World War Two

In much of the world, ambulance quality fell sharply during the second world war, as physicians, needed by the armed services, were pulled off of ambulances. In England , during the Battle of Britain , the need for ambulances was so great that vans were commandeered and pressed into service, often carrying several victims at once. Following the war, physicians would continue to ride ambulances in some countries, but not in others. Other vehicles, including civilian and police cars were pressed in to service to transport patients due to a lack of a dedicated resource.^[28][20]

Move to life saving, not just transporting

A 1964 police cruiser, which is also fitted to transport patients. This was used before the advent of EMS services.

This situation persisted into the 1960s, when a chain events occurred that led to a redesign of the services provided by ambulance crews, and thus of the ambulance itself: CPR was developed and accepted as the standard of care for out-of-hospital cardiac arrest ; defibrillation , based in part on an increased understanding of heart arrhythmias, was introduced, as were new pharmaceuticals to be used in cardiac arrest situations; in Ireland , a mobile coronary care ambulance successfully resuscitated patients using these technologies; and well-developed studies demonstrated the need for overhauling ambulance services. These studies placed pressure on governments to improve emergency care in general, including the care provided by ambulance services. Part of the result was the creation of standards for ambulance construction concerning the internal height of the patient care area (to allow for an attendant to continue to care for the patient during transport), in the equipment (and thus weight) that an ambulance had to carry. Few, or perhaps none of the then-available ambulances could meet these standards.

An early 1970s Cadillac Miller Meteor ambulance. Note the higher roof, with more room for the attendants and patient

Most ambulances at the time, were built on a car chassis (often based on hearses), which could not accept the weight and other demands of the new standards; van (and later, light truck ) chassis would have to be used instead.^[20][29]

Ambulance design therefore underwent major changes in the 1970s. The early van-based ambulances looked very similar to their civilian counterparts, having been given a limited amount of emergency vehicle equipment such as audible and visual warnings, and the internal fittings for carrying medical equipment, most notably a stretcher .

As time went on, ambulances matured in parallel to the newly developed EMS , gaining the capacity to carry additional equipment (both portable and permanently installed) as EMTs and paramedics added this equipment to their arsenal.

***** References:

20.  Kuehl, Alexander E. (Ed.). Prehospital Systems and Medical Oversight, 3rd edition. National Association of EMS Physicians. 2002. @ ch. 1.

29.   National Academy of Sciences. Accidental Death and Disability: The Neglected Disease of Modern Society. 1966. @ pp. 5, 6, 13, 15.