A Doctor’s Reflection on Ambulance Design

J Brent Myers, MD MPH

Director | Medical Director

Wake County Dept of EMS

Source of Response Time Measure

De Maio: Ann Emerg Med, Volume 42(2).August 2003.242-250

Proportion of Patient’s Surviving Vs. Response Time of Defibrillator

Ultra-Time Critical = BLS

Clinical Condition Ultra-time critical treatment

BLS or ALS

Cardiac arrest Compressions and defibrillation

BLS

Severe trauma Hemorrhage control, reduction of fracture, rapid transport, chest decompression

BLS (save for chest decompression today)

Anaphylaxis IM Epinephrine BLS

Asthma Inhaled beta agonist, IM Epinephrine

BLS

ALS Response Times that Matter?

Severe respiratory distressCPAP (can’t this be BLS?)

IV medications for treatment

Advanced airway management

Chest pain/STEMIDysrhythmia treatment

EKG interpretation

Cardiac arrest management

Summary

Lighting/conspicuity that is evidence-based

Climate control that is appropriate for pharmaceuticals (and pharmaceuticals that are appropriate for the climate)

Speed that is measureable and can be monitored as well as attained

Safe use of interior spaces

We succeed only as we identify in life, or in war, or

in anything elsea single overriding objective

and make all other considerations bend to that

one objective.- Eisenhower