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You will probably never have a good encounter with an ambulance. Either they're shrieking past in traffic and making you late for work, or you're riding in one while blood squirts from a horrific fireworks injury.

Well, we have bad news: The world of ambulances, and the long-suffering crews who work inside them, is quite a bit more horrifying than you thought.

5Ambulances Tend to Explode

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You know you've had a bad day when you can't describe it without using the term "ambulance explosion." But ambulances do explode. A lot. The oxygen tanks carried by the majority of EMS units detonate every now and then, as compressed gas is wont to do, and sometimes ambulances themselves just burst into flames for no apparent reason. One ambulance caught fire while just sitting in the bay after only one year of service, and another ignited while transporting a patient to the hospital.

Via Wusa9.com
Tragically, their brand of burn salve turned out to be highly explosive.

The thing is, you kind of assume ambulances are the safest mode of transportation around. After all, they're designed specifically to transport fragile sick people. And look at them -- they're like big medical tanks. Surely they have been expertly constructed to be death proof, like in the Kurt Russell medical docudrama of the same name.

Nope. Ambulances are fragile and extremely crash-prone for a variety of reasons, and they're dangerous as hell for the people inside. For starters, even with seat belts for the emergency medical technicians (EMTs) and restraints for the patients (which often aren't used), the patient compartment is very unsafe for all passengers. Everyone is riding in a box full of cabinets and loose equipment ready to crash into your skull should something go wrong.

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"Sir, you're going to have to stop screaming, the ambulance is here to help you."

And things frequently go wrong. Ambulances are wired with dashboard computers, high-tech radios, navigation systems and phones -- all of which must be used by the EMTs while weaving in and out of traffic at top speed and blasting through stoplights like they're being chased by the Batmobile.

All of this adds up to a potentially chaotic driving experience, particularly when you consider that many drivers make no attempt to clear a path for rampaging emergency vehicles, because The Adventures of Tin-Tin starts in 15 minutes and goddamn if they're going to miss all the previews.

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"If he doesn't move in three seconds, he becomes a passenger."

According to one study, EMTs in the United States have an estimated fatality rate of 12.7 per 100,000 personnel (more than double the national average), with the worst coming when riding in the patient compartment. Another study tallied the destruction caused by 339 ambulance crashes, totaling a shocking 405 fatalities and 838 injuries. That averages out to more than one person killed in every ambulance wreck. We're pretty sure goddamned jet packs are safer.

4Patients Abuse the System in Ridiculous Ways

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Are you annoyed that it took your ambulance too long to get there? Do you wonder what they were off doing? Well, they probably weren't tearing through the streets with lights and sirens blazing while EMTs in the back struggled to keep a patient from slipping over the brink of death. They were probably responding to some frivolous bullshit. The reality is that only about 10 percent of calls are life-and-death situations. About half are in no way life-threatening at all, and a sizable chunk are just fucking ridiculous.

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"I was just wondering if this looked cool. It's hard to tell from my perspective."

One center estimates they receive about 10 calls an hour that are of the completely stupid variety, including a person calling 911 because someone had smeared their doorknob with Vaseline and they were afraid to touch it. Other calls included asking for directions to the mall, the start date of daylight savings time and whether to use hot or cold water to do the laundry. But even when the operator decides the call is ambulance-worthy, it's often because the caller has an ulterior motive. People wind up manipulating ambulances as a sort of taxi service, thinking that taking the ambulance to the hospital will get them to see a doctor faster without an insurance check.

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"Congratulations, clever man, you've hacked the U.S. health care system."

The truth is, people will be triaged in the emergency room regardless of whether they came in an ambulance, a car or a huge truck shaped like a hot dog. If the ambulance took you to the hospital for an earache, you won't see a doctor before the guy who walked in bleeding like a Japanese horror movie. But people do it anyway.

Some people who call 911 for non-life-threatening reasons do so a couple times a week or even multiple times in one day. Industry experts are calling the chronic abuse of EMS the 911 "safety net" system, wherein people struggling with headaches, toothaches and even feelings of loneliness call 911 because they have no one else to talk to. Wait, are we crazy, or is there a fortune to be made from a service that does nothing but listen to people complain on the phone for a small fee? Get us in contact with some investors.

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"Oh, she's fine. We're just taking her out to pick up some groceries."

3The Burnout Rate for the Crew Is Sky High

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It does not take a Conan Doyle level superdetective to figure out that medical professionals get extremely stressed from their jobs. When you have an erotic three-way with life and death on a daily basis, you're going to need to take a break every so often for someone to finish crying (at least that's how our three-ways go). However, the degree to which EMTs experience this is worse than you can imagine.

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"Sir, if you're going to die, you need to let me know, because I just can't deal with that crap today."

EMTs will almost always experience burnout, which is defined as "exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration." It's because EMTs are routinely exposed to five unique stressors: high levels of uncertainty, high interpersonal tension, frequent exposure to human tragedy, extreme fear and a heightened physical response to the sound of an emergency alarm, which basically means that after working so long around emergencies, your body goes into overdrive whenever you hear an alarm.

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"Sorry, dude. Someone's car alarm went off and I just flipped out."

And they can't just kick back and take it easy for a while; many EMS organizations are understaffed, meaning everybody has to work monstrous amounts of overtime. But even if they don't work overtime, most services run in 12- or even 24-hour shifts. Exhaustion and sleep deprivation are part of the job, sort of like being in rehab, only without any methadone or impromptu visits by Gary Busey. Workers will get suspended without pay for falling asleep on the job, even though they are required to work superhuman shifts.

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"It's much safer for you to be constantly exhausted or methed out than to allow occasional naps."

The impossibly stressful long hours take a serious toll. Rates of post-traumatic stress disorder are higher than 20 percent among EMTs, and high-risk alcohol and drug use rates may be as high as 40 percent. So if your EMTs seem a little strung out, go easy on them. After all, if all of the crashes and frivolous calls and puking/bleeding/screaming patients don't get to them, they also have to deal with the fact that ...

2Procedures Are Constantly Changing, Then Sometimes Changing Back

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Even if you've never taken a class in CPR, you know the general concept: If someone isn't breathing and doesn't have a pulse, then it's time to open up a can of CPR (and no, that's not the can with the blue ribbon on it). You do the chest compressions and pause between every few to do mouth-to-mouth.

Well, you're doing it wrong. A while back, EMTs had to unlearn all of that -- it turns out CPR actually works better without the mouth-to-mouth rescue breaths. There are studies that show that CPR performed with only chest compressions results in 60 percent fewer dead people. In fact, traditional CPR with mouth-to-mouth is often as effective as doing nothing at all, except when CPR is being performed on small children.

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"Let him go. Even if he survives, he'll never dance again."

Hey, what about another staple of movie emergency medicine: the tourniquet? You know, somebody is bleeding badly, so they use a belt or rope to tie off the limb to stop the bleeding. Are EMTs supposed to do that? It depends on who you ask, and in fact varies from one ambulance service to the next. Some experts still stand by them, some say they just kill off tissue in the limb. Learn it today, unlearn it tomorrow. Relearn it again next month.

And that's par for the course; crews will often be trained on new gadgets, only to see them yanked later when it turns out they don't actually work (like medical anti-shock trousers that came in and out of fashion in the '80s and '90s).

spencer.it

Also, the patients are changing. Specifically, they are getting fatter. A heavy patient is going to need the same kind of attention as an average-size patient, but the methods must be altered dramatically, much like the Boba Fett costume the aforementioned heavy patient purchased from eBay last Halloween. Crews have had to completely rethink logistical problems with getting obese patients out of buildings with narrow halls, doors and stairs without everyone on the crew throwing their back out. It also means new equipment, as ambulance services across the country have to buy vehicles with specialized cots, ramps and winches to lift patients weighing between 350 pounds and Mighty Joe Young.

Via Pantagraph.com
In case of emergency, the winch is made of chocolate.

The ambulances themselves have to change to accommodate this, too -- they have ushered in the use of bariatric ambulances, or "fat trucks." These are designed to be double-wide to accommodate heavier passengers, or as this article literally stated, "to ferry the most obese."

Via Adam Harnett
And they're occasionally used to render aid to beached whales.

But nothing you see there addresses the difficulty of removing a patient weighing just shy of a ton from the seventh floor of an apartment building when they literally cannot even fit through the doorway. Presumably at this point, the EMTs just start a controlled blaze in the lobby and let the fire department come figure it out.

1Crews Are Constantly Getting Attacked

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You might expect EMTs to be relatively safe when dealing with patients -- after all, they are there to help. But in fact, EMTs face a lot of danger in the field, and they do so without the weapons and authority that police officers have. EMTs have been hit with cinder blocks, stabbed by syringes (often still filled with drugs), chased by dogs and shot at on a regular basis. In Boston, for instance, 28 percent of total EMT injuries in 2006 were the result of violent assaults.

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"Sir, we're here to help. I'm gonna have to axe you to put that down."

One study conducted in 1999 found that, over a 12-year period, each paramedic involved was assaulted an average of nine times, with the attacks reading like a laundry list of every injury sustained by Christopher Lambert in The Highlander, including "170 cases of blunt trauma, 73 lacerations, two gunshot wounds, 10 stabbings, one burn, eight fractures, nine dislocations, one choking and 56 cases of miscellaneous body injuries."


Not all of them are work-related.

Sure, part of it is because they have to plunge into the bad parts of town no matter what time of night. But even in the nice parts of town, they're still not safe, and it's often because of the patients themselves. Sometimes patients are panicking, sometimes they're drunk or high or in shock. And of course, sometimes they're just insane.

And it isn't just the patients who can pose a threat to an EMT -- they can encounter hysterical family members and violent bystanders who attack them out of misplaced blame and rage. At which point we're assuming the universal answer to them is "Hey, just be glad this ambulance hasn't exploded yet."

For more eye-opening behind-the-scenes looks, check out 8 Medical Terms Your Doctor Uses to Insult You and 5 Horrifying Tales Of 911 Incompetence.

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