Taking a Ride in an Ambulance

from one of my listeners. I shall just read out the email. Hi, Jonathan, I was catching up on some Tech Stuff episodes and had a crazy topic that I've not heard anyone outside the industry really talk about. Have you ever considered teaming up with Ben or Scott to talk about the tech of ambulances? Firefighting equipment is talked about adding zeum 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 trucks to the new Mercedes Sprinter that have mixed reviews to work in to the Volvo car based ambulances 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, 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, no, you know I recognize Lee's name, and I think this is such a

fantastic se gestion. Uh. Scott and I have been doing car stuff for quite 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, wait, we haven't done this when really heck I went to how stuff works dot com

typed an ambulance. Can't believe we don't have how ambulances work, right, Yeah, and uh, now we are verging on the very first official explanation of how ambulances work every 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 hyperbolie, scoot to the edge of your seats, um or you know, if you're driving, I guess, uh, stay focused on the road, right because number one, that's

rule number one. Of course. Now we looked into, um, we looked into some surprise 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 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 from the Latin word ambulaire or ambulare if you prefer don't, I don't speak with Latin, so, but that means to move about and the earliest ambulances weren't really about necessarily getting sick or injured people to medical treatment. Uh. 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 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 here 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, 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. Yeah, yeah, I 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. 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 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 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 can call anyone a winner really, but whichever side quote unquote one the battle 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 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 were officially 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 the military order. 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 it may 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. 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? I am absolutely serious? Okay? Is this um? Could you give me some time and space contacts? Were we talking like nineteen seventies, early twentieth century, nine, early I think thirty seven maybe? Uh? Yeah, his his um. His governing of Malta was not without political issues, political

and 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 began to use wagons to transport people in need of emergency medical care back in fourteen eight 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 tense that had medical and surgical 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 will be carried away by

an emergency vehicle on a regular basis. And that still wasn't perfect, right, 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 then you see the number of people who 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 them let them die. I mean it really was, 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, a 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 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 were 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. Yeah, yeah, it's it was. They were not picked for their ability 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 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 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 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 somebody's odds of living or surviving a war. 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 these kind of wagons.

So I doubt that it was based on any empirical research, more on more on the idea of 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 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 eighteenth century, organized ambulance service was starting to grow in Europe. In Europe, yes, yeah. 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 of the US. The American Civil War began in eighteen sixty in early eighteen sixty one. And uh, you don't have any mention of ambulances in 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 of bull Run. We're just saying this for an example. Instead of having an ambulance anywhere near, they walked twenty seven miles after 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 this conflict. Oh absolutely yeah.

I mean not only do you have Americans versus Americans, so I mean, no matter what the casual needs, an American here's that. 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 often would just treat you as if you had died. Um. It was 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 soldiers into response teams to carry wounded to a site where they then could be transported to field hospitals or are 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, 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 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 up saving a lot of lives.

He also demanded that there be one ambulance for every one fifties 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 in war, which is training time, and cavalry. So yeah, yeah, you'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. There's a reason for that. They just they were not nearly as as organized as the as the Union was during 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 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 of hyperbole on my part, Jonathan, 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 is during the Crusades, they weren't always saving everybody.

There's a lot of othering going on, I'm sure, but the Red Cross as this international, neutral, benevolent force that somehow 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 are not okay to shoot at, but these

other people are totally okay to shoot at. This is this is where my pacifism comes in, 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 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. In fact, this is something car stuff listeners will enjoy. Usually we do a an inflation calculator that Scott always does. But i'll at Lee, you probably recognized 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 in uh, you know, eighteen sixty five dollars in two thousand 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 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 sixty five and now we're finally getting to automotives. Automotives, right, yeah, yeah, yeah.

The get the first motorized ambulance in Chicago. It 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, 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. Now, the next year, New York's St. Vincent Hospital would get its own motorized ambulance. It's horseless carriage ambulance. And these were interesting. They were not gasoline powered vehicles. These were and and Ben you know this because you've covered car stuffer so long. They were electric vehicles. The electric vehicle

predates the internal combustion engine. And that store is actually so interesting that we're going to have to table it for another episode because you and I 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, your 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. But this 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 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 that note you have about the speaking tube. I wish we still had those cars. That sounds so much more fun than an intercom. Yeah, yeah, we're 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. Um. So here we are. We're approaching the twenty century. Yeah, we're

in the twentieth century. We're 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 ambulance. Got it first, 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 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 laying 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 uh advanced in automobile technology compared to there there the other cars that were on the road at the time. So again early twent 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 main 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 lungs. Yeah, yeah, it's very important in that sense. The the ambulance itself also had pneumatic tires, which was unusual at the time.

Most vehicles had solid tires. It wasn't until later 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 that favorite ambulances, and I was like, yes, 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 get to where it needed to be. Going on to the earlier point that you made, which I 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, 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 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 drivers safe, which later get trickled down

into other vehicles because their their efficacy is proven. And 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 service ambulances, but there 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 centered the war, the Americans brought along the Model t Ford to serve as ambulances.

These were actually modified Model t Fords. They were had a 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 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 in World War One.

And one of the methods I saw had a stretcher 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 worst would you know, trod

along to wherever it was supposed to go. I assumed there was also a writer, but 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 you know it's not it's not perfect. Is he jumping off point right? Right? Yeah? Or a falling down? Okay? 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 needed more ambulance services. So you have a lot more areas, like you know, there were cities like London 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 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 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 that treatment begins the moment E M S arrives. But up until this point,

there wasn't really an E 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 hospit spittle 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 idea of having medically trained people go out to see 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 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 ambulances that were used before this time didn't necessarily have of 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, a lot of the ambulances were just meant to allow people to take a wounded or sick person to the hospital. 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, published 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 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 law, the quality of life declines sharply if they 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 B S or you know other elements as we've been down to 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 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 ray roof, and Type three has a van chassis but with a modular component in the back.

And in the United States, these will all have something called the Star of Life. We've all seen this. It's a blue uh, six pointed 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, 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. Yeah,

let's keep it okay, alright, cool. The next time you look at one of these six pointed 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 projecting points stands for one 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 Right to st John, you don't.

You don't. Typically when you're making a logo, you don't want it to 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 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, totally 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 pulls up and it doesn't have this mark on it, don't get into the van. Not the same thing. Yeah, that's the first thing that that occurred

to me when you were talking about this. No, we we name the three types right that they have there, but UH ambulances, as we established at the top, don't have to necessarily be a car automobile. Yeah, they 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 least one usually to UH, and that can treat you on the way to a medical facility like a 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 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 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 in general. So you may think, like, well, where do ambulances come from? Who makes them? 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, 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 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 chat see 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, 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. 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 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 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 operated a 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 in 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

Holy State owned enterprises. The more and more we learn about ambulances, the more we learned that while they all have the same aim for the most part, they have that 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, 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 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, which is to alert people. Hey, 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

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, 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, 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 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, 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 refused to acknowledge each other's existence.

I mean, it happens. It happens. We spent a lot of time hanging out their ups and downs. But no, uh, this is strange because I had a conversation that dovetailed with this, which was one of my friends complaining about 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. So let's try not to be too judgmental if we see an ambulance, you know, appear 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 m t s are not paid enough. I don't care what anyone says.

And and it's quite possible that they have a patient in the back 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 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 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 the siren and lights the entire time, but they need to get through this intersection. They can't stop for traffic. I have a 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 going at its bustle blistering four miles per hour, and they needed 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 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 to way. Yeah, that you've got the Doppler effect. Where it's coming towards you, it's a higher pitched and as it's going away it's a lower pitch. But either way you identify that as

the sound of an emergency vehicle, right, 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 the United States, 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 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 not apply in the next state over. So if I see flashing lights as I go state by state, I won't ness 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 a completely And it's a snowplow, which I would already be confused because we don't have those here in Atlanta.

So 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 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, One thing you don't want to do when you are designing your emergency medical response strategy is to create more emergencies. 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 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 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 companies have already vested so much money and 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, 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, 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 zone. So wherever you are, you know you've called in the ambulance. Uh, they will look at the zone that you are in. 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 the ambulance fleet and they are responsible for a given

area within a region, and they get that called. 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 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 was. I'm not well versed in this, so I aim, yeah, so I'm emergency medical 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 m T s who have to do around a HU. 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,

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 m T s have to have to be able 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 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 exception to that rule. So what do paramedics do then, So they're advanced emergency medical care providers. They build on those e m T skills with even more skills and more tasks that they can do, such as administering medicine or starting an I V line in the back of

an ambulance. So they're allowed to use need tosh. 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 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 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, 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, it varies region by region. I thought I would pick one of the most famed slee 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 US. Atlanta is pretty bad, but l A is worse. Uh 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, 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 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, 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 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 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, of course you're gonna take in the farthest hospital away, so he can rack up the bill. But that's not that's not however, 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, four hundreds not unusual. Now, Typically insurance will end up paying for ambulance services, depending as long as the the the it 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, 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 will 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 become convinced that our office was haunted,

and he invited a ghost hunter. This is like last week, and after you got so irritated 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, right, and so you get so infuriated that you uh that you kick like a baseboard. Alright, 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 like that's awesome. Okay, Well I'm glad you asked ben. Alright, 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 guurney to the patient, put the patient on, and then when you wheel it back in. They'll you can let the legs contract and push the gurney back into it's lays flat or flat ish against the floor of the ambulance compartment. Yeah, that's great. The paramedic will get

in the back of the ambulance with you. Uh. 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 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 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 space, and you want to carry as much life saving equipment as you possibly can, stuff that you might need in any given a cool 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 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. 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 um. There's also no lab, 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 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 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. But they do have other stuff. They do have diagnostic of equipment like blood pressure cuffs, you know, things that being able to take a patient's vitals quickly 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 defibri later so they can do the whole clear and 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 gauds for treating wounds. UH. They have you know, like the stretcher board, the solid stretcher board you pribce see these these are those are meant to

immobilize a patient. So if a patient has suffered like 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 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 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 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 they were to they were to administer oxygen, things have gone 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

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 born early or there's some kind of weird pain. Yeah, she's she's going into labor unexpectedly, whatever,

whatever the reason. Ambulance cruise 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, gauze, umbilical clamps, scalpel uh how polls, 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 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 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 friend uh, 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 i V. So there's also i V equipment and needles and things like that on or an ambulance, so they be the E M T driving paramedic. And some companies, 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 just awes. Yeah uh.

And in other places they the person who's behind the 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

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, 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

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 tea. Yeah, but I'm already pretty intimidated. Let 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. Man, I hope you don't

break that hypothetical foot on our 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 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 side of an ambulance. I just 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 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 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 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 won't because it is it's essentially that that's same undulating frequency, but now it's a lower pitch than the other one, and again it's underneath the regular sirens, so you hear both at the same time. I 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 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 crews because there's there's always the potential that you could be accused of malpractice, and they're meant to help maintain a level of accountability as well as protection for ambulance crews to say, well, we reviewed the 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.

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. You either know

who you're dealing with. You you either have to be able 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 might be volatile situations, like let's say that there's a

riot going on in the 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 another one. Yeah, actually, 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 u UM employees as well. 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 get passed on into the cab 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 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 welly and 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 and a data recording system in an ambulance might be in communication with a network of some sort, but typically in your average consumer 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 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, 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. I see, you've got an interesting little, um, little little blurb that we're wrapping up. 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 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 say for later episodes. So a Lotus of Aora is a sports car. Yes. Do you know if they actually transport patients or is this just to get responders to a patient? I think it's because I was looking at this um 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 to dispel it, I think it's it's more for them to show up on the scene and do treatment on the scene or donuts in the parking lot. 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 VIHEO. If you've ever had a sports car written sports car, you know trunks are that's being generous. But

but rear storage compartment is filled with medical equipment. Uh, 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 think I would recommend. Not a doctor either, But but

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 ridiculous. But it was one about really bizarre car races, and 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 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, 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.

One It was kind of terrifying. I actually watched some some excerpts and and it was pretty crazy and was on the circular track, so it was all about 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 to wide, it would cause the whole thing to spin out. It's kind of spectacular. So yeah, that's 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 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 so varied, 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 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. 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. So where can people find you? Uh, well, usually you you and I are hanging out on a show called What the Stuff and another show called brain Stuff, which is the old timey movie thing we referenced earlier, which I was really happy and I was really happy with that episode. I thought you did a great job,

especially because you use that accent regularly. Anyway. Um, I also do a car stuff with Scott Benjamin, who is our guru of all things automotive, and I am on Stuff they Don't Want You to Know, which is a spooky show about secrets and critical thinking. Yeah, it's it's interesting that you that you came out to say you were in favor of the cameras and you also are

a host of Stuff they Don't Want You to Know. Yeah, well absolutely, I mean I that that's something for a different show, but I would love to have you on that show maybe one day about that. I would love that. Yeah. So guys, if you have any suggestions for future episodes of tech Stuff, maybe you've got an idea for an episode, you've got a comment about ambulances, or you just have

other questions, please send them to me. My email address is tech Stuff at how stuff works dot com, or drop me a line on social you could find me on Twitter and over on Tumblr and on Facebook, all with the handle text stuff h s W and We'll talk to you again really soon. For more on this and bathands of other topics, does it have stuff works dot com