Ambulances

I've been riding around a lot in ambulances recently. I remebered an earlier blog about ambulances, back in 2019. I re-read it and it's much better than this one. It flows more easily and it's reasonably interesting in a Big Chief I-Spy sort of way. The sort of simple information with which you can amaze your friends and confound your enemies. So far as I can see there have been no basic changes to the legislation since I wrote that blog but that didn't stop me publishing this rewrite.

This piece is about the ambulances that are contracted by the Generalitat Valenciana, the Regional Government in, the region I live in. Every now and again Valencia put a contract out to tender and anyone interested enough to bid has the potential for providing the ambulance fleet for the requirements of the region. There are other ambulances, private and NGO ((Non Governmental Organisation). The private clinics and hospitals need ambulances to move their customer/patients around and other groups, for instance the Red Cross, run ambulances which can be hired out to provide part of the safety cover at events from half marathons to encierros.

There is national legislation about the construction, status and identification of ambulances and within that legislation there are some regional variations but, in general, everywhere follows a similar sort of classification which is pretty simple, pretty logical and easy to understand.

The first thing is that, discounting helicopters, rapid response vehicles and the like there are two broad classes of ambulance - those that can provide medical care en route, classes C and B, and those that don't, Class A.

The non-care ambulances, classes A1 and A2, are used to transport ill people around and are not designed to offer medical care to patients en route. These are the ambulances that take people to rehab sessions, to visit physiotherapists and the whole range of appointments at hospitals, outpatient clinics and the like. In the legislation these ambulances are divided into those that transport people on stretchers and those which are collective transport but nearly all the ambulances I've been in over the past six weeks have been halfway between. They have space for one stretcher, space for a standard sort of wheelchair and six or seven individual seats. They also have things like oxygen and defibrillators on board. The drivers will have a qualification as drivers and as first aiders having done a course that lasts about 350 hours. Sometimes these ambulances bear the letters TNA for non assisted transport. These ambulances are predominantly white in colour and have side windows in the rear of the van. 

The Assistance ambulances, class B or class C, are equipped to take care of sick people en route. These are the ambulances that will turn up if you dial the emergency number 112. There are a range of other numbers but 112 is the foolproof one for any emergency service.

The Class B or SVB ambulances are designed to provide basic life support. As a minimum they will have a crew of two, the driver and another person both of whom will have at least the Emergency Health Technician, TES in Spanish (Técnicos en Emergencias Sanitarias) qualification that requires a couple of thousand hours of study over a two year period and with regular updates and refresher courses along the way. These ambulances are SVB, Soporte Vital Básico (in Castilian) or Suport Vitál Basic (in Valenciano) and those letters are usually very obvious on the side of the ambulance. They carry a lot of medical kit on board.

The Class C or SVA ambulances (Soporte Vital Avanzado or Suport Vital Avançat) are designed to provide an advanced life-saving service. Again these ambulances will have a driver who holds the TES  qualification and, at least a qualified emergency nurse. The course to become a nurse in Spain is a four year university degree course. Most SVA nurses also do a further two years masters in nursing on top of the basic qualification. On occasions the nurse may be replaced by an emergency doctor or there may be three, or more, crew on the ambulance. A Spanish SVA Doctor will have done six years at university, a couple of years on a Masters in Emergency Medicine and another four years or so on a specialism like cardiology or intensive care medicine. By the time we're at that sort of staffing level we're into ambulances which are "medicalizadas", they're basically intensive care units on wheels and will sometimes bear the letters SAMU Servei d'Ajuda Mèdica Urgent, Servicio de Ayuda Médica Urgente Urgent.

It seems to me, though it may not be a figment of my imagination that as the ambulances become more serious the colour scheme utilises more yellow, there are still the red roofs and red lettering but the SVA/SAMU ambulances have swathes of yellow while the SVB only have a band of yellow colour.

One last thing thing came from chatting to one of the drivers who normally drove B and C class but had been drafted in for the transport ambulances to cover a sick colleague. It was about the use of lights and horns. If it's a real emergency, urgencia in Spanish because we lay folk know when something is urgent but it may or may not be an emergency, they will put the blue lights on but they really only use the horns to protect themselves when, for instance, crossing red traffic lights. The driver told me that time after time Spanish drivers would react in a very haphazard way if they suddenly found multi tone horns behind them and, as well as drop their mobile phone, they might do any sort of daft thing - so, better to arrive safe and a bit later rather than be the first vehicle on scene having been involved in another road traffic accident.