital in the United States to implement fully automated external defibrillators at the bedside. The location of a public access AED should take in to account where large groups of people gather. community centers. Some areas have dedicated community first responders. Police or fire vehicles often carry an AED for first responder use. and reduce their deployment cost. An AED at a railway station in Japan. and this is shown on the right. Bras with a metal underwire and piercings on the torso must be removed before using the AED on someone to avoid interference. American TV show Mythbusters  found evidence that use of a defibrillator on a woman wearing an underwire bra can lead to arcing or fire but only in unusual and unlikely circumstances. shopping centres. hotels. A study analyzed the effects of having AEDs immediately present during Chicago's Heart Start program over a two-year period. casinos. fitness centers. Of 22 individuals 18 were in a cardiac arrhythmia which AEDs can treat (Vfib or Vtach). and are mounted in protective cases near the entrance of a building.  by High-rise buildings are densely populated. which can act as a pacemaker if the heart rate is too slow (bradycardia) and perform other functions which require a skilled operator able to read electrocardiograms. theme parks.
 and many advocate the more widespread use of community responders. The number of devices in the community has grown as prices have fallen to affordable levels. This system is not only safer (charging only when required). There has been some concern among medical professionals that these home users do not necessarily have appropriate training. everyone should avoid touching the patient so as to avoid false readings by the unit. although others will require the opening of the case to find the date stamp. and a razor for shaving those with very hairy chests. after the shock is delivered most devices will analyze the patient and either instruct CPR to be given. The pads allow the AED to examine the electrical output from the heart and determine if the patient is in a shockable rhythm (either ventricular fibrillation or ventricular tachycardia). This is usually marked on the outside of the pads.Automated external defibrillator A trend that is developing is the purchase of AEDs to be used in the home. Some models are designed to make this date visible through a 'window'. If the device determines that a shock is warranted. a small towel for wiping away any moisture on the chest. as opposed to internal defibrillators. other models have a self check system built in with a visible indicator. The use of easily visible status indicator and pad expiration date on one model of AED When charged. Depending on the manufacturer and particular model. or administer another shock. It is also important to ensure that the AED unit's batteries have not expired. the AED will instruct the user to connect the electrodes (pads) to the patient. Automatic refers to the unit's ability to autonomously analyse the patient's condition. the device instructs the user to ensure no one is touching the patient and then to press a button to deliver the shock. and it is important to ensure that the pads are in date. the vast majority of units have spoken prompts. Once the pads are attached. a pair of trauma shears for cutting through a patient's clothing to expose the chest. 44 Preparation for operation Most manufacturers recommend checking the AED before every period of duty or on a regular basis for fixed units. it will use the battery to charge its internal capacitor in preparation to deliver the shock. Mechanism of operation An AED is external because the operator applies the electrode pads to the bare chest of the victim. When turned on or opened. and to assist this. a pair of nitrile rubber gloves. who can be appropriately trained and managed. . and some may also have visual displays to instruct the user. The AED manufacturer will specify how often the batteries should be replaced. Some units need to be switched on in order to perform a self check. which have electrodes surgically implanted inside the body of a patient. All manufacturers mark their electrode pads with an expiration date. Typically. but also allows for a faster delivery of the electrical current. particularly by those with known existing heart conditions. an AED kit will contain a face shield for providing a barrier between patient and first aider during rescue breathing. human intervention is usually required to deliver the shock to the patient in order to avoid the possibility of accidental injury to another person (which can result from a responder or bystander touching the patient at the time of the shock).
which provides a platform for mutual support and for engaging in the mission to help save other lives. many AEDs now include visual prompts as well. which experts agree has the potential to be the single greatest advance in the treatment of out-of-hospital  cardiac arrest since the invention of CPR. Some units also have voice recording abilities to monitor the actions taken by the personnel in order to ascertain if these had any impact on the survival outcome. Some AEDs may be used on children .those under 55 lbs (25 kg) in weight or under age 8. It automatically diagnoses the heart rhythm and determines if a shock is needed. with each shock moving in an opposite polarity between the pads. the user cannot override a "no shock" advisory by an AED. which gave a high-energy shock. all that is required is the use of more appropriate pads. Semi-automatic models will tell the user that a shock is needed. This lower-energy waveform has proven more effective in clinical tests. the Sudden Cardiac Arrest Foundation developed the National SCA Survivor Network . NREMT-B and many state EMT training and many CPR classes incorporate or . up to 360 to 400 joules depending on the model. as well as offering a reduced rate of complications and reduced recovery time. Liability Automated external defibrillators are now easy enough to use that most states in the United States include the "good faith" use of an AED by any person under Good Samaritan laws. All AEDs approved for use in the United States use an electronic voice to prompt users through each step. but the user must tell the machine to do so.Automated external defibrillator Many AED units have an 'event memory' which store the ECG of the patient along with details of the time the unit was activated and the number and strength of any shocks delivered. an automated external defibrillator requires minimal training to use. Because the user of an AED may be hearing impaired. given that the harm or death was not intentional and the responder was acting within the limits of their training and in good faith. Automatic models will administer the shock without the user's command. Some AED units even provide feedback on the quality of the compressions provided by the rescuer. Most units are designed for use by non-medical operators. Good Samaritan laws provide some protection for the use of AEDs by trained and untrained responders. This caused increased cardiac injury and in some cases second and third-degree burns around the shock pad sites. usually by pressing a button. In the United States. "Good faith" protection under a Good Samaritan law means that a volunteer responder (not acting as a part of one's occupation) cannot be held civilly liable for the harm or death of a victim by providing improper or inadequate care. Newer AEDs (manufactured after late 2003) have tended to utilise biphasic algorithms which give two sequential lower-energy shocks of 120 . 45 Simplicity of use Unlike regular defibrillators.200 joules. The first commercially available AEDs were all of a monophasic type. In most circumstances. For this reason. AEDs create little liability if used correctly. Their ease of use has given rise to the notion of public access defibrillation (PAD). If a particular model of AED is approved for pediatric use. All this recorded data can be either downloaded to a computer or printed out so that the providing organisation or responsible body is able to see the effectiveness of both CPR and defibrillation. Usual placement of pads on chest The number of people who survive sudden cardiac arrest is increasing gradually. thanks to the use of AEDs.
Graham. gov/ health/ dci/ Diseases/ aed/ aed_use. Alfred P. archive. (page 63). Zuckerman.  "Cardiopulmonary Resuscitation (CPR) Statistics" (http:/ / www. zoll. nih. bmj.. Yardley. discovery. jhtml?identifier=4483) from the original on 19 November 2008. . New York Times.  "Heartstart Home Defibrillator" (http:/ / www. shtml) from the original on 29 April 2009. heartstarthome. Thies. Retrieved 2007-06-28. com/ press_releases/ 01232002Maimonides. We had the thrill of yelling. Med. .3d 1515 (11th Cir. at page 64). as the chest should be dried prior to AED pad attachment (id. "Public use of automated external defibrillators". J. Lufthansa German Airlines. . Lloyd (2006-03-22). html?ei=5088& en=84d7afacd0fd7943& ex=1272772800& partner=rssnyt& emc=rss& pagewanted=all& position=). 46 Reliability Automated external defibrillators are under recent scrutiny by the FDA which is now considering reclassifying AEDs as class III premarket approval devices. org/ services/ hss/ courses/ adultcpraed. html)  "AED Plus Biphasic Waveform" (http:/ / www.Automated external defibrillator offer AED education as a part of their program. CBS News. William H. Archived (http:/ / web. PA: StayWell. Retrieved 2008-10-27. archive. americanheart. References  Kerber. nhlbi. Nichol. Retrieved 2007-06-15. Michos. com/ vid/ krys-rebeca-lufthansa-german-airlines-36137815 Leonard Krys. . com/ fansites/ mythbusters/ db/ human-body/ underwire-bra-mess-with-defibrillator. Ontario. org/ presenter.  American Red Cross. org/ cgi/ content/ full/ 95/ 6/ 1677) from the original on 8 June 2007. Pepe PE. com/ zollaedplus. Archived (http:/ / web. html). Defendant-Appellant. redcross. org/ cgi/ content/ full/ 95/ 6/ 1677). in most cases by component failures or design errors. Archived (http:/ / web. com/ stories/ 2006/ 03/ 22/ opinion/ garver/ main1429483. Retrieved 2007-06-15. Canada also has the "Chase McEachern Act (Heart Defibrillator Civil Liability). lifetecmedical. archive. archive. com/ content/ why_defibrillators/ why_defibs2_detail. CPR/AED for the Professional Rescuer (participant's manual). heartstarthome. org/ services/ hss/ courses/ adultcpraed. 347 (16): 1242–7. "Breathing Easier" (http:/ / www. org/ web/ 20090429132957/ http:/ / www. Richard O. archive. PMID 9118556. Roger D. Retrieved 24 May 2011. Retrieved 2008-10-27. Engl. v. 2007 (Bill 171 – Subsection N)". Press Release Life Tech Medical AED  http:/ / www. . nytimes. Rebeca Krys. archive. Richard E. National Heart Lung and Blood Institute. Ornato. American Red Cross. doi:10. org/ web/ 20070613234818/ http:/ / www. html) from the original on 3 July 2007. Over the last several years dozens of AED models have been recalled from nearly every manufacturer. Archived (http:/ / web. gov/ health/ dci/ Diseases/ aed/ aed_use. page 65 ("[a] safety surgical razor should be included in the AED kit.  de Vries.  "CPR Adult Courses" (http:/ / www. . In addition to Good Samaritan laws. Plaintiffs-Appellees. org/ web/ 20070608013544/ http:/ / circ. Retrieved 2007-06-28.  "How To Use an Automated External Defibrillator" (http:/ / www. ZOLL Medical Corporation. jhtml?identifier=4483). asp).  Zoll AED Plus Provides Compression Feedback (http:/ / www. Archived (http:/ / web. Bourland. shtml).  CPR/AED for the Professional Rescuer. Becker. 1997). White. which is an Automated External Defibrillator. com/ stories/ 2006/ 03/ 22/ opinion/ garver/ main1429483. Joseph P. The major reason for this appears to be technical malfunctions that may have been the cause for apparently hundreds of deaths between 2004 and 2009.  Barnaby. N. such as the gloves (used throughout patron assessment) and the towel. Cummins. Hallstrom. Barnaby J (2005-05-03). Becker LB (October 2002). asp) from the original on 13 June 2007. org/ presenter. ahajournals. com/ content/ why_defibrillators/ why_defibs2_detail. html) from the original on 23 June 2011. Mary B. php/ newsItem/ en/ nid=204/ ). com/ 2005/ 05/ 03/ business/ 03jolt. "We got a short lesson in using an AED. Willoughby PJ. American Red Cross. passed in June. edu/ index. nhlbi. com/ cgi/ content/ full/ 328/ 7438/ E271  "ILCOR presents a universal AED sign" (http:/ / www. Philips Electronics. His Wife. lifeassisttraining. wordpress. org/ web/ 20081119200414/ http:/ / www. Retrieved 2009-04-22. Archived (http:/ / web. PMID 12393821.") The other items not directly mentioned in this text but are used in AED preparation. nih. "Do It Yourself: The Home Heart Defibrillator" (http:/ / www. org/ web/ 20070703221912/ http:/ / www."  http:/ / dsc. Joseph D. "Automatic External Defibrillators for Public Access Defibrillation" (http:/ / circ. "Clear!" Unfortunately this also brought on a little anxiety when Sean mentioned if the patient were a woman with a metal underwire in her bra or with metal piercings on her torso. html  Caffrey SL. cbsnews. European Resuscitation Council. erc. .  http:/ / beavermedic. aspx?id=728). cbsnews.1056/NEJMoa020932. which protects individuals from liability for damages that may occur from their use of an AED to save someone's life at the immediate scene of an emergency unless damages are caused by gross negligence. 119 F. americanheart. com/ product_resource. org/ web/ 20110623095339/ http:/ / www. we'd have to remove them. Lance B. . 2006. com/ 2010/ 02/ 10/ look-for-me-in-airportshockey-arenas/  http:/ / vlex. . doc. ahajournals. Bram D (March 18. supra. redcross. html). 1997)  http:/ / www. 2007. . Circulation (American Heart Association) 95 (1677–1682): 1677–82.
gov. org/ biomedical/ devices/ the-shocking-truth-about-defibrillators/ 0). sca-aware. • Airway: the protection and maintenance of a clear passageway for gases (principally oxygen and carbon dioxide) to pass between the lungs and the atmosphere. choking and drowning. ca/ DBLaws/ Source/ Statutes/ English/ 2007/ S07010_e.org. via the perfusion of blood throughout the body.  State Laws on Heart Attacks. 2007 (http:/ / www. paramedics. lifeguards. . and police officers are often required to be BLS certified.heart. ncsl. this will include manually opening the patients airway (Head tilt/Chin lift or jaw thrust) or . CPR provided in the field increases the time available for higher medical responders to arrive and provide ALS care.fda. aspx?tabid=14506)  Health System Improvement Act. In an emergency situation. BLS is generally used in the pre-hospital setting. Many countries have guidelines on how to provide basic life support (BLS) which are formulated by professional medical bodies in those countries. BLS is also immensely useful for many other professions. Basic life support consists of a number of life-saving techniques focused on the medicine "CAB"s (previously known as ABC. This improves survival outcomes in cardiac arrest cases. BLS helps the patient ensure his or her own CABs. 47 External links • Sudden Cardiac Arrest Foundation (http://www. on. and by laypersons who have received BLS training.redcross. Retrieved on 2008-03-23. ncsl. such as daycare providers. ieee. An important advance in providing BLS is the availability of the automated external defibrillator or AED. (http:/ / www. 2008 update. or assists in maintaining for the patient who is unable to do so.org/services/hss/courses/aed. org/ national-sca-survivor-network  Laws on Cardiac Arrest and Defibrillators.org) • American Heart Association: Learn & Live (http://www. especially critical organs. and can be provided without medical equipment.html) • Resuscitation Council (UK) (http://www.uk) Basic life support Basic life support (BLS) is the level of medical care which is used for victims of life-threatening illnesses or injuries until they can be given full medical care at a hospital. due to illness (medical emergency) or trauma. ncsl. was recently changed by the American Heart Association) of pre-hospital emergency care: • Circulation: providing an adequate blood supply to tissue. For airways. BLS generally does not include the use of drugs or invasive skills. org/ cgi/ content/ full/ 102/ suppl_1/ I-1?ijkey=0ea84b1fa73ef72b72aef923e0f1adc6d4fd6ba5& keytype2=tf_ipsecsha)  http:/ / www. org/ default. htm) Retrieved on 26 June 2007  "The Shocking Truth About Defibrillators" (http:/ / spectrum. March 2012. Cardiac Arrest & Defibrillators (http:/ / www. teachers and security personnel and social workers especially working in the hospitals and ambulance drivers. htm) National Conference of State Legislatures. and can be contrasted with the provision of Advanced Life Support (ALS). The guidelines outline algorithms for the management of a number of conditions. ahajournals. such as cardiac arrest. Firefighter. • Breathing: inflation and deflation of the lungs (respiration) via the airway Healthy people maintain the CABs by themselves. Retrieved 2012-07-28.Automated external defibrillator  Introduction to the International Guidelines 2000 for CPR and ECC (http:/ / circ.org/HEARTORG/) • American Red Cross: Saving a Life is as Easy as A-E-D (http://www.sca-aware. html) • FDA Heart Health Online: Automated External Defibrillator (AED) (http://www. e-laws. htm)  Laws on Cardiac Arrest and Defibrillators (http:/ / www. including emergency medical technicians.gov/hearthealth/ treatments/medicaldevices/aed.resus. It can be provided by trained medical personnel. Most laypersons can master BLS skills after attending a short course. org/ programs/ health/ aed. so as to deliver oxygen to all cells and remove metabolic waste. org/ programs/ health/ aed. IEEE Spectrum.
If unwilling / unable to perform rescue breathing. The algorithm for providing basic life support to adults in the USA was published in 2005 in the journal Circulation  by the American Heart Association (AHA). respiratory arrest. so as not to delay treatment until arrival of EMS Early use of a defibrillator Early advanced life support and post-resuscitation care Bystanders with training in BLS can perform the first 3 of the 4 steps.‘A’ directs rescuers to open the Airway . as well as students and others certified first responder.Check for Danger . For breathing. and should be encouraged. and foreign body airway obstruction (FBAO. the American Heart Association's BLS protocol is designed for use by laypeople. as any attempt at resuscitation is better than no attempt. often assisted by emergency oxygen.Basic life support possible insertion of oral (Oropharyngeal airway) or nasal (Nasopharyngeal airway) adjuncts. 48 BLS in the United States BLS in the United States is generally identified with Emergency Medical Technicians-Basic (EMT-B). and to some extent. then perform compression-only CPR.‘C’ directs rescuers to perform 30 Compressions to patients who are unresponsive and not breathing normally.‘D’ directs rescuers to attach an AED as soon as it is available and follow prompts The major change is that in the patient who is unresponsive and not breathing CPR commences with chest compressions rather than rescue breaths. For circulation. The AHA uses four-link "Chain of Survival" to illustrate the steps needed to resuscitate a collapsed victim: • • • • Early recognition of the emergency and activation of emergency medical services Early bystander CPR. Basic Life Support 2011 Guideline 2010 Circulation article http://circ. .org/content/122/18_suppl_3/S685 Steps in resuscitation are now DRS C-A-B in this sequence . this may include bleeding control or Cardiopulmonary Resuscitation (CPR) techniques to manually stimulate the heart and assist its pumping action. It includes cardiac arrest. higher medical functions use some or all of the Advanced Cardiac Life Support (ACLS) protocols. EMT-B is the highest level of healthcare provider that is limited to the BLS protocol.Check for Response .ahajournals. to keep the airway unblocked (patent). this may include artificial respiration. drowning.‘B’ directs rescuers to check Breathing but no need to deliver rescue breaths . higher medical function personnel. followed by 2 rescue breaths . or choking). However. in addition to BLS protocols.‘S’ has been added for Send for help .
re-checking the airway for obstructions. • If patient is not breathing assess pulse at the carotid on your side for an adult. stopping every 30 compressions. • After 5 cycles of CPR. Laypersons are commonly instructed not to perform re-assessment. assessing the patient's airway. (3) the rescuer is too physically tired to continue CPR. but this step is always performed by healthcare professionals (HCPs). This procedure has been discarded as this may push the foreign body down the airway and increase chances of an obstruction. If an AED is available it should be activated immediately and its directives followed and (if indicated). open the airway using the head-tilt/chin-lift maneuver. allowing chest to recoil in between. If ventilation is still unsuccessful. • Look. it is possible that they have a foreign body in their airway. For infants up to 3 cm or 1/3 of the chest diameter antero-posteriorly. and the victim is unconscious. The mouth-to-mouth technique is no longer recommended. reposition (i. listen. assess for the presence of a pulse at the carotid artery. Continue for five cycles or two minutes before re-assessing pulse. If no response call for help by shouting for ambulance or EMS and ask for an AED( which is available in offices and building floors). If the jaw-thrust is ineffective at opening/maintaining the airway. Press hard and fast maintaining the rate of at about 100/minute. . the BLS protocol should be repeated from the beginning. then the patient should continue to receive artificial ventilation's at an appropriate rate and transported immediately. unless a face shield is present. If a pulse is detected. • Ensure that the scene is safe. as they may push foreign objects deeper into the airway. and feel for breathing for at least 5 seconds and no more than 10 seconds. • Blind finger-sweeps should never be performed. Begin chest compressions. and checking for a spontaneous pulse as per new protocol sequence C-A-B. Otherwise. the airway should be opened with the jaw-thrust technique. (2) the rescuer is relieved by another rescuer of equivalent or higher training (See Abandonment). If defibrillation is performed. checking for spontaneous breathing. if the victim has suspected neck trauma. or (4) the patient is pronounced dead by a medical doctor. Assess:* If the patient is breathing normally. begin immediately with chest compressions at a rate of 30 chest compressions in 18 seconds followed by two rescue breaths in 5 seconds each lasting for 1 second. • If the ventilations are successful. if it does not. Continue chest compression at a rate of 100 compressions per minute for all age groups. at the brachial for a child and infant for 5 seconds and not more than 10 seconds. Keeping these facts as such follow the sequence introduced by AHA guidelines 2010 recommendations C-A-B should be followed in learning and teaching BLS. • Assess the victim's level of consciousness by asking loudly and shaking at the shoulders "Are you okay?" and scan chest for breathing movement visually. Transport if required. Verify that the chest rises and falls. This is another step that has been discarded and considered loss of valuable time. a very careful head-tilt/chin-lift should be performed. re-open) the airway using the appropriate technique and try again. If the victim has no suspected cervical spine trauma. and pulse is present then the patient should be placed in the recovery position and monitored. begin CPR at a ratio of 30:2 compressions to ventilation's at 100 compressions/minute for 5 cycles. call for clearance before defibrillation/shock should be performed. Allow recoil of chest fully between each compression. or wait for the EMS to arrive and take over.Basic life support 49 Adult BLS sequence • C-A-B is recommended in the new AHA EU guidelines.  • Attempt to administer two artificial ventilations using the mouth-to-mouth technique. Keep counting aloud.e. removing any found. For adults push up to 5 cm and for child up to 4 cm. or a bag-valve-mask (BVM). • BLS protocols continue until (1) the patient regains a pulse. After every 30 chest compressions give two rescue breaths in adult and child victim. and re-attempting ventilation.begin chest compression immediately after shock.
 Adult BLS sequence • Ensure the safety of the victim. and remove it if it is evident. and reassess him regularly. A lone rescuer is typically advised to give CPR for a short time before leaving the victim to call emergency medical services. Abdominal thrusts should not be used in infants under 1 year of age due to risk of causing injury. . When the airway is opened during CPR. and if indicated. Foreign body airway obstruction (choking) • Rescuers should intervene in victims who show signs of severe airway obstruction. the rescuer should look into the mouth for an object causing obstruction. based on the 2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations (CoSTR) published in November 2005. • Check the victim for a response by gently shaking the victim's shoulders and asking loudly "Are you all right?" • If the victim responds. • The CPR cycle is often abbreviated as 30:2 (30 compressions. Wet clothes should be removed. and repeat assessment before doing another five cycles. the breathing and pulse should be checked for 30 to 45 seconds as both breathing and heart rate can be very slow in this condition.Basic life support • At the end of five cycles of CPR. CPR should be started immediately. Since the primary cause of cardiac arrest and death in drowning and choking victims is hypoxia. rescuers should not interfere with this process. abdominal thrusts should be applied in rapid sequence until the obstruction is relieved. • If a victim shows signs of severe airway obstruction. the rescuer. Hypothermia • In unresponsive victims with hypothermia. Note CPR for infants and children uses a 15:2 cycle when two rescuers are performing CPR (but still uses a 30:2 if there is only one rescuer). defibrillate. CPR should be continued until the victim is assessed by advanced care providers. leave him in the position in which he was found provided there is no further danger. rescue breathing is important in this situation. and any bystanders. chest thrusts can also be used. and the victim should be insulated from wind. or inability to speak or breathe. 2 ventilation's or breaths). try to find out what is wrong with him and get help if needed. always perform assessment via the AED for a shockable rhythm. Two person CPR for an infant also requires the "two hands encircling thumbs" technique for the rescuer performing compressions. • If cardiac arrest is confirmed. BLS in the United Kingdom Adult BLS guidelines in the United Kingdom were also published in 2005 by the Resuscitation Council (UK). it is more important to provide rescue breathing as quickly as possible in these situations. and the rescuer should call emergency medical services and initiate CPR. cyanosis. In particular. such as a silent cough. • If a victim becomes unresponsive he should be lowered to the ground. 50 Drowning Rescuers should provide CPR as soon as an unresponsive victim is removed from the water. whereas for victims of VF cardiac arrest chest compressions and defibrillation are more important. Chest thrusts can also be used in obese victims or victims in late pregnancy. If this is not effective. • If a victim is coughing forcefully.
 It is also acknowledged that rescuers may either be unable. turn him on to his back and open the airway using the head-tilt/chin-lift. If the victim is able to speak and cough effectively. "education certificate for the team first aid activity") . turn him into the recovery position and get help. • For an adult victim. again checking if each attempt has relieved the obstruction. • If the victim has signs of mild airway obstruction. • Look. • If the obstruction is still present. give up to 5 abdominal thrusts.Basic life support • If the victim does not respond. the obstruction is mild. call for an ambulance. do nothing else. • • • • Spain: SVB (soporte vital básico) Belgium: aide médicale urgente ("emergency medical assistance")/ EHBO (eerste hulp bij ongelukken. call an ambulance. although this is only effective for about 5 minutes. so that 30 chest compressions are given immediately after a cardiac arrest has been diagnosed. • Rescuers are taught to give chest compressions in the center of the chest. or is unable to breathe or is breathing with a wheezy sound. • If the victim has signs of severe airway obstruction. to give effective rescue breaths. Total of 5 hours course is conducted under the guidelines of American heart association In other countries The term BLS is also used in some non-English speaking countries (e. "first aid") Brazil: SBV (Suporte básico de vida) France: PSE 2 (premiers secours en équipe 2e niveau. rather than measuring from the lower border of the sternum. in Italy) for the education of first responders. or unwilling. continuing chest compressions alone is advised. lower him to the ground. and begin CPR. If the victim is unable to speak or cough effectively. These changes were introduced to simplify the algorithm. listen and feel for normal breathing for no more than 10 seconds. in this situation. give up to 5 back blows (sharp blows between the shoulder blades with the victim leaning well forwards). Check to see if the obstruction has cleared after each blow. These guidelines differ from previous versions in a number of ways: • They allow the rescuer to diagnose cardiac arrest if the victim is unresponsive and not breathing normally. the airway obstruction is severe. continue alternating 5 back blows and 5 abdominal thrusts. Shout for help. If 5 back blows fail to relieve the obstruction. If the victim is breathing normally. Continue to check for breathing. and is conscious. to allow for faster decision making and to maximize the time spent giving chest compressions.g. "team first aid 2nd level) = former CFAPSE (before 2007)(certificat de formation aux activités des premiers secours en équipe. BLS Training in India In India Basic Life Support (BLS ) and (CPR) training and certification is provided on same day by Medical Colleagues CPR also known as McCPR accredited by American heart association. and the victim still conscious. encourage him to continue coughing. this is because interruptions in chest compressions have been shown to reduce the chance of survival. • If the victim becomes unconscious. • If the victim is not breathing normally. • Rescue breaths should be given over 1 second rather than 2 seconds. the initial 2 rescue breaths should be omitted. 51 Adult choking sequence • Assess the severity of airway obstruction.
Circulation 105 (19): 2270–3. . December 2005. resus. Med.  "Circulation" (http:/ / circ. edu/ index. ahajournals. Copass M (May 2000).1056/NEJM200005253422101. Steen PA (May 2002). 912 Kb) .  Resuscitation Council (UK) Adult Basic Life Support (2005) (http:/ / www. org/ cgi/ reprint/ 112/ 24_suppl/ IV-19). vfv. pdf) (Italian). PMID 12010909. "Cardiopulmonary resuscitation by chest compression alone or with mouth-to-mouth ventilation". org/ cgi/ pmidlookup?view=long& pmid=16314375). PMID 10824072. "2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" (http:/ / circ. Johnson E. org/ cgi/ pmidlookup?view=long& pmid=12010909). doi:10. erc. PDF document (12p. uk/ pages/ bls. ahajournals. Engl. "Effects of interrupting precordial compressions on the calculated probability of defibrillation success during out-of-hospital cardiac arrest" (http:/ / circ. it/ tecnica/ capitolo_4. doi:10.Basic life support • • • • • Poland: Podstawowe zabiegi resuscytacyjne Germany: Lebensrettende Sofortmaßnahmen (basic life support) Romania: SVB (support vital de bază) Netherlands: BLS ("first aid" is referred to as EHBO (Eerste hulp bij ongelukken)) Turkey: TYD (temel yaşam desteği. N. org/ cgi/ content/ full/ 112/ 24_suppl/ IV-19). . ahajournals. php/ guidelines_download_2005/ en/ )  Eftestøl T. PMID 16314375. Sunde K.166553. pdf)  European Resuscitation Council guidelines and CoSTR documents (http:/ / www. org.  Hallstrom A.  Nozioni primo soccorso BLS (http:/ / www. J. .105. Circulation 112 (24 Suppl): IV-19–34. "basic life support") 52 References  Part 4: Adult Basic Life Support (http:/ / circ. ahajournals.1161/CIRCULATIONAHA. 342 (21): 1546–53. Cobb L.
2011.gov] Employees Annual budget Agency executive The California Emergency Medical Services Authority (EMSA or EMS Authority) is an agency of California State government. emergency medical technician regulations. The program has roughly 14. MD. and was appointed by Governor Jerry Brown on July 26. verify licensure and credentials. The mission of the California EMS Authority is to ensure quality patient care by administering an effective. the EMS Authority is responsible for paramedic licensure. MPH. . Disaster Healthcare Volunteers  is California’ initiative to pre-register. 39 Disaster Medical Support Units that supply ambulance strike teams. The EMS Authority manages the state's medical response to major disasters. dentists. 4th Floor Rancho Cordova. injury prevention. This includes maintenance.ca. Director Website [www. In California.ca. FACEP is the current Director.California Emergency Medical Services Authority 53 California Emergency Medical Services Authority California Emergency Medical Services Authority (EMSA) Agency overview Formed Jurisdiction Headquarters 1981 Government of California 10901 Gold Center Drive. The California EMS Authority is one of the thirteen departments within the California Health and Human Services Agency. technicians. pharmacists. and three 40-person medical assistance teams that are prepared to respond to a disaster. The director is required to be a physician with substantial experience in emergency medicine. Smiley has been the chief deputy director since 1989. staffing and deployment of three 200-bed mobile field hospitals. Daniel R. etc. and s mobilize professional healthcare volunteers.emsa.gov www. ambulance service coordination. statewide system of coordinated emergency medical care. The EMS Authority operates the EMS Central Registry . Howard Backer. nurses. MD. a public access database that provides information about licensing and certification status of EMTs and paramedics.emsa. trauma center and trauma system standards. and disaster medical response.000 registrants representing 47 professional license types including doctors. paramedics. California 95670 38°35′ N 121°16′ W 33″ 46″ 80 US$25 million ($NaN in 2012) (2011) Howard Backer. and disaster medical response.
It is principally through these agencies that the EMS Authority works to promote quality EMS services statewide.California Emergency Medical Services Authority 54 History and Background Paramedic programs were established as a county option in California in 1971 by the Wedworth-Townsend Pilot Paramedic Act (SB 772). Before 1980. Los Angeles County became the first county in California with paramedics. an agency established and operated by the county. an entity with which the county contracts for the purposes of EMS administration or a joint powers agency. gov/  https:/ / www. ca. and legislators to establish a state lead agency and centralized resource to deal with emergency and disaster medical services. centralregistry. healthcarevolunteers. In California. ca. gov/  http:/ / www. This legislation (SB 125) was the culmination of several years of effort by local administrators. ca. day-to-day EMS system management is a local responsibility. the responsibility for emergency medical services (EMS) and disaster medical preparedness was spread among a variety of state departments. It became clear that a more unified approach to emergency and disaster medical services was needed. consumer groups. The Emergency Medical Services System and Prehospital Emergency Medical Care Personnel Act (California Health and Safety Code sections 1797 et seq. The popular television show Emergency! demonstrated the potential for improved pre-hospital care. health care providers. Paramedic programs began to be established in many counties in California. gov . Each county developing an EMS system must designate a local EMS agency (LEMSA) which can be the county health department. External links • State of California EMS Authority  References  http:/ / www. There are 32 single-county or multi-county local EMS agencies. Role The EMS Authority is charged with providing leadership in developing and implementing Emergency Medical Services (EMS) systems throughout California.) created the Emergency Medical Services Authority in 1980. emsa.
Campus Response Teams. EMS). Volunteer Fire Departments. are certified first responders. Certified First Responders in Canada Many options are available in order to become a certified First Responder in Canada. fire. Limitations on Certified First Responders First Responders from St. and the Department of National Defence. emergency childbirth as well as advanced first aid. and German emergency responders. This is the required level of training. Courses are offered by many sources including the Canadian Red Cross. John Ambulance. and in others as the primary emergency response organization. as well as for employment with some private stable transport companies that provide inter-hospital transfer for patients in need of a bed. and many other countries. which is a generic term referring to the first medically trained responder to arrive on scene (police. Certified First Responders who are providing medical coverage to events (such as Red Cross and St. in some cases they have a Duty To Act . for U. St. and the Canadian Coast Guard all provide Certified First Responder level emergency medical care. automated external defibrillator usage. John Ambulance and fire departments assist paramedics during an exercise outside Thunder Bay. Certified First Responder courses in Canada are separated into either "First Responder" or "Emergency Medical Responder" level courses. and those who receive certification at this level can work for Emergency Medical Services in some provinces. The term "certified first responder" is not to be confused with "first responder". Ontario. Examples The Canadian Ski Patrol System. nurses. Some police officers and firefighters take more training to become EMTs or paramedics. They have more skill than someone who is trained in basic first aid but they are not a substitute for advanced medical care rendered by emergency medical technicians (EMTs). First responder courses cover A portion of the accident scene for Ansbach. "Emergency Medical Responder" level courses meet the Paramedic Association of Canada's National Occupational Competency Profile. emergency physicians. as well as those who are employed by Volunteer Fire Departments. October 2007. or paramedics. Germany incident response exercise cardiopulmonary resuscitation (CPR). in some cases.Certified first responder 55 Certified first responder A certified first responder is a person who has completed a course and received certification in providing pre-hospital care for medical emergencies. oxygen and. spinal and bone fracture immobilization. John Ambulance's Patient Care Divisions at community events). and St. "First Responder" level courses are usually 40 hours in length and is considered the minimum level of training for crews providing medical standby at events. Most police officers and all professional firefighters in the US and Canada. John Ambulance Patient Care Divisions. in some cases as a support to existing services.S. Campus . but are stable and do not require advanced medical care. Canada While all Certified First Responders in Canada are covered under Good Samaritan laws in jurisdictions where they are enacted.
ISP). correct and permitted use of Blue Lights on a vehicle does not allow the driver to cross solid white lines to overtake. • Responders are members of the community who are trained to use Automated external defibrillator. the firefighter nurse (infirmier sapeur-pompier. are liveried with high-visibility ambulance markings. Responders have no special dispensation to break the rules of the road whilst attending calls. Certified First Responders are immune to successful prosecution if assistance was given in good faith up to. within the community in which they live or work. and maintain patient stability whilst professional crews are in attendance. The first responders are thus the most frequent answer to emergency calls. these nurses are the French equivalent of paramedics. when looking at the locations for Responder Groups. These are typically estate cars. have been trained to attend emergency calls received by the NHS (National Health Service) Ambulance Service. First responders in the United Kingdom In the United Kingdom. or their care exceeds their scope of practice and causes harm to the patient. civil protection (protection civile) or others. Under the Road Traffic Act and various other UK traffic law. most statutory NHS ambulance services deploy paid first responders who drive dedicated "Rapid Response Vehicles" (RRVs). take the following into consideration: • Towns or villages where it is challenging for an emergency ambulance to arrive at scene within 8 minutes – this is usually in the more rural areas of the county. and others who are required to perform Emergency Medical Response as part of their duties all have a Duty to Act. The intermediate scale. and not beyond. those who work in the aforementioned areas can be accused of and prosecuted for negligence if they fail to respond when notified of a medical emergency. et cetera. 56 First responders in France In France. These vehicles are generally single-crewed. most emergency situations) or from a private ambulance company (relative emergency at home). These CFR volunteers are allowed to supervise massive outside meetings. but does allow the driver to treat a red light as a 'Give . providing potentially life-saving treatment and first aid until an emergency ambulance arrives. at all 70 hours of training). Community First Responder Schemes A Community First Responder Scheme is made up of groups of volunteers who.Certified first responder Response Teams. or by a medical team that includes a physician. as French red cross (croix rouge française). a nurse and an ambulance technician (called "SMUR"). ensuring motivation of the group members and that their contribution would have a valued. is only a recent evolution and is performed by nurses specially trained acting with emergency protocols. student fests. if their care does not meet the standard to which they were trained. The Welsh Ambulance Services NHS Trust. This differs from most ambulances in the UK. significant effect on patients. Scottish Ambulance Service "First Responder" vehicle • The total number of calls received within these locations must be significant enough for training to take place. In addition. the pre-hospital care is either performed by first responders from the fire department (sapeurs-pompiers. in France there exists a network of first responder associations. These volunteers have followed the same special rescuer training as firefighters (PSE 1 & PSE 2. MPVs or 4x4s. As with all medically trained and certified persons. While Certified First Responders in general are not required to render aid to injured/ill persons. the limits of certification and training. Oxygen and other lifesaving equipment to assist ambulance crews. and fitted with blue flashing lights and sirens. which usually have two crew members. by a Paramedic.
In the US the term "Emergency Medical Responder" will largely replace the term "Certified First Responder" beginning 2012. Scope of practice First Responders in the US can either provide emergency care first on the scene (police/fire department/park rangers) or support Emergency Medical Technicians and Paramedics. issued a manual for an intermediate level of training called "First Responder. applying splints. 57 First responders in the United States History The U. and calling for more advanced medical help. Out of all the Ambulance trusts in the UK. They are also trained in packaging. a handful have CFR schemes with dedicated cars. In 1995 the D. aspirin. Automated external defibrillator use.) recognized a gap between the typical eight hours training required for providing advanced first aid (as taught by the Red Cross) and the 180 hours typical of an EMT-Basic program. suction.T. CPR. The First Responder training program began in 1979 as an outgrowth of the "Crash Injury Management" course. The American Red Cross conducts a course titled "Emergency Medical Response" that fits this definition. conducting a primary life-saving patient assessment. Some areas give more training in other life-saving techniques and equipment (see below)." This training can be completed in forty to sixty hours. Department of Transportation (D. and these are not given blue lights as CFR's do not undergo blue light training. . this training can be conducted by an EMT-Basic with some field experience—which is a resource available "in-house" for many volunteer fire departments who do not have the resources for full EMT training. Other supplementary skills at this level can include the taking of vital signs including manual blood pressures. in-line spinal stabilization and transport. oxygen.Certified first responder Way' sign. and epi-pens.S. spinal immobilization. advanced splinting and the use of the Automated External Defibrillator (AED). CFRs can also assist with providing glucose. controlling bleeding. and airway adjuncts. First responder skills and limitations First responder training differs per state or country.T.O. and assist in emergency childbirth (in some areas they are trained in the use of suction and airway adjuncts).O. The first responder training is intended to fill the gap between First Aid and EMT-Basic. CPR. protection from blood borne pathogens. Emergency medical oxygen is a common supplementary skill that may be added in accordance with the 1995 DOT First Responder:National Standard Curriculum guidelines or under the authority of EMS agencies or training providers such as the American Red Cross. some rural communities could not afford the comprehensive training and highly experienced instructors required for a full EMT-Basic course. Importantly. provide basic first aid. Lifesaving skills in the first responder course include recognizing unsafe scenarios and hazardous materials emergencies. Emergency responders are tested during a training exercise. Also. moving and transporting patients.
oil rig) Security Officers Bodyguards General aviation pilots and commercial flight attendants Sports coaches and Athletic trainers Hunting and fishing guides Search and rescue personnel Campus Responders and campus police Lifeguards/Ski Patrollers Camp counsellors Boy Scouts and Girl Scouts and leaders Community Emergency Response Team (CERT) members (varies by jurisdiction) Airport ground personnel Stagehands .Certified first responder First Responders can serve as secondary providers with some volunteer EMS services. or as a limited provider of emergency medical care when more advanced providers are not yet on scene or available.e. childcare workers. Therefore.. whether it is an EMS Department or Fire Department that runs the rescue. in most all rescue environments. commercial vessel. Traditional first responders The first responder training is considered a bare minimum for emergency service workers who may be sent out in response to a call for help and is almost always required for professional firefighters who require valid CFR-D (Certified First Responder-Defibrillation) certification for all firefighters. or Paramedics. A certified first responder can be seen either as an advanced first aid provider. as most every rescue has a patient involved. Non-traditional first responders Many people who do not fall into the earlier mentioned categories seek out or receive Certified First Responder training through their employment because they are likely to be first on the scene of a medical emergency. and school bus drivers Designated industrial workers in a large facility (industrial plant) or at a remote site (fish-packing plant. etc. are Medical First Responders. Some of these non-traditional first responders include: • • • • • • • • • • • • • • • • • • Park rangers Taxi Drivers Utility workers Teachers. 58 Rescue The National Fire Protection Association standards 1006 and 1670 state that all "rescuers" must have medical training to perform any technical rescue operation. Emergency Medical Technicians. or because they work far from medical help. including cutting the vehicle itself during an extrication. the actual rescuers who cut the vehicle and run the extrication scene or perform any rescue such as rope rescues. The first responder level of emergency medical training is also often required for police officers. Many Responders have location specific training such as water rescue or mountain rescue and must take advanced courses to be certified (i. ski patrol/lifeguard).
National Fire Protection Association (2009 ed. asp?DocNum=1670).  "First Responder: National Standard Curriculum" (http:/ / www. 2008. 7. Columbus. nremt. nhsfr. ny. org/ aboutthecodes/ AboutTheCodes. nremt. pp. ISBN 978-1-58480-404-8. Emergency Care Manual. 2008. National Fire Protection Association.  http:/ / www.). American Red Cross Silicon Valley Chapter. Guelph. php?option=com_content& view=article& id=158:emergency-response-training-hspro103& catid=75:professional-responder-courses-& Itemid=164) on 2011-01-06.  " Your Transition Plan: From First Responder to Emergency Medical Responder (EMR) (https:/ / www.). The Canadian Red Cross Society (1 ed. . siliconvalley-redcross. Quincy. Ohio. pp. Retrieved 2011-10-04. 9. who will soon be known as Emergency Medical Responders. Fall 2011. gov/ people/ injury/ ems/ pub/ frnsc.). Retrieved 2009-11-19. org/ web/ 20110106170731/ http:/ / www. pp. The Canadian Red Cross Society (1 ed. nhtsa. us/ nysdoh/ ems/ cfr. dot. ISBN 978-1-58480-404-8.Certified first responder 59 External links • National Registry Of Emergency Medical Technicians. Guelph. php?option=com_content& view=article& id=158:emergency-response-training-hspro103& catid=75:professional-responder-courses-& Itemid=164). pdf)". Retrieved 2009-11-18. 2009. Dept of Health. National Fire Protection Association (2008 ed.  NFPA 1006 Standards for Technical Rescuer Professional Qualifications (http:/ / www. aspx?ContentID=4& ContentTypeID=2|title=Paramedic)  "1". htm). org/ nremt/ about/ reg_1st_history. paramedic. • UK First Responder Scheme  References  Association of Canada's National Occupational Competency Profile (http:/ / www. asp?DocNum=1006). ca/ Content.). pp. 2007. . Emergency Care Manual. org/ index.  Certified First Responder (CFR) Original Course Curriculum (http:/ / www. pp. Archived from the original (http:/ / siliconvalley-redcross. 2 Quebec St. National Registry of Emergency Medical Technicians. ON: The StayWell Health Company. xiv.  NFPA 1670 Standard on Operations and Training for Technical Search and Rescue Incidents (http:/ / www. Guelph. Retrieved 2011-10-04. United States Department of Transportation: National Highway Transportation Safety Administration.  This US organization also certifies Certified First Responders. nfpa. org/ nremt/ downloads/ Newsletter_FR_FINAL. org/ aboutthecodes/ AboutTheCodes. The Registry. pdf). org/ index. ON: The StayWell Health Company. ISBN 978-1-58480-404-8. New York State. Suite 107. The Canadian Red Cross Society (1 ed. health.  http:/ / theemtspot. org.). uk/ . pp.  "1". 9. nfpa. archive. . ON: The StayWell Health Company. asp  http:/ / www. Emergency Care Manual. MA: National Fire Protection Association. 1670-12. . com/ 2009/ 06/ 23/ what-is-the-duty-to-act/  "1". 2008. state. 1006-13 through 1006-15. 2008. Retrieved 2009-11-18. 1995.  "Emergency Response Training" (http:/ / web.
but shall be employed on their medical duties insofar as the need arises. to be used to protect themselves and the wounded or sick in their care. Swedish Army medic in Afghanistan 2006. nurses or auxiliary stretcher-bearers. History Surgeon Dominique Jean Larrey directed the Grande Armée of Napoleon to develop mobile field hospitals.S. or "ambulances volantes" (flying ambulances). Army). to alleviate the suffering of wounded and sick military personnel.Combat medic 60 Combat medic Combat medics (also known as medics) are military personnel who have been trained to at least an EMT-Basic level (8 week course in the U. including care for disease and battle injury. These medics are specifically trained. and to protect trained medical personnel as civilians. Combat medics are normally co-located with the combat troops they serve in order to easily move with the troops and monitor ongoing health. adopted the First Geneva Convention to save lives. When and if they use their arms offensively. should the need arise. Norwegian medics during an exercise. in the act of rendering aid. as hospital orderlies. in addition to a corps of trained and equipped soldiers to aid those on the battlefield. they then sacrifice their protection under the Geneva Conventions. transport or treatment of the wounded and sick shall likewise be respected and protected if they are carrying out these duties at the time when they come into contact with the enemy or fall into his hands. Medical team at work during the Battle of Normandy. Before Larrey's ." Article 29 reads "Members of the personnel designated in Article 25 who have fallen into the hands of the enemy." According to the Geneva Convention. shall be prisoners of war. knowingly firing at a medic wearing clear insignia is a war crime. most combat medics carry a personal weapon. or carry arms that qualify as offensive. Article 25 of the Geneva Convention states that "Members of the armed forces specially trained for employment. In modern times. Geneva convention protection In 1864. sixteen Europeanstates (referring to themselves as "High Contracting Parties"). They are also responsible for providing continuing medical care in the absence of a readily available physician. in the search for or the collection. and who are responsible for providing first aid and frontline trauma care on the battlefield. Chapter IV.
established on June 23. 1917 and the Sanitary Corps. rapid transport to designated trauma facilities. Medical Director of the Army of the Potomac. patient administration. and a new type of medical corpsman. organizations. and venereal disease control. which allowed the victim to survive the journey to definitive care. physical reconstruction.Combat medic initiative in the 1790s. it revealed that soldiers who were seriously wounded on the battlefields of Vietnam had a better survival rate than those individuals who were seriously injured in motor vehicle accidents on California freeways. realized a need for an integrated medical treatment and evacuation system. It was during the American Civil War that Surgeon (Major) Jonathan Letterman. resource management. gas defense. laboratory engineering. 61 . including comprehensive trauma care. On August 4. Officers of the Sanitary Corps served in medical logistics. Congress created the Medical Service Corps. hospital administration. Maryland. The United States Army’need for medical and scientific specialty s officers to support combat operations resulted in the creation of two temporary components: the US Army Ambulance Service. wounded soldiers were either left amid the fighting until the combat ended or their comrades would carry them to the rear line. The Letterman plan was first implemented in September 1862 at the Battle of Antietam. 1947. Better known as "The White Paper" to emergency providers. established on June 30. x-ray. In the United States. Early research attributed these differences in outcome to a number of factors. a report entitled "Accidental Death and Disability: The Neglected Disease of Modern Society (1966)". 1917. They IDF field doctors training in Israel were dedicated members of the medical team that enabled American generals to concentrate on enemy threats rather than  epidemic threats. He saw the need to equip this system with its own dedicated vehicles. one who was trained to perform certain critical advanced medical procedures such as fluid replacement and airway management. was published by National Academy of Sciences and the National Research Council. and personnel. facilities.
or do not care. medical personnel did not carry weapons and wore a distinguishing red cross. 2003. Modern day Traditionally. Note that the only Turkey.S. originally called for "Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field. the enemies faced by professional armies in more recent conflicts are often insurgents who either do not recognize the Geneva Convention. Under Protocol III. For this reason. Since the US Marine Corps is part of the Department of the Navy. It is an amendment to the Geneva Conventions relating to the Adoption of an Additional Distinctive Emblem and authorizes the use of a new emblem. and readily engage all personnel. The colloquial form of address for a Hospital Corpsman is "Doc. This symbol was meant to signify to enemy soldiers that the medic qualifies as a noncombatant. . The US Navy deploys FMF Hospital Corpsman attached to US Marine Corps units as part of the Fleet Marine Force. Although these symbols were officially sponsored by the International Federation of Red Cross and Red Crescent Societies. at least while providing medical care. would use a red crescent instead of a red cross as its emblem. US Navy Hospital Corpsman providing treatment to a wounded Iraqi soldier. However. to denote their protection as noncombatants under the Geneva Convention. although it agreed to respect the red cross used by the other side. Protocol III was adopted.Combat medic 62 Red Cross." In the U. the Ottoman empire declared that it distinguishing feature is the medical pack on his back.S. and will employ the red crystal on international relief missions. Marine Corps. For indicative use on foreign territory. the MDA will continue to employ the red Magen David for domestic use. except for the extra medical equipment they carry. this term is generally used as a sign of respect. Combat Medics in the United States Army and United States Navy Hospital Corpsman are virtually indistinguishable from regular combat troops. used the Magen David (a red star of David on a white background). Israel's emergency relief service. Red Crescent. a private humanitarian institution based in Switzerland. During the 1876-1878 war between Russia and A U. it relies on Navy corpsmen and other Naval medical personnel for medical care. any national society can incorporate its unique symbol into the Red Crystal. irrespective of noncombatant status. most modern combat medics are armed combatants who do not wear distinguishing  markings. This practice continued into World War II." officially adopted the red cross on a field of white as the identifying emblem. the Magen David Adom ("MDA"). known as the third protocol emblem or the Red Crystal. Islamic countries use a Red Crescent instead. The first Geneva convention. Army Combat medic (Center) in Afghanistan. To enable MDA to become a fully recognized and participating member of the International Red Cross and Red Crescent Movement. and MDA The International Committee of the Red Cross. Israeli medics still wear the Magen David. provided the first official symbol for medical personnel.
com (http://www. 1949-08-12. the bulk of the course material and instruction will now be shared between medical personnel of the different services. Icrc.com) – a website run by Docs for Docs of all US military services • 90th Infantry Division / 315th Medical Battalion (http://www. .First 1949 Geneva Convention" (http:/ / www. nsf/ WebART/ 365-570030?OpenDocument).naemt. Though all combat medical personnel are universally referred to as "medic". Retrieved 2010-12-13. 1949-08-12.  http:/ / www. icrc. Retrieved 2010-12-13. nsf/ WebART/ 365-570047?OpenDocument). Thomas A.org. Although each service will have some training peculiar to its branch. nsf/ WebART/ 365-570027?OpenDocument). net/ ~steinert/ #Brief History of the Medical Corps)  "International Humanitarian Law .com. Iraq".org) • NHTSA Emergency Medical Services (http://www. aetc. mil/ news/ story. icrc. HEALTH CARE SPECIALIST. 1949-08-12. Icrc. . . mil/ shared/ media/ document/ AFD-071026-035. Armytimes.nremt.ems. SKILL LEVELS 1/2/3/4/5  "Combat medics as EMT-Basic (8 week course in the U. Icrc. org/ ihl. com/ news/ 2012/ 04/ army-amedd-change-of-command-plenty-to-learn-david-rubenstein-says-040112w/ ). . Retrieved 2012-07-27. UPNE.us/Medical/index.First 1949 Geneva Convention" (http:/ / www. German and Japanese medics • http://www.html) webpage (90th Infantry Division Preservation Group website) – has links to other pages showing equipment of US.arc. icrc. Retrieved 2010-12-13. att. Icrc.med-dept. the US Department of Defense has moved most medical training for all branches of the armed forces to Fort Sam Houston of Joint Base San Antonio.S. org/ ihl.  "International Humanitarian Law .org.  "International Humanitarian Law . .corpsman. 7.S.provides vast amounts of data relating to WW2 US Army Medics • National Registry of Emergency Medical Technicians (http://www.joining the Army's existing AMEDD Center & School. MOS 91W. As a result of the 2005 BRAC.Combat medic USAF medics have frequently served attached to US Army units in recent conflicts.90thidpg.First 1949 Geneva Convention" (http:/ / www. af.First 1949 Geneva Convention" (http:/ / www. armytimes. Retrieved 2010-12-13. icrc. 63 References • STP 8-91W15-SM-TG SOLDIER'S MANUAL AND TRAINER'S GUIDE. "Saber's Edge: A Combat Medic in Ramadi.org) • National Association of Emergency Medical Technicians (http://www. asp?id=123211901  http:/ / www.com/WW2 US Medical Research Centre . nsf/ WebART/ 365-570026?OpenDocument).org. Army)" (http:/ / www. National Highway Traffic Safety Administration) • The short film Big Picture: Blood and Bullets (http://www. (2010). org/ ihl. aetc. the skill level. A new Medical Education and Training Campus was constructed and the Air Force's 937th Training Group and Naval Hospital Corps School were relocated to Fort Sam Houston. af. 1949-08-12. pdf External links • Corpsman.org/details/gov.  Middleton.  (http:/ / home. p.archive. org/ ihl. within different branches of the US military. quality of training and scope of work performed by medics varies from branch to branch.org.archives.  "International Humanitarian Law . 2012-04-01.gov) official website (U.2569488) is available for free download at the Internet Archive [more] .
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Usanetsol.Article Sources and Contributors 64 Article Sources and Contributors Emergency medical technician Source: http://en. Casper Gutman. Doctorfluffy. DutchTreat. DaughterofSun. AmericanJets. Philippe. Lupinelawyer. Lwg9q. Vichingo93. Bluemoose. Michaelmariano. MrOllie. TimidGuy. Tangerines. Sehsuan. LinguistAtLarge. MaxDel.davies. Barbdelaney. Ukexpat. Nikyle. Bidgee. M@sk. ZS. Cbraidotti. Cheese023. Jclemens. Owain. Clarka. Shorty82. B. Nick19thind. Firerescuelieut. Bgwhite. EPO. PawełMM. Mike Selinker. Mais oui!. Jc3s5h. Pizzapotamus. Zeno Gantner. ThaddeusB. Jayapalmithravinda. Naddy. Graham87. The Thing That Should Not Be. FrankLea2k. Cburnett. Chester Markel.andrew. Coderedkyle. Darylcheng. Marokwitz. Scope2776. Luminousmoose. Garcia. TMC. Vegaswikian. Exxolon. . RDBrown. Eamonn sullivan. Patrick-br. TBM10. Idmdave. Pdcook.Nut. Ingolfson. Pete. Shirulashem. TastyPoutine. SubContinentalGuru.AWH. GraemeLeggett. Ospalh. Jeticuleasing. Sandstein. DXRAW. Peter. Wolfkeeper. Mark. 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Rob 301. Hippykid99. Olivier. Amandacthomas53515. Kwekubo. Retep558. Wasted Time R. SYSS Mouse. Struthious Bandersnatch. Rhallanger. Gaius Cornelius. IslandHopper973. Voidvector. Marokwitz. Justcurious947. Dictouray. J. Bobblehead. Get CERT. Angusmclellan. RainbowOfLight. Mzajac. ShelfSkewed. Eagle4000. Nathan Johnson. Jclemens. Adnergje. Geo Swan. CnBy. Rjwilmsi. 1ForTheMoney. Wideangle. AzureFury. Clngre. Evans1982. Necrothesp. Jeepday. Aknorals. Fraggle81. Kjacket0. Onthost. Subwayguy. Coolmanafo.Article Sources and Contributors California Emergency Medical Services Authority Source: http://en. Woohookitty.Xp. Corvettecrazy262. DXRAW. Fayenatic london. Gene Nygaard. Kjetil r. Brian in denver. Eastlaw. 9 anonymous edits Certified first responder Source: http://en. MBK004. Hydnjo. Wavelength. Cuvtixo. Delldot. Int21h. Scottie theNerd. Lupinelawyer. Blinks. Munkee. Oneliner. BD2412. 188 anonymous edits 65 . Topbanana. Mrg3105. Sun Creator. DXRAW. Haseo9999.wikipedia. Rama. Whoisjohngalt. WikiPuppies. Johnpacklambert. Mr. Alison.org/w/index. Andy85719. McSly. Cburnett. Halosix. TimBentley. Iridescent. Epolk. Oxymoron83. Genyjoe. Texdoc41. Dfcrone. ITasteLikePaint. Gurch. Gadget850. Mike McGregor (Can). Rifleman 82. Dragomiloff. Una Smith. JustAGal. Bobo192. Shyamdash. Shevchenko-adeen. Jmb. Moyalvytn. K1RLR. WikHead.php?oldid=476530121 Contributors: Circeus. Froid.php?oldid=527750066 Contributors: 13231323a. Omar77. Pwwuk. Hanchi. William Avery. Johan Lont. DavGreg. JesseW. Buster7. Ianwarren. Sevinstorey. Levineps. Paris75000. JBOURNE. Dybdal. TabooTikiGod. Andrewjuren. Racooon. Echuck215. Jc3s5h. Mercury. Tewfik. Crowish. Jeffrey Mall. ExtraDry. Rich Farmbrough. Frmatt. Nick Number.wikipedia. Cabez. A Nobody. WinterSpw. Jordanmills.org/w/index. Diagraph01. Cburnett. Evaristé93. Scottalter. Sietse Snel. Alai. Enzo Aquarius. SudoGhost. Ingolfson. Bobarob. John of Reading. Darwinek. Bayonetblaha. Curb Chain. Troymacgill. Khargas. Cahk. Ghakko.delanoy. Cavdoc. Nono64. JPINFV. Binksternet. RJFJR. Tsuchiya Hikaru. Kintetsubuffalo. Tr1290.php?oldid=527305037 Contributors: 2000navy. Fastilysock. Versageek. Sheppin. Gildir. Sam Coutu-Oughton. Wingman4l7. ExtraDry. Mild Bill Hiccup. Natalya. TastyPoutine. O'Dea. Yachtsman1. Ipatrol. Cdang. Mofocollier. MONGO. WacoJacko. Gimmetrow. Stevegray. AnnaFrance. J04n. Rlaager. Mere Mortal. Sam Hocevar. Koavf. FlieGerFaUstMe262.org/w/index. Ohnoitsjamie. Gffghgfhkghfk44323. LAX. Search4Lancer. John. Fry1989. Fingerz. Rjwilmsi. Pjcroad. Jj137. MrOllie. KarasuGamma. Paul1776. DocKrin. Lifertiq. Cuvtixo.rrt. Mato. Fr33kman. 132 anonymous edits Combat medic Source: http://en. Peruvianllama. Dbchip. Elagatis.msc. Fabartus. Danski14. Poxnar. Prolog. Je. Noclador. Sgroupace. Howcheng. Exit2DOS2000. Redsox04. Legless562. WikiUser16. Dfrg.wikipedia. Bluemoose. MER-C. Daniel Smiley.
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