TechStuff Classic: Taking a Ride in an Ambulance

What is ambulance technology all about? Ben Bowlin joins the show to explore this listener-suggested topic.

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Episode Transcript

Speaker 1 (00:04):
Welcome to tech Stuff, a production from I Heart Radio.
Hey there, and welcome to tech Stuff. I'm your host,
Jonathan Strickland. I'm an executive producer with iHeart Radio and
a love of all things tech. It is time or
a tech Stuff classic episode. This episode originally published on
December two, thousand fourteen. It is titled Taking a Ride

(00:30):
in an Ambulance. Firefighting equipment has talked about ad nauseum
in public forums, and fancy new medical equipment sometimes gets
the spotlight. But what about the ambulance. I'll admit that
until recently, they hadn't changed significantly since the nineteen seventies
when they were modified from being inspired from hers is
the only vehicle designed for a passenger lying down at
the time. However, now ambulances range from the massive bariatric

(00:54):
trucks to the new Mercedes Sprinter that have mixed reviews
to work in to the Volvo car based ambul lenses
Europe is experimenting with. It has taken nearly half a century,
but the humble ambulance is beginning to see some innovations,
including the introduction of safety features. Watch ambulance crash tests
on YouTube. Efficiency and tech to save lives. I'm certainly biased,

(01:16):
being a volunteer medic and having many paramedic friends, but
maybe you, Scott or Ben and the Tech Stuff audience
could find it an interesting topic to dive into. Take
Care Lee, Yeah, now you know I recognize Lee's name,
and I think this is such a fantastic suggestion. Uh,
Scott and I have been doing car stuff for quite

(01:37):
a while. Um, not quite as long as Tech Stuff,
which is one of the original three podcast we ever
started making. But we have this moment which I'm sure
you've encountered to, Jonathan, where you're looking back over a
list of all the stuff you've done and you go, way,
we haven't done this when really, heck, I went to
how stuff works dot com typed an ambulance. Can't believe

(01:58):
we don't have how ambulances were right? Yeah, and uh
now we are verging on the very first official explanation
of how ambulances work ever. Ever, not not just for
how stuff works. I'm saying like no one has taken
the time to actually explain this until this moment, right,
which might be hyperbole. Scoot to the edge of your seats,

(02:20):
um or you know, if you're driving I guess, uh,
stay focused on the road, right, because it's rule number one.
That's rule number one. Of course, Now we looked into, um,
we looked into some surprising twist and turns about the
story of the ambulance. And one of the things that
a lot of people don't really think about is that

(02:42):
the ambulance itself predates the automobile. Yeah. In fact, ambulance
can apply to lots of different types of vehicles. And
to really understand the importance and the place of the ambulance,
you kind of got to look back into history. And
the word itself, ambulance comes on the Latin word ambulaire
or ambulare if you prefer. I don't speak Latin, so,

(03:06):
but that means to move about. And the earliest ambulances
weren't really about necessarily getting sick or injured people to
medical treatment. They were more about moving them away from
the healthy people by force, so kind of like a
prison bus for sick people. Now that there were different kinds, right,
You had you had the military type, which was all
about retrieving injured soldiers and moving them out of the

(03:27):
field of battle. But then you also had the type
that were in more populated like urban areas, some of
the growing cities, and that was more about this person
over year doesn't seem to be acting properly. Let's get
this person away from everybody else before it spreads. Yeah,
let's put you on the plague cart. Yeah, and it
could have been the plague. It could have been mental illness,

(03:49):
medicine wasn't quite where it was, could have been your neighbors,
or just a bunch of jerks. It will claim that
you are sick something. Yeah, you got that. That werewolf
is UM. But if you look at the the development
of emergency response, you'll see that it is in fact
closely tied to warfare. Again, not a big surprise. UM.

(04:11):
During the Roman era, you would have teams of soldiers
that would carry away the injured on litters. That would
be like a device that would be not quite a cart.
It's kind of hooked up, usually to an animal of
some sort, and it carries you at an incline. The
other end of it drags on the ground. Often it's
not the most comfortable way to move around, or they

(04:32):
might use stretchers. They would actually receive compensation for each
wounded soldier returned safely, which is interesting when you think
about working on commission, it's it's probably one of the
most efficient, although soulless ways to ensure that they maximize
their efficiency. Right, yeah, yeah, it was really and this
was something that was common throughout the ancient to medieval

(04:55):
era of warfare, was that there would be a reward
given for the return of wounded soldiers because often in
this era you had at the end of the battle
one side, whichever side was you know, less worse off,
because I don't know that you could call anyone a
winner really, but whichever side quote unquote one the battle

(05:18):
would end up taking prisoners and then ransoming them off.
So being able to be removed from the field of
battle when you're no longer able to fight without being
captured by the enemy was a big deal. So the
Knights of St John a k a. The Knights of
Malta or the Knights Hospitalitier were charged with the purpose

(05:38):
to care for the poor, the injured and the sick
back in the eleventh century. They were formed about the
same time as the Knights Templar, because this is all
during the time of the Crusades. Now, the reason I
bring up the Knights of St John is because they
were very much involved in the retrieval of wounded soldiers
during battle. Uh. And when the Knights Templar are officially

(06:00):
dissolved in twelve, much of the wealth that they owned,
and there was a lot of it, went to the
Knights of St. John and the order itself divided into
two branches. One of them became a military order similar
to the Knights Templar, and the other one continued to
care for the sick and injured. Now one of those
two branches no longer exists, right, I guess which one

(06:22):
the military order. I'm gonna that's That's an excellent guest,
and you are correct, sir, Thank you. I am a
bit of an armchair guess. Or. One thing that is
interesting about this before we move on, however, with the
Knights of St. John, is that I believe and me
being correct here, but I believe this was one of
the first organizations, at least in the West, that would
care for people regardless of which side. That's that's correct.

(06:48):
They would. They would retrieve soldiers wounded from any side
of a battle and treat them. Uh. They're the Maltese
Cross also eventually evolved into the Red Cross. UH. Also
just random trivia here. One of my distant relatives used
to rule Malta. So what yeah, wait, when are you serious?

(07:10):
I am absolutely serious? Okay is this um? Could you
give me some time and space context? Were we talking
like nineteen seventies, early twentieth century night, early thirty I
think thirty seven maybe? Uh? Yeah, his his um. His
governing of Malta was not without political issues, political and

(07:32):
religious issues. That's all I can really say about that
without turning this podcast into something completely okay, But for
the record, I think people probably want to hear that story.
I know I do, so we can talk about it
off the air. Since it doesn't sound like the controversy
was ambulance related, it wasn't. It wasn't. So the Spanish, now,
moving on from from the eleventh to fourteenth centuries, they

(07:56):
began to use wagons to transport people in need of
emergency medical care back in fourteen seven, that's during the
whole like we're getting into Ferdinand and Isabella time. They
also introduced field hospitals, which were called ambulancia's, So that
was the that referred to the field hospital, not the wagon. Now,
these field hospitals were tents that had medical and surgical

(08:18):
supplies in them, but they were very rarely used. It
was hard to actually get soldiers to where they needed
to be. These wagons were not terribly maneuverable. And it
wouldn't really be until the seventeen hundreds, three years later,
that you would actually see wounded soldiers receiving treatment and
field hospitals or be carried away by an emergency vehicle
on a regular basis. And that still wasn't perfect, right,

(08:40):
Like a lot of people died on the way to
or from Oh yeah, no, if you look at if
you look at casualty records, uh, one of the many
reasons why researching this was getting to me today. But
if you look at casualty records, it's a pretty grim story.
So you see the number of people who were outright
killed and and you see the number of people who

(09:01):
were retrieved by the folks manning the ambulance as the
wagons um, and you hear about their casualty rates, and
they were extreme. I mean it was it was not
good news if you were wounded in battle. Uh. For
a very very long time, the prevailing wisdom was let

(09:22):
them let them die, right, I mean it really was. Yeah,
unless you're a higher order officer of some sort, right, Yeah,
it's it's tricky when we think about, um, when we
think about those attrition rates, especially when we consider a
very sad fact which I'm sure you ran across as well. Uh,
ladies and gentlemen, the people who were picked for the

(09:42):
medical retrieval teams were not the crack soldiers. They weren't
the smartest, they weren't the fastest. They were considered to
be the ones who are least likely to actually kill
the enemy. Therefore, let's go ahead and put them in
charge of this wagon for all the soldiers who have
been wounded, right, they were considered the grade B fighters. Uh, yeah,
it's it was. They were not picked for their ability

(10:04):
to actually retrieve people. They were picked because they were
least likely to be useful on the front lines. Um.
And speaking of front lines, that was part of the problem.
Like these wagons were actually usually located the back of
the army, and they were very heavy, they're very cumbersome,
so it took so much time and effort to maneuver
them that offense soldiers were dying on the battlefield before

(10:27):
they'd ever have a chance to be rescued, let alone
incur any problems along the way. So this was a
big issue until a French surgeon named Dominique Jean Larry
designed a lightweight, two wheeled wagon to create a faster
response vehicle. And they were called flying ambulances. And it's

(10:47):
not because they could fly through the air, because they couldn't. Uh. Sorry,
I didn't mean to cut you off there, Ben, But
they were often stationed with the flying artillery, which also
could not fly. Oh yeah, sorry, this is just a
bummer across the board. Well, they're called flying artillery because
they were very light artillery that would be towed by

(11:07):
horses to their location, so they could they could relocate
relatively quickly, as opposed to field artillery, which was so
heavy and cumbersome that you planted it and you didn't
move it, you know, until the battle is over. It's
staying right there. So uh, they would be stationed with
the flying artillery. So these are both horse cavalry type units.
They normally be cavalry support and that changes fundamentally changes

(11:31):
somebody's odds of living or surviving a war wound. Oh yeah, yeah,
there is a huge improvement. Some people were suggesting that
it was an improvement as much as that that that
you know, you had a rate of casualty that was
being reduced to ten because of this. Now that was
someone who was writing in support of funding more of

(11:53):
these kind of wagons. So I doubt that it was
based on any empirical research. More on, more on the
idea of I think how many lives we could save,
which still is a noble effort, you know, if you
have to fudge a few numbers. But some hospitals at
this time, such as the Staffordshire General Infirmary, started to
employ their own ambulances. So now we start seeing ambulances

(12:16):
in the civilian life, not just in in warfare. And
these were still wagons pulled by horses. The Staffordshire's wagon
was described as quote a carriage hung upon strings to
be drawn by one or more horses for the conveyance
of the sick or maimed end quote. And by the
close of the eighteenth century, organized ambulance service was starting

(12:36):
to grow in Europe Europe Europe, yes, the United States
was not so quick to adopt this. Ambulance service was
practically absent during the beginning of the American Civil war,
which if you guys aren't familiar, Uh, a lot of
our listeners are from outside the US. The American Civil
War began in eighteen sixty by really eighteen sixty one.
And uh, you don't have any mention of ambulances in

(12:59):
those early in those early accounts, right yeah. And this
was um one of the bloodiest battles, right that people
remember in the United States. And uh, some of the
casualties in one of the battles, the Battle bull Run.
We're just saying this for an example, instead of having
an ambulance anywhere near, they walked twenty seven miles after

(13:22):
they were wounded to get some sort of treatment if
they survived. That's part of why there was such a
horrific attrition rate in this or casualty rate rather in
this um in this conflict. Oh absolutely yeah. I mean
not only do you have Americans versus Americans, So I mean,
no matter what the casualty is, an American, here's that.

(13:43):
But then you also had just these the you had
no preparedness, you had no ability to to help the people,
the soldiers who had fallen. And so again it was
one of those situations where if you fell in battle
if you were wounded, you know, people off would just
treat you as if you had died. Um. It was

(14:04):
only after the appointment of doctor Jonathan Letterman to the
post of Surgeon General of the Army of the Potomac
Medical Department. And this is where we mentioned the post
of surgeon general. The United States had not been invented yet.
There had there were surgeon generals in the armed forces,
and this is not the surgeon General of the Army
overall as a different, different post. But he uh organized

(14:27):
soldiers into response teams to carry wounded to a site
where they then could be transported to field hospitals or
even further on into general hospitals. In fact, they had
sort of a a primary response site where the anything
immediate would be attended to. The soldiers would then be
carried off to a field hospital. At the field hospital,

(14:48):
they would then determine whether or not to treat the
soldier there or to transport him further to the general hospital.
So it was a much more kind of chain of
command organized approach. Then William A. Hammond who became surgeon
General of the U. S. Army in the eighteen sixty two,
So the overall Army standardized ambulance response and also demanded

(15:09):
that hospitals be clean establishments, which was before back the
we knew about bacteria. So his theory was that the
clean establishments would save more lives, though he didn't have,
you know, like a scientific reason to point to, because
we hadn't discovered bacteria yet. But it turns out he
was right and um and so his his approach ended

(15:31):
up saving a lot of lives. He also demanded that
there'd be one ambulance for every one fifty soldiers serving
in the U. S. Army, and he got it, which
is pretty hardcore if you think about it back then,
because if we're talking about these response teams, right then
we're talking about a cost benefit analysis of things that
are pretty expensive and war, which is training time and cavalry.

(15:55):
So yeah, yeah, we're pretty persuasive. You're talking about not
just money, but actual people and animals resources that could
be dedicated to inflicting casualties upon the animally enemy. You'll
notice that I haven't really talked about the Confederates for
a reason for that, they just they were not nearly
as as organized as the as the Union was during

(16:16):
the Civil War when it came to things like treating soldiers.
Uh just watched the documentary film Gone with the Wind.
Uh don't. I mean, you can watch it. It's not
a documentary obviously. So in eighteen sixty four, Congress passes
the Ambulance Core Act, which established a standardized system of
ambulances in the United States. Now, these ambulances had distinct

(16:40):
labels to designate them as such, and then the Geneva
Convention of eighteen sixty four went further and adopted the
Red Cross as the international symbol for emergency medical responders,
which were to be treated as neutral parties. One thing
that is just fantastic about this is that this is
um and maybe it's a bit high, probably on my part,

(17:00):
ch Onathan, but this is one of the biggest steps
I think for the human species at large. We actually
took the idea of the Knights of St. John, which
which wasn't I mean, let's be honest, if it's during
the Crusades, they weren't always saving everybody. Sure, there's a
lot of mothering going on, I'm sure, but the Red
Cross as this international, neutral, benevolent force that somehow it

(17:28):
must have been a great day In eighteen sixty four
when they all agreed to let that slide. That's amazing
to me. I just wanted to stop and say, you know,
good for us people. Gosh, yeah, I mean it's it's
also a little one of those weird things to think
about the idea of we all agree that these people

(17:49):
are not okay to shoot at, but these other people
are totally okay to shoot at. This. This is where
my pacifism comes into right, where I'm just like, I
don't I don't get okay whatever, so um at any rate,
it is it is a great testament that we were
able to come to this agreement and by and large
people follow it because you know, it's it's it applies

(18:11):
to everyone. It's not something where only that side gets
to have the benefit of medical treatment. It's it's this
this international UH initiative. So in eighteen sixty five, the
Commercial Hospital in Cincinnati is the first one in the
United States to have a hospital based ambulance service. Bellevue
Hospital would follow in eighteen sixty nine. Oh fun fact,

(18:35):
this is something car stuff listeners will enjoy. Usually we
do a an inflation calculator that always does but I'll
at lee you probably recognize this, but I'll fill in
since UH Scott is occupied at the moment. So that
UH ambulance driver in eighteen sixty five there in Cincinnati
would make about three hundred and sixty dollars a year

(18:57):
in uh, you know, eighteen sixty five dollars in two
in fourteen, Jonathan, Uh, this is more than you would think,
but still not that much. It's about five thousand, two
hundred thirty dollars a year a year. Wow, yeah, all year.
I got a cut back on my Xbox consumption. And

(19:17):
that's probably what he was thinking right before he said,
what's the next box? Right right before they called the
second ambulance driver to pick him up, because he was
talking about things that made no sense back in eighteen six.
And now we're finally getting to automotives. Automotives, right, yeah, yeah, yeah,
the we get the first motorized ambulance in Chicago. It

(19:37):
was actually from why I understand, five hundred different business
men over in Chicago, UH donated money so that this
ambulance could become a reality. And so it was a
motorized ambulance that was donated to Michael Reese Hospital and
its top speed was a blistering sixteen miles per hour,

(19:58):
which still when you think about it, when you have
a reliable sixteen miles per hour and it's a device
that doesn't get tired. It can run out of juice,
but it doesn't get exhausted, Um, that's a big deal. Uh.
The now, the next year, New York's St. Vincent Hospital
would get its own motorized ambulance. It's horseless carriage ambulance.

(20:19):
And these were interesting. They were not gasoline powered vehicles.
These were and and then you know this because you've
covered car stuffer so long. They were electric vehicles. The
electric vehicle predates the internal combustion engine. Yes, and that
story is actually so interesting that we're going to have
to table it for another episode because you and I

(20:39):
could go off for twenty minutes about that. But that
is something that people need to know. And I know
it sounds hard to believe, but Jonathan, you are spot on.
The first cars were electric. Yeah. Yeah, you wouldn't think
of it now because whenever you see any sort of
advertisement for an electric vehicle, it's treating it like it's
a it's it's a brand new idea. Yeah, but this

(21:00):
is actually older than the gasoline powered cars where we've
been relying on for a century at any rate. Uh,
these electrical engine ambulances, they had a maximum travel distance
of between twenty to thirty miles, which is pretty good. Yeah.
You're talking about a city, right, You're not talking about
driving from one city to the next. You're talking about
an ambulance that would go out from a hospital to

(21:22):
a specific location within a city, pick up somebody and
bring it back. So bringing him or her back, and
the doctor in the back of the ambulance, because they
actually would allow a medical practitioner to go along, could
communicate with the driver in the front through a speaking tube. Yeah.
I love the I love of that note you have
about the speaking tube. I wish we still had those cars.

(21:44):
That sounds so much more fun than in intercom. Yeah. Yeah,
where be careful going around the corner. See. Yeah, obviously
that that brain Stuff episode about old timey voices is
stuck in my head. Keep falling into it. Oh that's
a good one. Um. So here we are. We're approaching
the twenty century. Yeah, we're in the twentieth century. We're

(22:06):
in the twentieth century. That's right, we're early on in it.
Because because New York's got there's nineteen hundred. I guess
if you want to be technical, nineteen o one is
into the twentieth century, you're not gonna be that guy. Okay. Well,
early in the twentieth century, Major Palace of the Canadian
Army introduced the first gasoline powered ambulances. Got it first,

(22:28):
and everyone went my word or they went a yeah,
one of those. Uh. At any rate, it makes sense.
Canada gets pretty cold. And we'll talk a little bit
about fuel types when we get further into the discussion.
So using gasolene made some sense. The first mass produced
ambulance came from a company that sold herses. Just like
Lee was mentioning, horses, were vehicles that, you know, we're

(22:51):
designed to have a person laid out in the back,
and so a patient who's suffering from some sort of
injury or illness may feel more comfortable down than sitting up.
And so the this company was called James Cunningham's Son
and Company, and there they had a really interesting design.
In fact, they were very h advanced in automobile technology

(23:13):
compared to their There the other cars that were on
the road at the time. Again, early twenteth century and
you end up getting this, uh, this machine that has
a cot in the back of it, and it had
its own suspension. So the cot had its suspension independent
of the vehicle, which allowed the passenger the patient to

(23:34):
remain more comfortable. They didn't feel all the bumps that
the ambulance is driving over. That can also prevent further
injury too, in the case of you know, a compound
break or yeah. Yeah, it's very important in that sense.
The the ambulance itself also had pneumatic tires, which was

(23:55):
unusual at the time. Most vehicles had solid tires. It
wasn't until Eater that pneumatic tires became kind of standard,
and these obviously also allowed for a much smoother, gentler
ride than a solid rubber tire. Can you imagine what
that must have felt like. I had to be pretty rough.
They didn't have a siren my favorite ambulance did I say? Yes,

(24:18):
they had a gong mounted on the side of the ambulance. No,
can we get a can we get a gong? Noise?
Someone must have someone must have fallen down and broken
a leg or something. Yeah, So they used that in
order to again, same reasons that that ambulances have sirens
to alert people that an ambulance was coming through so
that they could make way and allow the ambulance to

(24:40):
get to where it needed to be. It's Jonathan from one.
There's no emergency here. We're just gonna take a break
from writing in an ambulance and we'll be right back
going on to the earlier point that you made, which

(25:00):
which I think is so profound and cannot be over emphasized.
So many of the innovations in both performance and safety
into automobiles today come from two places, racing or war.
And it's weird when you think about it, because war
still has uh I would almost seeing even bigger parts
of play in the growth of the ambulance right. So sure,

(25:21):
because for one thing, you had to stay supply of
people who needed them. So, I mean, you know, just
from that, But but it is you're you're making an
interesting point here that both racing and war really drive innovation.
One in the sense means to use a pun that
one was not intentional. I usually go out of my
way for these, uh No, but they really do. Because

(25:44):
you have racing where there's a lot of money involved,
you want to be able to uh to get as
much money as you can if you're if you're running
a racing team, and you want your drivers to be
safe because they're the ones earning you the money, and
so you end up coming up with these innovative ways
of keeping your driver's safe, which later get trickled down
into other vehicles because their their efficacy is proven. And

(26:07):
then war, obviously you have the incentive to try and
keep as many of your men alive as possible on
inflicting as much damage on the enemy as possible, and
that requires lots of innovation. So that brings us to
World War One, Terrible War nineteen fourteen to nineteen eighteen,
and this saw motorized vehicles serve as ambulances, but there

(26:28):
were still a lot of horse drawn ambulances at the
same time. This is a moment of transition when the
automobile hasn't had universal acceptance or it's not universally available,
and early versions of ambulances were just converted buses or
Parisian taxis. They took taxis out of Paris and turned
them into ambulances. So when the United States entered the war,

(26:50):
the Americans brought along the model t Ford to serve
as ambulances. These were actually modified model T Fords. They
were had had a wider carriage to be able to
accept a person laying down um and they could travel
speeds up to forty and they could go across much

(27:11):
more rough terrain than your average wagon could. And there
was some experiments with airlifting patients, not using airplanes or helicopters,
but hot air balloons. This is crazy, actually one the
first one I've read about was in the Crimean War,
but there was also some in the World War One.
And one of the methods I saw had a stretcher

(27:31):
suspended beneath a balloon. So the balloon floats in the
air carries the the stretcher. And you think, how on
earth is the patients supposed to get to any place
meaningful as opposed to just getting away, And it was
because there there'd be a horse that would be tethered
to the stretcher, and the horse would you know, trod

(27:52):
along to wherever it was supposed to go. I assumed
there was also a rider that would go to the
nearest hospital and it would tow the balloon to the
hospital and us you would be able to bring the
patient back down to earth if they were not shot
from the sky. I mean, it's an innovative idea, yeah,
but uh, you know it's not it's not perfect. Is

(28:13):
jumping off point right right? Yeah? Or a falling down? Okay?
So post World War two, all right, So World War
two obviously more developments in the ambulance. By then we
had really switched to automobiles. But post World War Two
you also saw urban growth exploding, and it meant that
we need more ambulance services. So you have a lot
more areas, like you know, there were cities like London

(28:37):
in Paris that have been huge for hundreds of years.
But in general, we started to see more of a
move from agriculture to urban environments. This is the same
time as we're starting to see like some some really
big developments in industry that's just pushing people towards that.
And so it meant that we had a larger need

(28:58):
for ambulance services in cities, and that need was starting
to be met by various approaches. Again, many of these
ambulances were converted horses, but these didn't have a lot
of room for an attendant. You couldn't really have a
medical professional in the back who could easily attend to
any person. You essentially, we're just moving the injured person

(29:19):
to a hospital. So the standard thinking was that treatment
would begin once he got to the hospital, right. Yeah.
And now, of course, if you have ever been in
an ambulance, seen one, or just even watch TV, you
know the treatment begins the moment e M S arrives.
But up until this point, there wasn't really an e

(29:41):
M S thing. Yeah, yeah, this was again it was
one of those ideas where the people who were best
qualified to treat the patient, we're all at the hospital
or or urgent care center or whatever, something along those lines,
and the idea was you had to get the patient
to that person. There wasn't so much of an eye
idea of having medically trained people go out to see

(30:03):
the patient and attend to the patient while they are
being transported back to a hospital or other facility. And
it wasn't until the nineteen fifties that we really see
that birth of the emergency medical services movement. And this
is where we would see people who were treating trained
in medical emergency UH techniques to try and go out

(30:23):
and treat people and give them a better chance of recovery.
Or survival, even depending on the nature of the illness
or injury. Yeah, and we know that this eventually leads
to um leads to more improvements in the typical ambulance
because also the as strange as this sounds, uh, the

(30:45):
ambulances that were used before this time didn't necessarily have
medical equipment on board. R Yeah. It was essentially a
moving bed. Yeah, I mean, that's really what it got
boils down to, is that, uh, you know again, and
a lot of the ambulances were just meant to allow
people to take a wounded or sick person to the hospital,

(31:08):
that's it. But it changed once we started getting medical
professionals on board. Yeah. And in nineteen sixty five there
was the Accidental Death and Disability Paper, which I think
was actually published in sixty six, written in sixty five,
publish in sixty six, and it called for a new
type of ambulance to provide space for the not just
the patient, but also in attendant end equipment. The idea

(31:31):
here being we can treat this person as soon as
we're able to make contact with them. As soon as
we get to where they are, we treatment can begin
at that moment. There's no need to put it off
until they are at the hospital that too many lives
are being lost, too many or even if the life
isn't lost, the quality of life declines sharply if they

(31:53):
aren't able to receive help as early as possible. So
the nineteen seventy three e M S Systems Act required
that communities receiving federal funds for their programs had to
have ambulances that met federal specifications, which included things like
they're you know, crash test rating or having um A

(32:14):
BS or you know other elements as we've been down to,
like the frequency of maintenance. Y. Yeah, you had to
be able to meet these qualifications in order for you
to receive that funding. Otherwise you could have the funding
cut off. There are three types of chassiss that were
established by this and those three types are still the

(32:35):
types we we refer to today. So you've got type one,
which uses a small truck body with a modular component
in the back. Type two, which is I think the
most prevalent type here in the United States at least,
it has a van body with a raised roof, and
Type three has a van chassis but with a modular
component in the back and in the United States, these

(32:56):
will all have something called the Star of life. If
we've all seen this, it's a blue uh six point
in star uh with the with the rod in the
middle right and then the snake on it, you know,
the whole nine uh. This was originally designed by the
U S National Traffic Safety Administration, and it's kind of
like a It's weird because it's it's trademarked by them,

(33:18):
but it's kind of like a mark of authenticity for E. M.
S vehicles and for ambulances, um or and even you know,
of course, you see a paramedic, they will usually have
that somewhere on their on their body. And this you'll
see on our notes here. I had this as we
could skip this, but it's interesting. Let's keep it okay, alright, cool.

(33:41):
The next time you look at one of these six
point in stars on the side of an ambulance or
a paramedic, it looks almost like an asterisk. It pretty
It looks way more like an asterisk than it does
like a star, you know, because it has it has
flat ends, so it's more like three bars laid over
one another. Each of these project points stands for one

(34:02):
of the things that emergency services do. There's detection, reporting,
response on seen care, care and transit and then transfer
to definitive care. And to me, that's interesting because I
always wonder about the logic behind a logo, you know,
um where where, because everybody who makes one of these
has a story. Sure like the Red Cross, right the

(34:25):
right to st John, you don't. You don't. Typically when
you're making a logo, you don't want it to You
wanted to have some sort of significance or whatever it
is you're doing right, you want you wanted to tell
its own story so that not only do people recognize
it as your logo, but they at least get that
there's some sort of significance to it. I always I
feel so dumb because Jonathan, I always assumed that they

(34:47):
just stuck a logo on there because they said, hey,
you know what, let's let people know this is an ambulance. Well,
to be fair, Ben, that could be the answer. And
it could be that these six points were retro cond
you know, yeah, totally just you know, reckon the whole thing.
But I thought it was really interesting. It also makes
me think that if if you're hurt and a van

(35:09):
pulls up and it doesn't have this mark on it,
don't get into the van. Yeah, that's the first thing
that that occurred to me when you were talking about this. No,
we we came the three types right that they have
their but uh, ambulances, as we established at the top,
don't have to necessarily be a car automobile. Yeah, they

(35:32):
they can be, and in fact, i'd say the vast
majority of them are. But they can also be boats
or helicopters, fixed wing aircraft or even other vehicles. And
emergency ambulances are you know, the ones that we think
of that's the most common type, the emergency ambulances, the
type that has a medical professional in it um at

(35:52):
least one usually too, uh, and that can treat you
on the way to a medical facility like hospital. But
there are other types of ambulances as well, like charity ambulances,
which technically what they do is they transport patients to
some other location for you know, maybe an outing. So

(36:13):
think of like a children's hospital where there's an organized
trip to take children from the children's hospital to some
location like a zoo or essentially what is similar to
a field trip. So there are other ambulances as well
that are designed to carry patients or to get medical
professionals to patients. But emergency ambulances are the ones we're

(36:34):
focusing on because those are the ones that I think
most people when they hear the word ambulance, that's what
they're thinking about, right, And even more specifically, we're talking
about the van based ones because there's a very interesting
story about how these are created. Yeah, it takes a
it takes a village or at least two different manufacturers

(36:56):
in general. So you may think, like, well, where do
ambulances come from? Who makes like what what car company
makes them? And there's no single answer for that. In fact,
there are lots of different car companies that make the
chassiss that end up being used as ambulances. And then
you have other manufacturers that are not the big car
companies that make the various compartments like the actual you know,

(37:19):
maybe the modular components in some cases or in other cases,
they get they get possession of the chassis that was
manufactured by the first company, and then they put in
all the stuff like the fittings, the medical equipment, all
the kind of thing that actually makes it an ambulance.
The tech that will will talk about in just a bit.
And then they're also the second manufacturer is typically the

(37:43):
one who has to build to that federal code. Yes, yeah,
they build out that whole interior. They have to meet
the code, and the chassis obviously has to meet the
requirements of things like the crash tests, but the rest
of it also has to meet those same requirements. So
it's interesting that you wouldn't say, you know, because you
think of you think of vehicles usually as a single manufacturer. Yeah, yeah,

(38:05):
that's a Dodge such and such, you know that kind
of thing, whereas Dodge does make the chassis for some ambulances.
But it's not like you can't say the ambulance is
a blank vehicle. It's a type of vehicle, just like
a van is a type of vehicle, or sedan is
a type of vehicle. Yeah, that's a great point. And
they're so so varied in terms of just size, type, shape, function.

(38:28):
It really reminds me of limousines. Actually, yeah, because a
lot of limos are custom, custom coach jobs too. That's
what it's called when a manufacturer is building something, uh
to specification rather than to um production numbers, if that
makes sense. So we know also that this even goes

(38:49):
down to uh, oh, this is a point you made earlier.
This even comes down to what sort of fuel they use.
Oh yeah, yeah, because if you are in a cold area,
then you may not want to use diesel fuel. See,
diesel is often used in the warmer climates. It's it's
often thought of as being more efficient and also safer
because uh and if you are responding to let's say

(39:11):
a fire, then a gasoline powered vehicle is considered to
be dangerous because gasoline is very, very flammable. Diesel not
as much. So yeah, so so diesel vehicles are often used,
um in warmer climates, but in cold climates, diesel engines
take time to warm up to actually work. Anyone who's

(39:33):
operated diesel vehicle up in the Great White North knows
what I'm talking about, So they often will use gasoline
powered vehicles instead. Uh, you might find gasoline powered vehicles
and warmer climates to It kind of just depends upon
whatever the company that's running the ambulance has ordered. Right.
There are quite a few companies and US partially or

(39:55):
Holy State owned enterprises. The more and more we learn
of out ambulances, the more we learned that while they
all have the same aim for the most part, they
have their myriad ways to get there. And uh. One
great note about the diesel fuel right is, of course
you can't use a fuel, no matter how efficient it is,

(40:17):
you can't use the fuel that will slow you down
in these situations. I mean, you can't even really stop
for traffic lights or anything, which is why you have
those famous ambulance sirens and lights. What's interesting to me
is that the very first motorized ambulances had these electric
lights that were mounted on the outside to help people

(40:37):
be alerted to the fact that there was an ambulance
coming through. I think it was the New York one
that had the first ones. Yeah, which is kind of cool.
Now sirens came a little later, but this is one
of those things that we see common across emergency response vehicles,
whether it's police, ambulance, fire engines, etcetera. And obviously they
all have the same uh need or the same aim,

(40:57):
which is to alert people a you know, there, we
have got someplace, we have got to be very quickly.
People's lives depend on it. Please move out the way.
And so obviously if you're in the United States, you
know what you're supposed to do. You're supposed to pull
over to the side of the road and stop your vehicle,
not crawl along. You stop, you allow the emergency vehicles

(41:18):
to pass, and then you can resume normal operation. Uh.
So those lights and sirens. Uh, it's interesting. You know
you've probably wondered. I actually had a conversation about this
with friends of mine not too long ago about if
you hear a siren going off, you see the lights
going off, you wonder is there someone in that vehicle,

(41:40):
like a patient. Is there a patient in that vehicle
or are they on their way to get a patient? Well,
you can't really tell, except to say that statistically speaking,
it's far more likely if the siren is on and
the lights are going that there is not a patient
in the back. Generally speaking, the rules say, and the rules,

(42:01):
by the way, they vary from region to region, but
generally speaking, the rules say that if you are on
your way to try and and respond to someone who
has need of an ambulance, that's when you use the
lights and the sirens in order to get to where
you need to go as quickly as possible while treating
the patient in order not to put place more stress

(42:23):
on the patient, and also not to put more stress
on the driver who needs to make sure they get
to the hospital safely. They often will not use the
lights or sirens unless the patient is in a critical
state where they absolutely need to be able to get
to health care like a hospital as soon as possible.
You know that makes sense because I was having a conversation,

(42:46):
probably not with the same people I was having this conversation.
Were you in that same group? Was that one of
those moments where we just refuse to acknowledge each other's existence.
I mean, it happens. It happens. We spend a lot
of time hanging out their ups and down. But no, uh,
this is strange because I had a conversation that dovetailed
with this, which was one of my friends complaining about

(43:08):
seeing an ambulance. She maintained that it had its lights
on just to get through an intersection and then it's
turned them off or um. She said she had seen
police officers do this as well. But I think my
position in this was that we don't know what's going
on in the vehicle, We don't know what orders they're receiving,

(43:29):
so let's try not to be too judgmental if we
see an ambulance, you know, appeared to flick its lights
erratically or something like that, because you know, they may
have had their call canceled, somebody else may have picked
it up. And for Pete's sake, E and t S
are not paid enough, I don't care what anyone says.
And and it's quite possible that they have a patient

(43:52):
in the fact, because, uh, one of the times they
can use their lights and sirens, you know, outside of
of when they're trying to get to a patient, is
whenever they are going to use any moving privilege. That's
what you were talking about a second ago. Moving privilege
is the privilege that emergency vehicles have to go through

(44:12):
things like stop signs, red lights, um, go go into
opposing traffic, you know, things that you are really not
supposed to do. Emergency vehicles can do under special situations.
And in those situations that's they are required actually to
run the lights and siren because they have to alert

(44:33):
the traffic that normally would be going through that intersection
or going that opposite way of travel that they are
coming through. And it's quite possible that you know it's
again in order to get a patient to the hospital,
and it may be that the patients, um uh, their
state is such that they need to get there soon.
They're not so critical that they need to be running

(44:54):
the siren and lights the entire time, but they need
to get through this intersection. They can't stop for traffic.
I have question for you at the end of this
regarding regarding this very point, but we'll we'll hold it there. UM.
I think you already pointed out that when New York
launched this uh, this motorized ambulance or excuse me, not
motorized their first ambulance system, uh, that horse drawn cart

(45:15):
going at its bustle blistering four miles per hour. And
he did some lights to let everybody know. Um. There
were also not any federal standards for light based ambulance
alerts for a very long time. So it's all of
this customization and variation. Um. You know, if you've ever
heard a siren, you hear that it always has at

(45:36):
least two tones usually and and it oscillates between the
two right. And you know why that is too, because
the sound there makes it easier to hear if it's
coming toward you it's going away. Yeah, that you've got
the Doppler effect where if it's coming towards you, it's
a higher pitch, and as it's going away it's a
lower pitch. But either way you identify that as the

(45:59):
sound of an emergency vehicle. Yes. And also this this variation, though,
means that ambulances would have different sounds or different colors
of light for such a long time, such a long
time in fact, and this irritates the heck out of
me that it is still a patchwork at least in

(46:21):
the United States h state by state right. For instance,
in Minnesota, you can only use blue lights on a
vehicle if it's a snowplow or road maintenance UH set up.
But in Illinois h all the medical or fire emergency
vehicles have to use blue UH. So these things go
state by state, and the rules for one ambulance may

(46:44):
not apply in the next state over. So if I
see flashing lights as I go state by state, I
I won't necessarily be able to say with any authority, oh,
that's got to be a blank because the regulations in
that state could be different, where the light color could
mean completely and it's a snowplow, which I would already

(47:04):
be confused because we don't have those here in Atlanta.
On we have three, Yeah, we do have three. Three
do we buy a new one yet? I think we
really just have to. I think we really do only
have to. But we have several several salt trucks though.
Oh good bully for us. So part of the reason
you guys are probably asking yourselves, Jonathan ben if it's

(47:25):
been so long, why isn't there a better uniform rule
for ambulances. Well, part of the problem is, Uh, there's
there's a scientific debate going on. People are trying to
figure out how to hit the balance of the right color,
sound and frequency of siren uh, such that they can
alert drivers without distracting them and causing more accidents. Right. Yeah,

(47:49):
One thing you don't want to do when you are
designing your emergency medical response strategy is to create more
emergency right, to have some kind of clason that just
makes people's teeth vibrate and feel if the jelly in
your eyes starts to solidify, then that's clearly not what

(48:12):
you wanted in your emergency response vehicle. And so until
there's more uh, until there's a larger body of research
behind this, people are very very hesitant to try to
translate good intentions into policy. Um. And you know there
are researchers who are working at this, like Michael Flanagan
at the University of Michigan but are at their Transportation

(48:36):
Research Institute. Excuse me, Dr Flanagan. And uh, what we're
hoping for is that and some point, the sooner the better,
there will be some kind of uniform code. But also
at this point kind of roped into it because so
many states and so many private and publicly owned ambulance

(48:56):
companies have already invested so much money in They have
a they have a fleet of vehicles that are already
designed as you would have to retrofit all these vehicles.
Not that that wouldn't be a worthwhile endeavor, but that
costs money. And you know that when you get down
to it, when we talk about businesses that provide ambulance service,

(49:17):
it's a business. We'll get into that in a little bit.
So let's talk a little bit about what happens when
someone does call for an ambulance, Like what's the process?
And we're gonna go through the whole nine one one
route because that's a very very common one here. Um,
If it's If you're in the UK, it's O one one.

(49:37):
Remember that episode the I T crowd Um, but nine
one one, So if you were to dial nine one
one or I believe in the UK. The way it
works is operators will dispatch an ambulance according to zones.
So wherever you are, you know you've called in the ambulance. Uh,
they will look at the zone that you are in,

(49:58):
it will correspond to whatever you know address you gave,
and then they will look at the ambulances that are
available in that zone. There there are companies that are
responsible for specific zones within a region. Yeah. Yeah, So
you've got an ambulance team that is employed at least
in part by some company. Uh. The the company runs

(50:20):
the ambulance fleet, and they are responsible for a given
area within a region, and they get that call, then
the ambulance team itself typically includes in the United States
at least one paramedic and one emergency medical technician or
e m T. Now I say this, but keep in
mind that these terms aren't universal. That it's not like

(50:43):
there's a definition of what one is and and that
applies across the entire world. In the United States, there's
actually two different levels of e m T. There's basic
and intermediate, and then you have paramedic. Uh and you
might be confused. You might wonder what's the difference between
the two. I I certainly us I'm not well versed
in this, so I s Yeah, so I'm emergency medical

(51:05):
technician paramedic. You might not even know just on hearing
those two, if you aren't in the medical field, you
might not know which of those two is allowed to
do more extensive medical procedures. Uh. So the answer to
that is the paramedics. Paramedics have to complete between twelve
hundred and eighteen hundred hours of training compared to e

(51:26):
m t s who have to do around a hundred. Yeah. Well,
and it's because again the nature of the work that
each person can do on a patient. But you I
need to stress both of these both of these types
of careers require attendance to lectures, hands on training. I mean,

(51:48):
I don't I do not wish at all to disparage
e m t s because they do amazing work and
they have to go through a lot of training in
order to do it. So, in fact, e mt s
have to have to be to demonstrate life saving skills
including CPR, administering oxygen, administering glucose for diabetics. Uh. They
are not, though in general, at least allowed to provide

(52:10):
treatments that break the skin, so no needles are allowed,
with a couple of exceptions, things like severe asthma attacks
or an allergic reaction. Those can be allowed. Because I
have severe allergies. It gets to a point where I
cannot swallow a pill, right, so I have to have
an injection. I am personally thankful that that is an

(52:33):
exception to that rule. We're gonna take another quick break,
but we will be back in just a moment. So
what do paramedics do that? So they're advanced emergency medical
care providers. They build on those e m T skills

(52:54):
with even more skills and more tasks that they can do,
such as administering medicine or star an IV line in
the back of an ambulance. So they're allowed to use needles.
They are trained in that, they're allowed to administer medication
to a patient. Usually the medications We'll talk about all
the equipment on there, but I might as well mention
it here. Medications that are usually included in an ambulance

(53:16):
are the ones needed for those emergency responses. It's the
most common type of medications that are needed for that
sort of thing. Epinephrin would be a big one, for example.
Um but uh, and you know you have to be
really careful obviously, because sometimes those medications include things like narcotics.
So uh, ambulance teams are are responsible for the inventory

(53:38):
inside their vehicles, which means that if you find out
that you have a shortage of narcotics in your vehicle,
you have some serious explaining to do. I mean, they
have a huge amount of accountability in that department. Yeah,
absolutely understandably. So how speaking of accountability, how long does
it take them to respond to a call? Okay, well
that's that's a great question. Again at various region by region,

(54:01):
I thought I would pick one of the most famously
congested areas in the United States, the city known for
the worst traffic in the US, Los Angeles. Los Angeles,
I believe takes number one. If if not, it's at
least culturally referred to as the worst traffic in the U. S.
Atlanta is pretty bad, but l A is worse. Uh

(54:23):
So Los Angeles an ambulance is supposed to be able
to get to a patient within eight minutes fifty nine
seconds of receiving the call from the nine one one dispatcher.
So just a hair under nine minutes, that's how long
they have to get to the the person. Yeah, it's
it's pretty pretty fast, considering again that this is a major,

(54:43):
sprawling city. Now granted again, that's why they divide them
up into zones, right, because if you just had the
entire city as the place where you worked, then you
might take an hour to get to somebody, and that's
not acceptable, and they may not always be going to
the closest hospital, right. Yeah. If you've ever seen an
ambulance that has its sirens on, its lights on, or

(55:06):
maybe maybe it doesn't, but you just see them driving
with purpose, like it's clear they're they're making their way someplace,
and they're driving past a hospital, you might ask yourself, well,
why aren't they going into that hospital? And it's because
the team has to weigh the patients, uh, the nature
of the patient's problem with the various locations that are nearby,

(55:28):
So they may not go to the closest hospital if
that hospital is not well equipped to handle certain kinds
of medical emergencies. So, for example, if there's a hospital
that has a really good cardiac arrest response team and
it's a little further away than the hospital it's closer
in but doesn't really have that that equipment, Yeah, then

(55:50):
the ambulance can go to that other hospital. By the way,
you can ask the ambulance drivers to take you to
a specific hospital if you want to. You can say
I want to go to this particular hospital. You can
do that. However, that ambulance team may or may not
fulfill your request. It will depend on how far away

(56:10):
that hospital is. That if that hospital is way outside
the ambulance team's zone, then they say, listen, we're gonna
have to take you to this other place. It's closer.
They are well equipped to deal with your your emergency
and uh and we just we can't go that far
to take you to this other place. Right, And a
lot of our more cynical listeners might be saying, well, yeah,

(56:32):
of course they're gonna take in the farthest hospital away
so they can rack up the bill. But that's not
that's not how they don't run a meter. They're not
it's not an uber or yeah. So, but but your
trips can cost a pretty penny. I mean like they
can rape. They can go up way above a thousand
dollars for a single trip. Hundreds not unusual now. Typically

(56:58):
insurance will end up paying for ambulance services, depending as
long as the the the hit is uh determined that
it was merited. Right, if you stub your toe and
you call an ambulance and you ride in the ambulance
and they say, yeah, you stubbed your toe, you know
in a day, it's gonna feel better. You can bet
that insurance is not going to cover that particular expense,

(57:21):
right because it wasn't life threatening. Here's okay, here's the thing.
Let's do this instead of a stubb stub toe situation,
Let's go hypothetical. Alright, don't don't really, I won't really
hit you. So, Jonathan, here's what happened. You were at
work and uh, someone I won't name a Coword or
Josh Clark. Okay, So Josh had convinced been become convinced

(57:41):
that our office was haunted and he invited a ghost hunter.
This is like last week, and after you got so irritated,
got because the ghost hunter is actually in our office
and the fact that the ghost hunter one exists and
two is in my friend field of vision unto our right.
And so you get so infuriated that you uh that

(58:04):
you kick like a baseboard, all right, and so you've
got a broken foot, but it's like seriously broken. They
haul you call nine one one. Let's say they're in
there in like five minutes. We're rushing you downstairs. You're
still cursing at the ghost hunter, and they hop you
onto the ambulance. What do you see when you get inside?
What's the gear? Okay, I like that. That was the

(58:29):
That's awesome. Okay, well, I'm glad you asked Ben. All right,
So your typical ambulance has a gurney in it. That's
the that's the cot that's usually on wheels that they
with the legs that extend out. So when you pull
the gurney out from the back of the ambulance, the
legs extend. You can then wheel the gurney to the patient,
put the patient on, and then when you wheel it
back in, they'll you can let the legs contract and

(58:51):
push the gurney back into it's lays flat or flat
ish against the floor of the ambulance compartment. Yeah, that's great,
the paramo. I think we'll get in the back of
the ambulance with you. There is actually a bench usually
in most of these van ambulances where typically uh they're
used if you ever have to transport to people at

(59:12):
the same time, although most ambulance crews will do their
best to avoid that because it divides the attention of
the medical personnel really and they can't guarantee that each
person is going to get the best response. So normally
you want to send as many ambulances as you have
people who who need them, which is why you'll see
multiple ambulances on a scene. Yeah. Now, occasionally that you

(59:35):
know what is ideal and what is real don't match up,
and you have to transport to people at the same time,
and that's why there's a bench in there as well. Uh.
You will also start seeing lots of equipment, some of
it you might not see because it's stowed away. Ambulances
are kind of like I think of it like the
International Space Station, right. You have you have very limited

(59:55):
space and you want to carry as much life saving
equipment as you lee can, stuff that you might need
in any given medical emergency, and there are tons of
different medical emergencies, so you've got a lot of different
potential stuff to carry with you. It's kind of like
playing Dungeons and Dragons. You're like, I want to have
every possible thing that my character might need on any

(01:00:18):
given adventure, and then you're told yes, but you have
to worry about weight and incumbrance, and you think, why
can I just have a magical bag of holding thing
that makes everything. Ambulances don't have a bag of holding,
so you have to put all that stuff someplace. So
pretty much every square inch of that interior is holding
some equipment or or equipment is hanging off of a hook.

(01:00:42):
It all depends on what we're talking about, but that
equipment is pretty much what you would find in a
standard emergency room, with a couple of exceptions. There's no
X ray machine doesn't really fit, you know, making everyone
put on lead, driving down on um. There's also no lab,

(01:01:03):
so they can't run any tests or anything. They can
just respond to two things that are are apparent. Okay, Yeah,
so then that would be stuff that will that will
just give you a quick quick look at what you
need to do immediately to the patient. Yeah. So it's
again you're trying to stabilize the patient as much as
possible so that you can get the patient to hospital

(01:01:25):
care where a more detailed analysis can take place. So
if we're talking in the case of illness as opposed
to a broken foot, then that would mean they would
treat any symptoms that were life threatening, but otherwise not
really mess with the patient too much because they can't
they can't determine exactly what's wrong, right, and it's kind
of pointless at this stage in technology to have a

(01:01:46):
lab on a on a vehicle like this, because labs
wouldn't work quickly enough. No, you you would get to
the hospital faster than you would receive any unless you're
just like tooling around town, which seems like a pretty
you know, inappropriate use of resources to me. So stuff.
They do have diagnostic equipment like blood pressure cuffs, you know,
things that being able to take a patient's vitals quickly

(01:02:09):
are that's important, so stethoscope, that sort of stuff. They
also have monitoring equipment like a cardiac monitor to track
a patient's heartbeat, clearly important, especially if the patient has
um suffered a heart attack, cardiac arrest, or something like that. Uh,
they have response equipment so this is the stuff that
they use to respond to emergency situations. So if you
were to go into cardiac arrest, they have a defiber

(01:02:31):
later so they can do the whole clear you know,
you've seen it a billion times in movies to try
and zap your heart back into into action. They also
have bandages and gauze for treating wounds. Uh. They have
you know, like the stretcher board, the solid stretcher board
you price seeing these These are those are meant to
immobilize a patient. So if a patient has suffered like

(01:02:53):
a back injury or a broken limb that needs to
be immobilized, they can use that. They also have splints,
including inflatable splints a lot of times where because they
don't take up a lot of space when they're not inflated, right,
So then you put them around the wound. You you
inflate them and they they they stabilize the limb so

(01:03:13):
that you're not able to uh further injury yourself. Um.
That includes neck injuries, lem injuries, that kind of thing. Uh.
And then they also have airway equipment specifically to help
patients who are having trouble breathing or perhaps are are
simply having respiratory distress, like someone who maybe was in

(01:03:34):
a building that caught fire. They didn't suffer any burns,
but they may have suffered smoke inhalation. You know, this
would be something used for them. So these are usually
tools that either help a patient breathe or will breathe
for a patient. Uh includes oxygen tanks, so those will
be in the back of an ambulance as well. Probably
won't be needed for my broken foot. I think if

(01:03:56):
they were too, they were to administer oxygen. Things have
on well beyond the broken foot problem. You probably also
won't need this next thing, not the OBI kuit. No, No,
unless my broken foot has broken the rules of of
God and man where suddenly I've become incredibly pregnant. No,
the OBI kit is for for ambulance teams that have

(01:04:20):
to do an emergency delivery. And by emergency delivery, I'm
talking about a person. So so let's say that an ambulance,
you know, an expectant mother calls an ambulance because her
she has no one to take her to the hospital,
she can't take herself, was born early, or there's some
kind of weird pain. Yeah, she's she's going into labor

(01:04:40):
unexpectedly whatever, whatever the reason. Ambulance CRUs carry ob kits,
and that contains all the supplies that an ambulance uh
like a paramedic would need in order to deliver a
baby on the move if the baby has decided that
the baby is not gonna wait. And so it involves
things like latex gloves, as umbilical clamps, scalpel uh towels

(01:05:04):
like all the sort of stuff is in your typical
obi quit actually looked this up online. I was looking
at a company that sells the equipment to ambulances and
I looked I was like, huh obi kit inquired, like,
I'm curious to find out what's in this. That's how
I know, because this is in a world that is
far removed for me. The eagle scout me wants to

(01:05:24):
buy one and just have it in my car, But
I know I will totally just lose my marbles if
I'm ever in that situation, which is I would just
I would give you three days before you get so
bored that you start using the umbilical clamps for something
incredibly inappropriate attentions. Yeah, but you mentioned medication too, yep,
So that includes things like any histamines and f friend uh,

(01:05:46):
anything that could be used for treating life threatening injuries
or illnesses. That sort of stuff is going to be there.
There's you know, most of these medications are given intravenously.
That's why you need a paramedic. Um so you're using
an ivy. So there's also I V equipment and needles
and things like that on board an ambulance. So they'll
be the E M T driving paramedic. And some companies,

(01:06:10):
some companies, it all depends again on the region, not
just in the United States, I'm talking about globally here.
Some companies have ambulance drivers who are not medically rated
at all. They might have a first Aid certificate, but
they their purpose is to drive the vehicle. They're yeah uh.
And in other places they the person who's behind the

(01:06:31):
wheel is fully qualified to treat emergency medical situations. It
all depends upon the area. So how do they talk
to each other? Well, they don't shout because that would
be disturbing to the patient. They use radio these days,
we don't. We no longer have the talking tubes. Sadly,
we now use radio. So now we do break or
breaker stuff. But yeah, it's a two way radio communication

(01:06:53):
that you can use. Also, that radio can uh usually
be used to contact hospitals to let a hospital know
the nature of the patient, um, you know, whether there
it's an injury or illness or whatever, and they can
get more direction from the hospital that way, Like if
they get a information from the hospital that the hospital
is completely overwhelmed by some other terrible thing that's happened,

(01:07:17):
then the ambulance can reroute and go to a different
facility if necessary. So it's a really important tool. In fact,
there's some ambulances that have computer systems on board that
also do this, where they're tied into an overall network
of computers to help keep track of not just what
that ambulance is doing, but what other ambulances and hospitals
are doing in order to give the best chance for

(01:07:39):
that patient possible. Uh. So that's that's your communication. You also, uh,
you want to know how long you might have to
do this if you're if you're working in on an
ambulance team. Yeah, I'm already pretty intimidated. Le Okay, so
I watched a video where they said, yeah, you know,
your average ambulance team works anywhere between eight and twenty
four hours in a row, and I hope you don't

(01:08:01):
break that hypothetical foot on our Yeah, no joke. Uh.
He was also talking about how there are you know,
obviously different facilities for ambulances. Some hospitals have uh like
essentially a holding area like a garage and uh and
there you could get out of your ambulance and and
relax as much as you can while on the job

(01:08:22):
before you go on call. But other ambulance teams there
their office is their car, their vehicle, they're inside the cab.
For the guy who did the video, he did it
for twelve hours at a time. That was how long
his shift was. So for twelve hours when he wasn't
actively helping a patient, he was sitting in the passenger

(01:08:43):
side of an ambulance. I just have everyday such immense
respect for people who do that, and we know that
this is not the end. Ambulance technology continues as we
record this podcast. Yeah, I wish I could tell you
that there's a ton of super cool, like groundbreaking tech,
but a lot of this is again because we're talking

(01:09:03):
about stuff that has to be proven to be helpful.
It's a slow kind of a slow evolution because we
need to make sure that they work. You don't want
to employ a technology or technique simply because it's new
without first knowing that's helpful. Right If we were to
do otherwise, than we could potentially negatively impact patients, and

(01:09:25):
that's the last thing you want to do. But some
of the things that have been incorporated over the past
few years are howler sirens, which are they complement the
regular ambulance siren. They don't replace it, but this is
a lower frequency sound that penetrates further and is supposed
to help alert drivers on the road that an ambulance

(01:09:47):
is approaching. To me, I listened to a few because
I was like, I don't know if I've heard this
or not, and I have heard it before, but to me,
depending on the video, it sounds kind of like the
old pac Man eating pellets and won't won't because it
is it's essentially that that same undulating frequency, but now
it's a lower pitch than the other one, and again

(01:10:09):
it's underneath the regular sirens, so you hear both at
the same time. Impression, thank you, Yeah, I've played a
lot of pac Man. And also it is low enough
frequency where you can actually feel those vibrations. Yeah, So
the idea being that even if you don't if you
don't actively register it as you know, hearing it, you
feel it, and so that alerts you that there's an

(01:10:31):
ambulance coming um And they say that you can feel
the pressure from those sound waves if you're within two
feet of the ambulance. Some of the ambulances around the
world are being fitted with closed circuit television cameras internally
and externally. The internal ones are meant partially as protection
for ambulance crept because there's there's always the potential that

(01:10:52):
you could be accused of malpractice, and they're meant to
help maintain a level of accountability as well as protection
or ambulance crews to say, well, we reviewed the footage
and they did exactly what they were supposed to do.
That kind of thing. Yeah, that's gotta be huge. I'm
I'm a I'm an advocate of that kind of monitoring,

(01:11:14):
as creepy as it might sound to some people. If
we're talking about firefighters, police officers, e m s. Anybody
who's in a situation where they're dealing with the public,
then you have to have some kind of way to
establish a firm inarguable record. Yeah, exactly. Either know who
you're dealing with, you you either have to be able

(01:11:36):
to say, this person who we put into a position
of trust violated that trust and therefore we need to
react appropriately, or you need to be able to say,
the person who we put in this position did exactly
what they were supposed to do, and this is what
shows us. So another the external ones are meant in
order to try and keep an eye on things that

(01:11:57):
might be volatile situations. Let's say that there's a riot
going on in a city like here in the United States.
We occasionally have them for things as silly as a
sports victory, and that may mean that someone ends up
being injured in the process and you have to send
them out. But you also want to be careful because
people are not acting rationally. So yeah, attempted ambulance theft surprise. Yeah, actually,

(01:12:22):
and well, when you remember that there are lots of
medications in that ambulance, you could understand there are some
some temptations for people to try and steal them. So
these externally mounted cameras are meant to be both a
deterrent and also just an aid to the people inside
the ambulance to keep an eye on how things are
going to make sure that they stay safe, not just
the patient, but the ambulance uh UM employees as well.

(01:12:44):
Then you have also aboard, we're seeing air filtration systems
being installed. This is not necessarily new. Again, in fact,
most ambulances have climate control that's separate in the ambulance
compartment from the cab, so you have two different climate
control systems. And part of that is to make sure
that any pathogens that are coming from the patient don't

(01:13:07):
get passed on into the cabin and uh UM you
know in fact the person driving the vehicle as well,
so it's to try and keep them safe. UM and
some also have data recording systems that keep track of
the vehicle's speed that's breaking its position. It's kind of
like the black box on an airplane. An interesting fact
for that, in the United States, the federal government has

(01:13:28):
passed some regulations requiring something like a black box to
be in most automobiles. So it's not just an ambulance
that has this. And while a lot of people have
these or wellyan objections to it, I just want to
point out that these things just records sort of flight
data sort of the metadata of your driving and h

(01:13:51):
A data recording system in an ambulance might be in
communication with a network of some sort, but typically in
your average consumed or vehicle, they're not talking to anyone. No,
it's recording simply within your vehicle itself, and ultimately that
system might end up helping you as a driver. Let's
say that you are driving a vehicle that suffers a

(01:14:12):
mechanical failure, that's a manufacturing problem, and it's recorded in
there so that anything that happens, maybe maybe you have
an accident and hopefully it's one that doesn't result in injury,
but you have an accident that affects your car and
it's due to a manufacturing problem, and that was recorded
on that black box. Is gonna be thankful for that,
right as opposed to someone saying, oh, you're a careless driver. Yeah,

(01:14:36):
And it's important for ambulance is to have that because
they are statistically more likely to be involved in an accident. Sure,
because they're they're entering areas that are already dangerous. They
are also having to go through, you know, intersections, they
have to go through heavy traffic at times, they have
to go through opposing traffic at times. This is obviously
putting themselves at a higher risk for that sort of thing.

(01:14:59):
I see you've got an interesting little, um, little little
blurb here, and that we're wrapping up so we have
time for it. Okay, all right, Well, first off, thank
you for for having me on. It's always a pleasure. Um.
We we added some stuff folks under what we called
fascinating but not totally necessary facts and we both have one. Yes, uh,

(01:15:20):
mine is that as of October two thousand fourteen, Dubai
is home to what they call the world's fastest ambulance.
It's a refitted Lotus of Aora. It can travel up
to a hundred and eighty five miles per hour, and
they have a couple of other things they're working on
which will save for later episodes. So a Lotus of
Aora is a sports car. Yes. Do you know if

(01:15:41):
they actually transport patients or is this just to get
responders to a patient. I think it's because I was
looking at this and I think that there might be
a way for them to strap somebody onto it. But
you need to do a Google image. But I don't.
I don't think just a dispeller. I think it's it's

(01:16:01):
more for them to show up on the scene and
do treatment on the scene or donuts in the parking lot. Donuts.
This thing, look, I mean it's going fast standing still, right,
I mean, that's that's what this thing is doing. And
all the medical equipment is in that the quote unquote
trunk of this vehicle. If you've ever had a sports
car written sports car, you know trunks are that's being generous.

(01:16:23):
But but rear storage compartment is filled with medical equipment
and there's really I mean, if you have two responders,
then there's no room for a page. Yeah. I just
don't see how That's my problem with. I don't see
how you could attach somebody, right, Yeah, unless you strap
them to the top Christmas tree style, which I don't

(01:16:43):
think I would recommend. Not a doctor either, but I
don't think. But what's your what's your fascinating facts? So
we do have one article on how stuff works that
relates to ambulances that popped up, and this one just
amused me because it popped up and I was like, well,
I'm going to include this because it's a day ulus.
But it was one about really bizarre car races and

(01:17:05):
they talked about how On Spike TV's Car Apocalypse, which
keep in mind this is for a like almost like
a reality game show sort of thing, they had a
crazy race that involved ambulance is called a chain race. Now,
a chain race is when you have two vehicles, one
towing the other with a chain, but you have drivers
in both vehicles. So the driver in the front vehicles,

(01:17:25):
the one providing all the power and making turns and stuff.
The driving the back vehicle is trying their best to
maintain control over their unpowered but still very rapidly moving
vehicle so that when they're going around turns and stuff,
they're not slinging way off to the side. And the
winner of the quote unquote races whichever vehicle still you know,

(01:17:46):
is able to complete it and still be towing their
respective car behind them. So these were ambulances towing other cars,
and they had two person teams, one person behind the
wheel of the ambulance, one behind the wheel of the car.
About that one, it was terrifying. I actually watched some
some excerpts and and it was pretty crazy. And it
was on the circular track, so it was all about

(01:18:06):
spinning out, you know, like they would they would take
a turn and the person in the back, you know,
they have very limited vision of what they could say
that most of their vision is taken up by the
back of an ambulance, and so they're they're trying to
their best to kind of move with it, but if
they swung out too wide, it would cause the whole
thing to spin out. It's kind of spectacular. So yeah,

(01:18:27):
that's uh, that's the low down on ambulances. And uh,
you know, I think once we see more technology be proven,
you know, have it's worth proven in the field, we'll
see it make its way into ambulances. I don't again,
I don't disagree with taking time to make sure that
that's there. I I as someone who loves technology, My

(01:18:51):
first instinct often is to adopt something first and then
hope that the value plays out. But you don't want
to do that when people's lives are at stake. I
have no problem with it taking some time. I mean,
obviously there's the frustration because if something could be saving lives,
you wanted to be out there, but you have to
prove that that could is is real. And ambulances being

(01:19:14):
so very it's obvious to me and although I will
admit this is an assumption. I think it's a fair
one that ambulances also have wildly differing ranges of equipment
with levels of sophistication. So there are you know, surely
there are ambulances that have the insta burn graft kind
of technology, crazy crazy stuff that that you know that

(01:19:36):
could use some more time to be proven. Yeah. Again,
it's not one of those those cookie cutter type things
where a standard model like you don't get the standard
ambulance and standard ambulance response team that just ends up
being you know, put out through all of the world.
As as this is what we use from here on out.

(01:19:57):
There's it's definitely a great answer. Yeah, maybe maybe one
day we'll get to that standard. And uh, if we do, Lee,
You're going to be one of the first people I
write to about it because I thought this was an
excellent suggestion. And thank you so much for having me
on the show. Thank you for being on, Ben, I
really appreciate it. And that wraps up another classic episode
of tech Stuff. I hope you enjoyed it. If you

(01:20:17):
have suggestions for topics I should cover in future episodes
of tech Stuff, please let me know the best way
to do that. Is over on Twitter. The handle for
the show is text stuff H s W and I'll
talk to you again really soon. Tex Stuff is an
I Heart Radio production. For more podcasts from my Heart Radio,

(01:20:41):
visit the i heart Radio app, Apple Podcasts, or wherever
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