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Nicholas Studer
01-23-2017, 06:00 AM
I recently read an article on “four-litter ambulances” at http://www.emsclassics.com/columndetails.php?Number=23&Content='4 Stretcher' Ambulances. Litter is an often-military term referring to “stretcher.” I’ve heard the four-litter capability discussed in person and in various online forums before. It generally seems to be considered a physical manifestation of the apparent failings of then-contemporary ambulance service – only capable of transport, but now with added discomfort. Four-litter capability appears to become more and more uncommon in new ambulances by the 1980s.

However, it is worth noting the four-litter ambulance is not dead. Most observers would note that the vast majority of US military field ambulances have been four-litter vehicles. This of course includes today’s M997 HMMVW “Truck, Ambulance, 4-Litter,” but even the latest HH-60M air ambulance is designed to carry six litter patients. Each is doctrinally staffed by a single medical attendant – as transport is heavily prioritized in military care.

I suspect it is less widely known that General Services Administration specifications have four-litter capability as an available option on Type I, II, and III civilian-type ambulances from Wheeled Coach. I've primarily seen it on ambulances sold to the Department of Defense. For whatever reason, the Air Force and Navy didn’t embrace the HMMWV ambulance like the Army, and choose to maintain Type I civilian-type ambulances even for expeditionary purposes. It’s interesting to me – they represent a nexus of the military and civilian ambulance today. You can see from below photos – they even have Red Cross markings, and the ones I’ve seen often were ordered with 4x4, military radio pre-installation kits, arctic winterization kits – and, four-litter capability. The rear doors of the ambulance are off-set to the right, to allow for a length-wise compartment that holds four NATO-standard litters. Next photo shows an exercise where the capability is in use and the hardware visible. The hooks are quite similar to the “Insta-Ready” hooks available on 1970s Miller-Meteor and Cotner-Bevington ambulances.

If you look back to the 1960s-1970s when four-litter capability in civilian ambulances was commonplace, the draft was in place and many ambulance personnel had at least some military service. A significant number would’ve had combat experience. If multiple-casualty incidents weren’t more frequent in civilian settings compared to today, there was surely a greater expectation that fewer ambulances (perhaps even just one) would need to handle it. Civilian ambulance service seems quick to try to find contrast with its forebears in order to demonstrate advancement, and this area is one such cited. Even the largest “Monster Medic” civilian ambulances in service today can only carry two patients who require stretchers. As opposed to the military, treatment is held up as the top priority – and four-litter capability implies less than maximal care to each patient. In the day-to-day matters of civilian ambulance service, it’s likely unnecessary to carry more than 1-2 patients – but in the setting of terrorist bombings and mass shootings – perhaps the four-litter ambulance isn’t as archaic an idea as civilian ambulance service often seems to believe it is.

John ED Renstrom
01-23-2017, 01:48 PM
they were by far more popular in the less populated corners of the country. my wife joined the ambulance service in Faith Sd a town of 500 110 miles from anywhere in north central Sd. they had a clinic with a PA. so if you could not walk of drive after then incident you needed transportation. the most people that encountered was a van roll over with 10 people inside. it was a rusty old thing with all the doors welded shut except the drivers. it was laying on it of course. it a lot different when your only resources are you

Nicholas Studer
01-24-2017, 12:41 AM
they were by far more popular in the less populated corners of the country. my wife joined the ambulance service in Faith Sd a town of 500 110 miles from anywhere in north central Sd. they had a clinic with a PA. so if you could not walk of drive after then incident you needed transportation. the most people that encountered was a van roll over with 10 people inside. it was a rusty old thing with all the doors welded shut except the drivers. it was laying on it of course. it a lot different when your only resources are you

Ed - I agree! Rural areas were and still generally are an austere prehospital care environment not much different from the military. However, my intent was to point out: 1. The military still requires the feature on most of its civilian-type as well as field ambulances. Thus, it's not a "bad idea" relegated to the past. 2. I think the post-WWII/Korea military experience and mindset of contemporary ambulance crew was what led the four-litter civilian ambulance to have its heyday.

1960s S&S advertisements really pushed their capacity as a feature - to the point they pictured putting a patient in between the cot and bench seat for a total of 5 litter patients.

Wayne Krakowski
01-24-2017, 07:11 AM
The most I ever personally did was six, 4 children, two toe to toe on the hanging cots and two adults on the main and jump stretcher on the bench.there were no other units available and weather forced the decision,you did what you had to do...

John ED Renstrom
01-24-2017, 12:42 PM
yes you do. the best tool on the coach it the one between your ears.

but as I recall the Korean war was the big turn around for the military. at that time that had buses equated to haul stable pt on litters from field units to safer locations. 6 by's set up the same way.

my 53 is Armbruster is set up for 2 on hanging and one on a gurney. there is not enough room for two gurneys side by side in it.

Robert L. Koryciak
02-15-2017, 02:09 AM
I can remember putting two small children on a backboard, toe to toe, and two boards (4 Kids) in Houston at a vehicle accident. Most of the cars I worked on in the mid 70's still had mounts for two suspended stretchers. I do remember seeing an "AmLiner" Ambulance in Michigan in 1977 that was a converted Motor Home, and actually had five stretcher positions, with three Ferno Roll-In stretchers, and two folding stretchers! It was custom built for a Volunteer Company in the Upper Peninsula where they were the only ambulance service for about 50 miles, and was built as a Motor Vehicle Accident Responder.

David Henry
02-15-2017, 07:55 AM
Back in those days it was never our best work to load a rig up to or exceeding its capacity. When you "hung" a patient you did not have much room to provide any care, especially to the patients whose noses were inches from the ceiling.

My worst case of having to do this was in a 72 Chevy suburban with 4 stretcher patients, 3 injured but lower priority patients, my partner and myself. (Of course I was the driver :o ) for the 15 mile ride and we were the back up car to that scene.

Abe Bush
02-15-2017, 10:39 PM
Many years ago, circa 1989, when I worked for Reed Ambulance in Denver, CO (no longer in business, but it was a competitor of Ambulance Service Company, Inc. [commonly just called Amservice, which is also no longer in business, I believe they were purchased by AMR], everyone all across Denver from private ambulance service employees regardless of company to firemedics, to paramedics working for Denver General (city and county of Denver employees, responsible for all Denver originated 911 medical calls), and hospital staff referred to an ambulance stretcher as a "pram". Until coming to Denver, I had never even heard that word before. I remember looking it up in my dictionary and it said a pram was a baby buggy. But when you look it up on dictionary.com, it refers to a pram as a "flat-bottomed, snub-nosed boat used as a fishing vessel or tender for larger vessels." Just shows to go you how many different words, and terms can mean many different thing, depending on what type of organization you work for, or in this case, what region you work in. Everyone in Denver also referred to what I was used to being called a "code blue" (cardiac arrest) to a core 0. A medical core was just a core, but a trauma core was a trauma core. And even different hospitals had the same weird "code language". In some hospitals they would just announce "code blue" in whatever room #, and one hospital coded it by saying "Mr. Gallagher to room whatever. One hospital would page code black for tornado, code red for fire, and so on while the other hospital would have specific last names that meant what type of incident. So Mr. Gallager to room blank for a cardiac arrest, Ms. Sheridan, telephone please for a tornado bla bla bla. So weird!

Steve Lichtman
02-21-2017, 01:15 PM
We had 4-stretcher ambulances when I worked in Tulsa in the mid-80s. The only time I used that capability was in October of 1986. We had significant flash flooding, and we had to evacuate a nursing home. I carried 4 on stretchers, and we had 3 other units do the same, to move all the patients to a hospital for shelter (patients who could be in a wheelchair went on busses). Of course, we had to take them back, too.

By the way, use of civilian-style ambulances by the military was not confined to Navy and AF. Here is one from US Army's Fort Meade in MD in 2006. This was their attempt to make an olive-drab unit look like a civilian ambulance - not successful.

Nicholas Studer
02-21-2017, 05:54 PM
By the way, use of civilian-style ambulances by the military was not confined to Navy and AF. Here is one from US Army's Fort Meade in MD in 2006. This was their attempt to make an olive-drab unit look like a civilian ambulance - not successful.

Yes, non-deployed Army installations have civilian ambulances and ground ambulance service. At many bases, it is operated by the Medical Activity or Medical Center (MEDDAC/MEDCEN - the hospital/clinic) and at some by the Department of Emergency Services (owns the Fire Department and Emergency Management folks). They generally use Type I, but sometimes Type III, a few like Fort Hood have "Medium Duty" vehicles. Vast majority are white with orange stripe - standard KKK markings. There's a trend towards going to red stripes or making them more "Fire" looking, particularly DES-operated ones. Having "US ARMY" in red letters on the side is becoming common. All of them are staffed by Dept. of the Army civilian EMT and Paramedics, none I am familiar with currently have active duty 68W Healthcare Specialists working on-post response. Sadly, there is a trend to contract out the service or just have the local service cover the base.

However, the Army's civilian-type ambulances are not for deployment, unlike the Air Force or Navy which buys theirs to support overseas contingency operations. While the Army buys from Wheeled Coach under the same GSA contract - I have yet to encounter one with the 4-litter configuration, red crosses, military radio pre-wiring, etc. M998 HMMWV ambulances are very common in the Army for that purpose, while the HMMWV platform in general is rather uncommon for Navy/Air Force even for deployments. Another small exception is the Multinational Force & Observers mission in Egypt, where the MFO organization purchases the equipment the US uses there - where Israeli-made "Redler"-brand Type II ambulances are used.

This does not mean there isn't an Army civilian-type ambulance out there with the hybrid military bells/whistles - or there's been an exemption to what I've seen.

Kurt Arends
02-28-2017, 06:06 PM
Old Navy Rig.