Ambulance

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This article or paragraph describes the situation in Germany , Austria and Switzerland . Help me to describe the situation in other countries.

Ambulance

Ambulance of the professional fire brigade Frankfurt am Main
Ambulance of the professional fire brigade Frankfurt am Main

Vehicle data

Abbreviation: Ambulance
Crew: Germany:
Co-driver / transport driver: emergency paramedic (temporarily also paramedic ),
driver / machinist: sometimes only a "suitable person" (e.g. in Bavaria), often paramedic

Austria:
Paramedics (driver and co-driver), often emergency paramedics
Switzerland:
dipl. Paramedic (driver), passenger

Commitment: acute emergencies , ambulance transport

An ambulance ( RTW ) is a vehicle of the rescue service for emergency rescue. Ambulances are designed for the supply, monitoring and transport of emergency patients in accordance with the staffing and medical-technical equipment. According to the definition, emergency patients are patients with an existing, expected or non-ruled out risk to life. Colloquial, but imprecise names are the abbreviations Sanka or Sankra for medical vehicles .

Distinguished from the ambulance are the ambulance (KTW), which is used for the emergency medical usually not urgent , an emergency ambulance (NAW), which, unlike the ambulance, is additionally manned by an emergency doctor , and an intensive care vehicle (ITW), which is mainly intended for the transfer of patients in critical health status to another hospital.

Emergency ambulances (NKTW) are widespread in Austria and are used both in emergency rescue and ambulance transport. They mostly correspond to DIN EN 1789 Type B (Emergency Ambulance) and are therefore not as extensively equipped for emergency use as an ambulance (DIN EN 1789 Type C: Mobile Intensive Care Unit).

In Germany, emergency ambulances are also used, which most closely correspond to an ambulance with additional equipment for patient transport and usually with smaller internal dimensions. Because these vehicles are used in the multipurpose vehicle system, they are often referred to simply as a multipurpose vehicle. However, this is not an official name, but a slang term. The article Emergency ambulance provides more information .

history

Wheel stretcher from 1900
Ambulance around 1900
The Granit 30 phenomenon as a Wehrmacht medical vehicle

The ambulance in its current form is a type of vehicle whose origins can be found in the late second half of the 19th century. After the founding of civilian Samaritan associations , which came into being at the suggestion of Friedrich von Esmarch from 1882, of the medical columns of the Red Cross and other charitable associations, as well as the assumption of patient transport by fire brigades, there was an increasing number of people carrying bicycles, carriages and other vehicles for urgent transport or seriously ill people in hospitals or to the doctor. At the end of the 19th century, regular patient transport services were set up in all major German cities. The main task was the transport, but not the on-site medical assistance that is taken for granted today to stabilize the condition before the transport. However, already at the 1st International Rescue Congress in 1908 in Frankfurt am Main, the Leipzig doctor Paul Streffer formulated the demand for general medical accompaniment for ambulance transports and the use of ambulance doctors for initial medical care on site and during the transport.

The extensive establishment of motorized vehicles, especially after the end of the First World War , led on the one hand to the putting into service of many motorized "ambulances" in the cities and finally also in the countryside, and on the other hand to the first serious traffic accidents . The maxim of fast patient transport to the (accident) doctor did not change until well into the 1960s.

In 1938, the Heidelberg surgery professor Martin Kirschner, in his essay “The mobile surgical clinic”, took the view that more patients could be saved through preclinical medical treatment. This principle was taken up again from 1954 by Kirschner's successor at the Heidelberg chair, Karl Heinrich Bauer , when he brought his “Klinomobil” onto the road in 1957 in a Heidelberg model test. It is assumed that the increasing number of people who had fatal accidents at the time could have played a role. However, this cumbersome bus vehicle was too costly for long-term accident care in a large city. In contrast, a model developed at the same time by the Cologne surgeon Engelbert Friedhoff , the "emergency doctor's car", was more successful. Since there were no legal regulations, the ambulance service remained characterized by pure transport activities until the 1970s.

Correspondingly, the usual ambulance transport, which is not supported by a doctor, remained with the " rear-view mirror rescue ": This colloquial term means that the driver of the ambulance observes the condition of the patient in the rear part of the vehicle using the rear-view mirror - because no one else was part of the crew. Any deterioration in the condition that was possibly visible to the driver did not lead to immediate treatment, but rather to an increase in driving speed in order to reach the clinic quickly.

The modern pioneers of today's preclinical rescue services came from aid organizations, clinics and also developing organizations such as the Björn Steiger Foundation . When trying to get better equipment for ambulances, they fell on deaf ears in many places.

VW Type 2B ambulance

The first innovations, including the introduction of vehicle radio, a two-man crew with paramedic training, the possibility of calling in an emergency doctor to the scene of action and the maxim of first aid to ensure safe transportability mostly occurred in the 1970s.

The onset of rapid development of emergency medicine accelerated the great successes in reducing patient lethality , especially up to the point of arrival at the hospital. In the course of this, the standards of the equipment were developed, with which the best possible first aid could be carried out, taking into account the limited space available in the vehicle. In particular, the possibility of carrying and administering medication, the equipment with EKG and external defibrillators , the possibility of differentiated and hygienic ventilation by ventilators as well as the alignment of the vehicles for the most gentle patient transport possible are milestones in the development of today's ambulance standards.

From the development of the technical design and equipment of this type of vehicle for transporting emergency patients, it can be seen which significant developments in emergency medicine have led to fundamental tactical changes in the preclinical rescue service.

In 2006, 8,656,294 rescue and ambulance trips were undertaken in Germany alone for patients with statutory health insurance. A large part of the transports in Germany are made up of ambulances (4,333,093 cases), ambulances (2,689,601 cases) and ambulances (1,570,190 cases).

tasks

RTW and NEF

The tasks of the ambulance are:

The ambulance is used in all emergencies to bring rescue specialists to the site who are supposed to use the equipment from the vehicle and their specialist knowledge to avert serious damage to health or to restore or maintain vital functions.

It is used for repatriation services when the transport requires the equipment of an ambulance; Usually this type of transport is covered by KTWs.

crew

Germany

The staffing of the ambulance is stipulated in the state rescue service law of the respective federal state. It always consists of two people, including an emergency paramedic as the medically responsible (transport driver) in each federal state or paramedics in the transition period, in the future only emergency paramedics and as the second person / driver in most federal states a paramedic, in Lower Saxony there are also rescue workers as a second person and in Bavaria a "suitable person" is to be appointed as the second crew member. Often there is also a trainee to become an emergency paramedic or paramedic as the third crew member on the vehicle.

Austria

An ambulance in Austria must be manned by at least two paramedics , whereby more and more often at least one crew member has completed the advanced training to become an emergency paramedic . In some federal states such as Vienna or Vorarlberg, training to become an emergency paramedic with emergency competence in pharmaceuticals (NKA) or vein access (NKV) is a criterion for professional employees.

Switzerland

In Switzerland, the crew consists of at least one qualified paramedic and one other employee with additional training in the emergency services.

technology

In Germany, if the patient's condition so requires, ambulances often make use of special rights and rights of way according to Sections 35 and 38 of the Road Traffic Regulations and are accordingly equipped with special signal systems (blue rotating beacon and acoustic horn ).

Due to the high power consumption of the special signaling system and the possibly existing air conditioning as well as the medical technology carried, many ambulances have an engine run- on circuit .

Vehicle types used

Vehicles with spacious box bodies made of aluminum sandwich panels, plywood, aluminum frame construction or glass fiber reinforced plastic (GRP) are widespread in the rescue service. The chassis is provided by delivery vans with a gross vehicle weight between 3.5 t and 7.49 t. Mostly the Mercedes-Benz Sprinter , depending on the region also as an all-wheel drive, the almost identical VW model VW Crafter , the Iveco Daily , the Ford Transit , the Fiat Ducato and Opel, Renault or Nissan chassis with box bodies are used. This box body is usually produced by a supplier of special vehicles who expands the vehicle and equips it with the desired equipment. As a rule, efforts are being made to be able to convert the box body with its medical expansion to a new, suitable chassis after the basic vehicle has worn down, in order to keep the investment costs low. For overweight patients, special heavy-duty ambulances (S-RTW) are available at larger locations , which are adapted in terms of equipment and space to the special requirements and often have a suitable tail lift at the rear. For patients with (particularly) contagious diseases, there are sometimes infection ambulances . The type of large-capacity ambulance (GRTW) is used to transport several patients .

  • Fiat Ducato (box body)

  • MB Vario (box body)

  • MB Sprinter (box body)

  • VW LT (box body)

  • VW Crafter (box body)

  • Unimog U 1250 (special vehicle for demanding terrain)

Coloring

White, red and sulfur or Euro yellow ( RAL 1016) are widely used as the basic colors for rescue service vehicles . The ivory (RAL 1014) that was used in the past is hardly used any more. Different shades are used for the red color, fire red (RAL 3000) or daylight red (RAL 3024). The vehicles are usually clearly labeled as belonging to the rescue service, e.g. rescue service or ambulance , in the case of vehicles occupied by the fire service also fire service . It is not uncommon for the basic color to be supplemented by surrounding strips of different colors or foil stickers in different colors. Reflective material or also contour markings complement active safety. Some vehicles are "decorated" with a stylized EKG line. The rear of the ambulance is increasingly being provided with large diagonal red / yellow stripes. In Germany, with the exception of the federal states of Rhineland-Palatinate , Schleswig-Holstein, Saarland, Bremen and Bavaria, it has not yet been possible to design the ambulance uniformly. A Europe-wide uniform basic color such as sulfur or euro yellow is discussed again and again.

It is common practice to label ambulances (e.g. on the doors) so that the vehicle can be correctly assigned to its owner and crew regardless of the license plate number .

Special vehicles

Fire rescue vehicles

Fire rescue vehicle of the Essen professional fire brigade

In Essen , a vehicle concept was developed for the local professional fire brigade in which ambulance vehicles are combined with a pre- equipment vehicle (VRW) and a small fire engine (KLF) . These special vehicles are known as fire rescue vehicles ( LRF ) and are manned by three firefighters, including an emergency paramedic or paramedic and a paramedic. In addition to the standard equipment of a KTW type C, they have a hydraulic rescue kit , a portable pump , a 400 liter water tank, a foam compound tank and the corresponding accessories for using the above equipment, for example roller hoses , a standpipe and more. The concept was developed in order to be able to rescue people or fight fires in traffic accidents with trapped or trapped people and car fires when the volunteer fire brigade and professional fire brigade are still on their way. The vehicle concept is particularly aimed at outdoor areas in which the deployment of volunteer fire brigades cannot be calculated and the journey for the professional fire brigade is particularly long.

Mobile stroke units

For the acute care of patients with a stroke or suspected stroke, the special ambulance Mobile Stroke Unit - sometimes also called Stroke-Einsatz-Mobil ("STEMO") in Germany - was developed by the Saarland University Hospital and put into service for the first time in November 2008. The vehicles are u. a. equipped with a mobile CT scanner , mobile laboratory diagnostics and telemedical device . The vehicle's operational concept - rapid treatment of the patient with subsequent transfer to a stroke unit - was adopted worldwide in the years that followed.

Medical equipment

Germany

The rescue service in the Federal Republic of Germany is the responsibility of the federal states in accordance with the federal state order. There are 16 different rescue service laws, ordinances, implementation provisions and sample service instructions in Germany.

Exemplary interior view of an ambulance (view of the driver's cab):
1: EKG with defibrillator ; 2: syringe pumps ; 3: suction pump ; 4: special ventilator; 5, 6, medicine cabinet; 7, 8: Cabinets and drawers for other equipment (medication, supplies, consumables); 9: disposable gloves ; 10: stretcher ; 12: ventilator ; 13: Emergency case

All medication and equipment necessary to maintain vital functions and avert serious damage to health until reaching the clinic are kept in an ambulance . Similarly painkillers kept on an ambulance.

To facilitate patient care directly at the scene of an emergency, part of the medical equipment is transported in a specially standardized emergency case or backpack, or electronic medical products such as the EKG device can be removed from the holder, which is also the charging station for the battery.

Diagnosis: stethoscope , sphygmomanometer , pupil light , reflex hammer , blood glucose meter or measuring strip, (digital) clinical thermometer , pulse oximeter , capnometer
circuit: infusion solutions, devices and material for the supply and warming up of infusions , syringe pump , EKG device with defibrillator and pacemaker -
Breathing function : Oxygen bottles , ventilator with oxygen inhalation function, intubation set , tubes / Güdeltuben , resuscitation bags , suction pump
Other: medication , set for poisoning emergencies, bandages, set for burn wounds, emergency surgical instruments, splints, immobilization of the limbs , vacuum mattress or spine immobilizer rescue corset , cervical rails for immobilization of the cervical spine, material for Amputatversorgung , Koniotomieset , scoop stretcher , carrying with chassis, carrying chair . In addition, according to the DIN EN 1789 standard, a multi-function tool is required on ambulances.

Austria

According to the constitution, the rescue service in Austria is incumbent on the municipalities, which can (and did) hand over the competence to the federal states in accordance with the principle of indirect administration. The last federal state to take this step was Tyrol in 2009. The federal states, for their part, have contracts with the individual providers (Red Cross, Johanniter, Maltese, Arbeiter-Samariter-Bund, MA70 etc.) to take over the rescue and ambulance services closed. The medical and technical equipment of the emergency vehicles used in the rescue service is specified by the respective legislature in several federal states. Either existing standards such as EN 1789 (for example in Salzburg) or newly created minimum equipment regulations (for example in Lower Austria) are used.

Vehicle from Upper Austria used in emergency rescue.

In principle, most vehicles not manned by a doctor comply with EN 1789 Type B, while vehicles standardized according to EN 1789 Type C are usually used as ambulances . Exceptions to this are, for example, the vehicles of the Medical Corps of the City of Graz or the emergency vehicles "RTW-C" described in the Lower Austrian Rescue Service Minimum Equipment Ordinance 2017, which are used in the provincial capital St. Pölten , among others .

Mandatory medical equipment of an ambulance in Austria
designation Lower Austria Vienna
Cot x x
Shovel stretcher / spine board x x
Vacuum mattress x x
Carrying chair / stair chair - x
Carrying sling / mattress x -
Equipment for immobilizing the cervical spine x x
Equipment to immobilize bone bridges / upper extremities x x
Stationary oxygen system min. 2000 l x (at RTW-C min. 4000 l) x
Portable oxygen system min. 400 l x (at RTW-C min. 800 l) x
Resuscitators with masks for all ages x x
Suction device x x
Endotracheal intubation equipment (x) (only with RTW-C) x
Supraglottic airway x -
Sphygmomanometer, blood glucose meter, pulse oximeter, ear thermometer x x
(Semi) automatic defibrillator x x
12-lead ECG - x
Perfusor - x
Ventilator - x
Equipment for laying an intraosseous access - x
Capnography (x) (only with RTW-C) x
Birth kit x x

standardization

For the EU area there has been the specification of EN  1789 Type C: "Mobile Intensive Care Unit (MICU)" or German "Ambulance vehicles and their equipment - ambulances" (last change 2014-12) with specifications for dimensions and the equipment, but the vehicles are equipped differently depending on the rescue service operator, sometimes in addition to the scope specified in the standard. In Germany, in addition to DIN EN 1789, Type C, DIN 75076 "Rescue systems - intensive care vehicles (ITW)" applies to ground-based intensive care transport with general requirements and tests.

division

The vehicles are operated by various organizations and are used to care for and transport patients. They may also be equipped with other devices for special use by the fire brigade.

designation Category DIN EN 1789 use
Ambulance Type A1 Used to transport a single non-emergency patient
Ambulance Type A2 Used to transport several non-emergency patients
Emergency ambulance Type B Used to establish and maintain the transportability and transport of emergency patients
Ambulance Type c Used for the transportation, advanced treatment and monitoring of emergency patients
Emergency doctor vehicle Used to transport the emergency doctor to the emergency site (rendezvous system).

See also

literature

  • DIN (Hrsg.): Rescue Service: Norms - DIN-Taschenbuch 257th 2nd edition, Beuth, Berlin, Vienna, Zurich 2000, ISBN 3-410-14558-3 .
  • DIN (Hrsg.): Emergency services: Norms - DIN-Taschenbuch 257.Beuth, Berlin, Vienna, Zurich 2004, ISBN 3-410-15843-X (CD-ROM)
  • Wolfgang Jendsch: Technical book / illustrated book emergency vehicles of the medical and rescue services - Motorbuch Verlag, Stuttgart, 1st edition 2009, ISBN 978-3-613-03099-2 .

Web links

Wiktionary: Ambulance  - explanations of meanings, origins of words, synonyms, translations
Commons : Ambulance in Germany  - collection of pictures, videos and audio files
Commons : Ambulance in Austria  - collection of pictures, videos and audio files
Commons : Ambulances of other countries (worldwide)  - collection of pictures, videos and audio files

Individual evidence

  1. ↑ Kirschner, Martin: The mobile surgical clinic: X-ray, surgical and seriously injured department. Special print from: Der Chirurg 10, 20 (1938), Identifier-PPN: 263274993, pp. 713-715.
  2. ^ A b Bettina Wagner: The Hamburg rescue service and its history: 160 years between authority and honorary office , p. 61, Diplomica Verlag; 2014, ISBN 978-3-8428-8680-3
  3. ^ Nils Kessel: History of the ambulance service 1945–1990. From the “people of lifesavers” to the job description “paramedic” , Peter Lang Verlag, Frankfurt 2008, ISBN 978-3-631-56910-8 , pp. 65–72.
  4. ↑ Health care costs ( Memento from February 15, 2016 in the Internet Archive )
  5. ↑ rettungsdienst.de - Heavy duty, intensive and infection ambulance for Munich ( Memento from February 3, 2014 in the Internet Archive )
  6. ^ Essen fire brigade: special rescue vehicles
  7. ↑ cf. for such vehicles e.g. rettungsdienst.de - heavy-duty, intensive and infection ambulance for Munich ( Memento from February 3, 2014 in the Internet Archive )
  8. ↑ NOTE D'INFORMATION TECHIQUE NIT 273: 2006 - SIGNALIZATION COMPLEMENTAIRE DES VEHICULES D'INCENDIE ET ​​DE SECOURS (PDF; 160 kB). Retrieved August 7, 2019 .
  9. ↑ Emergency vehicles Trier
  10. ^ Association for rescue services and fire brigade alarms, Saarland ( Memento from June 18, 2013 in the Internet Archive )
  11. ↑ Emergency vehicle: Florian Bremen 92 / 83-01 - BOS vehicles - Emergency vehicles and guards worldwide. Retrieved August 5, 2019 .
  12. ↑ Alexandra Jane Oliver: Stroke: Special ambulance accelerates therapy. In: Spiegel Online . April 11, 2012, accessed January 11, 2019 .
  13. ↑ a b Angela Misslbeck: Stroke treatment: Stroke emergency vehicles have proven themselves. In: Doctors newspaper . June 27, 2018, accessed January 13, 2019 .
  14. ↑ a b Stroke-Einsatz-Mobil. Berlin fire brigade , accessed on January 13, 2019 .
  15. ↑ First Mobile Stroke Unit. German Society for Neurology , January 22, 2009, accessed on January 11, 2019 .
  16. ↑ The hospital comes to the patient. UKS Neurological Clinic , accessed January 11, 2019 .
  17. ^ Heinrich J. Audebert, Martin Ebinger: Stroke: Pre-hospital use precious minutes. In: Deutsches Ärzteblatt . 2015, accessed January 13, 2019 .
  18. ↑ MSUs worldwide. UKS Neurological Clinic , accessed January 11, 2019 .
  19. ↑ VJ Calderon, BM Kasturiarachi, E. Lin, V. Bansal, OO Zaidat: Review of the Mobile Stroke Unit Experience Worldwide. S. Karger , October 2018, accessed on January 11, 2019 .
  20. ↑ Law of July 1, 2009, which regulates the public rescue service in Tyrol (Tyrolean Rescue Service Act 2009) ( Memento of April 6, 2012 in the Internet Archive )
  21. ↑ RIS - Ordinance on General Rescue Service - SRV - State law consolidated Salzburg, version dated April 24, 2018. Retrieved April 24, 2018 .
  22. ^ RIS - Lower Austrian Rescue Service Minimum Equipment Ordinance 2017 - Consolidated provincial law Lower Austria, version of April 24, 2018. Retrieved April 24, 2018 .
  23. ↑ Reinforcement for the new emergency doctor system . ( noen.at [accessed April 24, 2018]).
  24. ↑ Appendix Lower Austrian Rescue Service Minimum Equipment Ordinance 2017. Accessed on April 24, 2018 .
  25. ↑ S800-010 - Implementing Ordinance for the Vienna Rescue and Ambulance Transport Act - WRKG. Retrieved April 24, 2018 .
  26. ↑ DIN EN 1789: 2014-12 - Beuth.de. Retrieved October 22, 2017 .
This version was added to the list of articles worth reading on November 3, 2005 .