ALS Ambulances?

Jeremy D. Ledford

PCS Volunteer Chapter President
The other day I was looking over what all I have as ambulance equipment and the supplies stocked in my 73 M-M combination and got to thinking about what makes an ALS (Advance Life Support) ambulance? Back in the 70's I'm sure some hightops, vans etc most defiantly would have been but would any combination cars have been ALS units? I'm sure it boils down to equipment that's on board and the training but what are the specifics of the ALS unit?
 
Short answer is Paramedics and their related equipment. It's the training and equipment that make it ALS, not the vehicle. Our back-up ride for a long time was a low top straight ambulance that on occassion ran as an ALS unit. Not pretty, but it worked.
 
At best, they'd have a cabinet area for a monitor/defib (as Cliff Bergum's '72 Cadillac/Superior did). The "Action Bar" was also designed to accomodate the new-fangled ALS gear. The interior that allowed easy access to the head of the stretcher was important as it's really hard to manage an airway and ventilate from beside the patient.

Of course graphics indicating that this was an ALS/Paramedic unit also helped similar to the graphics of "Oxygen Equipped" and "Radio Dispatched".
 
In Jetmore, Kansas(Pop. 900) we had a 1972 Pontiac combo that we ran out of the Funeral Home. It had an Oxegen bottle with a nasal cannula and a 8X10 first aid kit. I don't think there were any ALS Ambulances anywhere in the area. When we had a funeral, the back up ambulance was a 1970 Chevy station wagon. We've come a long way, baby!!!

Most of us were not even EMT's. I was the only full time person besides the boss. No training........ Volunteers got paid $5.00 per run.
 
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The tough thing as I recall about running ALS out of a low top was getting your IV high enough to run. Space was limited as well with the monitor/defibrillator. I remember FW had a table made for the Lifepak 5 that fit across the legs of the model 30. I have been looking for one but no such luck.
 
Advanced Life Support

Hey Jeremy!

I personally have never seen a "Combination" set up for ALS. Although it's not beyond the scope of the vehicle being able to handle (provide) ALS... equipment, it was VERY unlikely.

You'll have to review the history, to find that pre-hospital (Paramedic) care as we know it today, really started in 1965, in Pittsburgh, with the creation of Freedom House Ambulance Service (1967-1975)

Here, unemployed and often "at-risk" men were recruited from the poorer communities in Pittsburgh and trained by Peter Safar, MD (father of CPR) and Nancy Caroline, MD (Emergency Care in the Streets) and Don Benson, MD. For nearly 2 years these people were trained at Presbyterian University Hospital prior to beginning the first ALS service in early 1967.

Part of Dr. Safar's vision was to create a vehicle, capable of carrying the ALS equipment and having the ability/room to perform advanced life support in the field. FHA had 3 units that I remember. They were comprised of International (bread truck) followed by two van style ambulances that were adapted specifically for this purpose.

When I started in EMS in 1971, ALS was provided in "straight" ambulance pro-cars equipped with a monitor/ defibrillator, a drug box, some advanced airway equipment and IV's. These pro-cars (at least in Pittsburgh) eventually became a thing of the past, morphing into vans and modules by the end of the decade. In 1976, I did work for a funeral director in Pittsburgh (Frank R. Perman) who ran a successful ambulance business initially using 3 pro-cars (all Superior/ 2 cadillacs and a Pontaic) and then van style ambulances. All units were ALS equipped, with the vans being primarilly used for neonatal transports (Magee Women's Hospital) and VA (Veteran's Administration) contracted calls. (VA had 3 hospitals in Pgh)

I do recall a competing service Zepfel Ambulance, also funeral home based, that ran a combination car, as an ambulance although I do not believe it was ALS.

Hope this gives you some useful information!

Rick
 
I do recall a competing service Zepfel Ambulance, also funeral home based, that ran a combination car, as an ambulance although I do not believe it was ALS.

A site search for "Zepfel" will show an Olds combination as well as a home-brew Suburban ambulance.
 
In Jetmore, Kansas(Pop. 900) we had a 1972 Pontiac combo that we ran out of the Funeral Home. It had an Oxegen bottle with a nasal cannula and a 8X10 first aid kit. I don't think there were any ALS Ambulances anywhere in the area. When we had a funeral, the back up ambulance was a 1970 Chevy station wagon.

Are there any photos of these cars you can share with us?
 
Steve,
I don't think I have any photos of that era of my life. That year was 1974. If I accidently run across any, I'll think of a way to get them on here. The Pontiac was silver with a black crinkle top. Don't remember the coach builder. Had a removable Bubble with a small siren under the hood.....

Thanks,
Mike
 
My first salary as an EMT Basic medic...

in 1977 was $1.80/hr. We worked 72 hour shifts, not paid from 2300 - 0700 unless out on a call and then we were paid for time out only. Responsible for first $100.00 of vehicle damage if it was our fault. We were an ALS unit as my partner was a "cardiac technician", which meant I got to lug the big orange box into the house when needed. Every truck inventoried at 0700 daily. AM/FM radios were installed one Christmas as a company gift to the crews. We re-used esophageal obturator airways, and never wore gloves unless the patient was "really infectious". MAST trousers were "cut" off by uninformed ER crews. We had a vhf radio (mobile only, no handheld), and a vhf pager. On Saturday mornings, we all had to wax one of the designated units. First call on Saturday typically didn't come in until 0900 or so. On Sundays we were placing membership flyers under windshields at the local churches. No women medics back then, only Vietnam era combat medics. I was the first non-military medic. Funny how later I went and joined the USAF until retirement. They impressed me.

And it was a great job!
 
The tough thing as I recall about running ALS out of a low top was getting your IV high enough to run. Space was limited as well with the monitor/defibrillator. I remember FW had a table made for the Lifepak 5 that fit across the legs of the model 30. I have been looking for one but no such luck.

This is a photo of my rig with the rack that Ron wrote about.
 

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in 1977 was $1.80/hr. We worked 72 hour shifts, not paid from 2300 - 0700 unless out on a call and then we were paid for time out only. We re-used esophageal obturator airways, and never wore gloves unless the patient was "really infectious". MAST trousers were "cut" off by uninformed ER crews.

And it was a great job!

That is funny! My boss WAS right I DIDn't know how good I had it. Same year 1977 I was making $3.30 per hour, we worked 34 on 38 off. No pay from 0000-0800 unless you were called. Out four hours you got paid all night. We re-used EOAs, suction catheters, ambu bags, c collars.

It was the BEST job I ever had!
 
ALS Ambulances

Short answer is Paramedics and their related equipment. It's the training and equipment that make it ALS, not the vehicle. Our back-up ride for a long time was a low top straight ambulance that on occassion ran as an ALS unit. Not pretty, but it worked.

San Jose Ambulance Service , that started the first ALS / paramedic ambulance service in the San Francisco Bay Area around 1974 used MM Criterions as ALS units . Bay Cities Ambulance Service in Chula Vista , CA , had a 1973 Superior high-top ambulance that was a backup ALS unit according to a friend of mine that used to work for them many years ago . I also recall through my own career in EMS , that Ada-Boi Critical Care Transport in Boise , Idaho had a hi-top Superior Caddy that was also both an ALS and CCT unit . They had to make do and utilize every inch of room they had in it , but it worked .
 
out here in the fronter of medicine. the big city paramedic would jump in the chase car and meet you in rout. then jump in your ambulance with there jump kit. thus making your basic life support ambulance a advanced life support ambulance.

the problem with medicine is the consent need for more and the unwillingness to admit that some things are just not survivable. this is a two edged sward. driving cost up to leaves imposable to sustain just because something might happen. that gives you the 1000.00 trip across town when no one does any thing but transport the pt. things we would do a a volunteer service for 75 bucks.

but hay the 85 year old lady afflicted with Alzheimer has the head wound from a fall she is all ready stable but might in the mile trip do something. besides Medicare is paying for it and we need a bigger???
 
I know, from being told by folks from the FD that owned it, that my '70 Volunteer ambulance was the first ALS ambulance west of Hagerstown, MD starting in 1974, prior to them getting a modular. And there were times, when the Volunteer was out of service, that they borrowed a local funeral home's combination, so it's conceivable that the combo ran ALS.

One night in early 1989, I saw a 1970 S&S lowtop from Pennsylvania running lights/sirens in Washington, DC on an ALS cardiac transport. (I followed them to the hospital, and good thing I did, because when they went to leave, they needed a jump-start after running 100 miles with the siren, Sola-Ray, beacon, flashers, headlights, interior lights, and invertor running the monitor). Steve Loftin and I photographed it later that year.
 

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I can remember putting glass IV bottles in the overhead "linen" compt to get the height needed to keep an IV running in the combinations, but running in the combos was only a last resort. Any of the hightop Cadillacs made good ALS units, especially the M&M Critierions and Superior 54XLs.
 
San Jose Ambulance helped create the curriculum for the first paramedic program at Stanford University Medical Center. They had 7 students in class number one in 1973. The students were certified and went into service in 1974. SJA purchased Miller-Meteor Criterions for the initial 3 years.
 

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One night in early 1989, I saw a 1970 S&S lowtop from Pennsylvania running lights/sirens in Washington, DC on an ALS cardiac transport. (I followed them to the hospital, and good thing I did, because when they went to leave, they needed a jump-start after running 100 miles with the siren, Sola-Ray, beacon, flashers, headlights, interior lights, and invertor running the monitor). Steve Loftin and I photographed it later that year.

I forget - did we ever determine the lineage of this car?
 
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