Most people see an ambulance and think that they are all the same. However, there are a few ambulances—known as critical care transport ambulances—that may appear the same on the outside, but are very special on the inside.
Here are five things you probably didn't know about receiving critical care in the back of an ambulance:
Critical care ambulances are staffed with at least one paramedic and one critical care nurse. The nurse adds the ability to deal with medications and technology that are not part of paramedic training, such as ventilators, IV pumps, and specialized lines like arterial lines or pulmonary artery catheters. These special ambulances ensure that the care you receive does not decrease. Medical rules state that if a patient is transported from one hospital to another, the level of care they receive may not diminish. This means that if you are being cared for by a critical care nurse at the sending and receiving hospital, the same should go for transport.
Critical care transport ambulances can't pick and choose their patients or the patients' conditions. In the hospital there are cardiac ICUs for heart attacks, neuro ICUs for patients with strokes, trauma units for accident patients, and surgical ICUs for patients who undergo complex surgeries. Critical care ambulances have to be able to care for all of these patients, as well as premature babies to the very elderly.
The crew that is transporting you probably has more certifications than most staff nurses at the hospital caring for you. The ambulance company I work for requires that I have a national critical care certification—emergency nurse certification (CEN), critical care certification (CCRN), or critical care flight certification (CFRN)—as well as trauma certifications, obstetric classes, neonatal classes, and practical clinical experiences, where I follow around a nurse in the pediatric unit or mother-baby facility to get hands-on experience.
The critical care ambulances are stocked with medications and equipment to care for every type of patient we may need to transport. We carry most medications that your emergency room or intensive care unit does, from adrenaline to propofol, and can administer the same medications you are receiving at the hospital. Our critical care ambulance has advanced specialty equipment, like a neonatal isolette for newborns, fetal heart rate monitors, external pacemakers to help keep your heart beating when it tries to slow down, and a ventilator to breathe for you if you can't on your own.
Sometimes a critical care transport can be several hours (like when we transport from Tampa, Florida to Gainesville, Florida), so it's not unheard of for critically ill patients to take a turn for the worse in the back of the ambulance. Nurses in the hospital frequently have to call doctors for almost any order that they need. In a critical care ambulance, although we have immediate access to doctors by radio should the need arise, we rarely need to call for orders. Instead, we have a huge manual of protocols that we have studied and memorized, which covers frequent or unusual circumstances that we may encounter.
Due to the advanced training and credentialing that the critical care transport paramedics and nurses undergo, the doctor who runs our program has made a list of situations, the decisions we need to consider, and instructions that we follow for them. This is vitally important; when something goes wrong with a critically ill patient, we frequently have limited time to respond to the situation. Also, there are only two people in the back of the ambulance and both of them are probably needed to perform tasks, rather than call for orders.
Some companies have critical care ambulances that are staffed with only a critical care EMT and paramedic, but no nurse. The nurse is one sent from the hospital and may very well be the same nurse caring for you prior to being transported. The skills of this nurse are ample for care in the hospital setting, but in the back of an ambulance, there are issues for which hospital critical care nurses are not prepared. That is not to say that they are not able to provide great critical care during your transport, but dedicated transport nurses do provide advantages:
Critical care ambulances are a vital piece in the care of very ill patients. These specialized ambulances are well stocked with all the medications and devices you may need for extended care outside of the hospital setting, and are staffed with personnel that have advanced training. Rest assured your nursing and medical care will not diminish should you require transport in a critical care ambulance.