Nicholas Studer
PCS Elected Director 2022-2025
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.
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.